1. Community Care John Prosser

2. Class today Aim of lecture part –Basic overview of community care –Background and principles –Review legal methods

3. Legal Method - an Act An Act is made up of Parts Each part has sections Sections can have sub-sections Most Acts also have Schedules An Act comes into force at midnight unless it has a section saying it will come into force at another time. http://www.opsi.gov.uk/acts/acts1990a.htm

4. Law in practice Law –Act of Parliament –Statutory Instrument (Regulations) Guidance –Manuals –Circulars –Letters

5. Legal method - case technique 1 Identify law Identify facts Apply law to facts

6. Legal method – case technique 2 Identify problem(s) Law –Identify relevant legal issues and problem(s) Facts Identify relevant facts Apply law to facts to solve problem

7. Overview What is community care History and Background Legal framework

8. What isn’t community care? Hospital inpatient services -

9. What is community care Any service to help someone stay out of hospital Includes –Accommodation Residential accommodation Non-residential accommodation –Non-accommodation services –Carers’ services

10. History and Background National Health Service Act 1948 (health care) National Assistance Act 1948 (community) Shift from hospital care to community from late 1950s Cost of community care (Griffiths) –NHS –Local authority –Social Security

11. NHSCCA 1990 Duty to provide information about services (s.46) – community care plan Duty to assess (s.47)

12. How it operates Assessment process –Can the individual benefit from services? –Should the service be provided? –If so, who should provide it?

13. Assessments - when is the duty triggered Potential user comes to notice of local authority Is s/he in need of services LA could provide? If No – no right to get assessment. If Yes -….

14. If have “mental disorder” Right to community care assessment

15. If don’t have “mental disorder” If ‘client’ is under 18 use Children Act 1989 If client over 18 then see if they are ill or recovering from an illness or they are a drug user or are elderly. If yes then have a right to be assessed.

16. Stages in assessment Information gathering Service provision decision

17. Information gathering Identify needs which could potentially be met by community care provision Gather all evidence necessary NHSCCA 1990 s47(1)(a)

18. Service Provision Which of the needs ‘call for’ the provision of community care services? Must have regard to s47(1)(a) but not bound by it. Community Care Services defined by reference to other acts

19. Provision according to law

20. Community Care Services NHSCCA 1990 s46 – refers to Pt III of National Assistance Act 1948 Health Services and Public Health Act s45 NHS Act 1977 s21 and Sch 8 Mental Health Act 1983 s117

21. Hierarchy of aims following assessment (a) support so that the service user can live at home; (b) move to more suitable accommodation; (c) move to another household; (d) move to residential care; (e) move to a nursing home; (f) long-stay hospital care. (DoH Policy Guidance)

22. Assessing the individual Within any relevant National Service Framework Taking into account (circular 92(12)) (a) capacity/incapacity; (b) preferences and aspirations; (c) the living situation; (d) support from relatives and friends; and (e) other sources of help.

23. Assessment according to priority Fair Access to Care Services, look at problems with health, control over environment, abuse/ neglect, personal care/domestic routines, work, education or learning, vital social or family relationships and categorise each need as –Critical –Substantial –Moderate –Low Authorities then decide at which level needs will be met and assess each need of each individual against these criteria

24. Meeting individual assessed needs Duty to meet assessed need Assistance in home, access to facilities, holiday, meals, communication aids for disabled service user under CSDPA s.2 Home help and laundry for older people, disabled, mentally disordered or physically ill under NHSA sch 8 Power to meet assessed need Sheltered employment for disabled under DPEA s.3 Meals, home assistance, help with finding accommodation for older persons under HSPHA s.45

25. Legislation.

26. Legislation 1/2 NHS and Community Care Act 1990 –Before National Assistance Act LASSA 1970 –After Carers (Recognition and Services) Act 1995 Box 16.1 (pg.522 Brayne and Carr) – lists 17 Acts. All aware of this list

27. Legislation (2/2) - powers NAA 1948 – - residential care –- services in the community for the disabled HSPSA 1968 - support for older people NHSA 1977 - support for expecting mothers/mothers of under fives, discharged patients MHA 1983 - after-care/guardianship of mental patients