Adult Social Care - Choice Policy

Purpose

1.1 

The purpose of this Policy is to clarify the process which Brighton & Hove City Council (the “Council”) will follow when considering the accommodation and care and support needs of residents within the community. This includes when the Council is responsible for funding care and accommodation in residential or nursing home care and complies with the Care Act 2014. 

Also included within scope of this policy are people living in their own homes and people who were previously self-funding their own care arrangements. 

1.2

In summary, an assessment under the auspices of the Care Act 2014 will determine whether a person has eligible care and support needs. 

The assessment will include whether a person is eligible for care and support needs to be funded by the Council. The Council will listen and take account of the service user's preferences as to how those needs are met. In doing so the Council also has a duty to consider the public purse and weigh up the alternative options considering choice and cost.  

1.3

The Council must promote wellbeing when carrying out any of its care and support functions in respect of a person. The wellbeing principle applies in all cases where the Council is carrying out a care and support function, or making a decision, in relation to a person. 

1.4

The Intention of the Council is to offer choice of one or more providers through commissioning processes. Where available options are limited we will work with the service user and/or representative to ensure that care and support needs are met in accordance with Council responsibilities. 

1.5

This Choice Policy is not intended for use in Extra Care Placements. Service Users will have a choice as to whether they enter Extra Care (if it is available to them). However once in placement service users needs are met through an on-site team; there is no availability to choose an alternative provider for this element of care.

Approach

1.6

The Council’s aim for Adult Social Care service users is that everyone should have access to services that best meet their assessed needs.  

1.7

The Council believe in enabling people to live a life, not just experience a service. We do this by adopting a strength and assets-based approach which focuses on what people can do, not what they can’t do, and by building on their service user strengths, networks and utilising community assets.  

1.8

Wherever possible we will provide support for service users to be around established support networks and familiar environments, whether that be in their own home or other accommodation. 

1.9

The Council has a duty to advise people to obtain information about possible options and take independent financial advice before they are at the point of considering a move into accommodation and before any detailed work on assessment of their care and support needs takes place. The Council is committed to ensuring all residents and potential service users have information on available options to them when accessing Adult Social Care services in the city. You can find more information on our Adult Social Care hub.

1.10

This policy applies to all service users including new requests to access care funding from the Council for the first time, those with existing care and those who have previously funded their own care but are now requiring support from the Council.  

1.11

The Council will undertake an assessment of an adult’s needs for care and support in accordance with the Care Act 2014. 

When the Council arranges care and support to meet a service user's needs, they will assess the service user's financial resources to ascertain whether the Council will charge the service user for providing the care and support. 

This financial assessment will be undertaken in accordance with the Care Act 2014 including occasions when a representative arranges care on behalf of the service user with limited Council involvement. 

1.12

The thresholds which will be referred to when undertaking the financial assessment at clause 1.11 above can be found at Charging policy for care services.

The Council recommends that even if a service user is a self-funder with significant financial resources, they are advised to seek Independent financial advice as to options to best manage their financial resources in relation to their care and support needs now and in the future. 

It is important that service users are clearly informed in writing that, in circumstances where their funds fall below the statutory threshold and they become eligible for their care to be funded, they may not be eligible for the funding to continue in their current setting or at their current cost or level. 

1.13

The Council understands the importance of choice in the care and support planning process. The cost of each service users care will be calculated and available options will be considered in partnership with the service user and/or their representative, ensuring eligible care needs are met in the most cost effective way.

The Council will adhere to Annex A of the Care and support statutory guidance when considering accommodation for service users.   

1.14

The Council aims to meet everyone’s service user needs for care and support within the city. However, with regard to care home placements, there are scenarios where options for out of area placements will be considered. 

The Care Act 2014 requires the Council to comply with the Care and Support and After-care (Choice of Accommodation) Regulations 2014 

2.1

To ensure that public funds are used in the most effective and efficient way, the Council will not fund a registered placement or care support package where:

• 2.1.1 - the registered provider is rated Inadequate by Care Quality Commission (“CQC”) or significant safeguarding concerns have been raised;
• 2.1.2 - the cost of the service user care package exceeds the best available option that has been identified. 
  The best available option will determine the service user’s personal budget. If a service user wishes to purchase a more expensive service that has been identified to meet their eligible needs, then the Council will usually agree to fund at the personal budget rate (less any assessed contribution). 
  The Care and Support Plan will explain how the additional cost or service level will be funded or provided, either by the person, or a third party (for example a relative).   
• 2.1.3 - the provider has not given written explanation of how they will meet the service user’s care and support needs.
• 2.1.4 - the Council does not consider the placement or package to be appropriate to meet the service user’s care and support needs. 

2.2

The Council is required to deliver value for money in every available service. The consideration on value for money will include:

• 2.2.1 - that the provider service is in line with nationally recognised levels. 
  Where this is a registered provider with the CQC our preference is to commission services from those providers with a “Good” or “Outstanding” rating. 
  We will contract with providers with a “Requires Improvement” rating, however in principle we will not place service users with regulated services from a “Inadequate” provider. 
  There may be exceptions to this, considered on a case-by-case basis. 

3.1 Top-ups

As referenced above, the Council will offer care and accommodation that meets the service users assessed care and support needs and provides value for money. This approach will not stop a service user identifying alternative services that require a top-up in fees to meet the overall cost.

Full explanation will be provided to each service user and/or their representative so that they can consider the full implications of this scenario.

• (a) the Choice of Accommodation regulations for residential and nursing care provision require that self-top ups are only permissible for those who own a property and those subject to section 117 of the Mental Health Act. All other top-ups must be paid by a third party or parties. 

  The council is required to contract with the care home at the full fee, including the third party element. The council’s policy is to arrange with the care home to collect the third party contribution directly from them and also to collect the resident’s assessed contribution. (Subject to exceptional circumstances).  

• (b) ensure the person paying the top-up understands the full implications of this choice, remembering that this is often made at a point of crisis; 
• (c) provide the person with enough information and advice so they understand the terms and conditions, including actively considering the provision of independent financial information and advice; 
• (d) ensure the person is willing and able to meet the top-up, and that they recognise that this may be for some time into the future; and 
• (e) ensure the person enters into a written agreement with the Council, agreeing to meet the cost. 
  • This is specifically important as the Council remains responsible for the placement should the top-up arrangement break down in future. Care Providers cannot request a top-up fee from a person if they have accepted the placement will be funded in full by the Council at an affordable rate.

3.2 Direct Payments

Service Users can choose to have their Care and Support or s117 Mental Health Act needs met by requesting Direct Payments to arrange their own care and support. 

Direct Payments cannot be used to fund residential care but provide a flexible approach to the individual or their authorised representatives, if they lack mental capacity, to s117 and/or care and support needs being met. 

Individuals or their representatives must be aware of the availability of Direct Payments as a possible option for them to choose how their care and support needs are met in accordance with the Care Act, Mental Health Act and Direct Payment Regulations.

When considering a request for Direct Payments the Council will take into account whether the individual’s needs can be met by providing those Direct Payments within the assessed personal budget. 

If the costs of the care the individual wishes to purchase via a Direct Payment exceeds the personal budget the individual may still choose to have their needs met at the higher cost by paying the additional fees necessary, provided they are able to evidence how those additional fees can be managed and sustained. 

3.3 Additional fees for non-residential services 

Where a service user's needs have been assessed and can be met within an assessed personal budget the council will agree to meet their needs at that cost. For example, this may be the market cost of a care home to meet 24-hour needs.

However, the service user may still choose to have their needs met at a higher cost (for example, with a live-in care service at home or a personal choice of provider) provided they are able to specify how the alternative arrangements can be managed. This could either be by paying the additional cost direct to the care provider (in addition to their assessed contribution) or by arranging for someone else to provide the additional levels of care needed, for example, by family or friends or privately funded personal assistant. This should be clearly recorded in the care plan and fully explained to the service user and any representatives. 

The council will contract with the provider for the personal budget amount only and will not be liable for the additional fees.