Legal Requirements of a Support Plan Review and Tools

Under Section 27 of the Care Act 2014, the Local Authority must keep Support Plans under periodic review. This means they must have a system or process in place to ensure that reviews are carried out and monitored in a manner appropriate to the needs and circumstances of the carer whose plan it is.

The Local Authority is responsible for the review function, even if a decision is made to delegate some or all of that function to another person or organisation.

The review should be carried out in a timely way, based on the needs and circumstances of the carer. Because every carer is different, the Care Act does not specify the frequency in which a Support Plan review must take place. That said, the statutory guidance does expect the Local Authority to endeavour to carry out a Support Plan review as follows:

1. A review of a new service or Support Plan should be carried out within 6-8 weeks of the service/change commencing;
2. A review of an on-going stable Support Plan should take place no less than 12 months after the date of the 6-8 week review, and then no less than once every 12 months after that;
3. Where the carer's needs or circumstances are likely to change reviews should be arranged as required to monitor the situation and respond to changes in a timely way (thus keeping the plan under review).

Wherever possible there is an expectation under the Care Act that a Support Plan review and a Direct Payment review are carried out at the same time, preferably as a joint process. Doing so will prevent unnecessary duplication for both the carer and the Local Authority.

See: Reviewing a Direct Payment.

Any person carrying out a review must be:

1. Competent to carry out the function; and
2. Possess the skills, knowledge and competence required based on the carer's needs and circumstances (for example being skilled to adapt communication appropriately).

Whenever you carry out a review you must involve:

1. The carer with Support needs;
2. Anyone else that the carer has asked you to involve;
3. The carer's representative (when they have substantial difficulty).

There are particular broad elements that you must establish when carrying out a Support Plan review:

1. Have the carer's circumstances and/or Support needs changed?
2. What is working in the plan, what is not working, and what might need to change?
3. Have the outcomes identified in the plan been achieved or not?
4. Does the carer have new outcomes they want to meet?
5. Could improvements be made to achieve better outcomes?
6. Is the carer's personal budget enabling them to meet their needs and the outcomes identified in their plan?
7. Is the current method of managing the personal budget still the best one for what they want to achieve?
8. Is the personal budget still meeting the sufficiency test?
9. Are there any changes in the carer's informal and community support networks which might impact negatively or positively on the plan?
10. Have there been any changes to the needs of the person being cared for which might mean they are at risk of abuse or neglect?
11. Is the carer satisfied with the plan?

The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the review process, but it does acknowledge that a good tool can be helpful. However, any tool should:

1. Facilitate and maximise the carer's involvement;
2. Support the information gathering process;
3. Be flexible and adaptable; and
4. Be appropriate and proportionate to the needs being met by the Support Plan.

See below for details of the tools that are available for you to use as required.

The process of review involves having a skilled conversation about:

1. What is working/not working;
2. What may have changed about the carer's situation, needs or outcomes; and
3. What may need to change in the Support Plan as a result.

Depending on the nature of the review and the presenting issue there may be a need to explore in more detail:

1. Changes in Needs; and
2. Risk.

You should consult with the carer when arranging the review to understand the specific communication needs that they have so that any review tool you use will maximise their involvement in the conversation.

If you do not feel that the review tools available to you will be appropriate you should speak to your manager about how they can be adapted.

Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of review. These are known as tools.

First and foremost you should have regard for any available practice guidance or good practice examples provided by the Local Authority.

tri.x have also developed a range of person centred tools that can support a carer to:

1. Think about what matters most to them, now and in the future;
2. Think about Wellbeing;
3. Think about needs and what a good day/bad day looks like; and
4. Think about what is working/not working about a Support Plan and any services or support they receive.

See Resources for Person Centred and Strengths Based Conversations.

Anybody can make a request for a Support Plan to be reviewed and the Local Authority must consider all requests made. There is a duty to carry out a review whenever a request is deemed 'reasonable'.

Any request for a review that is made at a time reflective of that recorded in the Support Plan is usually reasonable. If these are the circumstances of the request a review should be arranged and carried out at the earliest opportunity.

Deciding whether a review request made at any other time is 'reasonable' involves considering a number of factors before making a professional judgement. These include:

1. Is the information on which the request is being made accurate?
2. If a review has been carried out in the last 6-8 weeks, has there been a change in need or circumstance?
3. Is the Support Plan still working as intended?
4. Are the eligible needs identified at assessment being met?

The carer whose Support Plan it is must be consulted before any decision is made about the need to review, and their views must be regarded.

If the review is deemed reasonable you should make arrangements to carry it out at the earliest opportunity.

There is no duty to carry out a review if the request is deemed 'unreasonable'.

If the decision is made not to carry out a review you should inform the carer whose Support Plan it is, and the person who made the request (if this was a different person) as soon as possible.

You should explain:

1. That the review request has been declined;
2. The evidence upon which the decision was made;
3. When a planned review will be carried out;
4. What the carer should do if their needs or circumstances change before then; and
5. The carer's right to complain about the decision.

You must also provide information and advice about:

1. Adult Care and Support in general as required;
2. Ways that needs could be prevented, reduced or delayed.

In all cases where communication has been provided by telephone a follow up letter confirming the conversation and outcome should be sent to the carer as a formal record.

You should also make a proportionate record of the decision, the carer's views and the information that has been given to them, specifically any timescales that have been agreed.

A proportionate response to a review request may be to agree monitoring arrangements.

There is a duty under the Care Act to carry out proportionate monitoring whenever there is a risk that a carer's needs may change or their situation may become unstable.

The arrangements to monitor must be:

1. Proportionate and appropriate to the carer's situation and risk;
2. Agreed with the carer; and
3. Agreed from a strengths based approach to promote resilience of the carer and their informal networks of support.

If you are unclear about the need to monitor you should seek advice from your line manager.

Monitoring arrangements must be clearly recorded. Where you are making arrangements for someone else to monitor the situation (rather than monitoring it yourself) you must make sure that you have recorded this in a way that will ensure monitoring activity takes place at the agreed time.

Any monitoring activity carried out should be clearly recorded and you should use supervision effectively to discuss and agree the need for continued monitoring.