1. Introduction

Adults who use care and support services, and those of partner agencies, are at the centre of the personalisation agenda and the Care Act 2014. Feedback from adults and carers about their service experience and outcomes – that were either achieved or not achieved – are vital to providing effective and appropriate services.

2. Co-production

Co-production is a way of working whereby everybody – adults who use services, carers and staff – work together on an equal basis to create a service or come to a decision which works for them all.

However, the definition of co-production changes in different settings (see What is Co-production? TLAP).

The Care Act states:

Co-production is when you as an individual influence the support and services you receive, or when groups of people get together to influence the way that services are designed, commissioned and delivered.

The TLAP National Co-production Advisory Group says:

Co-production is not just a word, it is not just a concept, it is a meeting of minds coming together to find shared solutions. In practice, co-production involves people who use services being consulted, included and working together from the start to the end of any project that affects them. When co-production works best, people who use services and carers are valued by organisations as equal partners, can share power and have influence over decisions made.

The New Economics Foundation notes six main aspects of co-production:

Recognising people as assets: People are seen as equal partners in designing and delivering services, rather than as passive beneficiaries or burdens on the system.

Building on people’s capabilities: Everyone recognises that each person has abilities and people are supported to develop these. People are supported to use what they are able to do to benefit their community themselves and other people.

Developing two-way reciprocal relationships: All co-production involves some mutuality, both between individuals, carers and public service professionals and between the individuals who are involved.

Encouraging peer support networks: Peer and personal networks are often not valued enough and not supported. Co-production builds these networks alongside support from professionals.

Blurring boundaries between delivering and receiving services: The usual line between those people who design and deliver services and those who use them is blurred with more people involved in getting things done.

Facilitating not delivering to: Public sector organisations (like the government, local councils and health services) enable things to happen, rather than provide services themselves. An example of this is when a council supports people who use services to develop a peer support network.

3. Involving Adults

Adults who use services should be involved at each level of development, delivery, and review of care and support services in order to ensure:

• that services are developed to meet the care and support needs of adults;
• that the services which are provided are of good quality;
• positive outcomes for those who use the service.

Service commissioners should ensure that adults who use services can:

• have their views considered in the development of new strategies and services;
• contribute to the review and performance management of existing strategies and services;
• receive information on planning and delivering of new services in an accessible and jargon-free format;
• contribute to meetings and decision making where practicable. This may include practical support (for example, reimbursement of expenses; considering the time and venue for meetings) and other assistance (for example help to deal with jargon – see TLAP Care and Support Jargon Buster);
• access appropriate training and mentoring support to enable them to contribute to planning arenas.

Social workers and service providers should ensure adults:

• have easy access to information about their rights and responsibilities within the service;
• have easy access to clear information on all the services available (see Information and Advice chapter);
• have access to information on their care and support options (see Care and Support Planning chapter);
• are fully involved in the assessment process and development and review of their individual care plan and have their needs, wishes and goals incorporated into their plan (see Assessment chapter);
• receive information on how to make comments, complaints and compliments about the service they receive (see Complaints, Comments, Compliments and Questions chapter);
• contribute to the evaluation of the service.

User led organisations (ULOs) are one approach to facilitating user involvement as referenced in the Care and Support Statutory Guidance. ULOs are organisations that are run by and controlled by people who use care and support services, including disabled people of any impairment, older people, and families and carers. See also A Commissioner’s Guide to Developing and Sustaining Local User-Led Organisations (SCIE).

4. Further Reading

4.1 Relevant chapters

The Care Act 2014

Personalisation

4.2 Relevant information

Think Local Act Personal, Coproduction

Am I Invisible? Using Co-production to Advocate Change in Social Care (SCIE)

Quality Statement 4: Using People’s Views to Improve Services (NICE)

1. Introduction

NHS Continuing Healthcare (CHC) is care arranged and funded by the NHS and provided to adults who have been assessed as having a ‘primary health need’ (see Section 2.3, Eligibility). It is free of charge, unlike care from adult social care for which there may be a charge depending on the adult’s income and savings (see Charging and Financial Assessment chapter).

It can be provided in any setting, including a care home, nursing home, hospice or the home of the adult with the healthcare needs. It will cover their care home fees (including board and accommodation), personal care (help with bathing, dressing and laundry for example) and healthcare costs (community nursing or specialist therapy services for example).

For adults living at home, it will cover their personal care and healthcare costs.

Support for carers may also be available – see NHS Continuing Care: Information for Adults and Carers.

There is a difference between NHS CHC and NHS-funded Nursing Care; NHS-funded Nursing Care is the funding provided by the NHS to those who are eligible and living in care homes with nursing, to support the provision of nursing care by a registered nurse.

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health and Social Care)  was revised in July 2022. It includes Practice Guidance to support staff delivering NHS CHC.

This chapter is a summary of key information in the Framework.

2. Key Concepts in NHS Continuing Healthcare

2.1 Primary health need

To assist in deciding which – if any- health services it is appropriate for the NHS to provide to someone, the term ‘primary health need’ is used. Where an adult has been assessed to have a primary health need, they are eligible for NHS CHC and the NHS will be responsible for providing for all of their assessed health and associated social care needs, including accommodation – if that is part of their overall need. Deciding whether an adult has a primary health need involves looking at all of their relevant needs; to do so they must be assessed by a multidisciplinary team (MDT) using the Decision Support Tool (DST), see Section 7, Decision Support Tool.

An adult is said to have a primary health need if, having completed the DST, it can be said that most of the care they require is focused on addressing and / or preventing health needs. Having a primary health need is not about why someone needs care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day-to-day care needs taken as a whole.

Each adult’s case has to be considered on its own facts, in line with the principles outlined in the National Framework.

There should be no gap in the provision of care. People should not find themselves in a situation where neither the NHS nor the relevant local authority will fund care, either separately or together.

The requirement for a primary health need means that ineligibility for NHS CHC is only possible where, taken as a whole, the nursing or other health services the person requires:

• are no more than incidental or ancillary to the provision of accommodation which local authority social services are under a duty to provide (depending on the adult’s circumstances); and
• are not of a type beyond which a local authority could be expected to provide.

In applying the primary health need test, Integrated Care Boards (ICBs) should take into account that section 22 of the Care Act 2014, applies the ‘incidental and ancillary’ test in all situations, including where care is being provided in the adult’s own home. As there should be no gap in the provision of care, ICBs should consider this test when determining eligibility. Eligibility is the same for all individuals, whether their needs are being met in their own home or in care home accommodation.

Please note: ICBs replaced Clinical Commissioning Groups on 1 July 2022.

2.2 Characteristics of need

Certain characteristics of need – and their impact on the care required to manage them – may help determine whether the ‘quality’ or ‘quantity’ of care required is more than the limits of a local authority’s responsibilities, as set out in the Care Act 2014:

• nature: this describes the particular characteristics of an adult’s needs (which can include physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the adult, including the type (‘quality’) of interventions required to manage them;
• intensity: this relates both to the extent (‘quantity’) and severity (‘degree’) of the needs and to the support required to meet them, including the need for sustained / ongoing care (‘continuity’);
• complexity: this is concerned with how the adult’s needs present and interact to increase the skill required to monitor the symptoms, treat the condition/s) and / or manage their care. This may arise with a single condition, or multiple conditions or the interaction between two or more conditions. It may also include situations where an adult’s response to their own condition has an impact on their overall needs, for example where a physical health need results in the adult developing a mental health need.
• unpredictability: this describes the degree to which an adult’s needs fluctuate, which can create challenges in managing them. It also relates to the level of risk to the adult’s health if adequate and timely care is not provided. An adult with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.

Each of these characteristics may, alone or together, show the adult has a primary health need, because of the quality and / or quantity of care that is required to meet their needs. All of their overall needs and the effects of the interaction of their needs should be carefully considered when completing the DST.

Practice Guidance note 3 in the National Framework contains examples of questions which the multidisciplinary team can use to develop an understanding of how each characteristic relates to the needs of the adult being assessed.

2.3 Eligibility

Eligibility for NHS CHC is a decision taken by the local ICB, based on an assessment of the adult’s needs, which is undertaken by the multidisciplinary team (MDT) using the Decision Support Tool. The diagnosis of a particular disease or condition is not in itself a deciding factor of eligibility for NHS CHC. As noted above, NHS CHC may be provided in any setting (including for example a care home, hospice or the adult’s own home). Eligibility is, therefore, not decided or influenced either by the setting where the care is provided or by the characteristics of the adult who delivers the care. When making a decision whether someone is eligible for CHC, a need should not be dismissed just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need will this have an impact on the adult’s eligibility for NHS CHC.

Financial issues should not be considered as part of the decision on an adult’s eligibility for NHS CHC.

In summary, the reasons given for a decision on an adult’s eligibility should not be based on the:

• adult’s diagnosis;
• setting of care;
• ability of the care provider to manage care;
• whether or not NHS-employed staff provide care;
• need for ‘specialist staff ’ in care delivery;
• the fact that a need is well-managed;
• the existence of other NHS-funded care; or
• any other input-related (rather than needs-related) rationale.

Eligibility for NHS CHC is not indefinite, as needs could change. This should be made clear to the individual and / or their representatives.

Not all those with a disability or long term health condition will be eligible.

A decision about whether or not an adult is eligible should usually be made within 28 days of completion of the assessment.

2.4 Options for people who are not eligible

If the adult is not eligible for NHS CHC funding, the local authority maybe responsible for assessing their care and support needs and providing services if they are eligible.

If the adult is not eligible for NHS CHC but is assessed as having healthcare or nursing needs, they may still receive some care from the NHS. For an adult who lives in their own home, this may be provided as part of a joint package of care and support, where some services come from the NHS and some from adult social care services (see the chapters on Integration, Cooperation and Partnerships, Eligibility and Charging and Financial Assessment).

If the adult moves into a nursing home, the NHS may contribute towards their nursing care costs.

Once eligible for NHS CHC, care will be funded by the NHS, but this is subject to review; should care needs change, the funding arrangements may also change.

3. Information for Adult Social Care Staff

The National Framework sets out the principles and processes which should be applied in order to assess an adult’s eligibility for NHS continuing healthcare and NHS funded nursing care.

Joint working between NHS and adult social care, and any other partner organisation/s who are involved, is essential to ensure the adult’s needs are met in the right way and that their care is effectively coordinated. The National Framework sets out the local authority responsibilities in relation to NHS continuing healthcare.

In order to understand and be able to implement CHC procedures, staff should:

• familiarise themselves with the National Framework for NHS Continuing Healthcare documentation;
• understand the definition of ‘primary health need’;
• be familiar with the Decision Support Tool;
• be able to apply the four key characteristics of need (see Section 2.2, Characteristics of need);

as well as the primary health need test to the adult’s assessed needs (see National Framework p.60).

If adult social care staff consider that an adult may be eligible for NHS CHC, they must follow their local processes in order to refer the adult to the ICB.

Where at all possible, the same staff member should be involved with the adult and their carers throughout the continuing healthcare assessment process.

4. Consent

See also: Full Consent Form for Participating in the NHS Continuing Healthcare Process and for Information Sharing with Family / Friends / Advocates (opens in Word) and Data Protection: Legislation and Guidance chapter.

There are a number of principles which underpin this process. Most importantly is that assessments and reviews should always focus on the adult’s individual needs and follow a person-centred approach. The adult should be fully informed and empowered to participate actively in the assessment process and any subsequent reviews, and their views should always be considered. There are also a number of legal requirements when it comes to obtaining an adult’s consent for parts of the NHS CHC process.

Before completing the Checklist and the Decision Support Tool (DST) (see below), consent must be obtained and recorded. Consent is sought for:

• completion of the DST;
• sharing of the adult’s personal information between different organisations involved in their care, and the continuing healthcare assessment and decision making process.

5. Mental Capacity

If there is a concern that the adult may not have mental capacity to give consent to taking part in the continuing healthcare process, this should be decided in line with the Mental Capacity Act 2005 and Code of Practice (see Mental Capacity chapter). A third party can give consent for an assessment of eligibility for NHS CHC on behalf of an adult who lacks capacity, if they can demonstrate they have a valid Lasting Power of Attorney for Welfare or that they have been appointed a Welfare Deputy by the Court of Protection.

If the adult lacks the relevant capacity to either give or refuse consent to a physical intervention / examination, care and treatment as part of continuing healthcare, a ‘best interests’ decision should first be made and recorded (see Best Interests chapter).

ICBs and local authorities should ensure that all staff involved in NHS CHC assessments are appropriately trained in Mental Capacity Act 2005 principles and responsibilities.

6. Checklist Tool

See NHS Continuing Healthcare Checklist

The Checklist is the NHS CHC screening tool which can be used in a variety of settings to help practitioners identify individuals who may need a full assessment of eligibility for NHS CHC.

The regulations state that if an initial screening process is used to identify where someone may have a need for CHC, the Checklist is the only screening tool that can be used for this purpose. The purpose of the Checklist is to encourage proportionate assessments of eligibility so that resources are directed towards those people who are most likely to be eligible for NHS CHC, and to ensure that a rationale is provided for all decisions regarding eligibility.

The Checklist can be completed by a variety of health and social care practitioners, who have been trained to use it. This could include local authority staff such as social workers, care managers or social care assistants.

Completion of the Checklist should be quite quick and straightforward. It is not necessary to provide detailed evidence along with the completed Checklist.

There are two potential outcomes following completion of the Checklist:

• a negative Checklist, meaning the adult does not require a full assessment of eligibility, and they are not eligible for NHS CHC; or
• a positive Checklist meaning an adult now requires a full assessment of eligibility for NHS CHC. However, that does not necessarily mean they will be eligible for NHS CHC.

7. Decision Support Tool

See NHS Continuing Health Care Decision Support Tool

Once an adult has been referred for a full assessment of eligibility for NHS CHC – after the Checklist has been completed or if it was not used in an individual case –a multidisciplinary team (MDT) must assess whether the adult has a primary health need using the Decision Support Tool (DST).

The DST is used to inform the decision as to whether an adult is eligible for NHS CHC. It is not an assessment in itself; the information gathered will need to be supplemented with professional analysis and conclusion. It is designed to assist data collection, analysis and presentation of information of the adult’s healthcare needs, including evidence from assessments and reports completed by other members of the MDT.

8. Multidisciplinary Working

See The Multidisciplinary Team (MDT), National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care 

The core purpose of the MDT is to make a recommendation on eligibility for NHS CHC drawing on the multidisciplinary assessment of needs and following the processes set out in the National Framework.

An MDT in this context means a team consisting of at least:

• two professionals who are from different healthcare professions, or
• one professional who is from a healthcare profession and one adult who is responsible for assessing people who may have needs for care and support under the Care Act 2014.

The MDT should usually include both health and social care professionals, who are knowledgeable about the adult’s health and social care needs and, where possible, have recently been involved in their assessment, treatment or care.

As far as is reasonably practicable, the ICB must consult with the local authority before making any decision about the adult’s eligibility for NHS CHC. Different approaches can be used (for example face-to-face, video / tele conferencing) for arranging an MDT assessment, to ensure active participation of all MDT members, the adult and their representative, and any others with knowledge about the person’s health and social care needs as far as is possible.

It is best practice for assessors to meet with the person being assessed, ideally before the MDT meeting. All arrangements should take a person-centred approach.

If an adult with mental capacity refuses to participate in the assessment process, the MDT may consider relevant health and care records or existing assessments to decide the best way to meet their needs and whether they are eligible for NHS CHC. The consequences of undertaking the NHS Continuing Healthcare assessment or review as a paper-based exercise should be carefully explained to the adult, including that this may affect the quality of the assessment, if information is not up to date for example.

Both the MDT recommendation and the decision should be recorded in the adult’s case records. The NHS CHC process should usually be completed within 28 calendar days. This timescale is measured from the date the ICB receives the completed Checklist, indicating the need for full consideration of eligibility (or receives a referral for full consideration in some other acceptable format), to the date that the eligibility decision is made. However, wherever practicable, the process should be completed in a shorter time than this.

9. Decision-making by the ICB

See Decision-making on eligibility for NHS Continuing Healthcare by the ICB, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

ICBs are responsible for eligibility decision making, based on the recommendation made by the MDT. Only in exceptional circumstances, and for clearly stated reasons, should the MDT’s recommendation not be followed.

ICBs should ensure consistency and quality of decision making.

The ICB may ask an MDT to carry out further work on a DST if it is not completed fully or if there is a significant lack of consistency between the evidence recorded in the DST and the recommendation made.

10. Care Planning and Delivery

See Care planning and delivery, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

Where an adult is eligible for NHS Continuing Healthcare, the ICB is responsible for care planning, commissioning services, and for case management. It is also responsible for their case management, including monitoring the care they receive and arranging regular reviews.

The adult should be encouraged to have an active role in their care, be provided with information or signposting to enable informed choices and supported to make their own decisions.

ICBs may wish to commission NHS-funded care from a wide range of providers, in order to secure high-quality services that meet the adult’s assessed needs and offer value for money.

11. NHS CHC Three and 12 Month Reviews

See NHS Continuing Healthcare Reviews (at three and 12 months), National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

Where an adult has started receiving NHS CHC, a review should be undertaken within three months of the decision being made. After this, further reviews should be undertaken on at least an annual basis, although some adults will require more frequent reviews in line with clinical judgement and changing needs.

These reviews should mostly focus on whether the care plan or arrangements remain appropriate to meet the adult’s needs. It is expected that in most cases there will be no need to reassess for eligibility.

12. Equipment

See Equipment, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

Where an adult is eligible for NHS CHC and chooses to live in their own home, the ICB is financially responsible for meeting all their assessed health and associated social care needs. This could include:

• equipment provision;
• routine and incontinence laundry;
• daily domestic tasks such as food preparation, shopping, washing up, bed-making; and
• support to access community facilities (including additional support needs for the adult while their carer has a break.

However, the NHS is not responsible for paying for rent, food and normal utility bills such as gas, electricity and water.

13. Disputes

There are two types of disputes that may arise in relation to NHS CHC:

1. challenges by the adult or their carer / advocate, including requests for reviews (also known as appeals). Staff may be involved in the appeal process, including undertaking an assessment / review of the adult’s needs and attending MDT / DST meetings;
2. disputes between NHS and local authorities. In such cases staff should provide a clear rationale for disputing the outcome.

See Individual Requests for a Review of an Eligibility Decision and Inter-agency disputes, National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care for information about processes for resolving these situations including ordinary residence issues (see Ordinary Residence chapter).

14. Further Reading

 14.1 Relevant information

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health and Social Care)

NHS Continuing Healthcare Decision Support Tool

NHS Continuing Healthcare Checklist

NHS-Funded Nursing Care Practice Guidance

NHS Continuing Healthcare Fast-Track Pathway Tool

Full Consent Form for Participating in the NHS Continuing Healthcare Process and for Information Sharing with Family / Friends / Advocates (opens in Word)

See also:

NHS Continuing Healthcare (NHS) 

NHS Continuing Healthcare (AgeUK) 

Appendix 1: Flow Diagram which sets out the Process for NHS Continuing Healthcare

Appendix 1: Flow diagram CHC Process

1. Introduction

The Care Act sets out the local authority’s functions and responsibilities for care and support. Sometimes external organisations might be better placed than the local authority itself to carry out some of these functions. For instance, an outside organisation might specialise in carrying out assessments or care and support planning for certain disability groups, where the local authority does not have the in-house expertise.

The Care Act allows local authorities to delegate some, but not all, of their care and support functions to other parties. This power to delegate is intended to allow flexibility for local approaches to be developed in delivering care and support, and to allow local authorities to work more efficiently and innovatively, and provide better quality care and support to local populations.

As with all care and support, individual wellbeing should be central to any decision to delegate a function. The local authority should not delegate its functions simply to gain efficiency where this is to the detriment of the wellbeing of people using care and support.

The local authority retains ultimate responsibility for how its functions are carried out. Delegation does not absolve it of its legal responsibilities. When a local authority delegates any of its functions, it retains ultimate responsibility for how the function is carried out. Anything done (or not done) by the third party in carrying out the function, is to be treated as if it has been done (or not done) by the local authority itself. This is a core principle of allowing delegation of care and support functions.

People using care and support will always have a means of redress against the local authority for how any of its functions are carried out. For example, a local authority might delegate needs assessments to another organisation, which has its own procedures for handling complaints. If the adult to whom the assessment relates has a complaint about the way in which it was carried out, the adult might choose to take it up with the organisation in question. However, if this does not satisfy the adult, or if the adult simply chooses to complain directly to the local authority, the local authority will remain responsible for addressing the complaint.

In delegating care and support functions, local authorities should have regard to the Data Security and Protection Toolkit, in particular ensuring that all formal contractual arrangements include compliance with information governance requirements.

2. Importance of Contracts

The success of a policy by a local authority to delegate its functions to a third party will be determined to a large extent, by the strength and quality of the contracts that it makes with the delegated third party. The local authority should therefore ensure that contracts are drafted by staff with the necessary skills and competencies to do so.

Through the terms of its contracts with authorised third parties, the local authority has the power to impose conditions on how the function is carried out. For example, when delegating assessments it could choose to require that assessments must be carried out by people with a particular training or expertise, and that the training must be kept up to date.

The delegated organisation will be liable to the local authority for any breach of the contract, and as such this is the mechanism through which it is able to ensure that its functions are carried out properly, and through which it may hold the contractor to account.

Where a local authority uses its power to authorise another party to carry out its care and support functions, it should specify how long the authorisation lasts, and it should make clear that it may revoke the authorisation at any time during that period.

It should put in place monitoring arrangements so that it can assure itself that functions that have been delegated are being carried out in an appropriate manner. This should involve building good working relationships which allows the local authority to guide third parties about how it is exercising the functions, but equally for it to learn about innovations and knowledge that third parties may be able to provide.

Since care and support functions are public functions, they must be carried out in a way that is compatible with all of the local authority’s legal obligations. For example, the local authority would be liable for any breach by the delegated party of its legal obligations under the Human Rights Act or the Data Protection Act. The local authority should therefore draw up its contracts so as to ensure that third parties carry out functions in a way that is compatible with all of its legal obligations.

Although the local authority retains overall responsibility for how its functions are carried out, delegated organisations will be responsible for any criminal proceedings brought against them.

The local authority is able to choose the extent to which it delegates its functions. It should make clear in its contracts with authorised parties, the extent to which the function is being delegated.

The fact that a local authority delegates its functions does not mean that it cannot also continue to exercise that function itself. So, for instance it could ask a specialist mental health organisation to carry out care and support planning for people with specific mental health conditions, but it may choose to do care and support planning for people with other mental health conditions itself, or it may choose to offer people a choice between itself and the external organisation.

3. Which Care and Support Functions must not be Delegated?

Certain functions must not be delegated.

• