April 2020: Changes in relation to Coronavirus Act 2020
See also Coronavirus Act 2020 chapter
The Care Act Easements relieve the local authority of the duty to undertake assessments of children transitioning to adult social care, if the local authority deems it necessary to do so. See Annex B: Guidance on streamlining assessments and reviews, Care Act easements: guidance for local authorities (Department of Health and Social Care).
- 1. Introduction
- 2. When a Transition Assessment must be carried out
- 3. Adult Carers and Young Carers
- 4. Features of a Transition Assessment
- 5. Consent and Mental Capacity
- 6. On Completion of the Transition Assessment: Providing Information and Advice
- 7. Continuity of Care after the age of 18
- 8. Transition from Children’s to Adult NHS Continuing Health Care
Effective transition planning is essential to help young people and their families prepare for adulthood. Transition to adult care and support comes at a time when a lot of change can take place in a young person’s life. It can also mean changes to the care and support they receive from education, health and care services, or involvement with new agencies such as those who provide support for housing, employment or further education and training.
Whilst people who use the service are adults, for those who have just transitioned from children’s services it is important to ensure that the statutory processes, as outlined below, have been completed.
The years in which a young person is approaching adulthood should be full of opportunity. Some of the life outcomes that matter for young people approaching adulthood and their families, may include (but are not limited to):
- paid or voluntary employment or participation in other activities;
- good health;
- completing exams or moving to further education;
- independent living(choice and control over one’s life and good housing options);
- social inclusion (friends, relationships and community).
Early conversations provide an opportunity for young people and their families to reflect on their strengths, needs and desired outcomes, and to plan ahead for how they will achieve their goals.
The duty to conduct a transition assessment applies when someone is likely to have needs (‘likely need’) for care and support (or support as a carer) under the Care Act 2014 when they or the person they care for transitions to the adult system.
A transition assessment must be conducted by the local authority for all those who have likely needs, however the timing of this assessment will depend on when it is of ‘significant benefit’ to the young person or carer. This will generally be at the point when their needs for care and support as an adult can be predicted reasonably confidently, but will also depend on a range of other factors discussed in the section below “When a transition assessment must be carried out”.
2. When a Transition Assessment must be carried out
Transition assessments should take place at the right time for the young person or carer and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like after the young person in question turns 18. There is no set age when young people reach this point; every young person and their family are different, and as such, transition assessments should take place when it is most appropriate for them.
The local authority must carry out a transition assessment when there is:
- significant benefit to the young person or carer in doing so; and
- if they are likely to have needs for care or support after turning 18.
The provisions in the Care Act relating to transition to adult care and support are not only for those who are already receiving children’s services, but for anyone who is likely to have needs for adult care and support after turning 18.
2.1 Likely need
If a young person or carer is ‘likely to have needs’ this means they are likely to need care and support as an adult – needs are not just those needs that will be deemed eligible under the adult statute. It is highly likely that young people and carers who are in receipt of children’s services would be ‘likely to have needs’ in this context, and local authorities should therefore carry out a transition assessment for those who are receiving children’s services as they approach adulthood, so that they have information about what to expect when they become an adult.
2.2 Significant benefit
When considering if it is of ‘significant benefit’ to assess, the local authority should consider the circumstances of the young person or carer, and whether it is an appropriate time for the young person or carer to undertake an assessment which helps them to prepare for adulthood. The consideration of ‘significant benefit’ is not related to the level of a young person or carer’s needs, but rather to the timing of the transition assessment. When considering whether it is of significant benefit to assess, a local authority should consider factors which may contribute to establishing the right time to assess (including but not limited to the following):
- the stage they have reached at school and any upcoming exams;
- whether the young person or carer wishes to enter further/higher education or training;
- whether the young person or carer wishes to get a job when they become a young adult;
- whether the young person is planning to move out of their parental home into their own accommodation;
- whether the young person will have care leaver status when they become 18;
- whether the carer of a young person wishes to remain in or return to employment when the young person leaves full time education;
- the time it may take to carry out an assessment;
- the time it may take to plan and put in place the adult care and support;
- any relevant family circumstances;
- any planned medical treatment;
- other issues for consideration.
2.2.1 Young people with Special Educational Needs
For young people with special educational needs (SEN) who have an Education, Health and Care (EHC) Plan under the Children and Families Act 2014, preparation for adulthood must begin from year 9. The transition assessment should be undertaken as part of one of the annual statutory reviews of the EHC Plan, and should inform a plan for the transition from children’s to adult care and support.
Equally for those without EHC plans, early conversations with the local authority about preparation for adulthood are beneficial; when these conversations begin to take place will depend on individual circumstances. For care leavers, local authorities should consider using the statutory Pathway Planning process as the opportunity to carry out a transition assessment where appropriate.
