Choice Policy

Defined Terms

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Introduction and Purpose

1. The purpose of the Choice Policy is to ensure that all Adults who have been assessed as having eligible needs for care and support under the Care Act 2014, and other relevant legislation, are offered choice and control over how their needs are met, and that this is balanced with the need to commission safe and effective care, the Council’s duty to treat Adults equitably, and the Council’s duty to set a balanced budget and to operate within that budget.
2. In developing this Policy, the Council has had due regard to the Care Act 2014 and other relevant legislation, regulations and statutory guidance.

Scope

3. The scope of this policy applies to:
   1. Adults who have been assessed as eligible for care and support under the Care Act 2014; and
   2. Adults eligible for funding under Section 117 of the Mental Health Act 1983 (“MHA 1983”).
4. The right to choice applies equally to those entering care for the first time, those who have already been placed by the Council, and those who have been self-funders, but because of diminishing resources are on the verge of needing the Council’s support. It also applies to self-funders who ask the Council to arrange their care package. 

Commissioning Responsibilities under the Care Act

5. The Council is required to assess any Adult who appears to have needs for care and support. Where the Council is satisfied, on the basis of an assessment, that the adult has needs for care and support, then the Council is either required to meet those needs or exercise its discretion to do so.  The Council has a wide discretion in determining how to meet care and support needs. To reflect these responsibilities, the Council will:
   1. Ensure the care and support planning process is person centred;
   2. Promote the Adult’s wellbeing when carrying out any care and support function, or making a decision in relation to them;
   3. Consider the Adult’s  wishes and feelings in so far these are ascertainable and relevant;
   4. Promote choice and control over how to meet an Adult’s needs; and
   5. Help Adult’s achieve the outcomes that matter to them in their life.

Key Principles                  

6. The following key principles will be applied by the Council when making decisions about how it will meet the Adult’s assessed eligible needs:
   1. Robust, fair and consistent: this Policy will be applied by the Council in such a manner that allows for robust, fair and consistent decision making.
   2. Proportionality: the Council will be holistic in its decision making; balancing individual choice with the need to commission safe and effective care and to make equitable distribution of resources.
   3. Cost effectiveness: the Council will consider the cost of the available placements / care providers against the expected outcomes to enable it to meet the Adult’s assessed needs for care and support in the most cost-effective way.
   4. Exceptionality: the Council will make decisions on an individual, case by case basis taking into account exceptional circumstances where applicable.
   5. Transparency: the rationale behind the Council’s decision-making will be clearly documented and communicated to the Adult and their representatives.
   6. Involvement of the individual: the approach taken by the Council will be person centred and fully involving the Adult and their family/representative at all stages of the care and planning process, where possible.
   7. Human rights impact: consideration will be given to any impact of the decision on the Adult’s Article 8 European Convention of Human Rights right to respect for private and family life.
   8. Protected characteristics: consideration will be given to any impact of the decision under the Public Sector Equality Duty and the Equality Act 2010.

Care and support planning process 

7. The care and support plan is a document prepared by the Council which specifies:

• The needs identified by the needs assessment;
• Which of those needs are eligible for care and support funded by the Council;
• How those needs are going to be met;
• The Personal Budget required to meet these needs; and
• Advice and information about what can be done to meet or reduce the needs in question and what can be done to prevent or delay the development of needs for care and support or of needs for support in the future.

8. Care and support planning will take account of the Adult’s needs, desired outcomes and preferences, irrespective of the extent to which they choose or are able to be actively involved in the process. The Council will pay due regard to the key principles in paragraph 6 throughout the care and support planning process.

Personal Budget

9. The Council will provide the Adult with a Personal Budget that is sufficient to meet their assessed eligible care and support needs. The Personal Budget is a key part of the care and support planning process, and a wider approach to enabling greater choice and control for people through:

• Understanding the total amount of the Personal Budget, including what proportion the Council will pay and what contribution (if any), the Adult or third party will pay for their care;
• Being able to choose from a range of options to manage the Personal Budget;
• Having choice over who is involved in determining how the Personal Budget will be spent; and
• Having greater choice and control over the way the Personal Budget is used to purchase care and support, and from whom.

