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Democratic ServicesWiltshire Council
County Hall
Trowbridge
Wiltshire
BA14 8JN
Decision details
Approval for use of Stage 2 flexibilities under the Care Act 2014
Decision Maker: Alison Elliott (Director of Adult Social Services)
Decision status: Recommendations Approved
Is Key decision?: No
Is subject to call in?: No
Decision:
To approve use of Stage 2 - flexibilities
under the Care Act 2014 - for Adult Social Care, in line with
Schedule 12, Coronavirus Act 2020
Reasons for the decision:
Regulations dated 31 March 2020 brought
section 15 of, and Part 1 of Schedule 12 to the Coronavirus Act
2020 into force so that local authorities in England do not have to
comply with certain duties in relation to meeting needs, and
carrying out assessments, under the Care Act 2014, and to modify
duties to meet needs under the Care Act 2014, until such time as
regulations are in force under section 88 of the Act (power to
suspend and revive provisions of the Act), or the Act is no longer
in force. Care Act Easements: Guidance for Local Authorities dated
1 April 2020 sets out how Local Authorities can use the new Care
Act easements, created under the Coronavirus Act 2020, to ensure
the best possible care for people in our society during this
exceptional period. The document provides guidance on steps local
authorities should take before exercising the Care Act easements
(section 6) and describes a four-stage model to support local
decision making
The DHSC has emphasised that complying with Care Act duties must be
‘business as usual’ for as long as possible and in as
much of each local authorities services as possible. The Care Act
easements are not automatic. They are designed to enable
authorities to “prioritise the most pressing needs”
among those they would normally be under a legal duty should
Covid-19 bring about a full-blown resource crisis. Specific
circumstances to do with demand and workforce, when the easements
can be applied are described and guidance, which councils must have
regard to in their decision making, is provided.
Stages 1, and 2. are within Care Act:
Stage 1 - Operating the Care Act in full for as long as
possible.
Stage 2 - Using flexibilities under the Care Act to prioritise care
and support. E.g. certain types of service need to be changed,
delayed or cancelled because of staff absence, carried out in
consultation with the person.
Stages 3, and 4. Are within the Coronavirus Act:
Stage 3 - Streamlining services using the Care Act easements. If
pressures mount to the point that it is no longer possible to meet
Care Act duties in full, then councils should consider taking
advantage of the Coronavirus Act provisions to suspend assessments,
care planning, eligibility and reviews. DHSC must be
notified.
Stage 4 - Whole-system prioritisation of care and support. This
would involve reallocating resources between people and different
service types to ensure the most urgent needs would be met. This is
likely to involve use of the provision in the Coronavirus Act that
suspends councils’ duty to meet unmet eligible needs under
section 18 of the act, other than when this would involve a human
rights breach. DHSC must be notified.
The rationale and evidence for our current situation is described
below:
Stage 1
In Wiltshire Council business as usual or stage 1 (Care Act
easements guidance for local authorities; Annex A Decision-making
table) is our default position and we have continued to work fully
in line with the letter and the spirit of the Care Act 2014. We
took rapid action to ensure we maintained this and, also responded
to an anticipated increase in demand due to impact of coronavirus
by:
- Front door: Moving additional social workers, occupational
therapists and information officers to our advice and contact team
which takes calls and e mails at the first point of contact to
respond to increased volume of contacts and resolve these with high
quality signposting, information and advice using personalised,
strengths-based approaches; Adult Multi Agency Safeguarding Hub
(MASH) took on all aspects of section 42 enquiries, continuing to
carry out Investigating Manager role and additionally taking on the
Investigating Officer role to free up social work capacity in long
term teams;
- Waiting lists: Social workers, occupational therapists and
customer coordinators (trained and experienced social care workers)
taking a proactive and pragmatic approach in contacting people that
have been awaiting our input and resolving, reducing or delaying
their needs for care and support through use of personalised and
strengths-based conversations;
- Urgent response: Putting in place dedicated workers to undertake
the work that cannot be dealt with at the front door and is a
crisis that requires an urgent response; Mental health teams
enhanced their duty cover to include people presenting with mental
ill health and /or severe anxiety who are not known to secondary
mental health services; Community teams for people with learning
disabilities prioritised customers most at risk of harm.
- Releasing provider capacity: A number of service users contacted
us to say they did not need the care and support we were providing
at this time as they were able to meet their needs by other means,
usually family member(s) now being at home and able to support
them. A conversation was had with each person and/or their
representative to explore the circumstances, including any
significant risks and clear messages conveyed to contact us again
if there was a significant change to needs or arrangements to meet
needs.
