This annex sets out recommended governance and decision-making for directors of adult social services and PSWs in relation to use of the Care Act easements. Introduction During this period local authorities may need to take difficult decisions that impact on the way they respond to their responsibilities for care and support and their statutory functions. There should therefore be clear professional oversight and, where relevant, professional sign-off for such decisions as well as evidence that due consideration has been given to the possible consequences. The Coronavirus Act does not give authority to block, restrict or withdraw whole services. It enables local authorities to make and apply person-centred decisions about who is most in need of care, and who might need to have care and support temporarily reduced or withdrawn in order to make sure those with highest need are prioritised. Such decisions will in some cases be challenging, and therefore should always be made within the remit of the DHSC ethical framework. Importantly, they should be taken only where demand pressures and availability of staff in the coming period mean that the full range of services under the Care Act can no longer be delivered. This should be differentiated from decisions that need to be made in response to the government’s guidance about social distancing. For example, it may be decided to close a service because it is no longer safe to keep people together in a building. However, this does not mean those people do not need the equivalent level of support at this time. In this example, staff might be asked to provide the equivalent level of support. The equivalent service might be an alternative, but it is to reduce the risk of breaching the social distancing guidance. Assessments, reviews and changes to care packages The Care Act pre-amendment currently allows local authorities to prioritise and review in differing ways. Local authorities should continue to be as flexible as possible, and ensure they stay within government guidelines around social distancing and self-isolating. Decisions about assessments or reviews, and decisions to either reduce or alter care packages will have an impact on the people being supported as well as their carers. Such decisions must also take account of risks both current and potential should the situation change for the person and/or their carers. Where people decide to cancel or suspend their own care and support and manage alone or with support of their own family and community networks, this will mostly be for the person to decide themselves. However, where there are concerns that this may lead to unmanageable risk or safeguarding issues, practice oversight should be applied. This is not to undermine the views of the individual making the decisions about their care, but to ensure that, where necessary, the local authority in conjunction with the individual and their family have considered the possible consequences and the principles of safeguarding have been upheld. Deciding to apply the easements It is important that any decisions made in relation to Care Act easements are informed by discussions with local partners, in particular local senior NHS leadership. Health and wellbeing boards should also be informed about a decision to start operating under the easements. Recording by local authorities remains a priority and will them to ensure accountability and provide evidence for the thought processes behind the decisions they will be making. The following table sets out decision-making processes for local authorities. These decisions are not necessarily sequential but should follow a situation where there are increasing pressures on adult social care delivery. Key stages can be enacted together or separately over time so long as the decision to do so is evidenced and follows the guidance set out below. Decision-making tables Operating under the pre-amendment Care Act
StageDecisionProcess Stage 1: Operating under the pre-amendment Care ActBusiness as usualTo continue at this stage for as long as is feasible Stage 2: Applying flexibilities under the pre-amendment Care ActDecision for Individual service type to prioritise short-term allocation of care and support using current flexibilities within the Care ActWhere COVID-19-related absence means service types need to be changed, delayed or cancelled short term within that service type, for example home care or supported living, the relevant senior manager / assistant director should consult the PSW and should detail the: reason the decision needs to be taken; impact of the decision on the people who ordinarily use the service; impact of the decision on families and carers of people who ordinarily use the service; and possible alternative sources of care and support and the likelihood of this being available. Where the PSW is satisfied, this position can then be presented to the director of adult social services (or alternate locally agreed senior) for a final decision about moving into stage 2 It is important to note that all other services may well continue to deliver their services as business as usual Operating under the Care Act easements
StageDecisionProcess Stage 3: Streamlining services under Care Act easementsDecision to operate under Care Act easements as laid out by the Coronavirus ActThe Care Act easements allow local authorities to cease formal Care Act assessments, applications of eligibility and reviews. However, there is an expectation in the Act that local authorities will do everything they can to continue to meet need as was originally set out in the Care Act. Where the impact of the pandemic is making this unachievable or untenable, local authorities will need to make the decision to cease carrying out those eased Care Act functions and move to a position of proportionate assessment and planning. The relevant assistant director / senior manager will need to consult the PSW and be clear about the: reason the decision needs to be taken; impact of the decision on the people who ordinarily use the service; and impact of the decision on families and carers of people who ordinarily use the service. If the PSW is satisfied that the Care Act easements need to be enacted, a meeting of the senior management board should be called for a final decision. The decision should also consider and be informed by a conversation with the local NHS leadership. The director of adult social services and the PSW should ensure that their lead member has been involved and briefed as part of this decision-making process. DHSC should be notified using the Care Act easements notification form. Stage 4: Prioritisation under Care Act easementsWhole system prioritising care and supportWhere local authorities need to make decisions about changing support for people, they should consider and allocate capacity across the whole of adult social care. This may mean allocating resource from some service types that may not be under pressure to support those that are. An example might be where a local authority is faced with a decision about reducing personal care for one person so that another gets the help they need to eat. In this situation, the relevant assistant director / senior manager should consult the PSW. They should detail the: reason the decision needs to be taken; impact of the decision on the people who ordinarily use the service; impact of the decision on families and carers of people who ordinarily use the service; possible alternative sources of care and support and the likelihood of this being available. If a local authority decides it may need to move into stage 4, the PSW should call an emergency decision meeting of the director of adult social services where a decision about whether and how to prioritise care across adult social care (ASC) will need to be made. Sufficient care and support will have to remain in place at all times in order to ensure that the Convention rights of all those in need of care and support, and of carers, are respected. The director of adult social services and the PSW must ensure that their lead member has been involved and briefed as part of this decision-making process. DHSC should be notified using the Care Act easements notification form. Any decisions taken to prioritise or reduce support should be reviewed every 2 weeks with the PSW. Full service should be restored as soon as is reasonably possible. Business continuity planning Where provider services have submitted business continuity plans that have implications for direct services for people with care and support needs, professional practice as well as business oversight will be needed. Accountability for all such decisions lies with the local authority and provider services should not be making decisions about restricting or removing care. Any such decisions should be made in accordance with the process laid out in the prioritisation decision-making table above.