Page 8 - Community Living Magazine 32 - 2

legal: care planning and purchasing
Planning and purchasing:

shifting the cost to the client

There seem to be a few tricks being played on the local authority side in
adult learning disability care planning and purchasing. These need to be
called out, says belinda schwehr, who explains three common ruses

ocal authorities seem to be adopting user’s relative assumes that what was too different from the previous one,
tactics that appear underhand included before will be available again. It which was probably expressed in a fluffy
laround planning and buying care and is then the new provider, rather than any outcomes-focused way, with some
activities for people with learning commissioner, who has to explain to the wording along the lines of “happy, safe
disabilities. relative: “No, sorry, that’s not included in client … 24 hour care…”.
These include shifting the cost of our support plan. It’s OK though, to pay The Birmingham ex p Killigrew case,
activities to personal allowances, for the activity out of your relative’s which predates the Care Act, established
reorganising staffing ratios so people have personal allowance. If you want to.” the proposition that if a council is going to
to top up payments for activities, and The outcome is that the client’s say that a person’s needs have changed,
saying eligible needs have been met by personal allowance – their £24.90 to justify a cut in the budget/plan, there
low-level underlying support contracts. has to be a rational articulation by a
professionally competent person
since the activity is more
Activities funded out of a personal “ explaining where those needs have
allowance evaporated to.
This arises where a care home (or a intensively staffed than If a local authority commissioner wants
prospective alternative provider) is clients need, they will to change provider and impose that on a
persuaded by commissioners to drop their have to top up, if they service user, the council’s care plan has to
price or lower their tender. be revised – and only after a lawful proper
Usually this generous move, fuelled by want to take part assessment. Anything that was considered
concern about competition or loss of a not social care needs at all – is now ” necessary previously to meet need, but is
client, is justified by an agreement where no longer being offered, has to be
the commissioner removes previously per week for personal items that are analysed as to:
paid-for activities from the contract ● ●What need did it actually meet?
specification, and the provider removes seen as available to meet what were ● ●Does that need still exist?
them from the support plan. previously seen as necessary ● ●How should it still be met?
Generally, it is the cost of the entrance arrangements for meeting the person’s Resource difficulties are not relevant to
into the activity itself that is being cut, not assessed eligible needs. whether a need is met, only to the means.
the support that goes with the activity. So most people’s relatives who are Whatever is in a care plan has to be
However, because the provision was undertaking the role of appointee say delivered in kind, if not exactly as it is
previously “24 hour care”, providers had “yes” to that suggestion, then end up written, unless or until a lawful
paid for those activities out of the paying themselves for the person’s reassessment and plan have replaced
contract price. After all, it was not the toiletries and clothing. those previously in force.
client who was making any contractual Clever, eh? No doubt highly paid
arrangements with anyone for any consultants have come up with this Activities that are too highly staffed for
entertainment, day care or stimulation – it wheeze – but it is not lawful. the person’s needs, so they have to top up
was all part of their entitlement, by way The vast majority of relatives do not This wheeze involves a council getting
of care planning, through the council. know that, if a council’s care plan is together with a provider offering day care
Of course, this sort of a change is revised so as to make a large change to as part of the commissioned care
easiest done when someone is moving provision to meet need, the service user is package.
between care homes, because a service entitled to due process and a rational and in supported living; the essential point is
The clients might be in a care home or
transparent consideration of whether
“ If a commissioner their needs have changed. that activities are included in the
In our scenario, the needs have not
commissioner’s contract requirement.
In a contract review – well out of
changed at all, but the inputs for the
wants to change provider
relatives’ sight – after the commissioner
person have changed – either because the
and impose that on a provider has produced a different internal has negotiated a massive cut in the overall
payment to the provider, the provider will
support plan or because the local
client, the care plan has authority has not met any resistance in be invited to say what the staffing ratio for
” perspective, the new plan will not look service users.
to be revised issuing a new Care Act care plan. those activities is. This could be, for
Hopefully, from the council’s
example, one staff member to three
8 Vol 32 No 2 | Winter 2018 Community Living www.cl-initiatives.co.uk