HARINGEY ADULTS

REVIEW PRACTITIONER

MANUAL

2019

BETTER OUTCOMES BETTER LIVES

HARINGEY COUNCIL, RIVER PARK HOUSE, 225 HIGH ROAD, WOOD GREEN, N22

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Contents

1. Introduction 2

2. Reviews are everyone’s responsibility 3

3. Case history 3

4. Handoff between teams 3

5. Carers review 4

6. Maximising independence 4

7. Quality assurance 5

8. Finance 5

9. Analysis of support packages 6

10. Respite 6

11. Appropriate & proportionate 6

12. Prevention 7

13. Substantial difficulty to engage 8

14. Advocacy 9

15. Involvement of others 10

16. Strengths 11

17. Whole family approach 12

18. Risk assessment 12

19. Timeframes 13

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Adults Review Manual

1. Introduction

Ensuring all people with a support plan have the opportunity to reflect on what is working,

what is not working and what might need to change is a crucial undertaking. It ensures that

plans are kept up to date and relevant to the person’s needs and aspirations, provides

confidence in the system and mitigates the risks of people entering a crisis. It also allows us

to set goals and outcomes to ensure better quality of care and maximising independence of

those we support.

The review process should be person-centred and outcomes-focused, as well as accessible

and proportionate to the needs to be met. The process must involve the person needing care

their carer or care agency, other involved professionals and an independent advocate where

it is necessary to do so.

Reviewing intended outcomes detailed in the plan is the means by which Haringey complies

with its ongoing responsibility towards people with care and support needs. The duty on

Haringey therefore is to ensure that a review occurs, and if needed, a revision follows this.

Important note:

This manual is meant to be read in conjunction with the current Care Act guidance (October

2018) as it does not provide an exhaustive list of all areas or comprehensive information in

the areas that have been covered. Therefore, it is the responsibility of all practitioners to

have read and be aware of what the care act guidance states and what their responsibilities

are under the act.

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2. Reviews are everyone responsibility

Any worker who has a case allocated to them will be responsible for reviewing the support

arrangements that are currently in place including any carer’s review that may also need to

be undertaken. Cases cannot be closed until both pieces of work have been completed. There

is no requirement for the 12-month mark to be reached before an annual review is scheduled;

instead, if no review has been undertaken within the financial year and it is allocated to a

worker they will be required to undertake the review before the case can be closed.

3. Case history

Before undertaking a review practitioners must ensure they have read the service users case

file. Being aware of both past and present issues will support a clearer understanding of the

service user and the areas of particular focus the review should take. Entries on our system

such as safeguarding concerns, changes in behaviour, disengagement with services will peek

our professional curiosity to ask the right questions and to ensure our interventions are both

informed and measured.

4. Handoff between teams

The reviewing team’s remit will be to undertake annual reviews of services users that are not

allocated to social care practitioners.

Cases that require an annual review should be referred to the reviewing team through Mosaic

once the practitioner has undertaken the 6-week review. Unscheduled reviews due to

changes in needs of service users would not fall within the remit of the review team. In these

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circumstances, a decision will be made as to which team is most appropriate to undertake the

review dependent on the perceived level of risk to the individual.

5. Carers Reviews

To ensure the streamlining of our work, it is important that where a review for a cared for

person is due, practitioners check to see if there is an informal carer supporting that person

and whether there is a support plan in place. Where there is an informal carer’s support plan

then the practitioner has a responsibility to review this support plan. It is better to ensure

that both of these activities take place at the same time regardless of when the last carer

review was. This will ensure the alignment of reviews moving forward and reduce the amount

of contacts that have to take place.

6. Maximising Independence

Reviews should be person centred, holistic and focused on maximising the service user’s

independence. This means that the reviewers will need to be mindful of what support is in

place, what is currently being utilised and what is no longer necessary. We do not want service

users to become dependent on care where there is the potential for them to be do more for

themselves or where care and support can be less restrictive.

Setting clear and achievable outcomes is a very important part of this process. Wherever

possible the emphasis should be about supporting people to be more independent not to just

maintain their current levels of functioning. Those providing care and support should be

challenged to increase the independence of those they support, which should be set out

within the ‘Planned outcomes by next review’ section.

Practitioners should always consider assistive technology, reablement, community

provision/resources and informal care as resources to reduce the need for formal services or

prevent the need for them in the future.

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7. Quality assurance

There is an expectation that all reviews are to be completed to the highest standard. This

means that everyone must make sure that there is sufficient detail in the review document

providing a clear picture of the individual, his or her strengths and the outcomes that need to

be met.

There should be no sections of a review form left blank. Neither should there be insufficient

detail documented under the sections included within the review. All areas within a review

must be considered to be equally important and as such practitioners must make sure the

required information and analysis is documented to enable a detailed and accurate picture of

the individual’s needs and strength. We want all reviews to be done correctly the first time

of asking.

8. Finance

The review might be the only direct contact that Haringey has with the individual over a 12-

month period and as such, it is important as much accurate information for the individual is

obtained. This includes ensuring that we have the correct information relating to the

individuals personal financial situation. This supports us in ensuring that those who should

be funding part or all of their support do so while also making sure those who are in financially

difficulties are getting the support that they need. This will also help practitioners in

identifying those service users who have fallen behind on payments so that support can be

provided.

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9. Analysis of Support Packages

Within the ‘Review Overview’ of the document there are sections relating to the type of

support that the individual might be in receipt of. Practitioners should provide sufficient

scrutiny and detail within these areas to ensure that the commissioned services are being

provided (length and frequency of visits, 1:1/2:1 hours, community access and time spent

away from placement etc.) and that these support arrangements are still required. It is

essentially that evidence is gathered at the time of the review that demonstrates how the

hours/support is being provided to the individual. If hours are not being utilised as previously

agreed then the package of care must be reduced to reflect what is being provided.

For those service users in receipt of direct payments practitioner should ensure that

payments are being spent on the support that is outlined within the service users support

plan. The service user should not be purchasing services, resources or activities that have not

been documented in the previous support plan/review. If direct payments are not being used

as outlined then practitioners will need to make the necessary adjustments reflecting the

support being provided and budgets amended.

10. Respite

Practitioners must ensure that respite is discussed with the carer at the review and that this

discussion is captured with the ‘Review Overview’ section. As respite is a service for the cared

for person (although benefiting the carer) it needs to be captured within the review and

support plan so that it can be added as a service onto the cared for persons Mosaic record.

This must be reviewed at every annual review to ensure that we limit the amount of contacts

being made to First Response for ad hoc respite requests.

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11. Appropriate & Proportionate

The review must be person-centred throughout. Practitioners must find out the extent to

which the person being assessed wishes to be involved in the review and should meet those

wishes as far as is practicable do so, as the person is best placed to understand the impact of

their condition(s) on their outcomes and wellbeing.

The communication needs of the individual must be considered before the review is

undertaken. It may be appropriate to provide a copy of the review to the individual or carer

before the Review or for an interpreter to be involved if English is not their first language.

Those with more complex needs may require specialist input or communication aids or

strategies to allow them to engage in the review process. It is up to the practitioner to the

make any reasonable adjustments to the review so that the individual can be as involved as

possible. Time, location and medium must also be considered when making arrangements

for the review so that it best suits the individual.

12. Prevention

The review process is a key element of Haringey’s prevention strategy. It is during the review

where practitioners can identify needs that could be reduced, or where escalation could be

delayed, and help people improve their wellbeing by providing specific preventive services,

or information and advice on other universal services available locally. Early interventions can

prevent or delay a person’s needs from progressing.

In parallel with reviewing a person’s needs, practitioners must consider the benefits of

approaches which delay or prevent the development of needs in individuals. This applies to

both service users with current needs that may be reduced or met through available universal

services in the community, and those without needs who may otherwise require care and

support in the future. This could include directing people to services such as community

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support groups which ensure that people feel supported, including an ability to participate in

their local community. It may also include helping the person to access services which

Haringey provides as part of its universal offer on prevention.