Where young people aged 18 or over continue to have EHC plans and they make the move to adult care and support, the care and support aspects of the EHC plan will be provided. The statutory Care and Support Plan must form the basis of the ‘care’ element of the EHC plan.
Plans must clearly set out the care and support which is reasonably required by the learning difficulties and disabilities that result in the young person having SEN. For people over 18 with a Care and Support Plan, this will be those elements of their care and support which are directly related to their SEN. EHC Plans may also include other care and support that is in the care and support plan, but the elements that are directly related to SEN should always be clearly marked out separately as they will be of particular relevance to the rest of the EHC Plan.
2.2.2 Timing of assessments
Transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.
The local authority should not carry out the transition assessment at inappropriate times in a young person’s life, such as when they are sitting their exams and it would cause disruption. Local authorities should seek to agree the best time for assessments and planning with the young person or carer, and where appropriate, their family and any other relevant partners.
A young person or carer, or someone acting on their behalf, has the right to request a transition assessment. The local authority must consider such requests and whether the likely need and significant benefit conditions apply – and if so it must undertake a transition assessment. If the local authority thinks these conditions do not apply and refuses an assessment on that basis, it must provide its reasons for this in writing in a timely manner, and it must provide information and advice on what can be done to prevent or delay the development of needs for support.
3. Adult Carers and Young Carers
Preparation for adulthood will involve not only assessing how the needs of young people change as they approach adulthood but also how carers’, young carers’ and other family members’ needs might change. Local authorities must assess the needs of an adult carer where there is a likely need for support after the child turns 18 and it is of significant benefit to the carer to do so.
The SEND Code of Practice: 0-25 Years sets out the importance of full time programmes for young people aged 16 and over (see SEND Code of Practice chapter 8 on preparation for adulthood).
The local authority must also assess the needs of young carers as they approach adulthood. For instance, many young carers feel that they cannot go to university or enter employment because of their caring responsibilities. Transition assessments and planning must consider how to support young carers to prepare for adulthood and how to raise and fulfil their aspirations.
The local authority must consider the impact on other members of the family (or other people the authority may feel appropriate) of the person receiving care and support. This will require the authority to identify anyone who may be part of the person’s wider network of care and support. Young carers’ assessments should include an indication of how any care and support plan for the person/s they care for would change as a result of the young carer’s change in circumstances. For example, if a young carer has an opportunity to go to university away from home, the local authority should indicate how it would meet the eligible needs of any family members that were previously being met by the young carer.
4. Features of a Transition Assessment
The transition assessment should support the young person and their family to plan for the future, by providing them with information about what they can expect. All transition assessments must include an assessment of:
- current needs for care and support and how these impact on wellbeing;
- whether the child or carer is likely to have needs for care and support after the child in question becomes 18;
- if so, what those needs are likely to be, and which are likely to be eligible needs;
- the outcomes the young person or carer wishes to achieve in day to day life and how care and support (and other matters) can contribute to achieving them.
Transition assessments for young carers or adult carers must also specifically consider whether the carer:
- is able to care now and after the child in question turns 18;
- is willing to care now and will continue to after 18;
- works or wishes to do so;
- is or wishes to participate in education, training or recreation.
The same requirements and principles apply for carrying out transition assessments as for other needs assessments.
The young person or carer in question must be involved in the assessment for it to be person centred and reflect their views and wishes. The assessment must also involve anyone else who the young person or carer wants to involve in the assessment, for example their parents.
Transition assessments will often represent a very different context to that which the person is accustomed, so ensuring that people have general information and advice about adult care and support will sometimes be a prerequisite for giving more detailed information and advice. For example, the right to self-assessment applies as with other assessments under the Care Act. However there is the important caveat that for children – the local authority must ensure that a self-assessment is appropriate. This means for example ensuring that a young carer conducting a self-assessment is clear about the support available both to them and the person/s they care for, avoiding a situation where the young carer assumes the default of continuing in the same caring role through ignorance of other options.
When sharing information with a young carer about the person they care for as part of a supported self-assessment during transition, the local authority must satisfy themselves that it is appropriate for the young carer to have the information. They must have regard to all circumstances in taking this decision, especially the age of the young carer, however each case will be different and there is no one age at which a young carer is necessarily old enough to receive information. The local authority must ensure that the adult consents to have their information shared in this way.
Transition assessments should be carried out in a reasonable timescale and the local authority should inform the young person or carer of an indicative timescale over which the assessment will be conducted and keep them informed.
While like all assessments, transition assessments must identify all a person’s needs for care and support, they should be proportionate to that person’s needs. For someone with a low level of need, an assessment might be light touch, but in many cases a more thorough examination will be required to fully establish a person’s needs.
Transition assessments should consider the immediate short term outcomes that a child or carer wants to achieve as well as the medium and longer-term aspirations for their life. Progress towards achieving outcomes should be monitored.
EHC Plans must be person centred, and must focus on preparation for adulthood from Year 9. Therefore, for young people with EHC Plans, transition assessments should build on the plans which will already contain information about the person, their aspirations and progress towards achieving their desired outcomes.
Similarly, for young people and carers who do not have an EHC Plan, but who already have other plans under children’s legislation, the transition assessment should build on existing information.
5. Consent and Mental Capacity
In all cases, the young person or carer in question must agree to the assessment where they have mental capacity and are competent to agree. Where a young person or carer lacks mental capacity or is not competent to agree, the local authority must be satisfied that an assessment is in their best interests. Everyone has the right to refuse a transition assessment, however the local authority must undertake an assessment regardless if it suspects that a child is experiencing or at risk of abuse or neglect.
6. On Completion of the Transition Assessment: Providing Information and Advice
Having carried out a transition assessment, the local authority must give an indication of which needs are likely to be eligible needs (or none are eligible ) once the young person in question turns 18, to ensure that the young person or carer understands the care and support they are likely to receive and can plan accordingly.
There is a particularly important role for the local authority in ensuring that young people and carers understand their likely situation when they reach adulthood.
From April 2016, people who turn 18 with eligible care and support needs will have those needs met for free by their local authority for the rest of their lifetime. Forthcoming guidance on funding reform will set out the detail of how this will work.
Where the transition assessment identifies needs that are likely to be eligible, the local authority should consider providing an indicative personal budget, so that young people, carers and their families are able to plan their care and support before entering the adult system (see SEND Code of Practice and Personal Budgets).
For any needs that are not eligible, the local authority must provide information and advice on how those needs can be met, and how they can be prevented from getting worse. Information and advice must be accessible and proportionate to whoever needs it and must consider individual circumstances. For example when providing information and advice to young people and young carers, it is often more effective if information is given face-to-face from a trusted source, such as the young person’s care coordinator. See also Information and Advice.
7. Continuity of Care after the age of 18
The local authority must not allow a gap in care and support when young people and carers move from children’s to adult services.
Where a transition assessment was not conducted and should have been (or where the young person’s circumstances have changed), the local authority must carry out an adult needs or carer’s assessment (see Assessment).
The local authority can continue children’s services beyond age 18 and up to 25 for young people with EHC Plans if they need longer to complete or consolidate their education and training and achieve the outcomes set out in their plan. If, having carried out a transition assessment, it is agreed that the best decision for the young person is to continue to receive children’s services, the local authority may choose to do so. Children and adults’ services must work together, and any decision to continue children’s services after the child turns 18 will require agreement between children and adult services.
Where a person over 18 is still receiving services under children’s legislation through their EHC Plan and the EHC Plan ceases, the transition assessment and planning process must be undertaken as set out elsewhere in this chapter. Where this has not happened at the point of transition, the requirement to continue children’s services, as above, applies.
Young people and their parents should be fully involved in making decisions about their care and support. This includes decisions about the most appropriate time to make the transition to adult services. The EHC Plan or any transition plan should set out how this will happen, who is involved and what support will be provided to make sure the transition is as seamless as possible.
8. Transition from Children’s to Adult NHS Continuing Health Care
Clinical Commissioning Groups (CCGs) should use the National Framework for NHS Continuing Healthcare and supporting guidance and tools to determine what ongoing care services people aged 18 years or over should receive. The framework sets out that CCGs should ensure that adult NHS continuing healthcare is appropriately represented at all transition planning meetings to do with individual young people whose needs suggest that there may be potential eligibility. CCGs and LAs should have systems in place to ensure that appropriate referrals are made whenever either organisation is supporting a young person who, on reaching adulthood, may have a need for services from the other agency.
The framework sets out best practice for the timing of transition steps as follows:
- children’s services should identify young people with likely needs for NHS CHC and notify the relevant CCGs when such a young person turns 14;
- there should be a formal referral for adult NHS CHC screening at 16;
- there should be a decision in principle at 17 so that a package of care can be in place once the person turns 18 (or later if agreed more appropriate).
Where a young person has been receiving children’s continuing health care from a relevant CCG, it is likely that they will continue to be eligible for a package of adult NHS CHC when they reach the age of 18. Where their needs have changed such that they are assessed as no longer requiring such a package, they should be advised of their non-eligibility and of their right to request an independent review and mediation. The CCG should continue to participate in the transition process, in order to ensure an appropriate transfer of responsibilities, including consideration of whether they should be commissioning, funding or providing services towards a joint package of care.
As set out above, where it will benefit a young person with an EHC Plan, the local authority has the power to continue to provide children’s services past a young person’s 18th birthday for as long as is deemed necessary. Where there is a change in CHC provision, this needs to be recorded in the young person’s EHC Plan, where they have one, and advised of their rights to ask the local authority for mediation.