Community Care

John Prosser

Class today

• Aim of lecture part– Basic overview of community care– Background and principles– Review legal methods

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

Law in practice

• Law– Act of Parliament– Statutory Instrument (Regulations)

• Guidance– Manuals– Circulars– Letters

Legal method - case technique 1

• Identify law

• Identify facts

• Apply law to facts

Legal method – case technique 2

• Identify problem(s)

• Law– Identify relevant legal issues and problem(s)

• FactsIdentify relevant facts

• Apply law to facts to solve problem

Overview

• What is community care

• History and Background

• Legal framework

What isn’t community care?

• Hospital inpatient services

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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

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

NHSCCA 1990

• Duty to provide information about services (s.46) – community care plan

• Duty to assess (s.47)

How it operates

• Assessment process

– Can the individual benefit from services?– Should the service be provided?– If so, who should provide it?

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 -….

If have “mental disorder”

• Right to community care assessment

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.

Stages in assessment

• Information gathering

• Service provision decision

Information gathering

• Identify needs which could potentially be met by community care provision

• Gather all evidence necessary• NHSCCA 1990 s47(1)(a)

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

Provision according to law

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

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)

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.

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

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

Legislation

.

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

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