CQC We and I Statements
Theme 1 – Working with People: Assessing needs
We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.
I have care and support that is coordinated, and everyone works well together and with me.
I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and goals.
- 1. Introduction
- 2. Review of the Support Plan
- 3. Keeping Plans under General Review
- 4. Planned and Unplanned Reviews
- 5. Considering a request for a review of a plan
- 6. Decisions not to Conduct Reviews
- 7. Revision of the Support Plan
- 8. Timeliness and Regularity of Reviews
- 9. Meeting Urgent Needs
- 10. Further Reading
Ensuring all people with a support plan, or support plan have the opportunity to reflect on what is working, what is not working and what might need to change is an important part of the planning process. It ensures that plans are kept up to date and relevant to the person’s needs and goals, provides confidence in the system and reduces the risk of crisis situations.
2. Review of the Support Plan
The review process should be:
- person centred;
- outcome focused;
- accessible to the person and their carers;
- and proportionate to the needs being
The process must involve the person needing care and also the carer where feasible, and consideration must be given whether to involve an independent advocate who local authorities are required to supply in the circumstances specified in the Act (see Independent Advocacy chapter).
The duty on the local authority is to ensure that a review occurs, and if needed, a revision follows this.
The local authority can also authorise others to conduct the review. This could include the person themselves or carer, a third party (such as a provider) or another professional.
The local authority remains responsible for assurance and sign off of the review.
The review will help to identify if the person’s needs have changed and may then lead to a reassessment. It should identify any circumstances which may have changed, and follow safeguarding principles to ensure that the person is not at risk of abuse or neglect.
Reviewing and revising care plans are intrinsically linked as it is often not be possible to decide whether to revise a plan without a thorough review.
Where a review is being undertaken and the person has a carer, the local authority should consider whether the carer’s support plan requires reviewing too.
There are occasions when a change to a plan is required but there has been no change in the levels of need (for example, a carer may change the times when they are available to support).
There may also be small changes in need, at times temporary, which can be accommodated within the established personal budget.
In these circumstances, it may not be appropriate for the person to go through a full review and revision of the plan. The local authority should respond to these ‘light touch’ requests in a proportionate and reasonable way.
Where a revision is necessary, assessment and care planning processes as detailed in the Assessment and Support Planning chapters should be followed as appropriate and proportionate to the person’s situation. Where a plan is for a person with mental health problems, this chapter should be read in conjunction with the Mental Capacity chapter.
3. Keeping Plans under General Review
Keeping plans under review is an essential element of the planning process. Without a system of regular reviews, plans can become quickly out of date meaning that people are not receiving the right care and support required to meet their needs.
Plans may also identify outcomes that the person wants to achieve which are progressive or time limited, so a periodic review is vital to ensure that the plan remains relevant to the person’s goals and aspirations.
The local authority should have in place a system that allows for the proportionate monitoring of both support plans and support plans, to ensure that needs are continuing to be met.
This system should also include cooperating with other health and care professionals who may be able to inform the authority of any concerns about the ability of the plan to meet needs (see Integration, Cooperation and Partnerships chapter).
A review is a positive opportunity to take stock and consider if the plan is enabling the person to meet their needs and achieve their aspirations.
The process should not be overly complex or bureaucratic, and should cover the broad elements below, which should be communicated to the person before the review process begins.
- Have the person’s circumstances and / or care and support or support needs changed?
- What is working in the plan, what is not working, and what might need to change? This should include a review of any kennelled pets (see Protecting Property of Adults Being Cared for Away from Home, including Pets chapter)
- Have the outcomes identified in the plan been achieved or not?
- Does the person have new outcomes they want to meet?
- Could improvements be made to achieve better outcomes?
- Is the person’s personal budget enabling them to meet their needs and the outcomes identified in their plan?
- Is the current method of managing it still the best one for what they want to achieve, e.g. should direct payments be considered (see Personal Budgets chapter)?
- Is the personal budget still meeting the sufficiency test?
- Are there any changes in the person’s informal and community support networks which might impact negatively or positively on the plan?
- Have there been any changes to the person’s needs or circumstances which might mean they are at risk of abuse or neglect?
- Is the person, carer, and / or independent advocate satisfied with the plan?
4. Planned and Unplanned Reviews
There are several different types of review a care and support or support plan including:
- a planned review (the date for which was set with the individual during care and support or support planning, or through general monitoring);
- an unplanned review (which results from a change in needs or circumstance that the local authority becomes aware of, for example a fall or hospital admission);
- a requested review (where the person with the care and support or support plan, or their carer, family member, advocate or other interested party makes a request that a review is conducted. This may also be as the result of a change in needs or circumstances).
