Assessment and care planning

It has been decided that you will proceed with an assessment of Evelyn’s needs for community care services, as part of which you will consider what additional provision might be necessary to meet any identified needs of the children. You may assume that Evelyn has given permission, albeit reluctantly, for you to talk to whoever you need to. You must decide whether their needs call for the provision of services under a care plan.

  • You may consult any family member at this stage.
  • You may consult four professionals at this point.
  • You may consult four data sources now.

Consult one family member:

I am having to ask Sophie and Celeste to do too much for me. I am worried about my parents too, because they have relied on me in the past. Can you get me some help? My children are fine, at least most of the time. It is just me who needs help. However, if it would help you to speak to school teachers, then I guess you can but I hope you will not say too much about us. Also, try not to worry my parents if you speak to them - they do virtually nothing for me now as they have problems of their own. You can speak to my doctor if you wish.

We are worried about our mum and try to help her when we can. Sometimes this can be very difficult and upsetting, sometimes it can make us quite tired. We are doing alright at school but sometimes everything gets on top of us and we don’t work as hard at school as the teachers would like.

We are not able to do so much for Evelyn now. She has gone down hill quite a lot lately.

Evelyn’s condition was finally diagnosed six months ago but she has been ill for longer. Her prognosis is poor. She has lost much physical mobility and this will continue to deteriorate although at what rate is difficult to predict. At the moment she is in a plateau phase but this will not last forever. The impact on Evelyn has been quite devastating. She has consulted me about depression, refusing medication but agreeing to see a psychologist who provides counselling at the health centre. I rarely see her children.

I have visited the home on several occasions because Sophie has been missing school or arriving late. Things improve for a while and then slide back. She has too many responsibilities for a child her age.

Sophie and Celeste used to come to youth club regularly. Now Sophie, when she does come, seems tired and preoccupied. Celeste has practically stopped coming after several fights with other young people, quite out of character for her.

Sophie has begun missing school or arriving late and tired. Her work is suffering and she seems preoccupied with things that are happening at home. Celeste has recently begun to act up in class, sometimes bullying other children. The standard of her work has fallen.

Evelyn feels devastated by her own diagnosis and by her parents’ failing health. She feels caught up in a no-win situation in relation to the children – she has to rely on them to do things she feels she should be doing herself, and feels they are missing out on things as a result. At times she seems to despair.

I have provided some minor aids and adaptations to enable Evelyn to continue with practical and care tasks at home.

I have no information about this family. There is a long waiting list for a Disabled Facilities Grant.

No information contained on the register.

Records that Evelyn has previously expressed concern about her parents; notes that the Education Welfare Service has visited the home and that both schools involved have asked whether social workers are involved because of concerns about the children.

The Disabled Parents Network advocates for the rights of disabled parents to receive community care services to support them in their parenting roles (rather than for services to be focused solely on the children’s needs). Information and research findings are available to demonstrate the strength of their arguments.
www.disabledparentsnetwork.org.uk

You have found two sites that provide information for young carers and information about their needs, for example that caring may have adverse effects on mental health.
www.youngcarer.com
www.youngminds.org.uk/youngcarers

You recall from your training how care-giving can impact on relationships within families, and the importance of recognition and support. You find a web link to an organization that provides information, guidance about the law on carers’ assessments and research findings on what works well to support carers.
www.carersuk.org/information/helpwithcaring/carersassessmentguide

You have identified a local MS group. You find a web link to a national organisation that promotes good practice and provides information on research and service development.
www.mssociety.org.uk
www.mstrust.org.uk
www.msrc.co.uk

You find a local group of disabled people who run a peer advocacy service.

These advise you of the discretionary duty to assess Evelyn under section 47, NHS and Community Care Act 1990 and of the assessment duties in respect of young people in need or requiring protection under the Children Act 1989. The procedures do not clarify whether community care services would cover Evelyn as a parent. Any care package costing over £100 a week will have to be submitted to panel for approval because of the authority’s resource shortages. The procedures advise you not to refer to unmet need in written documentation.

Think of any Acts of Parliament that you judge relevant at this stage of the case.

Think about which guidance documents would be relevant at this stage of the case.

At this stage of the case, with the information you have, the following 14 Acts are relevant. How many did you identify correctly?

  1. NHS and Community Care Act 1990 - section 47 discretionary duty to assess where there appears to be a need for community care services.
  2. Disabled Persons Act 1986 - section 4 absolute duty to assess a disabled person.
  3. Children Act 1989 - sections 17, 18 and schedule 2 powers and duties towards children in need.
  4. Children Act 2004 - strengths co-operation and information sharing between agencies responsible for the welfare of young people.
  5. National Assistance Act 1948 - section 29 definition of disability relevant to the decision about use of the 1986 Act.
  6. Chronically Sick and Disabled persons Act 1970 - section 2 lists the services available for disabled people.
  7. NHS Act 1977 - section 21 and schedule 8 list the non-residential services available to respond to illness and mental disorder.
  8. Human Rights Act 1998 - duty to positively promote people’s rights.
  9. Data Protection Act 1998 - what information can be shared between agencies in what circumstances.
  10. Carers (Recognition and Services) Act 1995 - assessment duty towards carers of any age providing regular and substantial amounts of care.
  11. Carers and Disabled Children Act 2000 - assessment duty towards carers over 16 whether or not the cared-for person is undergoing assessment.
  12. Carers (Equal Opportunities) Act 2004 - carers over 16 must be informed of their right to an assessment.
  13. Housing (Grants, Construction and Regeneration) Act 1996 - enables the provision of Disabled Facilities Grants.
  14. Disability Discrimination Act 2005 - a duty to counteract discrimination and promote equal opportunities.

The following 13 pieces of guidance are relevant at this stage of the case.

  1. Care Management and Assessment: Practitioners Guide, 1991
  2. Community Care in the Next Decade and Beyond: Policy Guidance, 1990
  3. Community Care Assessment Directions 2004
  4. Direct Payments Guidance: Community Care, Services for Carers and Children's Services (Direct Payments) Guidance 2003
  5. Fairer Charging Policies for Home Care and Other Non-residential Social Services, 2003
  6. Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004: Combined Policy Guidance, 2005
  7. Fair Access to Care Services 2002
  8. Framework for Assessment of Children in Need and Their Families, 2000
  9. Children Act 1989 Regulations and Guidance, 1991
  10. Common Assessment Framework for Children and Young People: Practitioners' Guide, 2006
  11. Information Sharing: Practitioners' Guide, 2006
  12. Information Sharing: Further Guidance on Legal Issues, 2006
  13. Lead Professional: Practitioners' Guide, 2006

The correct decision is to provide services under a care plan. Services should include community care services for Evelyn (which are defined in s.46 of the NHS and Community Care Act 1990). These can include personal care, household tasks and resources to promote social and recreational activities. The care plan should include attention to future needs also. To be lawful the care plan must have a reasonable chance of meeting the needs identified.

The plan may also include family support services provided under s.17 and schedule 2 of the Children Act 1989, although it is arguable that the impact of better community care services to Evelyn herself may in time sufficiently lift the pressure on the children. The needs of the children as carers, however, will need to be taken into account in devising Evelyn’s care package. Equally, if it emerges that Evelyn provides a regular and substantial amount of care (of whatever nature) to her parents, then she will have been informed of her right to a carers assessment and services.

Application should be made for a disabled facilities grant to undertake any necessary adaptations to housing.