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Section 2: New implications for practice

In this section you will learn about:

The implications for practice of the revised FACS guidance and in particular:

  • using the eligibility criteria in your work
  • using an outcomes-based approach
  • ensuring rights, discrimination and equality
  • implementing personalisation effectively
  • thinking about prevention and early intervention
  • using signposting, information and advice for all
  • managing risks and safeguarding


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Section 2: New implications for practice

In this section we will be looking in detail at the implications for practice of the new FACS guidance.


Explore the sections below to examine seven areas where the guidance has major new implications.


When you've fully explored the areas on the right click on Back to start to move to section three where we will look at personalising outcomes.

Section 2.1


Eligibility criteria

We will be looking at a series of scenarios. These scenarios are only brief and normally you would have far more information to base your decision on.
Your supervisor/line manager may decide to select examples from your team's workload rather than use the scenarios provided on the next screens.

Section 2.1


Eligibility criteria

  • Critical eligibility - should have access to services
  • Substantial eligibility - needs to be signposted to other services
  • Moderate eligibility - early intervention could prevent escalation
  • Low eligibility - signposting to advice and information required
  • Not eligible - given information about support groups and other universal services

Read the four scenarios below and from the information provided, decide how you would assess the eligibility of each. Then click 'Our selection' to see if your selection matches ours.

Section 2.1


Mr Georgio

Mr Georgio aged 54, has significant learning disabilities. His health and mobility are deteriorating. He lives with his parents, but both are now too frail to provide the increased amount of support he needs to remain independent. Other family members have always contributed to his support, but are unable to replace the level of support he needs to be safe and as in control of his life as possible. He has been referred for an assessment by health colleagues.


Section 2.1


Mr Georgio



Substantial eligibility


Because of risk of neglect and abuse.


Mr Georgio's needs are assessed as coming into the substantial banding for eligibility because:

  • There is only partial choice and control over Mr Georgio's immediate environment.
  • There is the potential for his needs to be neglected because his parents can no longer meet his needs.
  • He is unable to carry out the majority of personal care tasks and daily domestic routines without support.
  • His parents are his major support system and their care cannot be sustained.

Note: If you do not agree with our judgement of Mr Georgio's level of need, you may want to talk to your supervisor or line manager about the reasons for your judgement.

Section 2.1


Mrs Starr

Mrs Starr, aged 42, has schizophrenia, which is usually controlled through drugs. She stopped taking her medication when she recently broke up with her partner of six years and was admitted to hospital when her mental health deteriorated. Her family live nearby and are currently caring for her two children under a Special Guardianship Order. They do not want to get any more involved in her support because this leads to conflict. The Community Mental Health Team are supporting her on a continuing basis. Adult services are asked to contribute to discharge arrangements.


Section 2.1


Mrs Starr



Low risk


Routine discharge arrangements


Mrs Starr's needs are assessed as coming into the low banding for eligibility because.

  • She is unable to carry out one of two personal and domestic routines.
  • She needs social support because her relationships with her partner and her family has broken down.
  • She is unable to care for her children, who are being cared for by family members.
  • The community mental health team will lead on coordinating her support

Note: If you do not agree with our judgement of Mrs Starr's level of need, you may want to talk to your supervisor or line manager about the reasons for your judgement.

Section 2.1


Mrs Ross

Mrs Ross, aged 85, lives at home with her husband, aged 87. Their adult children live too far away to provide day to day support. She has Alzheimer's disease and her symptoms are becoming more severe. Carers have been coming in three times a day, and this is supplemented by overnight respite for Mr Ross. Their daughter stays over the weekend once a month. Mrs Ross was found by the police in distress wandering the streets during the night. On investigation Mr Ross was found to have had a mild heart attack and needed hospital care.


Section 2.1


Mrs Ross



Critical eligibility


As situation is life threatening.


Mrs Ross's needs are assessed as coming into the critical banding for eligibility because:

  • She is in urgent need of hospital treatment and her life would be threatened without it.
  • Significant health problems have developed.
  • She has little or no choice over vital aspects of the immediate environment.
  • Vital family roles and responsibilities cannot be undertaken.