Practitioners can also support the person in understanding other types of support available

to them, such as within their own support networks, for example to seek to promote access

to appropriate employment, education or training, which can be an effective way of

maintaining independence. Such interventions at an early stage will help to sustain the

independence and wellbeing of those living in Haringey.

Practitioners must view the idea of prevention as holistically as possible. We must be aware

that anything that has a negative impact on someone’s wellbeing whether physically,

psychologically, emotionally or financially will place their independence at risk. This is why it

is so important for practitioners to identify all potential areas so that the right advice, support

and signposting can be put in place to reduce or delay those areas from developing to the

point where social and health care services are then required. We must strive to maximise

independence by tackling the issues before they occur.

13. Substantial Difficulty to Engage

In the ‘Supporting you in your review’ section of the review it asks whether the individual has

‘significant difficulty taking part in the review process?’ The care act asks practitioners to

consider the same four areas they would if they were assessing someone’s mental capacity

under the Mental Capacity Act 2005 (understanding, retaining, weighing and communicating).

You must make sure within this section you have provided adequate description to how you

have come to your decision. Under no circumstances should this box be left blank or with a

one sentence summary. At times it might not be immediately apparent until the review has

already begun. If during the review you feel the person does have significant difficulties the

review should be halted until an appropriate advocate can be identified.

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In some circumstances it may be deemed necessary for an advocate to be involved in the

review even if it appears the individual being assessed does not have any significant difficulty

in engaging in the review. This might be due to a number of reasons either stated by the

individual or in some other aspects you may have picked up. If in doubt make sure that an

advocate is present for the review or if they change their mind during the review again make

arrangements for an advocate to be present.

14. Advocacy

Advocates must be involved in the review if the service user has substantial difficulty in being

involved in the process or has difficulty in providing you with the necessary information. If an

advocate is needed consideration must be given to who can act on behalf of the individual.

Where there is a family member or friends who are willing and able to facilitate the person’s

involvement effectively, and who is acceptable to the individual and judged appropriate by

the practitioner, they may be asked to support the individual in the review process. Where

there is no one thought to be appropriate for this role the practitioner must make a referral

for an independent care act advocate. The advocate must be able to support the individual

in the review, support planning and reviewing stages and this will need to be confirmed with

the potential advocate if it is someone known to the individual.

Efforts must be made with the person being assessed to select their own advocate if they are

able to do so. Similarly the person’s wish not to be supported by an individual should be

respected. Where a person does not wish to be supported by a relative, for example, perhaps

because they wish to be moving towards independence from their family, then Haringey

cannot consider the relative appropriate. The person’s wish not to be supported by that

individual should be respected and if the person has capacity, or is competent to consent, the

person’s wishes must be followed. If the person has been judged to lack the capacity to make

a decision, then the practitioner must be satisfied that it is in a person’s best interests to be

supported and represented by the individual.

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The advocate cannot be someone who is already providing the person with care or treatment

in a professional capacity or on a paid basis (regardless of who employs or pays for them).

That means it cannot be, for example, the person’s GP, nurse, key worker or care and support

worker.

The advocate’s role is to support and represent the person and to facilitate their involvement

in the processes. In some instances it will be difficult for some people to fulfil this role easily,

for instance a family member who lives at a distance and who only has occasional contact

with the person, a spouse who also finds it difficult to understand the local authority

processes, a friend who expresses strong opinions of their own prior to finding out those of

the individual concerned, or a housebound parent. It is not sufficient to know the person well

or to love them deeply; the role of the appropriate individual is to support the person’s active

involvement with the Review, support plan and review processes.

15. Involvement of others

It is crucial that reviews are holistic in ensuring that we have a clear understanding of the

service users current circumstances. This is why is essential to ensure that other relevant

parties are involved in the review process even if they are unable to make the review itself.

If the individual is receiving home support the agency supporting the individual should always

be invited to attend the review and any placed based provision (Extra Care, Residential etc)

should be represented during the review. If the provider is unable to make the review they

should be asked to provide a written update that should be included in the review document.

Where there is no response from the agency to the requests being made this should be

flagged with your manager and documented in the review.

It will also be important to involve any other professionals who are supporting the service

users at that time. The expertise, insight and perspective of those professionals (health,

education, housing etc) working with an individual will provide us with a deeper and more

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holistic understanding of the individual’s current circumstances and supports greater

identification and management of risk.

Any identified family and friends should also be included in the process (with consent) and

again if they are unable to attend the review ensure that their views are captured before the

review is undertaken so that any issues can be actioned and discussed.

16. Strengths

While undertaking the review practitioners must consider what other than the provision of

care and support might assist the person in meeting the outcomes they want to achieve. In

considering what else might help, practitioners should consider the person’s own strengths

and capabilities, and what support might be available from their wider support network or

within the community to help. Strengths-based approaches might include co-production of

services with people who are receiving care and support to foster mutual support networks.

Encouraging people to use their gifts and strengths in a community setting could involve

developing residents’ groups and appropriate training to support people in developing their

skills.

Practitioners might also consider the ways a person’s cultural and spiritual networks can

support them in meeting needs and building strengths, and explore this with the person. Any

suggestion that support could be available from family and friends should be considered in

light of their appropriateness, willingness and ability to provide any additional support and

the impact on them of doing so. It must also be based on the agreement of the adult or carer

in question.

The individual’s strengths must be clearly documented within the review form. Here you

must provide a detailed analysis of the individual’s strengths and aspirations. It will not be

sufficient to enter limited information in this section and where this is done reviews will be

rejected. By encouraging greater thought in this area it will allow practitioners the ability to

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effectively plan what alternative provision or support options can be considered to maximise

that individual’s independence. This presents practitioners the opportunities to understand

the intricacies of each individual and be creative in how they are to be supported. We must

act as enablers for those that we support.

17. Whole family approach

The intention of the whole family approach is for practitioners to take a holistic view of the

person’s needs and to identify how the adult’s needs for care and support impact on family

members or others in their support network.

In considering the impact of the person’s needs on those around them, practitioners must

consider whether or not the provision of any information and advice would be beneficial to

those people they have identified. For example, this may include signposting to any support

services in the local community.

Practitioners must also identify any children who are involved in providing care. The authority

may become aware that the child is carrying out a caring role through the review, or informed

through family members or a school. Identification of a young carer in the family should result

in an offer of a needs review for the adult requiring care and support and, where appropriate,

the local authority must consider whether the child or young carer should be referred for a

young carer’s review or a needs review. The practitioner must consider if the caring role is

having an impact on the wellbeing, welfare, education or development of that child or

whether the duties they are undertaking are inappropriate.

18. Risk Assessment

Ensuring that risks are clearly identified and a strong rationale provided as to how these will

be mitigated is an essential element within the review. It is important that practitioners

provide both clarity and detail as to what the risks are and provide sufficient detail as to how

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the risk will be managed moving forward. No sections should be blank and if there are no

risks identified this needs to be documented. Additionally, risk should not just be viewed as

something negative. Positive risk taking should be supported if it supports personal growth,

independence and happiness of the individual. It is important that risk management whether

positive or negative is a shared responsibility so ensure that those relevant to the decision

making are included.

19. Timeframes

Reviews must be completed at least every 12 months with the first review happening 6 weeks

after the support package has started. If the practitioner conducting the review feels that is

necessary to undertake or schedule a review earlier then 12 months then they should

schedule accordingly. This may be due to areas of support that require closer monitoring

(such as higher levels of risk) or that changes of support (increasing or decreasing) might be

required to maximise the service users independence, then the practitioner should determine

when the next review should take place. Reviews must be written up and completed on

Mosaic within 28 days. Once completed a copy of the review must be sent to the service user

and their advocate if one has been involved.