10. The start of this process (following completion of the care assessment) is the setting of an Indicative Personal Budget which will be identified as follows:
11. For people who require a residential or nursing care home placement to meet their assessed eligible needs: an indicative cost of care may be estimated as below the Laing Buisson median for the relevant lot, or the Care Cubed calculation (depending on category of care home required) in line with the Council’s care home pricing strategy; the Indicative Personal Budget will be determined by the most cost-effective  offer of a placement within a reasonable distance of the person’s usual place of residence.
12. For people whose assessed eligible needs can be met in the community (including their own home): the Indicative Personal Budget will be calculated based on the number of hours of care required and the contracted rate for that type of care.
13. The Indicative Personal Budget may be increased or decreased throughout the care planning process, taking into account the Key Principles set out at paragraph 6 of this Policy, and ensuring that the Personal Budget that is sufficient to meet their assessed eligible care and support needs.

14. For care home placements the final Personal Budget will be calculated in accordance with paragraphs 17 and 18 of this Policy; for services in people’s own homes the final Personal Budget will be calculated in accordance with paragraphs 19 to 25.

     

Choice of accommodation to meet care and support needs

13. The Council will look at all types of accommodation options available to optimise the Adult’s independence, such as:
    1. care homes;
    2. housing with care (e.g. supported living and extra care); and
    3. home care provision to support people to remain in their own homes.
14. Where the assessment identifies that a package of care is required, and the Adult is eligible for Council funding, then support planning will consider the most appropriate type of care services based on their needs, desired outcomes and preferences.
15. In line with the Choice Regulations, where the Council has assessed the Adult as requiring a care home placement (including a nursing home); shared lives scheme accommodation or supported living accommodation, the Adult will have the right to choose the provider or location if the following conditions are met:

• The care and support plan specifies that the Adult’s needs are going to be met by the provision of accommodation of a specified type;
• The preferred accommodation is of the same type as that specified in the Adult’s care and support plan;
• The preferred accommodation is suitable to the Adult’s needs;
• The preferred accommodation is available;
• Where the preferred accommodation is not provided by the Council, the provider of the accommodation agrees to provide the accommodation to the Adult on the Council’s terms; and
• That any additional costs because of choice are met by the Adult or their representatives.

16. Adults who require specified accommodation as part of their mental health after-care under Section 117 of the Mental Health Act 1983 have the same rights to choice of accommodation as someone who receives care and support under the Care Act 2014, provided that the accommodation is available for mental health after-care purposes as part of the Adult’s assessed aftercare needs.
17. For care home placements, the procedure to set a Personal Budget will be:

1. The assessment identifies the type of care home and any specific requirements, and the Council will pay due regard to the Key Principles detailed in paragraph 6.
   1. For nursing care home placements, a separate decision for eligibility for FNC is made by the NHS (which if eligible will fund additional care from a registered nurse).
   2. The Council will source a care home placement that meets the assessed eligible needs within a reasonable distance of the person’s usual place of residence, and the Indicative Personal Budget will be determined by the most cost-effective placement that can meet those needs.
   3. The care home will assess the Adult and once it has confirmed that it can meet their assessed eligible needs the cost of this placement will set their Personal Budget. If the care home, after assessment, is unable to meet their assessed eligible needs then the process will return to paragraph 17c above. If the Adult refuses an assessment by the care home then the cost of this placement will set their Personal Budget.
   4. The Council will consider the Key Principles at paragraph 6 of this Policy, which include the individualised circumstances of the Adult, before the Personal Budget is finalised.
   5. The Adult can choose other options provided by the Council or they can identify their own preference for a care home. However, if the cost of their chosen care home exceeds their Personal Budget a top-up payment would usually be required (following consideration of all relevant factors) to cover any difference.
   6. For respite placements in a care home, the Adult may (if they choose) take their Personal Budget as a direct payment and arrange their own placement. This would mean that if they arranged their own respite in a care home that was more expensive than their Personal Budget, a top-up payment would be required to cover the difference.
   7. The Adult is free to choose their own care home placement, or to remain in their existing placement if they have been self-funding their care or if the NHS has been funding their care previously, either within the Council’s geographical area or in another local authority area, subject to:
   8. A completed Third Party Top-Up agreement being in place to cover the difference between the Personal Budget and the price of the Adult’s chosen placement. This needs to be signed before the placement starts [See Top-up Policy].; or
   9. For people who will be self-funding their own care home placements through a deferred payment agreement:
      • A Third Party or First Party Top-Up Agreement being in place to cover the difference between the Personal Budget and the price of the Adult’s preferred placement during the first twelve weeks of the placement (the property disregard period) [See Top-up Policy].; and
      • Completion of a Deferred Payment Agreement giving the Council a guarantee of recovering the costs of the care home placement from the value of the Adult’s property; and
      • Both of these have been signed before the placement starts.
   10. Confirmation that the care home can meet the Adult’s assessed eligible needs;
   11. Confirmation that the chosen care home meets the Council’s quality standards; and
   12. Confirmation that the chosen care home is willing to contract with the Council on its usual terms and conditions.
2. For the purposes of paragraph 17:
   1. Reasonable distance is defined as an area with a radius of 20 miles from the Adult’s usual place of residence.
   2. Where there are no care homes within this area that can meet the Adult’s assessed eligible needs then reasonable distance will be extended as appropriate. Distance will then be considered when reviewing the offers received.
   3. In a small number of cases the outcome of the assessment may determine that the Adult’s needs are best met by moving to another identified location in the country. In such cases the Council will determine the budget with regard to the Key Principles set out in paragraph 6 of this Policy.