If you do not agree with our judgement of Mrs Ross's level of need, you may want to talk to your supervisor or line manager about the reasons for your judgement.

Section 2.1


Mr Bennet

Mr Bennet, aged 90, has lived alone all his life. He recovered from a series of mini-strokes (Transient Ischemic Attacks - TIAs) sufficiently to remain independent. Neighbours say that he becomes aggressive if they try to help him. They contacted adult services because he has fallen over twice returning from shopping and has lost a lot of weight. He has not been seen going out to the shops since his last fall. The doctor is visiting, but he won't answer the door to neighbours, who can hear him inside the house.


Section 2.1


Mr Bennet



Moderate eligibility


Due to health and personal care risks


Mr Bennet's needs are assessed as coming into this banding for eligibility because:

  • he has stopped going to the shops since his falls and has no food in the house
  • his social support systems and relationships are not being sustained because he is refusing support from his neighbours and is isolating himself
  • he is vulnerable and is not taking steps to address his health and mobility needs.

Note: If you do not agree with our judgement of Mr Bennet's level of need, you may want to talk to your supervisor or line manager about the reasons for your judgement

Section 2.1


Implications for practice



Practitioners need:


  • knowledge of the council's FACS eligibility bandings and criteria for people using and seeking services and carers, in relation to presenting and eligible needs.
  • understanding, and ability to explain and provide advice about council's information on:
  • eligibility, the bandings and eligibility criteria for adults using and seeking services.
  • levels of risk to the caring role, in relation to the carer's bandings and risk criteria.
  • understanding, and being able to explain the opportunity and procedures for self-assessment.
  • to implement the council's priorities in terms of immediate, critical, substantial, moderate and low needs or risks to carers.
  • to be aware that intensive short term support or the provision of equipment can prevent needs escalating from moderate to substantial or critical.
  • to use a more open minded approach to providing or signposting information, advice and support for a wider group of adults and carers.
  • to access information, advice and support at the right time and in the right way enables adults and carers to make the most effective of use of universal services.
  • to ensure that adults using or seeking services and carers know the procedures for complementing and making complaints and are able to provide appropriate information and explanations about these procedures.
  • to work on supporting and strengthening community-based resources that can be provided as universal service.

Section 2.2

Outcomes-based approach

The guidance lists outcomes for adults. One is quality of life. There are seven others.

Now identify the outcomes below. All except two are correct. Can you identify the seven stated outcomes? Click on those that you think are correct.



Section 2.2


Exercising choice and control



Correct


Section 2.2


Health and well being, including mental and emotional as well as physical well being



Correct


Section 2.2


Access to services to meet all their needs



Incorrect


Section 2.2


Personal dignity and respect



Correct


Section 2.2


Freedom from discrimination



Correct


Section 2.2


Making a positive contribution



Correct


Section 2.2


Freedom to remain in own home



Incorrect


Section 2.2


Economic well being



Correct


Section 2.2: Outcomes based approach


Freedom from harm, abuse and neglect



Correct


Section 2.2

Outcomes based approach

The outcomes are not hierarchical except where life-threatening circumstances or serious safeguarding needs exist. Fairness and equality will be achieved by focusing on outcomes rather than providing specific services.

Select the 'Implications for practice' to find out more.


Section 2.2: Implications for practice

The outcomes are not hierarchical except where life threatening circumstances or serious safeguarding needs exist.


Fairness and equality will be achieved by focusing on outcomes rather than providing specific services


Staff should be able to:

  • focus all their work with adults using and seeking services and carers on identifying and achieving appropriate outcomes to meet their needs rather than on specific services.
  • work across organisational boundaries and in partnership with other organisations in the interest of adults using or seeking services, carers, local communities and the wider population to promote the achievement of outcomes.
  • understand, and work, with individuals to explore their presenting needs and identify:
  • identify the outcomes they would like to achieve.
  • recognise where unmet needs are preventing the realisation of such outcomes.
  • identify any external and environmental factors that have caused, or exacerbate, the difficulties the individual is experiencing.
  • understand the implications of any presenting needs which might pose risk to their independence and/or well-being, both in the immediate and longer-term.
  • explore the eligibility criteria within a broader context of universal services and community resources as a way of improving outcomes for the general population which may delay or prevent the need to access health or social care support.

Section 2.3: Ensuring rights, non-discrimnation and equality

Councils have a duty to promote disability, gender and race equality. They need to be proactive in ensuring that everyone within their area is not unfairly discriminated on the grounds of age, religion, personal relationships, or living and caring arrangements, or whether they live in an urban or rural area.

FACS 2010 highlights how equality should be prioritised and delivered so that people are treated with dignity and respect and have quality of life.

Select "Next" to find out more about the implications for practice

Section 2.3: Ensuring rights, non-discrimnation and equality

Staff should:

  • Work within their council's policies and procedures for promoting equality and challenging discrimination.
  • Apply a human rights approach and demonstrate the universal right to dignity and respect for adults using and seeking services and carers' ethnic heritage and culture.
  • Work with adults using or seeking services, or carers, to identify how culturally appropriate support can be accessed.
  • Promote the development and maintenance of community-based resources to meet the population’s social care needs.
  • ensure that the barriers to the social inclusion of adults using or seeking services and carers are identified and action taken to address them.

Section 2.4: Implementing personalisation effectively

A key aspect of FACS is promoting personalisation in the areas of:

Select from the links below to read more

Section 2.4

Universal services

transport, leisure, education, employment, health, housing, community safety, information and advice.

Section 2.4

Early intervention

helping people to live independently, and preventing them from needing social care support for as long as possible.

Section 2.4

Choice and control

adults using or seeking services, and carers, have a clear understanding of how much they have to spend on their care and support and allowing them to choose how to use this to suit their needs and preferences.

Section 2.4

Social capital

fostering strong and supportive communities that value people's contribution.

Section 2.4: Implementing personalisation effectively

Implications for practice

To promote personalisation staff will need to:

  • understand the council's policies and procedures for promoting personalisation, choice and control.
  • underpin their work with the principles of personalisation, ensuring that adults using and seeking services, and carers, are able to participate as fully as possible at all stages, from first contact, through assessment, planning, review, monitoring and service development.
  • know how to access and use information and advice on universal services, resources for early intervention, and community-based or specialist resource to enable the personalisation of services.
  • facilitate choice and control, enabling adults using or seeking services, and carers, to fully engage in planning or securing how they want to meet their social care needs and achieve agreed and shared outcomes.

Section 2.5

Prevention and early intervention

First of all, think about which of the three terms below fit the corresponding list of items.

When you are ready, select from the links below to see the result

  • 1.) Universal services
  • 2.) Targeted interventions
  • 3.) Care and support


  • 1.)

    Information and advice

    Community capacity

    Holistic checks

    Work, social participation and education



  • 2.)

    Choice and control

    Self-directed assessments

    Personal budgets

    Advocacy and support

    Brokerage



  • 3.)

    Equipment and aids to daily living

    Intermediate care and reablement

    Telecare

    Predictive tools

    Supported housing

    Falls clinics


The FACS 2010 Guidance states that prevention and early intervention are at the very heart of the vision for social care as set out in Putting People First

Section 2.5

Universal Services

  • Information and advice
  • Community capacity
  • Holistic checks
  • Work, social participation and education

Section 2.5

Targeted interventions

  • Equipment and aids to daily living
  • Intermediate care and reablement
  • Telecare
  • Predictive tools
  • Supported housing
  • Falls clinics

Section 2.5

Care and support

  • Choice and control
  • Self-directed assessments
  • Personal budgets
  • Advocacy and support
  • Brokerage
  • Section 2.5

    Prevention and early intervention

    As an assessor there are two types of prevention that you will be involved in. These are:

    • avoiding or delaying the need for more intensive or higher dependency support
    • aiming to reduce the effects of an illness, event, trauma or discrimination.

    Improving the infrastructure through universal services, community-based support and information can alleviate a problem occurring in the first place. Other action at the strategic level involves partner agencies such as health, education, income support, housing, transport and the environment.

    When you are ready click on the link below to read the implications for practice

    Section 2.5: Prevention and early intervention

    Implications for practice

    To promote prevention and early intervention throughout their work staff should:


    • always have prevention and early intervention at the front of their minds when carrying out any aspect of their work.
    • identify and work with individuals and their support networks whose situation presents a risk of deterioration or where problems are escalating, and where early intervention could prevent or delay the need for social care support.
    • provide targeted interventions (see diagram on this screen) to address a specific barriers preventing individuals achieving agreed outcomes.
    • help people seeking support to access short-term health or technological support and reablement, to promote independence and reduce risks.
    • use predictive tools that can identify and target individuals at risk, or who could potentially benefit from signposting and early decision-making.
    • identify sources of support for individuals, and carers, on the edge of needing social care, or who have low or moderate social care needs, to help them retain control over their lives and achieve the outcomes they want.

    Section 2.6 Using signposting, information and advice for all

    An essential aspect of FACS 2010 is that everyone can benefit from, and is entitled to, appropriate information, support planning and signposting to universal services.

    Section 2.6 Using signposting, information and advice for all

    Openness and transparency


    Openness and transparency of information are fundamental to fair and consistent access to services.

    Section 2.6 Using signposting, information and advice for all

    Broader population


    Under FACS 2010 information needs to take account of the much broader group of people from within the council's area.

    Section 2.6 Using signposting, information and advice for all

    Universal information, advice & advocacy


    Universal information, advice and advocacy will be available for people adults using or seeking services and their carers whether or not they are eligible for social care support.

    Section 2.6 Using signposting, information and advice for all

    Signposting


    Adequate signposting to alternative sources of support is expected for adults who are not eligible for social care services and for carers, to prevent the escalation of needs and delay the need for social care services.

    Section 2.6 Using signposting, information and advice for all

    Compliments, concerns and complaints


    Information, advice and signposting need also to be provided for adults using and seeking services, and carers, who wish to compliment the service, raise concerns and make complaints.

    Section 2.6 Using signposting, information and advice for all

    Implications for practice


    Staff will need to:


    • know how to access the wide-ranging information and advice that might be required in their job role, and share this knowledge with people seeking support.
    • understand that what is familiar information to them, is not necessarily known to people seeking support and their carers, and that information can be harder to take in when facing new or increasing levels of need, uncertainty and anxiety.
    • encourage and enable individuals to make the most effective use of universal services, in conjunction with their own strengths, capabilities and resources, to live as independently as possible.
    • avoid screening individuals out too early and ensure adequate signposting to other sources of support.
    • challenge inappropriate, inaccurate and discriminatory information.

    Section 2.7

    Managing risks and safeguarding

    Managing risks and safeguarding are at the heart of FACS. All aspects of risk and safeguarding, both general and specific need to be taken into account when implementing FACS into your practice.


    When you are ready, select 'Implications for practice' to find out more.

    You have reached the end of this section. You may return to the menu for Section 2 by selecting 'Back to menu' or go back to the different sections by selecting 'Back to start'.

    Section 2.7:Managing risks and safeguarding

    Good practice and decision making

    Managing and assessing risk are central to good practice and decision-making. When assessing and managing risk staff need to take account of:

    • the FACS risk-based eligibility system.
    • Personalisation, encouraging people to take control and responsibility for managing their own risks.
    • disability and age discrimination legislation and policy (both current and emerging).
    • NHS Continuing Health Care Decision Support Tools and frameworks.
    • assessing and responding to different forms of adult abuse and neglect.
    • the local authority's:
    • duty to operate effective inter-agency safeguarding measures.
    • responsibilities, for the well-being of those supported through direct payments and personal budgets and for the proper use of public funds.

    Section 2.7:Managing risks and safeguarding

    Risk assessment and management

    Risk assessment and management is central in all the eligibility bands. The primary focus of FACS is assessing the relative seriousness of the risks over time from adults' condition and circumstances, and/or carers' caring role, to:

    • their independence and control over their lives
    • their health, well-being and freedom from harassment and abuse
    • their family responsibilities, education, employment or other areas of their lives.

