Arranging Support and Services

An individual who has been financially assessed as able to afford the full cost of the services to meet their eligible needs (self funding) can choose to arrange and manage those services without the involvement of the Local Authority unless:

1. They lack capacity to do so; and
2. There is no other appropriate person to make and manage the arrangements on their behalf.

If an individual does not wish to arrange/ manage the services they can request the Local Authority do so. In these circumstances the Local Authority has a duty to arrange/manage the services as requested with one exception: the service to be arranged is a residential or nursing placement.

In the case of residential or care home placements the Local Authority can decide whether or not to arrange or manage the services unless:

1. The person lacks capacity; and
2. There is no other appropriate person to arrange/ manage the placement on their behalf; in which case
3. The Local Authority must arrange and manage the placement.

Sometimes an individual may request support to arrange services, but feel able to manage them when they are in place.

If the Local Authority has agreed to (or has a duty to) arrange the services a Care and Support Planning process is not required and your role may involve things like:

1. Facilitating communication between the individual and a service provider;
2. Communicating with a service provider on the individual's behalf; and
3. Supporting the individual to complete any paperwork required to arrange the service.

A record of the support provided in arranging the service should be made in the individual's electronic file.

When the service is arranged you must explain to the individual what steps they should take if:

1. They feel unable to manage their service in the future; or
2. They require further support from the Local Authority to arrange a different service; or
3. Their financial circumstances change.

Charging to arrange services

The Local Authority is legally entitled to charge an administration fee for making arrangements for self funders when:

1. Asked to do so by the individual; and
2. The individual has capacity to make the request; and
3. The services are not care home provision.

If an individual requests the Local Authority both arranges and manages their services, and the Local Authority agrees to do so (or has a duty to do so) those services must be arranged and managed as per any other service.

This means a Care and Support Plan must be developed and reviewed.

If at any time the individual becomes unhappy or concerned about the manner in which the Local Authority is managing their services you should explain to them the option to manage the service independently still exists, so long as:

1. They continue to be self funding; and
2. There is no legal obligation for the Local Authority to manage the service.

Charging to arrange services

The Local Authority is legally entitled to charge an administration fee for making arrangements for self funders when:

1. Asked to do so by the individual; and
2. The individual has capacity to make the request; and
3. The services are not care home provision.

Note: Where an out-of-area placement has been identified, you must also read the additional guidance specific to Durham County Council – the Care Package Guidance. This can be found within the Local Resource Area.

Note: Practitioners must not set up a service without first ensuring that the local authority has contracting arrangements in place with the chosen provider. Advice can always be obtained from the commissioning service (AHS.commissioning@durham.gov.uk). 

Identifying a suitable placement

The Commissioning Advisory Group (CAG) – for Learning Disabilities Service, Navigation Team, Mental Health Service meets monthly to provide support and advice to Adult Care operational staff to help identify suitable services for people with complex needs where the costs are expected to be over £5k per year. The CAG provides advice about different service options (including residential and nursing provision as well as Supported Living), processes, types of services and service availability outside of the meeting dates. CAG manage vacancies and voids across LD and Mental Health services and used by people supported by the Navigation Team. Vacancy lists are updated monthly and can be viewed on point 5 on the Integrated Strategic Commissioning Team intranet page. Practitioners must inform CAG if they are considering a placement as it may be already being considered for another person.

For further information, please contact AHS.commissioning@durham.gov.uk.

The Commissioning Team

The commissioning service will contact the host authority to determine the following: 

• Whether the placing authority currently contract with the service provider or a spot contract is required.
• Relevant costs depending on the type of care required.
• Any safeguarding concerns about the service provision.
• Are there any third party top up fees to be paid.

The Commissioning Service will take responsibility for negotiating out-of-area fees for care homes.

Concerns about a placement

Where safeguarding concerns are identified prior to a placement being made the Commissioning Assistant will gather detail from the host authority. The commissioning service would identify and pass information to the practitioner where relevant. 

If concerns are identified, then the practitioner would need to consider whether this is a potential option and this would require management oversight. 

In this circumstance, standard practice would expect the following to be considered/actioned:

1. A conversation between practitioner and manager regarding the concern/s and potential risks.
2. Monitoring information from host authority, where relevant.
3. What is the capacity of the individual to be involved in the decision?
4. Is the person unbefriended or without advocacy?
5. Is the person moving to be closer to family?
6. Is there an equivalent Practice Improvement Officer team in the host area for oversight?
7. Speak to Integrated Care System in the area about the provision.

Approving a placement

The approval for the placement is gained through care management and panel process. There are a number of panels, for example, high-cost panel, joint validation and residential panel, that meet frequently. Please ensure you book onto and submit sufficient materials in advance to support the panel application. 

Following the outcome of panel LD/MH/Navigation Team practitioners must inform CAG and the review database will be updated by the commissioning service accordingly for strategic oversight. This can be done by emailing AHS.commissioning@durham.gov.uk.

Finance

Following approval of the placement:

1. The practitioner must send notification of the placement to the Finance Team via Azeus on the relevant system form. Once the provision is created in Azeus, a placement letter will be issued to the home (currently posted out) confirming the status of the placement, the bed type and the weekly fee.
2. Practitioner to provide relative/representative details to Financial Assessment Team and to the home for invoices and correspondence.
3. Deputy and Appointee Team to notify the Department of Work and Pensions (DWP) Attendance Allowance and Personal Independence Payment Unit of changes to service user circumstance where the local authority are the financial deputy/appointee.
4. If applicable, contact Housing Benefit and Council Tax Benefit and notify them of move to residential care. This may be the responsibility of family.
5. If applicable, contact Welfare Rights to support the person with benefit entitlements.
6. Confirm practical matters e.g. close down community services, paying utilities etc. This may be the responsibility of family.
7. For those in a residential placement and if the personis in receipt of Attendance Allowance, this should stop after four weeks, unless an application is required to consider relinquishing a tenancy, for example under Court of Protection (CoP). Similarly, the care component of Disability Living Allowance / Personal Independence Payment also stops (unless they are self funding). The Department of Works and Pension (DWP) should be informed of the placement, this should be by either the person, family or panel deputy or Durham County Council where the local authority has financial deputyship/appointeeship. The latter must be made aware by the social worker/care manager/care coordinator. If the DWP are not informed within timescale the person will be required to returned the benefit from the date they were not entitled to it.

Reviewing an out-of-area placement

The Commissioning Service have a number of quality assurance review processes available. The quality assurance review option used will depend on the type of contract the placement is under. The options include:

1. Where Durham County Council ‘piggyback’ on a host authority contract and have robust QA processes there is no role for Durham County Council Commissioning Services.
2. Where Durham County Council ‘piggyback’ on a host authority contract but the host authority does not share quality assurance information – this is currently under review. In the interim, advice can be gained by contacting Zoe Smith, Adult and Health - Commissioning Services.
3. Where Durham County Council ‘piggyback’ but there is no host authority quality assurance process in situ or Durham County Council are unsatisfied then Durham County Council Commissioning Services will assess the level of risk and quality assure the service appropriately. This is currently under review. In the interim, advice can be gained by contacting Zoe Smith, Adult and Health - Commissioning Services.
4. Where Durham County Council contract directly with the provider Commissioning Services would ascertain whether there is an independent quality assurance process and, where this is not in situ, whether there is a role for Durham County Council quality assurance based on risk.

For further information, please see below: