April 2020: Changes in relation to the Coronavirus Act 2020

See also Coronavirus Act 2020 chapter

As outlined in the Coronavirus Act 2020, the local authority may have to make changes to:

  • conducting needs assessments,
  • eligibility decisions,
  • care and support planning and reviews for adults with care and support needs.

In such circumstances, it is essential that a person’s human rights must not be breached and that the values and principles laid out in the ethical framework are considered and applied when working with adults and their families. These are:

  • respect;
  • reasonableness;
  • minimising harm;
  • inclusiveness;
  • accountability and
  • flexibility.

See Responding to COVID-19: the ethical framework for adult social care (Department of Health and  Social Care)

1. Introduction

Person centred care is a way of thinking and working in a way that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs. Person-centred is about focusing care on the needs of the person rather than the needs of the service.

Most people who have care and support needs have their own views on what is best for them and what their priorities are. Services and workers, therefore, must be flexible to meet their needs – the service must suit the adult, rather than the other way round.

Every adult should be fully involved as possible in the setting of clear and measurable outcomes. Where outcomes have been set by commissioners who fund the service, the adult should be made aware of these and the plans the service has to achieve them.

The service will ensure that staff are trained to provide the appropriate care and treatment that meets the adult’s needs. Staff must ensure that consent is gained prior to providing support. Where the adult refuses support that places them at risk, staff will ensure that all relevant people are fully informed and action taken in line with legislation (see Consent and Deprivation of Liberty Safeguards).

Each person’s care and treatment needs and preferences should be assessed by staff with the required levels of skills and knowledge for the particular task. These will be agreed with the adult and / or their representative.

Every adult must be involved in all aspects of their daily living, ensuring they are engaged to the level they are able. All staff must ensure that each adult, regardless of their ability, has opportunity to live a full and valued life.

In some cases, people’s preferences for their care or treatment may not meet their needs. Where this is the case, and people lack mental capacity or are detained under mental health legislation, staff must act in accordance with the Mental Capacity Act 2005 and / or the Mental Health Act 1983 (see Mental Capacity). Where a person has capacity, it is important to act in agreement with their wishes.

2. Assessment of Needs and Preferences

See Assessment and Mental Capacity

Each adult and / or their representative must be involved in an assessment of their needs and preferences, as much or as little as they wish to be Staff should give them relevant information and support when they need it, to make sure they understand the choices available to them.

Assessments of people’s care and treatment needs should include all their needs, including health, personal care, emotional, social, cultural, religious and spiritual needs.

Further to a comprehensive pre-admission assessment, agreed risk management and support plans should be reviewed regularly and whenever needed throughout the person’s care and treatment. Additional assessments are required when there are changes to need or when individuals transfer between services, use respite care or are re-admitted or discharged. Care and support plan reviews should make sure that people’s goals or plans are being met and are still relevant.

Where the service shares responsibility for providing care and treatment with other services through partnership working, integrated care and multidisciplinary assessments, staff should also take into account information from all relevant teams, staff and services.

3. Views and Preferences of Adults who use the Service

A person’s care and treatment must be designed to make sure it meets all their needs. There may be times when their needs and preferences cannot be met, however, in these instances, staff must explain the impact of this to them and explore alternatives so that they can make informed decisions about their care and support. The explanation should show how staff have considered the impact of this on the person. This is so that they can make further informed decisions about their care and support.

When planning how to meet an adult’s preferences, staff should take into account, and make provision for, any impact this may have on other adults who use the service, robust risk management processes are essential in enabling individuals to achieve their personal outcomes safely.

A clear care and support plan, which includes agreed goals, must be developed and made available to all staff and others involved in providing the care. Staff are required to sign all care and support plans to acknowledge receipt of this information. Where relevant, it should include ways in which the adult can maintain their independence (see Review of Care and Support Plans)

4. Managing their Care and Support

Adults and / or their representatives must be given opportunities to manage as much of their care and support as they wish and are able to, and should be actively encouraged to do so. ‘Manage’ in this context may mean being actively involved, overseeing or making decisions about their care or support, depending on how much they need or want to be involved. This may include managing their medicines themselves, managing or supporting their personal care including eating and drinking, or using appropriate equipment and technology.

They should be given suitable information, advice, instruction and / or emotional support to help manage any care and support safely.

5. Providing Information

Adults and their representatives must be given relevant information in the most suitable way for them and in a way that they can understand. This includes information that describes:

  • the condition or conditions affecting the person using the service;
  • all possible relevant or appropriate care and treatment options;
  • the risks and benefits of each option;
  • the implications of not undertaking any, or only undertaking a part, of the care and support options;
  • costs / fees / tariffs associated with care and treatment;
  • reasonable expectations of the outcome of each care and support option.

6. Nutrition and Hydration

See also Meeting Nutritional and Hydration Needs

Where food and/or drink are provided for adults, they must have a choice that meets their needs and preferences as far as is reasonably practical. Monitoring of food intake will occur for all individuals and where there are specific health needs fluid will also be monitored.

Staff must make sure that they assess each person’s nutritional and hydration needs to support their wellbeing (see Promoting Wellbeing) and quality of life. This includes when there is no expected cure for an illness (see End of Life Care).