1. Section 47(1)(A) of the NHS and Community Care Act 1990 requires local authorities to:

    1. Assess everyone who asks for assessment
    2. Assess everyone who appears to them to be in need of a service which they may provide or arrange
    3. Assess everyone who is referred by a doctor or other professional
    4. Screen all applicants in order to decide whether to assess them
    5. Back to start
  2. Under s.4, Disabled Persons (Services, Consultation and Representation) Act 1986, disabled people are:

    1. Entitled to a service
    2. Entitled to practical assistance in the home
    3. Entitled to an assessment
    4. Entitled to a holiday
    5. Back to Question 1
  3. For the purposes of community care assessment, a person is disabled if:

    1. They say they are
    2. They meet the definition in the Disability Discrimination Act 1995
    3. They meet the definition in the National Assistance Act 1948
    4. A general practitioner provides a certificate
    5. Back to Question 2
  4. s.21 National Assistance Act gives local authorities:

    1. A power to provide residential accommodation
    2. A duty to provide residential accommodation
    3. A duty to assess the need for residential accommodation
    4. A duty to run residential homes for vulnerable people
    5. Back to Question 3
  5. Which of the following is not part of the legal framework for service provision to older people:

    1. NHS and Community Care Act 1990
    2. s.45 Health Services and Public Health Act 1968
    3. s.2 Chronically Sick and Disabled Persons Act 1970
    4. s.21 and sch.8 National Health Services Act 1977
    5. Back to Question 4
  6. In relation to carers, the local authority must:

    1. Decide whether to inform carers that they can be assessed
    2. Decide whether a carer's assessment is necessary
    3. Assess a carer's needs whilst the person they are caring for is undergoing a community care assessment
    4. Assess a carer's needs even if the person they are caring for has refused a community care assessment
    5. Back to Question 5
  7. Which of the attached statements best describes the decision of the House of Lords in R v Gloucestershire CC ex?? parte Barry?

    1. Local Authority resources were not to be taken into account when assessing need
    2. Resources were not to be taken into account when the Local Authority had exhausted them
    3. Resources may be taken into account when assessing needs and when deciding whether to meet needs
    4. Need is an absolute concept and qualitatively different from questions of resource
    5. Back to Question 6
  8. In deciding whether to provide services following community care assessment, the local authority can disregard:

    1. Needs expressed by the service user
    2. Future needs
    3. Psychological needs
    4. Needs that it is not necessary to meet
    5. Back to Question 7
  9. Which of the following is not an option for the protection of vulnerable adults:

    1. Removal under s.47 National Assistance Act 1948
    2. Guardianship under s.7 Mental Health Act 1983
    3. Court order directing intervention to protect
    4. Statutory duty on the local authority to investigate and protect
    5. Back to Question 8
  10. Once carers have been assessed, the local authority has:

    1. A duty to decide what services are necessary
    2. A duty to provide services that help the carer to care for the person they care for
    3. A power to provide services that help the carer to care for the person they care for
    4. A duty to provide direct payments to the carer
    5. Back to Question 9
  11. Which of the following must be provided without financial charge to the service user:

    1. Residential accommodation under s.21 National Assistance Act 1948
    2. Domiciliary services under s.2 Chronically Sick and Disabled Persons Act 1970
    3. Services to carers under the Carers and Disabled Children Act 2000
    4. Aftercare services under s.117, Mental Health Act 1983
    5. Back to Question 10
  12. For which of the following may direct payments not be used:

    1. To purchase health care
    2. To purchase care from a relative
    3. To purchase care from a live-in carer
    4. To purchase residential care
    5. Back to Question 11

Answers

  1. The correct answer is B: Assess everyone who appears to them to be in need of a service which they may provide or arrange

    Section 47(1), NHS and Community Care Act 1990 states:

    “... where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority -

    1. shall carry out an assessment of his needs for those services; and
    2. having regard to the results of that assessment, shall decide whether his need calls for the provision by them of any such services.”
  2. The correct answer is C: Entitled to an assessment

    Section 4, Disabled Persons (Services, Consultation and Representation) Act 1986 states:

    “When requested to do so by a disabled person or any person who provides care for him, a local authority shall decide whether the needs of the disabled person call for the provision... of any services in accordance with section 2(1) of the Chronically Sick and Disabled Persons Act 1970.”

