The Full Review Conversation

A light touch review is normally appropriate and proportionate whenever:

1. There are no known changes in need or circumstances; and
2. There are no changes required to a Care and Support/Support Plan (or minimal changes to how existing Care and Support is provided only); and
3. There are no changes required to the personal budget.

A light touch review should be specifically considered in the following circumstances:

1. At the 6-8 week review; and
2. When there is/has been on-going monitoring of needs or circumstance.

If a light touch review is appropriate, see: The Light Touch Review Conversation.

If you are not clear whether a light touch review is appropriate you should seek advice from your line manager.

Where the person is known to have a carer there is a requirement under the Care Act for the carer to be involved in the review process.

The purpose of doing so is:

1. To gather further information about the Care and Support/Support Plan in regards the way it is meeting the needs of the person;
2. To understand any risk to the carer's role in the plan;
3. To identify any needs of the carer and fulfil the duty to meet them.

When a person has not consented to the carer being a part of the review you should:

1. Advise the person that you have a duty to involve the carer;
2. Explain the benefits of the carer being involved; and
3. Agree the most appropriate way to involve the carer (for example a separate meeting with the carer).

If the person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless doing so would put the person (or another vulnerable adult or child) at risk of abuse or neglect.

The Care Act is clear that a whole family approach to review should be taken wherever possible. The whole family approach in review is the same as the whole family approach in assessment.

See: A Whole Family Approach, which includes guidance on who should be involved, consent and the responsibilities you have to adult and child family members.

A Plan that is working well is more likely to have a positive effect on the person's/carer's Wellbeing than a plan that is not working well. The Local Authority has a duty to promote individual Wellbeing, so must ensure that everything is in place in the plan and working as intended.

Wherever possible, every conversation with a person/carer should be from a strengths perspective. This means that before you talk about service solutions to anything that is not working you must support the person/carer to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. See: Care Act Guidance on strengths-based approaches.

Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

The conversation about what is working and not working must broadly establish whether:

1. All of the services and support in the plan are in place as intended;
2. All of the services and support in the plan are meeting eligible needs;
3. The plan is supporting the person/carer to achieve their outcomes;
4. The method of managing the personal budget is still the most effective way of meeting needs and supporting the person/carer to achieve outcomes;
5. Anything has changed that may indicate a change is needed to the Care and Support/Support Plan;
6. There any risks to the plan's sustainability;
7. The plan is reducing any identified risk to the person/carer (including risk associated with their needs and risk relating to abuse and neglect);
8. Everybody involved in the plan is satisfied with it.

Any questions that are used to support a person/carer to think about what is working and not working must:

1. Be proportionate to the level of information required;
2. Be appropriate, taking into account the person's/carer’s specific needs around communication and their specific circumstances;
3. Be realistic in respect of the persons mental capacity and ability to be able to answer the question; and
4. Be asked in a manner that is accessible to the person/carer.

Powerful questions

A powerful question is a specific type of open question that:

1. Encourages a person/carer to reflect;
2. Is thought-provoking;
3. Supports an exploration of options; and
4. Helps the person/carer to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the person/carer and promote a strengths based approach.

Appreciative Enquiry

An appreciative enquiry is a conversation that is led by the person/carer and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the person/carer to:

1. Talk about a time or times when something has been working well in their life;
2. Explore what it was that worked well and supported them at that time;
3. Think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

1. Tell me about a time when things were going well for you?
2. What did you learn about your strengths at that time?
3. If you had a magic wand what would the future look like?
4. What is it that you value most in your life now?
5. What small changes would make the most difference?

The use of tools

A tool can be helpful to shape and focus a conversation about what's working and not working. Tools are also useful because they:

1. Can be completed with the person/carer as part of any conversation you have with them; or
2. The person/carer can complete them in their own time as part of their preparation for the conversation.

See: Tools and Practice Guidance for Review.

If the conversation about what is working and not working identifies elements of the plan that are not working you will need to:

1. Explore the issues;
2. Explore the options to resolve the issues (from a strengths based approach); and
3. Wherever possible reach an agreement about how best to resolve them.

This should be done in an open way and should involve:

1. The person/carer with Care and Support / Support needs (or their representative if they lack capacity);
2. In case of a Care and Support Plan review, any carer;
3. The person or organisation to which the issue relates (unless doing so will put the person with Care and Support needs at risk of abuse or neglect).
4. Anyone else that the person/carer asks you to involve; and
5. Anyone else that you feel needs to be involved (with the person's/carer’s consent or if they lack capacity in the best interests of the person with Care and Support needs).

Examples of situations that may be identified as 'not working include:

1. When a carer has not been able to provide the support intended;
2. When formal services are not in place;
3. When needs are not adequately being met by the support and services in place;
4. When support and services are not supporting the person/carer to achieve their outcomes as intended;
5. When support and services are not managing risk effectively; or
6. When the support and services are not sustainable.

You will need to:

1. Understand the impact on Wellbeing of the issue identified;
2. Establish whether the issue is preventing an eligible need from being met;
3. Explore what has already been tried to resolve the issue and what the alternative options may be; and
4. Identify the risks to the person/carer, the plan and others if the issue is not resolved.

When exploring the range of options to resolve the issue a simple pros and cons list can be helpful to identify the most proportionate response.

It may be useful to prepare a simple written action plan for the purpose of recording and monitoring what has been agreed, and the steps that different people will be taking to resolve what is not working.

tri.x has developed a tool that can be used as required to action plan.

See: Action Planning Tool.

You will need to consider any requirement for urgent or interim support to ensure that eligible needs are met whilst steps are being taken to:

1. Resolve the issues with the Care and Support/ Support Plan;
2. Agree revisions to the Plan; or
3. Carry out any other action (for example safeguarding or a reassessment of need).

If there is an urgent need to be met, see: Urgent or Interim Support.

Outcomes can change when a person's/carer’s life priorities change. This can happen unexpectedly and unmet outcomes can have a dramatic impact on a individual Wellbeing. The Local Authority has a duty to promote Wellbeing and to do this it must:

1. Understand what is important for a person/carer to achieve, change or maintain in their life at any given point in time; and;
2. Take steps to support the person/carer to achieve these outcomes.

The conversation about outcomes must broadly establish whether:

1. The outcomes in the Care and Support/ Support Plan have been achieved or not;
2. The person/carer has any new outcomes they want to meet; and
3. Any improvements are required to the plan to achieve better outcomes.

Simple questions should be used to confirm that outcomes are being met by the Care and Support/Support Plan, such as:

1. How have you been able to work towards the outcomes in your plan?
2. Have there been any changes to the things that are important to you to achieve, change or maintain?
3. Do you think there needs to be any changes to the plan to support you to work towards your outcomes?

You should refer to the Care and Support/Support Plan to confirm what the outcomes were if this requires clarification.

If outcomes have not been achieved (or progressed) as intended by the services and support provided you must take steps to:

1. Establish if the outcomes are still important to the person/carer;
2. Where the outcomes are no longer important agree new outcomes; or
3. Where the outcomes are still important, agree how to resolve any issues in meeting them (see 'Resolving what is Working and Not Working' above for guidance).

Where there is a need to talk about new outcomes you should refer to The Skilled Conversation: Outcomes.

The Local Authority has a duty to meet eligible needs on an on-going basis, not just at the point that needs are established.

Review is an important element in ensuring that the duty to meet needs is met because it:

1. Offers assurance that eligible needs are being met; or
2. Provides evidence that needs have changed so that the Local Authority can provide an appropriate response to assess any new needs, reassess any change in existing needs and meet them if they are eligible.

The conversation about needs must establish whether the person's/carer’s needs have changed since the time that they were assessed and the Care and Support/ Support Plan agreed.

A simple question, such as 'Has there been any change to your needs' can be sufficient during a review.

You should refer to the assessment report to confirm what assessed needs were if this requires clarification.

If, as part of a review process there is disagreement about whether needs have changed it is your responsibility to make the final decision. To do this you should:

1. Consider all of the available evidence;
2. Give regard to the views of the person/carer; and
3. Consider the different views expressed by others.

You must make sure that the evidence upon which you base your decision is robust and you must be open about the evidence that you have used.

Once you have established that there has been no change in need there is no requirement to discuss needs further during the review.

If there has been a change in need you should explore:

1. Broadly, what the changes in need are;
2. What the impact of the changes are on the person's/carer’s Wellbeing;
3. What the impact of the changes are on any informal support networks and formal services; and
4. The impact of the changes on risk (to the person/carer and the plan).

Whenever there has been a change in need the outcome of the review must be to carry out a proportionate reassessment of need.

The reassessment must make effective use of the information gathered during the review to avoid duplication.

If, as part of a review process there is disagreement about whether a person's needs have changed it is your responsibility to make the final decision about whether needs have changed. To do this you should:

1. Consider all of the available evidence;
2. Give regard to the views of the person/carer; and
3. Consider the different views expressed by others.

You must make sure that the evidence upon which you base your decision is robust and you must be open about the evidence that you have used.

You will need to consider any requirement for urgent or interim support to ensure that eligible needs are met whilst steps are being taken to:

1. Resolve the issues with the Care and Support/ Support Plan;
2. Agree revisions to the Care and Support/ Support Plan; or
3. Carry out any other action (for example safeguarding or a reassessment of needs).

If there is an urgent need to be met, see: Urgent or Interim Support.

If a person/carer has experienced a change in need but this is only likely to be short term a reassessment of need is not required, as long as:

1. The needs can be met and are being met by the existing Care and Support/ Support Plan; and
2. It is reasonable to believe that the needs are short term only.

You will need to agree appropriate arrangements to monitor the person's/carer’s needs and circumstances. This could be through another light touch review in a shorter time frame. You will also need to ensure that  they know what action to take should the short term needs become more long term or the Care and Support/ Support Plan no longer meets the needs.