Services in the community (including their own home)  

19. For people wishing to remain in their own homes and have been assessed as having eligible needs, the Council will work with them to consider how these can be met utilising their personal strengths, friends and family, and opportunities available in the community.
20. Council funded care services for people living in their own homes in Staffordshire have set prices based on hourly or sessional rates. The Adult’s Indicative Personal Budget will be calculated based on the number of hours of care required and the contracted rate for that type of care.
21. The Council will source services to meet the Adult’s assessed eligible care and support needs and once a care provider has confirmed that it is able to provide them then the Personal Budget will be set according to the number of hours of care required and the contracted rate for that type of care.
22. The Council will consider the Key Principles at paragraph 6 of this Policy, which include the individualised circumstances of the Adult, before the Personal Budget is finalised.
23. The Adult may choose for the Council to arrange and directly contract with care providers. The Council will in the first instance, consider care providers that it usually contracts with and that are available. The Adult will be given a choice of all options that meet assessed eligible needs. The Council will highlight which of these options are within the Personal Budget, (with there being at least one option within the available Personal Budget).
24. Alternatively, the Adult may choose to take the Personal Budget as a direct payment and arrange their own care provider. The Personal Budget would be the same value as if the Council was commissioning the care package directly. The Adult can choose to arrange their own care package and use a provider who charges more than the Council’s contracted rate however, a top-up payment would be required to cover any difference.
25. In a small number of cases it may be that the Adult’s choice to remain in their own home does not match the outcome of the assessment. In these circumstances the Council may set the Personal Budget based on the cost of a care home placement that can meet the Adult’s assessed eligible needs. The Adult may choose to continue receiving care services in their own home subject to a Third Party Top-Up payment to cover the difference between the Personal Budget and the price of care services in their own home.

Promoting well-being 

26. Where people move to a care home a significant distance from family and friends and contact is important, or where people move to a different care home, then the Council will consider any risks to their well-being and produce a transition plan to mitigate these.

People who are unable to make their own choice

27. There will be cases where the Adult lacks the capacity to express a choice for themselves. The Council should therefore act on the choices expressed by the Adult’s advocate, carer, or legal guardian in the same way they would on the Adult’s own wishes, unless in the Council’s opinion it would not be in the best interests of the Adult.

Refusing to accept the Personal Budget

28. The Council will take into account the Adult’s circumstances and preferences when arranging care. However, where an Adult unreasonably refuses to accept arrangements that are affordable within the Personal Budget and has exhausted the complaints procedures, the Council is entitled to consider that it has fulfilled its statutory duty to meet needs and inform the Adult in writing that as a result they need to make their own care arrangements.
29. The Council will pay due regard to the Key Principles outlined in paragraph 6 of this Policy but there may be circumstances where the Adult chooses to remain in their existing care home placement, or with their existing care services and that cost exceeds the Personal Budget. If this has been communicated to them, they have refused the offer of a direct payment (note Direct Payments are not available for care home placements) then the Council would pay the care provider up to the value of the Personal Budget and the Adult or someone acting on their behalf would need to make arrangements to pay the difference up to the full cost of the service to the care provider directly. 

Complaints

30. Where the Adult or a person acting on behalf of the Adult is dissatisfied with the Council’s decision under this Policy, they may wish to raise a complaint through the Council’s complaints procedure. If the Adult is still unhappy (once the complaints procedure has been exhausted) and would like to take the complaint further, then it can contact the Local Government and Social Care Ombudsman. 

Review 

31. This Policy will be reviewed periodically, and when there are any material changes in legislation/national guidance.