  3. The correct answer is C: They meet the definition in the National Assistance Act 1948

    The definition is contained within section 29 of the National Assistance Act 1948, which refers to “persons aged 18 and over, who are blind, deaf or dumb, or who suffer from mental disorder of any description, and other persons who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed.” The wording has not been amended subsequently despite its inappropriateness for the twenty-first century. Reference to that definition may be found in the two mandates for assessment of disabled people for community care provision, namely the NHS and Community Care Act 1990 (section 47) and the Disabled Persons (Services, Consultation and Representation) Act 1986 (section 4).

  4. The correct answer is B: A duty to provide residential accommodation

    Originally section 21 of the National Assistance Act 1948 gave local authorities the power to provide residential accommodation. This was subsequently turned into a duty by policy guidance, LAC(93)10, which details the groups towards whom this duty applies. The duty arises once the need has been identified in an assessment and applies to older and/or disabled people who are in need of care and attention not otherwise available to them. Local authorities may delegate all their provision to the voluntary, independent and for profit/not for profit sectors. What is reasonable in terms of when the accommodation must be provided will depend on the circumstances of the case.

  5. The correct answer is A: NHS and Community Care Act 1990

    The 1990 Act merely provides the legal framework for assessment (s.47) and identifies (s.46) those Acts that comprise the community care service framework. These include, for older people, the 1968 and 1977 Acts referred to in the question. The Chronically Sick and Disabled Persons Act 1970 also forms part of the service provision framework for older people who meet the definition of disability contained in s.29 National Assistance Act 1948.

  6. The correct answer is D: Assess a carer's needs even if the person they are caring for has refused a community care assessment

    The Carers (Recognition and Services) Act 1995 gave carers entitlement to an assessment of their willingness and ability to continue to care, where the local authority was carrying out an assessment of the person they were caring for under s.47 NHS & Community Care Act 1990. This extended the previous position, whereby carers of disabled people had a right to have their ability and willingness to care taken into account when the disabled person was being assessed under s.4, Disabled Persons (Services, Consultation and Representation) Act 1986.

    The Carers and Disabled Children Act 2000 amended carers’ entitlement to assessment, extending it to situations in which the cared-for person has refused a community care assessment under the NHS & Community Care Act. The Carers (Equal Opportunities) Act 2004 requires the local authority to inform the carer of their right to an assessment.

  7. The correct answer is C: Resources may be taken into account when assessing needs and when deciding whether to meet needs

    The House of Lords allowed Gloucestershire’s appeal against the Appeal Court’s prior ruling that the local authority was not entitled to take account of resources when assessing or reassessing needs and deciding whether it is necessary to make arrangements to meet needs. In particular, Lord Nicholls considered the local authority should have regard to cost when assessing need, and that the criteria for establishing need can vary with the availability of resources. Lord Clyde considered the local authority should have regard to resources in deciding whether it is necessary to make arrangements to meet needs.

    NB This is the case of Michael, featured in Object 1.

  8. The correct answer is D: Needs that it is not necessary to meet

    The NHS and Community Care Act 1990 requires local authorities to assess where it believes that an individual may require community care provision. The authority may determine what level of need it recognises as requiring assessment and service provision, using Fair Access to Care policy guidance (2002) and Care Management and Assessment practice guidance (Department of Health 1991) as the framework. Judicial decisions have clarified that need includes future needs and psychological needs whilst the 1991 practice guidance is clear that, whatever service users might express in terms of needs, the local authority has the ultimate decision-making role.