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

The aim of any conversation about risk is to maximise the benefits and reduce the likelihood of harm.

It is important to talk about risk during a review for the purpose of establishing that:

1. Risks continue to be well managed by the Care and Support/ Support Plan;
2. There have been no changes to risk;
3. There is no risk to the person/carer from abuse or neglect; and
4. There is no risk to the Care and Support/ Support Plan's stability or sustainability.

To establish whether there have been any changes to risk simple questions should be used in the first instance, such as:

1. Are the things in the Plan keeping you safe?
2. Is there a chance that your plan could stop working well?

Examples of risk to a person with care and support needs include:

1. Risk of fall, accident or injury carrying out an activity or function;
2. Risk of harm from abuse or neglect; and
3. Risk to Wellbeing from not being able to do something (for example go to work or take part in a social activity).

You should refer to the Care and Support Plan to confirm the current contingency plan and what the risks are to the person if this requires clarification.

Examples of risk to a carer include:

1. Risk associated with the carers own impairment or disability (e.g. falls when carrying out caring related tasks);
2. Risk of accidental injury (e.g. from manual handling and supporting the cared for person to mobilise);
3. Risks to the carer from the person they care for (e.g. from verbal or physical abuse or from behaviour relating to the use of drugs or alcohol);
4. Risks to the carer's emotional health as a result of the caring role;
5. Risks to the carers work or family life as a result of their caring role; and
6. Risks to the carer's own network of support (e.g. is it sustainable and how likely is it to break down).

You should refer to the Support Plan to confirm the current contingency plan and what the risks are to the carer if this requires clarification.

If the review identifies that risks to the person/carer have not changed and the measures in place are effectively reducing risk there is no requirement to talk about risk to the person/carer further during the review.

If the review identifies that there are new risks to the person/carer, or that risks are not well managed you will need to explore:

1. What is working and not working with the current measures;
2. What steps can be taken to resolve any issues with the current measures to reduce risk; and
3. Any new measures to manage risk.

This should be done from a strengths based and positive approach that supports the person/carer (and others) to:

1. Explore and understand the benefits of taking the risk;
2. Explore and understand the potential harmful consequences of taking the risk;
3. Think about the measures that can be taken to reduce the likelihood of a negative consequence; and
4. Make an informed decision about whether to take the risk.

The process of talking about risk can be very empowering for a person/carer and build resilience, confidence and independence.

Depending on the level of risk a formal risk assessment may need to be carried out as part of the review process.

See: Risk Assessment.

Examples of risks to a Care and Support Plan could include:

1. Risks that informal care will not be sustainable;
2. Risks that needs will not be met if a service provider is temporarily unavailable;
3. Risks that the support or services in the plan will not be as effective at meeting needs or supporting the person to achieve outcomes as intended;
4. Risks that a Direct Payment will not be managed appropriately.

You should refer to the Care and Support Plan to confirm the current contingency plan and what the risks are to the person if this requires clarification.

Examples of risks to a Support Plan could include:

1. Risks that informal Support being provided to the carer will not be sustainable;
2. Risks that needs will not be met if a service provider is temporarily unavailable;
3. Risks that the support in the plan will not be as effective at meeting needs or supporting the carer to achieve outcomes as intended;
4. Risks that a regular Direct Payment will not be managed appropriately;
5. Risks due to a likely change in the needs of the cared for person.

You should refer to the Support Plan to confirm the current contingency plan and what the risks are to the person if this requires clarification.

If the review identifies that risks to the plan have not changed and the measures in place are effectively reducing risk there is no requirement to talk about risk to the plan further during the review.

If the review identifies that the plan is at risk or that the contingency plan is not adequately reducing risk to the plan you will need to explore:

1. What the risk to the current plan is;
2. What is working and not working with the current contingency measures;
3. What steps can be taken to resolve any issues with the current measures to reduce risk; and
4. Any new measures to manage risk.

See: The Skilled Conversation: Risk and Contingency.

If, as part of any conversation you have with a person/carer or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately.

See Keeping People Safe, which also includes information about how to raise a concern about a person under the age of 18.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Where the safeguarding is in respect of the person/carer whose Care and Support/Support Plan is being reviewed a decision will need to be made about the need to pause the review process to allow a safeguarding enquiry to take place.

There are 3 possible options:

1. The review process continues alongside any safeguarding process;
2. The review is paused with no on-going intervention by the person carrying out the review whilst a safeguarding process takes place; or
3. The review is paused but urgent interim support is arranged to ensure needs are met whilst a safeguarding process takes place.

Any decision should involve the person carrying out the review, the person who will be carrying out any safeguarding process, the person with Care and Support needs (or their representative) and any carer.

You must consider any appropriate action required to authorise deprivations of liberty whenever:

1. The person lacks capacity to make decisions about the Care and Support provided to them; and
2. You feel the level of restriction being imposed on the person is depriving them of their liberty; or
3. You feel the level of restriction required to meet their care and support needs following any reassessment to take place is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.