“1. Promoting individual well-being (1) The general duty of a local authority, in exercising a function under this Part in the case of an individual, is to promote that individual's well-being. (2) “Well-being”, in relation to an individual, means that individual's well-being so far as relating to any of the following- (a) personal dignity (including treatment of the individual with respect); (b) physical and mental health and emotional well-being; (c) protection from abuse and neglect; (d) control by the individual over day-to-day life (including over care and support, or support, provided to the individual and the way in which it is provided); (e) participation in work, education, training or recreation; (f) social and economic well-being; (g) domestic, family and personal relationships; (h) suitability of living accommodation; (i) the individual's contribution to society. (3) In exercising a function under this Part in the case of an individual, a local authority must have regard to the following matters in particular – (a) the importance of beginning with the assumption that the individual is best-placed to judge the individual's well-being; (b) the individual's views, wishes, feelings and beliefs; (c) the importance of preventing or delaying the development of needs for care and support or needs for support and the importance of reducing needs of either kind that already exist; (d) the need to ensure that decisions about the individual are made having regard to all the individual's circumstances (and are not based only on the individual's age or appearance or any condition of the individual's or aspect of the individual's behaviour which might lead others to make unjustified assumptions about the individual's well-being); (e) the importance of the individual participating as fully as possible in decisions relating to the exercise of the function concerned and being provided with the information and support necessary to enable the individual to participate; (f) the importance of achieving a balance between the individual's well-being and that of any friends or relatives who are involved in caring for the individual; (g) the need to protect people from abuse and neglect; (h) the need to ensure that any restriction on the individual's rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary for achieving the purpose for which the function is being exercised.”
“Assessment of an adult's needs for care and support (1) Where it appears to a local authority that an adult may have needs for care and support, the authority must assess – (a) whether the adult does have needs for care and support, and (b) if the adult does, what those needs are. (2) An assessment under subsection (1) is referred to in this Part as a “needs assessment”. ... (4) A needs assessment must include an assessment of – (a) the impact of the adult's needs for care and support on the matters specified in section 1(2), (b) the outcomes that the adult wishes to achieve in day-to-day life, and (c) whether, and if so to what extent, the provision of care and support could contribute to the achievement of those outcomes.”
“6.9 The purpose of an assessment is to identify the person's needs and how these impact on their wellbeing, and the outcomes that the person wishes to achieve in their day-today life. The assessment will support the determination of whether needs are eligible for care and support from the local authority, and understanding how the provision of care and support may assist the adult in achieving their desired outcomes.”
“... Local authority will have consider whether the adult's needs and their consequent inability to achieve the relevant outcome will have an important consequential effect on their daily lives, their independence and their wellbeing. In making this judgment, local authorities should look to understand the adult's needs in the context of what is important to him or her. Needs may affect different people differently, because of what is important to the individual's wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.”
“(1) Where the local authority is required to meet needs under section 18 ... or decides to do so under section 19...
“(1) A care and support plan ... is a document prepared by a local authority which – (a) specifies the needs identified by the needs assessment (b) specifies whether, and if so to what extent, the needs meet the eligibility criteria, (c) specifies the needs that the authority is going to meet and how it is going to meet them, (d) specifies to which of the matters referred to in section 9(4) the provision of care and support could be relevant or... (e) includes the personal budget for the adult concerned (see section 26), and (f) includes advice and information about (i) what can be done to meet or reduce the needs in question; (ii) what can be done to prevent or delay the development of needs for care and support or of needs for support in the future” (i) what can be done to meet or reduce the needs in question; (ii) what can be done to prevent or delay the development of needs for care and support or of needs for support in the future”
“(1) A personal budget for an adult is a statement which specifies – (a) the cost to the local authority of meeting those of the adult's needs which it is required or decides to meet as mentioned in section 24(1) (b) the amount which, on the basis of the financial assessment, the adult must pay towards that cost, and (c) if on that basis the local authority must itself pay towards the cost, the amount which it must pay”
“11.25 The Act states that the personal budget must be an amount that is the cost to the local authority of meeting the person's needs. In establishing the 'cost to the local authority', consideration should therefore be given to local market intelligence and costs of local quality provision to ensure that the personal budget reflects local market conditions and that appropriate care that meets needs can be obtained for the amount specified in the budget. To further aid the transparency principle, these cost assumptions should be shared with the person so they are aware of how their personal budget was established”
“(1) A local authority must- (a) keep under review generally care and support plans,… that it has prepared, and (b) on a reasonable request by or on behalf of the adult to whom a care and support plan relates … , review the plan. (2) A local authority may revise a care and support plan; and in deciding whether or how to do so, it – (a) must have regard in particular to the matters referred to in section 9(4) (and specified in the plan under section 25(1)(d)) and (b) must involve – (i) the adult to whom the plan relates, (ii) any carer that the adult has, and ... ... (4) Where a local authority is satisfied that circumstances have changed in a way that affects a care and support plan … , the authority must – (a) to the extent it thinks appropriate, carry out a needs… assessment, carry out a financial assessment and make a determination under section 13(1) and (b) revise the care and support plan … accordingly. (5) Where, in a case within subsection (4), the local authority is proposing to change how it meets the needs in question, it must, in performing the duty under subsection 2(b)(i) … take all reasonable steps to reach agreement with the adult concerned about how it should meet those needs.”
“... (a) a personal budget for an adult specifies an amount which the local authority must pay towards the cost of meeting the needs to which the personal budget relates, and (b) the adult requests the local authority to meet some or all of those needs by making payments to the adult or a person nominated by the adult”
“You must pay them at least the national minimum wage. On average, the typical hourly rate for a Personal Assistant is around£8.50 during the week and£11.05 at the weekend. You will need to pay them mileage expense (only incurred during working hours) ... You need to make sure that the hourly rate you choose is affordable, based on your Direct Payment amount and can be maintained in the long term. You will also need to factor in additional costs listed below. Additional costs to consider When you are deciding how much to pay your Personal Assistants you need to fact in additional costs, such as tax and National Insurance, sick leave .... etc . You will typically need to set aside 27-30% of your Direct Payment to cover these costs.”
“Article 19 - Living Independently and being included in the community States Parties to this Convention recognize the equal right of all person with disabilities to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community, including by ensuring that: a. Persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement; b. Persons with disabilities have access to a range of in-home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community; c. Community services and facilities for the general population are available on an equal basis to persons with disabilities”
“... in community care cases the intensity of review will depend on the profundity of the impact of the determination. By reference to that yardstick, the necessary intensity of review in a case of this sort is high. [Counsel] also validly suggests that a local authority's failure to meet eligible needs may prove to be far less visible in circumstances in which it has provided the service-user with a global sum of money than in those in which it has provided him with services in kind. That point fortifies the need for close scrutiny of the lawfulness of a monetary offer. On the other hand respect must be afforded to the distance between the functions of the decision-maker and of the reviewing court; [and some regard must be had to the court's ignorance of the effect upon the ability of an authority to perform its other functions of any exacting demands made in relation to the manner of its presentation of its determination in a particular case. So the court has to strike a difficult, judicious balance”
“My independence and to be able to continue to employ a team of carers of my own choice” and “To be able to take part in family occasions and outings with the help of my carers”
“What is working?” the answer given was “Team of six carers work various shifts in looking after Luke. To enable a carer to be available around the clock 24 hours” and “it is imperative to my wellbeing that no changes are made”
“It is important to me that I continue to have the same carers as they are my community.”; “Familiarity of my team who knows me well” and “My family”
“Luke depends on his family and carers for emotional support. He can become low in mood, tearful and extremely anxious when facing any change in his daily life, large or small and requires additional company and reassurance at such times ... He does need assistance when making major decisions as these are stressful for him, not because he does not understand the issues involved. In recent years Luke has required counselling and has been prescribed anti-depressants to treat persistent low mood. Luke is dependent on sounds around him to orientate himself. In complete silence, Luke is inclined to withdraw and become speechless as his lack of perception/spatial awareness overwhelms him and he becomes fearful. This can manifest as a kind of panic attack. Luke has self-harmed by scratching at his skin in the past”
“Luke needs care 24 hours a day owing to physical and visual impairments. He prefers not to have any care for 2 hours on Tuesday afternoons, as he likes to spend some time on his own. He has declined to consider doing this every day (though he has done so before) which would reduce the costs of his PAs. Luke and his mother feel that Assistive Technology would not assist him. Luke has said that he does not wish to have a live-in carer although this would be a more affordable option.”
“When alone for 2 hours Luke has access to a large button telephone which he can use to summon help. He has needed to do this once only, according to his mother”: “Care is required to be available 24 hours a day. This is currently being provided by a team of PAs. A live-in carer would be able to meet all of Luke's needs but he feels very settled with his PAs and there are significant risks attached to making such a major change to his care provision, especially in respect of his mental health and emotional wellbeing.”
“with additional A/T support to call for help remotely Luke could feasibly be left alone for longer periods if his anxiety was addressed. However Luke could experience difficulty moving his self propelling wheelchair in a hurry, if there was a fire”
“… Introduced in the plan are increased times when Mr Davey may be alone and it has been assessed that he can safely be left alone and these include when he would normally be resting in bed e.g two hours at the start of the day. Mr Davey had already elected to spend time alone on Tuesday afternoons. Discussions had been held on how the time he chooses to spend alone can be extended so that there are increased intervals when no carers are present. Built in to the plan are also times when he would be without a carer and options to manage those times had been discussed (such as use of a large button phone if assistance is required), his time alone has not been driven or constricted by funding.”
“Luke, Jasmine and Sue state they are happy with the current level of support, which they have been providing for the last 20 years, approximately and do not wish there to be any change to the current routine”
“Occupational Therapy intervention can provide further trial of improved moving and handling equipment ... Assistive Technology could improve independence and wellbeing, and reassurance to Luke's family and Carers regarding movements within Luke's home. ... Referrals to Rehabilitation Teams ... for assessment to further maximise independence living at home”
“Emotional well-being: Low/anxious once or twice a week ... Other mental health issues: No ... Details: Sue reports Luke has had some contact with professionals in the past regarding anxiety he may experience when he is alone ...”
“A reduction in Luke's current care package will enable regular visiting support rather than 24 hour support. Luke currently spends Tuesday afternoons alone at home, but has a carer present at all other times. This is Luke's choice to enjoy a period of privacy away from his carer support” ... “A referral to Assistive Technology was discussed with Jasmine, who stated that she does not wish to have additional monitoring systems installed at present. Jasmine reported she currently has no concerns regarding Luke being able to call for help independently, if the need arose.”
“Assistive Technology would offer the reassurance of an alert system to Luke if his care support reduces to regular support, from 24 hour support”
“Currently, a carer is present at all times, apart from Tuesday afternoon, when Luke requests that he enjoys some time away from his carer to watch videos in privacy”
“To improve Luke's independence in controlling his immediate environment; to independently operate his TV and media systems. To provide the option for Luke to spend more time alone, safely, in his home, to develop his independence, and reduce anxiety”
“Support considered: Live in Care Cost:£750 -900 approx Comments: Luke and his family have declined live in care at this time, preferring to retain a team of PAs”
“Life is full of risks. Risk is often thought of in terms of danger, loss, threat, damage or injury. But as well as potentially negative characteristics, risk-taking can have positive benefits. As well as considering what could go wrong, it is worth thinking about potential benefits ('nothing ventured, nothing gained')] This section of your support plan is to help you agree a level of risk that is acceptable.”
“Luke risks loss of independence and autonomy as although he lives in his own home he has become dependent on carers and family to meet his needs”
“Managed by carers encouraging Luke to do as much as possible for himself, within safe limits. ...”
“Having assessed his mental health needs holistically, the risks identified are not significant enough to warrant further intervention, other than those strategies which are already in place.”
“Care is required to be available 24 hours a day. This is currently being provided by a team of PAs. A live-in carer would be able to meet all of Luke's needs but he feels very settled with his PAs and there are significant risks attached to making such a major change to his care provision, especially in respect of his mental health and emotional wellbeing”