The short answer is ‘Yes’. In the first place it is essential to ascertain the lifestyle the person with a learning disability would like to have. A person-centred plan is important in informing parent-carers, professionals and others as to what the person’s wishes are. Once known this should form the basis of the planning process, which may take place over variable periods of time dependent on the pace the individual wishes to go at, whether decisions need to be made quickly etc. Ideally this will be a gradual process so ideas can be explored, good quality planning can take place and everyone be prepared for, and adjust to, changes in relationships, dependencies etc. that will take place.
The process has already worked for many adult children with learning disabilities in Sheffield who have left their family home and now moved into more independent living arrangements of their choice. Planning for the future should not depend on whether a social worker can be allocated – this would be severely restrictive given the relatively small number of social workers there are.
The Mental Capacity Act (the Act) provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. Everyone (including parents) who is working with/caring for an adult (aged 16 or over) who may lack capacity, must comply with this Act when making decisions or acting for that person when the person lacks the capacity to make a specific decision themselves.
Capacity is not a general or medical ‘condition’ but is ‘decision-specific’, i.e. a person may lack the capacity to make one decision such as whether to have medical treatment, but may have capacity to make a different type of decision e.g. where to live. The Act is based on five core principles:
- It is always presumed that a person has capacity
- A person must be given support to make their own decisions if possible
- An unwise or eccentric decision should not be treated as evidence of lack of capacity
- Any decision made on behalf of someone lacking capacity must be in their best interests
- Actions taken in respect of a person who lacks capacity must have minimal restriction of their basic rights and freedoms.
The Act requires two tests to be completed to assess capacity –
- A ‘diagnostic’ test which asks ‘Is there an impairment of or disturbance in the functioning of the mind or brain? If so, does it make the person unable to make that particular decision at that particular time?
- A ‘functional’ test which asks whether, after providing all reasonable support to enable a person to make their own decision, can the person understand information given to them relevant to the decision, retain that information long enough to be able to make the decision, use or weigh up the information available to make the decision communicate their decision?
If the assessment establishes a lack of capacity, any act done for, or any decision made on behalf of, someone who lacks capacity must be in their best interests. A best interests decision-maker is appointed and they must ensure parent-carers, other family members, and advocates are consulted prior to a decision being made.
(Further information about the Mental Capacity Act is available on the Sheffield City Council website at www.sheffield.gov.uk , type MCA into the search engine.)
There are a number of people who have been trained as person-centred planners, both within the local authority and other organisations in the voluntary, not-for-profit and private sectors. Much as we would wish it, this unfortunately does not mean there are sufficient people to ensure everyone who wishes to can be assisted to have a person-centred plan. We have targeted the resources available to us towards specific groups i.e. people with mental health and challenging behaviour; people currently living outside of Sheffield; people known to the Older Families Planning Project; young people in transitions; and people who are moving from the old learning disability hostels.
Person-centred planning is inextricably linked with the new self-directed support approach and it is anticipated that in future some people will wish to employ their own person-centred planner to help them with their support planning.
A person-centred plan stands as valid in its own right. It is a statement of what an individual’s hopes and preferences for the future are and tells others of how they would like to be supported. In this sense it informs the assessment and subsequent care plan.
There are two parts to this question; the first about assessment, the second about eligibility. Most assessments of need are currently done using the single assessment process (SAP) where the assessor works with the individual, their family members and others to collate all the available information, describe a range of needs, and then identify which are ‘eligible’ for support or help in meeting by the local authority. With the emergence of self-directed support in Sheffield some people are using a self-assessment approach, where they assess their own needs, submit this to the local authority and are then given an ‘indicative’ sum with which they can plan their own support.
Whichever method of assessment is used, once the range of needs have been described the local authority eligibility criteria has to be applied. The Department of Health guidance (Fair Access to Care (FACS)) required councils to use a single framework for setting their eligibility criteria for adult social care which was implemented in April 2003. Sheffield, consistent with most other local authorities in England and Wales, has set its eligibility threshold at ‘critical’ and ‘substantial’. Whether a need is described as critical or substantial will flow from the assessment process. If there is disagreement about the classification then this will be recorded separately.
People who under FACS are deemed to have needs which are not ‘eligible’ may receive advice and guidance on how they themselves may wish to address these, but the local authority is not legally responsible for ensuring these two categories (i.e. moderate and low) of needs are met. We do however encourage and support organizations through various grants such as the partnership and carers grants to provide services and support to a broad range of people with learning disabilities, including some people who do not meet FACS eligibility threshold.
If you would like further information on eligibility please let me know on my contact numbers below.
Self-directed support is not designed to leave large amounts of responsibility for families – only what they wish to take on themselves. Social workers, development workers and others are developing their understanding and skills with regard to self-directed support. It is anticipated that families will receive support from social workers, providers, brokers, friends, voluntary organisations.
As in all these types of decisions, it is a matter of parents being guided by the wishes, views, and possibly supported decision-making (see answer to Q2 above) of their adult child, whilst taking all the other information about different types of living and support arrangements into account. As more people with learning disabilities move into their own tenancies and as models of self-directed support become established, there is an increasing range of options available. Information is available from supported living social workers and a dedicated Housing Solutions officer.
We have less than 16 social workers and, following recruitment, 3.5 development workers across the city. We also now have 2 carers development workers and 1 development worker to assist individuals and families with longer-term planning.
As of November 2008 there were 1,243 people with a learning disability supported by the assessment and care management service. We therefore have to manage the social worker and development worker resources we have in a careful manner by ensuring we are able to fulfil our statutory duties by respond to unforeseen situations where people may require support at short notice, such as where there are safeguarding concerns, and at the same time retain some capacity to support people with learning disabilities and their parent-carers in a more planned way. We try to do this to the best of our ability, but it does mean we are not always able to provide social worker/development worker support at the point it is requested.
This question links to question 5 (above).
This information is not all held in one place, although it would be a good idea to have such a source of information that people can readily access and add to when they discover new pieces of information. As a response to this enquiry we will look to include such a ‘log’ on this website. If people get new information they can let us know using the feedback form on the website, and we can then make this information available for others. Alternatively we can be e-mailed with the information at ldwebsite@sheffield.gov.uk
Two of the best sources of information on wills and trusts that I have found are Values into Action, who can be contacted at www.via.org (telephone: 020 7729 5436) and Housing Options, who are found at www.housingoptions.org.uk (telephone 0845 4561497). Both offer free advice services. Values Into Action also produce an extremely useful guide entitled ‘Trusting Independence’, which although seven years old, is still relevant. I have a few copies of this publication which I am happy to send to anyone who requests them.
Contact Keith McKinstrie by phone on 0114 2734896 or by email at keith.mckinstrie@sheffield.gov.uk. Alternatively email the website inbox at ldwebsite@sheffield.gov.uk
