FOI 2025/1228

1. In the context of your adults’ social care (or if you are an ICB, your Continuing NHS Healthcare) service, does your council/ICB take the cost of residential or where needed, nursing care home services into consideration at the point of care planning for the person owed a duty ie after any eligibility decision has been made but before a budget for the duty owed to the client (or patient) is finalised (as it is lawful to do)?

Please answer for people owed a duty by your organisation

i) aged 18-65

ii) 66+

iii) in any particular client group cohort that is care planned for by a particular body of staff with specialist expertise, such as learning disabilities/autism/physical disability/EMI/sensory impairment

2. If the answer to Question 1 is yes, how do you ensure that the care planning staff do not apply those theoretically lawfully relevant costs to the care planning exercise without also balancing them with the person’s wishes and feelings, their state of cognitive functioning, their Choice of Accommodation rights anywhere in the country under the Regulations, their human rights to respect for their homes and family life, under article 8 and the UK’s Human Rights Act, and the fact that the wellbeing duty under the Care Act requires consideration of the emotional wellbeing of not just the client but also people’s carers (the definition of which is broad enough to include people who will be visiting the individual)? Please give a narrative answer.

3. If the answer to Question 1 is yes, but the person or their family says that a care home would not be acceptable to them, does your decision-making body or level of officer with delegated decision-making authority for the organisation (ie a panel, a forum, a meeting, a huddle)

a) follow para 10.86 of the Care Act Guidance (or the National Framework practice guidance if the person is entitled to CHC funding) and reconsider whether in fact the offer of a care home that has been aired may be unlawful in the first place, with regard to the pros and cons of a move at this time, the impact of the difficulties being faced by the person and the possibility that the person’s or support circle’s stance being conveyed may be an indication that appropriateness and suitability has not been properly considered, as yet? (…since only the cost of suitable and appropriate proposals can be of any lawful relevance to the ultimate offer from the Council or ICB?)

b) if the organisation is sure that the proposal being aired is at least lawful, consider the possibility that the person could also potentially be cared for in their own home or a non-registered setting, and that therefore the Best Value aspect of the two alternative suitable proposals for meeting the needs must in fact be engaged with and considered?

c) offer a direct payment capped to the cost of the care home you have been bearing in mind, regardless of any other consideration, on the basis that it is the person’s choice to refuse a care home, or if lacking in capacity, their relative’s choice?

d) offer a sum capped to the amount of the care home, but via a direct payment to enable the person to stay in their own home, IF the person and family are able to request a direct payment and your staff are satisfied that the shortfall will be secured through assets, strengths, voluntary contribution of labour or money from the person’s circle of support, or the payment by the individual from disregarded assets (for instance, savings below £14250)?

e) identify the actual lowest practicable minimum cost of either council or ICB commissioned or direct payment or PHB funded home care that would be regarded as professionally defensibly sufficient were the person to be supported in their own home, in order to meet whatever the actual extent of eligible unmet need will then be, after all assets and strengths as mentioned in d) are drawn in to meet what would otherwise have been the full extent of the eligible needs identified on assessment?

f) offer to fund whatever the person or their family is prepared to accept, so that the budget can be finalised and signed off in a timely fashion, for at least the short term future?

4. If the answer to Question 1 is yes, is the fee level taken into consideration either one or other of the two options below:

a) the local fees agreed with either the care homes on your list of approved providers (after some sort of commissioning exercise for admission to a Dynamic Purchasing System or pre-appoved providers), or

b) the standard rates of all the locally registered care homes who have formally agreed to do business with you at a range of rates representing their core fees for the placement (that is, allowing for the addition of one to one hours or services required for a person with the particular level of needs or band?).

c) the lowest spot rate that can be secured by commissioning officers or brokerage staff looking at a capacity tracking tool and communicating with suitable care homes as to what they would take to admit the person to whom your organisation owes a duty?

d) the level of any third party top-up that will also need to be agreed (or any privately arranged additional payment for wants and not needs) for particular aspects of the care home’s offered facilities before the person is admitted or allowed to stay on council or ICB terms?

1. In response to all three elements of Question 1, the answer is no. NHS Greater Manchester (NHS GM) first and foremost clinically consider an individuals’ needs, based on their respective eligibility against the National Framework for Continuing Healthcare (CHC). If the individual concerned is deemed eligible, then a package of care is sourced.

2. The CHC Nurse Assessors within the ten CHC Teams of NHS GM are required to compile an eligibility case for approval, which is clinically reviewed and scrutinised by the respective Lead Nurse, or Associate Director of Nursing, dependent of the value of the package of care.

Care planning for an individual is carried out by the Multi-disciplinary Team (MDT) involved with the induvial. This is based on assessed need by the relevant professionals and includes the best interest decisions with the individual concerned, pr an appropriate representative. The eligibility to CHC is a decision made based on assessed care needs and not financial.

3.

a) Best Interest Meetings always consider the needs and wishes of the individual.

b) Yes

c) Direct payments are determined by assessed clinical need and not the cost of a care home, unless appropriate.

d) No

e) The CHC eligibility criteria means that NHS GM will be and are expected to meet the full clinical needs of the individual’s care package. Therefore, there would be no unmet clinical care costs associated with a package of care.

f) See answer 3 (e) above.

4. N/A as answered no to question 1.