This chapter outlines for multi-agency practitioners how a care and support plan (for an adult with care and support needs) or a support plan (for a carer) must be provided where a local authority meets a person’s needs.
Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan, or the support plan in the case of carers.
The guiding principles in the development of the plan are that the process should be person centred and person led, in order to meet the needs and achieve the outcomes of the person in ways that work best for them as an individual or as part of a family.
The process and the outcomes should be built holistically around:
- people’s wishes and feelings;
- their needs;
- Values and aspirations.
These principles apply irrespective of the extent to which the person chooses or is able to actively direct the process.
Consideration of needs should also include the extent to which the needs or a person’s other circumstances may mean that they are at risk of abuse or neglect. The planning process may bring to light new information that suggests a safeguarding issue, and therefore lead to a requirement to carry out a safeguarding enquiry (see Safeguarding Enquiries). Where such an enquiry leads to further specific interventions being put in place to address a safeguarding issue, these should be included in the care and support plan.
Each partner in the plan should be clear about their role. For example, the person may need help to weigh up different service options to understand what each involves and to be able to choose the most appropriate and least restrictive option possible.
In some circumstances it may not be appropriate to jointly prepare the plan. For example, a person may not wish their family to be involved, the authority may be aware that family members may have conflicting interests, or the person may have asked the local authority to prepare the plan with someone who lives far away from the person and even with the assistance of email, phone and other methods of communication is unable to prepare the plan in a timely fashion.
The test for allowing the person and others to prepare the plan jointly with the local authority should start with the presumption that the person at the heart of the care plan should give consent for others to do so.
Safeguarding principles must be included in order to ensure that there is no conflict of interest between the person and the third party they wish to involve to prepare the plan jointly with (see Safeguarding: What is it and Why does it Matter?).
Where a person lacks capacity and cannot consent to third parties jointly preparing the plan, the local authority must always act in the best interests of the person requiring care and support.