Local authorities are supposed to make assessment itself, holistic and wider than just social care needs, if, for no other reason, just to refer people to the right ‘opening’ to make other agencies in the welfare law framework, consider their own duties. In particular, under the Care Act Assessment Regulations, councils are obliged to make a referral to the ICB for the purposes of getting the person a Decision Support Tool exercise regarding continuing NHS healthcare decision-making and that is why they have the power in a council to DO ie complete the Checklist, which is the screening tool for CHC.
They have to consider all needs related to a physical or mental impairment or illness, because that is one of the conditions underpinning eligibility for adult social services in the first place. Also, there are plenty of aspects of health service powers that count as overlapping with the scope of social care. Care is one of them – the NHS provides care and aftercare, under statute, not just registered nurse nursing care. So it’s not sensible for a council to refuse to assess someone altogether just on an arm’s length decision that all that they are in need of would be the health service’s responsibility.
The scope of social care is care and support responses, however, not treatment or diagnosis or medical interventions. So if they are flatly refusing to consider the impact of someone’s ill-health derived problems, that would be wrong and illegal, but if they were saying that they couldn’t and wouldn’t assess for physiotherapy, that would be a different thing, and not so obviously wrong, even though one might well say that being motivated to exercise and having massage might well be good for a person’s wellbeing.
Q. My understanding is that all needs should be assessed, then eligibility determined, then anything considered beyond ASC remit passed to CHC.
I agree with you that that is the idea. Under the old legislation it was specifically stated that the council was the lead and the agency that needed to bring Health and Housing to the table, but we haven’t got that now. There’s plenty of references in the Guidance though to being holistic.
Q. However I can’t find it explicitly stated in the Care Act 2014 what constitutes need.
It’s defined in the eligibility regulations in terms of what is eligible need, and in the case law as to what the scope of care and support is wide enough to cover. Support for instance includes financial assistance if there is no other way to meet an eligible need. There are also cases as to what could never be social care – and which the NHS would invariably have to fund, but again, with a discretion as to what extent.
Q. Also what principles apply regarding medicines management support for people in their own homes as it is not one of the ASC assessment outcomes and despite there being NICE guidelines, again I can’t find anything concrete as to where responsibility lies within the legal framework.
There are no principles around medicines management other than that PRN medicine must be provided by someone qualified to make the necessary judgment or delegated to a family member but under supervision – and it was deliberately left out of the eligibility criteria, having first been in there.
Most councils accept that if they are having to put services in for some other issue, the social care staff being commissioned can be expected to administer medication. But if there’s no reason to be there in a social care context, then the district nursing service has to do it. SOME councils provide medicines administration as AGENTS of the NHS, so that the line of responsibility is clear, and the cost of disposal of all the out of date medicine is met by the Health Service, but lots of others have just been bounced by the move towards integration into various s75 pooled budget arrangements (usually equally funded) for medicines administration and equipment.