- Joint working: Closer working between Wiltshire Council
departments and between adult social care and other agencies
(including Wiltshire CCG, Wiltshire Health and Care, Avon and
Wiltshire Mental Health Partnership Trust and a large number of
provider services) to provide rapid response for individuals at
significant risk of harm.
Stage 2
We took the decision for individual service types to prioritise
short term allocation of care and support and began operating at
stage 2 – applying flexibilities under the pre-amendment Care
Act - for some parts of the service from week beginning 23 March
2020. This was in response to providers giving us notice that they
could no longer sustain a particular service or were going to close
a particular service. It also was in response to implementation of
the Covid – 19 Hospital Discharge Requirements (19 March
2020):
- Service closure: Orders of St John Care Trust gave notice of
closure of day centres attached to care homes for older people. 31
users were contacted by an experienced registered social worker to
discuss the closure and their needs. This identified 28 people who
were able to meet their needs by others means within their own or
community network and three people who needed support as a result
of the service closure.
- Hospital teams: In line with the national hospital discharge
requirements, teams in three acute hospital trusts – Royal
United Hospital, Bath, Great Western Hospital, Swindon and
Salisbury Foundation Trust – a team covering community
hospitals and an intermediate care team commenced working seven
days a week from 8am until 8pm. All teams are operating a
‘discharge to assess’ model and working closely with
NHS and care provider colleagues.
- Reablement: The three occupational therapy led teams also
commenced seven days 8-8 working; The inhouse reablement service
has recruited and trained additional support workers. The service
combined with Wiltshire Health & Care’s Home First
Service to provide a single discharge route and maximise staffing
capacity. The whole service is now operating as a ‘Home
First’ service.
- In house domiciliary care: We have developed a Wiltshire Council
domiciliary care service utilising newly recruited and trained
workers to ensure capacity in the market to meet demand.
- Mental health: Teams have been supporting the discharge of all
appropriate in-patients on psychiatric wards. This is to help
enable the setting up of an isolation psychiatric ward for the
admission of individuals with symptoms of Covid-19 to prevent wider
spread.
- Supporting legal and ethical decision making: Principal Social
Worker and Principal Occupational Therapist have developed and
implemented a framework for ‘Decision Making in Adult Social
Care’, supported by guidance on strengths-based working and
guidance on the Mental Capacity Act. The principle here is that we
will adhere as closely as possible to the Care Act and in line with
the Ethical Framework for ASC (DHSC, March 2020). We amended our
electronic record system to reflect this and put this in place for
all teams from 2 April 2020.
- Good practice in adult social care: All of the above took place
within the context of embedded good practice approaches of
strengths-based working by information officers, social workers,
occupational therapists, customer coordinators and others that puts
the person at the centre of each conversation and focuses on their
assets, provides high quality information and advice and works
alongside the person to reach a tailored solution to meeting their
needs for care and support.
I confirm that in making this decision I have considered the
following in line with Wiltshire Council’s
Constitution:
Key decision requirements: Yes
Views of relevant cabinet member(s), committee chairman, area
board(s): Yes - leader and cabinet member
Consideration of the area boards and delegated decision checklist
for officers on the issue of when and how to involve local
councillors and area boards in decisions about local services:
Yes
Implication of any council policy, initiative, strategy or
procedure: yes
Consultation in accordance with requirements and expectations of
consultation with the public: yes - A number of partner agencies
were consulted including Elizabeth Disney, Wiltshire CCG
Range of options available: yes
Staffing, financial and legal implications: yes
Risk assessment: yes
Involvement of statutory officers and/or directors: Terence Herbert
- Chief Executive Officer, People; Alistair Cunningham, Chief
Executive Officer, Place; Emma Legg Director, ASC Operations;
Claire Edgar Director, LD and MH; Helen Jones, Director,
Commissioning; Kim Holmes, Principal Social Worker
Regional or national guidance from other bodies: YES. National
guidance confirms the requirement for a decision making report on
stage 2 to be considered by the DASS and for the decision to be
recorded
The council’s constitution: yes
This contract is suitable for execution under the e-signature
process: NA
Alternative options considered:
Fully described in the four stages set out
above.
Conflict of Interest: None
Background: As the Director for Adult Social Care I am responsible for any matters relating to adult social care in the County of Wiltshire on behalf of Wiltshire Council. The power to make a decision in respect of this matter is delegated to me pursuant to Wiltshire Council’s Constitution.
Contact: Alison Elliott.
Publication date: 02/06/2020
Date of decision: 28/04/2020
Accompanying Documents: