First contact –
– screening out of assessment, by raising wrongful/false barriers (ie Care Act non-compliant ones) or discriminatory ones, or ridiculous approaches to what counts as an appearance of need;
– requiring consent from a person before going any further, regardless of obvious cognitive difficulty;
– and statements along the lines of ‘We don’t do this, that or the other‘ when in fact that would be narrowing the scope of the Act beyond what is a defensible interpretation, given the criteria, the well-being duty and the overall statutory purpose.
Hospital Discharge –
- lack of any meaningful involvement of relatives in care planning
– complete confusion about who is paying for what now that the Covid monies/scheme AND the winter pressures funds for bedded only discharge, have ceased…
- mixing up of reablement and rehab/stepdown/interim/discharge to assess NHS funded beds or services leading to lack of clarity about charges and when they start.
- lack of congruence between the decision-maker, capacity assessments and applications for DoLS authorisations for discharge into care homes.
Assessment –
– refusing it, or doing it via a quickie conversation in which the assessor factors IN existing support, thereby reducing the number of people found to be eligible, even if they’re not going to have unmet needs by the time their informal support has been checked out for willingness and ability to continue, and that’s been factored back in;
– insisting on particular forms of assessment regardless of personal circumstances or concerns; or on consent to the process itself (as opposed to information sharing with non-health or social care third parties) before getting on with it;
– failures to refer for CHC checklisting of those most obviously in need of a DST;
– not combining it with any form of conversation with informal carers, about willingness or ability to continue;
– failure to do paperwork identifying ALL the needs, or all apparent needs for anything remotely within the concept of Care or Support – and thus ignoring anything that doesn’t strike an assessor as likely to be eligible, straightaway.
Advocacy –
– failing to apply the trigger of ‘substantial difficulties’ with regard to the specific issue of engaging with complex processes aligned to legal rights;
– failing to commission enough of it, or enough skilled Care Act advocacy;
– failing to get the consent of a capacitated but IMPAIRED person to being informally supported by their relatives, rather than having a potentially better informed formal advocate (potentially!) by one’s side.
Straight after assessment –
– failing to allow for correction of factual mistakes before eligibility, or the next stage.
Carers’ rights -
– not telling people that they can be found eligible if they go through an assessment, and what rights and duties are thereby triggered for them, or for their cared for person;
– not having any rationale for what sort of impact on a carer attracts what/how much, by way of support or funding;
– obliging carers to go on well beyond the point of deterioration of mental or physical conditions, based on avoidant thinking about the impact on carer and client of the load being borne; or failure to address obvious evidence of inability, on top of the carer’s ‘choice’ that constitutes ‘willingness’
– treating respite hours as arbitrarily capped (bearing in mind it is a service for the service user in most cases, and that arbitrary allocation is inappropriate anyway).
– not involving carers in the assessments and care planning processes for their loved ones, in any real sense, or disregarding the need to consult them on best interests, and sometimes on the actual capacity of the cared for person, even when the relative holds an LPA for welfare….
Eligibility decision-making -
– failing to disregard existing informal support when evaluating a person’s inability to achieve, or the impact being sustained – or ignoring the extended definition of inability in the regulations;
– failure to do the paperwork as required – written reasons are required, either way
– failure to identify the nature of an ‘indicative’ budget after the eligibility decision.
Care Planning -
– failing to explore what social care could or should be available to do, of relevance to the needs;
– failing to explain how the budget is arrived at, at the point of finalisation;
– failing to base the rate on local market rates at the time;
– failing to provide a rationale for the sufficiency of the budget in light of the unmet needs after informal care has been negotiated and secured;
– failing to consider the suitability of any informal ‘universal’ service for the meeting of needs, despite remonstrations to the contrary;
– telling a person they need to pay for the meeting of their own needs privately because the council no longer meets needs;
– outcomes planning only, without inputs specified in the name of flexibility but in fact supporting complete lack of accountability for the budget’s sufficiency and legality;
– cost capping one route by reference to the cost of a cheaper one that doesn’t actually have vacancies or any suitable vacancies, and applying this as a deterrent policy to short circuit proper engagement as to other ways of meeting need and reducing the shortfall,
– insisting on top-ups for needs and not just wants and refusing top-ups for respite services;
– giving direct payments to people who lack capacity instead of using s32 to appoint an Authorised Person;
– imposing illegal conditions on direct payments outside the framework for them;
– purporting to manage a budget in-house for a capacitated direct payment client and then ignoring that that makes the council-employed manager accountable to the holder, and a fiduciary;
– refusing to be drawn into making of exceptions for allowing family members to be paid via the direct payment on grounds of necessity;
– not considering the inadequacy of the rate in payment for direct payment clients’ needs, regardless of representations/reviews/evidence of non-existence of care and refusing to allocate budget by reference to the local quality market rate.
Commissioning -
– avoidant behaviour to ensure that the money being spent is not needs-led but spent with regard to managing demand, or the existing exposure to running out of money;
– failure to performance manage the contractors who are delivering under contract to the council;
– delay without regard to human rights, or the rest of the legal framework that says eligibility is the point at which the duty arises, albeit all duties can be discharged within a reasonable period.
Safeguarding
– either too much or too little, generally ignoring the fact that capacitated rejection of intervention can block actual interventions in most cases; or ignoring incapacity when there’s a stroppy relative with money, in the way, or just going on what comes out of a person’s mouth first off, rather than paying attention to the other building blocks for the presumption of capacity
Charging -
– not coming off the fence about whether no longer disregarding PIP for those not receiving funded night-time care, is the policy, or whether the council is choosing to do it, and not even consulting about that or any change to practice, on the footing that they just don’t have to, because PIP doesn’t have a night time rate;
– not allowing for affordability appeals after a review of the actual maths in the assessment;
– indefensible policies about DRE;
– not having considered the Norfolk case by now, in the light of legal advice available to the council.