    Section 2.7:Managing risks and safeguarding

    Responding to risk

    How staff respond to risk is critical to the well-being of adults requiring services and their carers. It is important when responding to low level risks not to equate them with low-level services. Assessment at:

    • critical or substantial levels would normally lead to consideration of eligibility for intervention and support.
    • low or moderate levels may require action to prevent them escalating into the substantial or critical bands requiring social care support.
    • Responding to risk in these instances would be through:
    • targeted interventions including short term, intensive and complex interventions to remove or reduce the immediate, medium and longer-term risks.
    • agreeing strategies with the individual and their family.
    • enabling the individual or the carer to access their own support.
    • working with commissioned service providers, health partners, user-led or carer-led, voluntary and community organisations.

    Section 2.7:Managing risks and safeguarding

    Risk management and equalities strategies

    Equalities legislation questions assumptions about how older people and other groups should be treated in matters of risk-taking, and what should be done to extend their opportunities for equal treatment.

    Risk management strategies include stimulating the development and provision of a range of services and support for adults, their carers and the wider community.

    Direct payments and personal budgets were introduced to allow people more choice and greater control over the ways their assessed support needs are met. They may choose to take greater risks than a local authority or registered provider would have done. It is important to remember, however, that the authority retains some responsibility for the well-being of the person receiving publicly-funded support in this way.

    Section 2.7:Managing risks and safeguarding

    Financial risks

    New risks are created for local authority adult services in fulfilling their responsibility and accountability for the use of public funds. Most adults with personal budgets and direct payments use them effectively and efficiently for their social care support but in some instances public funding will not be used appropriately.


    • individuals and carers do not manage personal budgets and self-directed support appropriately and leave care needs unmet that create unacceptable levels of risk to their safety or that of others
    • the capacity of individuals and carers to access and manage their own support has been wrongly assessed
    • there is an unexpected change in the balance between independence and the need for safeguarding.

    Section 2.7:Managing risks and safeguarding

    Implications for practice – Safeguarding

    When working to strike the right balance between assessing and managing risk, ensuring people have maximum choice and control over their lives, challenging discrimination, safeguarding individuals at risk, and supporting the authority in its responsibility for the use of public funds, staff should be able to:

    • implement the organisation's procedures for safeguarding, including joint working agreements with partner agencies.
    • work with other professionals and agencies to reduce risk and safeguard adults and carers.
    • respond using the organisation's procedures to signs and symptoms of possible harm, abuse and neglect.
    • take appropriate action when there are serious safeguarding concerns, seeking advice from line managers and accessing specialist expertise.
    • work with children's services when there is any indication of child safeguarding concerns.

    Section 2.7:Managing risks and safeguarding

    Implications for practice – Risk assessment and management

    When working to strike the right balance between assessing and managing risk, ensuring people have maximum choice and control over their lives, challenging discrimination, safeguarding individuals at risk, and supporting the authority in its responsibility for the use of public funds, staff should be able to:

    • implement the organisation's procedures for risk assessment and management, including joint working agreements with partner agencies.
    • use agreed approaches to the assessment and management of risks when working in situations of uncertainty and unpredictability.
    • seek support when risks to be managed are outside own expertise.
    • when necessary, work within the organisation's procedures for managing media interest in risk and safeguarding situations.

    Section 2.7:Managing risks and safeguarding

    Implications for practice – Resource allocation and accountability

    Following FACS assessment and a decision about eligibility, staff identifying resource requirements should be able to:

    • work within and apply the council's resource allocation system.
    • explain to people and their families the different ways of holding a personal budget.
    • agree with individuals their preferred method of holding the personal budget and any support they need to set it up and manage it effectively and securely.
    • work within the council's financial systems to:
    • provide individuals with an early indicative allocation of the level of funds for which they are likely to qualify.
    • agree the final amount of money that is available to the person on the basis of their assessment.
    • set out the arrangements for monitoring the use of the budget.
    • give information on what the individual and carers should do if they have difficulties with managing the personal budget, and what options the authority would consider.