  9. The correct answer is D: Statutory duty on the local authority to investigate and protect

    There is no statute that provides a duty of investigation and protection of vulnerable adults. Policy guidance entitled 'No Secrets' (Department of Health, 2000) provides a framework for responding to the suspected or alleged abuse of vulnerable adults. It requires an inter-agency policy and administrative framework, led by social services, and local strategies for responding to reports and providing services. However, courts can use their inherent jurisdiction to direct an outcome, such as where a vulnerable adult must live, thus offering protection from abusive environments (Re F (adult: court's jurisdiction) [2001]) where a person lacks capacity to decide for themselves.

    Section 47, National Assistance Act 1948 provides for the compulsory removal from where they are living of a person who is; 'suffering from grave chronic disease or, being aged, infirm or physically incapacitated, is living in unsanitary conditions, and is unable to devote to themselves, and is not receiving from other persons, proper care and attention.' Their removal must be necessary in their own interests or to prevent injury, or serious nuisance, to others.

    Guardianship under s.7, Mental Health Act, is available for someone with mental disorder of a nature or degree warranting admission into guardianship where guardianship is necessary in the interests of their welfare, or for the protection of others. The guardian can:

    1. Require the patient to live in a specified place, including the power to take and convey them there, and to return them if they abscond;
    2. Require the patient to attend for the purpose of medical treatment, occupation, education or training;
    3. Require access to the patient to be given to any doctor, AMHP or other person.

    People with learning disability, however, cannot be subject to guardianship unless their disability is associated with abnormally aggressive or seriously irresponsible conduct.

    The Family Law Act 1996, covering violence in domestic settings and providing for non-molestation and occupation orders, may also be of assistance to some vulnerable adults.

    In addition, the Domestic Violence Crime and Victims Act 2004 makes it a criminal offence to physically or sexually abuse, harm or cause deliberate cruelty by neglect of a child or an adult. Equally, the Mental Capacity Act 2005 makes it an offence to ill-treat or wilfully neglect a person who lacks capacity.

  10. The correct answer is C: A power to provide services that help the carer to care for the person they care for

    The Carers and Disabled Children Act 2000 gives local authorities the power to provide services to carers, following assessment under the Carers (Recognition and Services Act 1995), in order to help the carer care for the person they are caring for.

    The Act also gives local authorities the power to make direct payments to carers, including those aged 16/17, to arrange for services they have been assessed as needing. Note, however, that both of these provisions are powers rather than duties.

  11. The correct answer is D: Aftercare services under s.117, Mental Health Act 1983

    To charge for services provided under section 117 Mental Health Act 1983 is unlawful (R (Stennett and Others) v Manchester CC [2002] 5 CCLR 500. Local authorities must charge for residential care provision (section 22 National Assistance Act 1948 and section 44, NHS and Community Care Act 1990). The Community Care (Residential Accommodation) Act 1998 lays out the basis of the charges regime that local authorities must follow. The upper and lower limits of an individual’s resources that operate in respect of charging for residential care are varied annually. Section 55 Health and Social Care Act 2001 allows for deferred payments. For domiciliary services charging is optional but strongly encouraged (section 17, Health and Social Services and Social Security Adjudications Act 1983. Charges must be reasonable and inability to pay should not mean withdrawal of provision. Under the Community Care (Delayed Discharges etc) Act 2003 local authorities are not allowed to charge for items of community equipment for clients or carers if the cost of buying and fitting them is less than £1000, or for services forming part of a package of intermediate care for the first six weeks.

  12. The correct answer is A: To purchase health care

    Under the Community Care (Direct Payments) Act 1996, later integrated within the Health and Social Care Act 2001, the local authority may provide cash payments to service users in relation to whom it has accepted that services should be provided to meet assessed need. Originally restricted to disabled people between 18 and 65, direct payments are now available to any adults (with the exception of some mentally disordered people), to carers for services to meet their own assessed needs, and to disabled children of 16/17. The Community Care (Direct Payments) Amendment Regulations 2000 identify permissions and exclusions in relation to the use of direct payments, which include the prohibition on purchasing health care.