4.1 Planned reviews
During the planning process, the person and their social worker, or relevant professional may have discussed when it might be useful to review the plan and therefore agree to record this date in the plan.
This may be helpful so that people know when their review will take place, rather than the review being an unexpected experience. The person concerned may have a view as to a suitable timeframe for the review to occur. Setting review dates may also help authorities future workload planning.
The first planned review should be an initial ‘light touch’ review of the planning arrangements 6-8 weeks after sign off of the personal budget and plan. Where relevant, this should also be combined with an initial review of direct payment arrangements (see Direct Payments chapter). A light touch review aims to check that the plan is working as intended, and identify any teething problems. Where plans are combined with carers, education, housing, or health and care plans which may be reviewed annually) the local authority should be aware of the review arrangements with these other plans and seek to align reviews.
Local authorities should ensure that the planned review is proportionate to:
- the circumstances;
- the value of the personal budget;
- any risks identified.
In a similar way to care and support or support planning, there should be a range of review options available, which may include:
- peer led review;
- reviews conducted remotely, over the telephone or video conferencing;
- face to face reviews with a social worker or other relevant professional.
For example, where the person has a stable, longstanding support package with fixed or long term outcomes, they may wish to complete a self-review at the planned time which is then submitted to the local authority to sign off, rather than have a face to face review with their social worker.
This does not mean that they cannot request a review at another time or a face to face review if there is an unplanned change in needs or circumstances.
4.1 Who should be involved?
In all instances, the method of review should, wherever reasonably possible, be agreed with the person and must involve the adult to whom the plan relates, any carer the adult has and any person the adult asks the authority to involve.
The local authority should take all appropriate measures to ensure the involvement of the person concerned and the involvement of other people if appropriate, such as an independent advocate where this is required.
If a person has a mental impairment and / or lacks capacity to make some decisions, careful consideration must be given to the date of the next review. In these instances, a social worker may be identified as the lead professional.
Where health conditions are progressive, and / or the person’s health is deteriorating, reviews may need to be much more frequent.
Similarly where a person has few or no family members or friends involved in supporting them, the risks are higher, and again, reviews or monitoring may need to be more frequent.
It may helpful l to put a ‘duty to request a review’ into commissioned services, so employees are required to inform the local authority if they think that there is a need for a review.
Where this occurs, the person should still be involved in the review process to ensure their views are taken account of.
4.2 Unplanned reviews
Consideration should be given to immediately conducting a review if circumstances change so that:
- a carer is no longer able to provide the same level of care;
- there is evidence of a deterioration of the person’s physical or mental wellbeing;
- or the local authority receives a safeguarding alert.
During the review process, the person concerned, or the person acting on their behalf should be kept fully involved and informed to reduce anxiety at a time where things in the person’s life may have changed substantially.
5. Considering a request for a review of a plan
5.1 Advice and information
In addition to the duty on local authorities to keep plans under review generally, the local authority has a duty to conduct a review if a request for one is made by the adult or a person acting on the adult’s behalf.
Local authorities should provide information and advice to people at the planning stage about how to make a request for a review. This process should be in accessible formats and include the different way of to making a request, by phone, email, or text for example.
Information given should also outline what happens after a request is made, and the timescales involved in the process.
5.2 Considering the request
The process should be made as simple as possible, with the local authority acting promptly after a request has been received. Consideration should also be given to the accessibility needs of the local population. This may, for example, include multiple language versions, and non-internet routes to request for people who may not have access to the internet, or in areas of digital exclusion. Local authorities should also consider the role that local community and voluntary organisations can play to help people log requests.
The right to request a review applies not just to the person receiving the care, but to others supporting them or interested in their wellbeing. For example a person with advanced dementia may not be able to request a review, but a relative or a neighbour may want to draw the attention of the local authority to a deterioration in the person’s condition. The local authority should consider the request even if it is not made by the adult or their carer.
5.3 Considering a review
Upon receipt of a request to conduct a review, the local authority must judge the merits of conducting a review. In most cases a review should be organised unless the authority is reasonably satisfied that:
- the plan remains sufficient;
- the request is frivolous;
- is made on the basis of inaccurate information, for example where a person lodges multiple requests for a review in a short period of time and there is no reason to believe that the person’s needs have changed;
- or is a complaint, in which case the complaints process should be followed (see Complaints chapter).
Local authorities should clearly set out the process that will be used to consider requests.
The authority must involve the person, carer and anyone else the person requests to be involved where feasible, and identify anyone who may have significant difficulty in being fully involved in the review and when there is no appropriate person who can represent or support their involvement and consider the duty to provide independent advocacy (see Independent Advocacy chapter).
Example: Accepting a renewal request
A local authority receives an email from a relative of an older person receiving care and support at home. The email provides details that the older person’s condition is deteriorating and supplies evidence of recent visits to the GP. The local authority therefore decides to review their support plan to ensure that it continues to meet their needs.
Example: Declining a renewal request
A local authority receives a phone call from Mr X. He is angry as he feels that he has needs that have not been identified in his care plan and requests a review of the plan. The authority has on a separate recent occasion reviewed his plan, when it came to the conclusion that no revision was necessary and informed Mr X of the decision and the reasons for it. Therefore, the local authority declines the request in this case and provides a written explanation to Mr X, informing hi m of an anticipated date of when it will be formally reviewing the plan together with information on its complaints procedure.
6. Decisions not to Conduct Reviews
Where a decision is made not to conduct a review following a request, the local authority should set out the reasons for not accepting the request in a format accessible to the person, along with details of how to pursue the matter if the person remains unsatisfied.
In most cases, it would be helpful for this to include information that the authority will continue to monitor the plan to ensure that it remains fit for purpose, and that the decision does not affect the right to make a future request for review. It may also be useful for the local authority to set out when the person can expect a formal review of the plan.
7. Revision of the Support Plan
Where a decision has been made following a review that a revision to the care plan is necessary, the authority should inform the person, or a person acting on their behalf of the decision and what this will involve.
Where the person has substantial difficulty in being actively involved with the review, and where there are no family or friends to help them to engage, an independent advocate must be involved
When revising the plan the local authority must involve the person, their carer and any other persons the adult may want involved, and their advocate where the person qualifies for one.
The local authority must take all reasonable steps to agree the revision.
If circumstances have changed to the extent that a major change is needed to the care and support or support plan, the local authority must carry out a needs or carer’s assessment and financial assessment, in order to revise the revise the plan and personal budget to meet the changes circumstances.
The assessment process following a review should not start from the beginning of the process but pick up from what is already known about the person and should be proportionate.
In some cases a complete change of the plan may be required, whereas in others minor adjustments may be needed. In either case, the following aspects of care planning should be followed:
- the person’s wishes and feelings should be identified as far as possible and they should be supported to be involved;
- the revision should be proportionate to the needs to be met;
- where the plan was produced in combination with other plans, this should be considered at the revision stage;
- the person, carer or person acting on their behalf should be encouraged to be at the central of the review process to self-plan in conjunction with the local authority where appropriate;
- the development of the revised plan must be made with the involvement of the adult / carer, and any person the adult asks the authority to involve;
- any elements that were in the original plan should be replicated in the revised plan where appropriate and agreed by all parties;
- the sign off process should be made clear, especially where the revised plan is prepared by the person and the local authority.
Particular attention should be taken if the revisions to the plan propose increased restraints or restrictions on a person who has not got the capacity to agree them. This may become a deprivation of liberty, which requires appropriate safeguards to be in place. The social worker, occupational therapist and any other relevant social care qualified professional or Mental Capacity lead should be involved, as well as an advocate (see Deprivation of Liberty Safeguards chapter).
The local authority must consider in all cases whether an independent advocate may be required to facilitate the person’s involvement in the revision of the plan.
Where the plan was produced with the assistance of an independent advocate, then consideration should be given to whether an independent advocate is also required for the revision of the plan.
The advocate would ideally be the same person to ensure consistency and continuity with the case details. Similarly, where a specialist assessor has been used previously in the assessment, consideration should be given to whether they need to employ the expertise of the specialist assessor in the review.
8. Timeliness and Regularity of Reviews
In the absence of a request for a review, or any indication that circumstances may have changed, the local authority should conduct a regular review of plan.
The date of the review can be indicated at the planning stage or reviews can be linked to the compulsory review of the direct payment arrangements, where this is appropriate.
Reviews should be completed no later than every 12 months, although a light touch review should be considered 6– 8 weeks after agreement and sign off of the plan and personal budget, to ensure that the arrangements are accurate and there are no initial issues to be aware of.
This light touch review should also be considered after revision of an existing plan to ensure that the new plan is working as intended, and in cases where a person chooses a direct payment, should be aligned with the review of the making of the direct payment (see Direct Payments chapter).
The review should be proportionate to the needs to be met, and the process should not contain any surprises for the person concerned.
Periodic reviews and reviews in general must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstance.
As with support planning the revision of the plan should be completed in a timely manner proportionate to the needs to be met.
9. Meeting Urgent Needs
Where there is an urgent need to intervene, local authorities should consider implementing interim packages to urgently meet needs while the plan is revised. However, local authorities should work with the person to avoid such circumstances wherever possible by ensuring that any potential emergency needs are identified as part of the support planning stage and planned for accordingly.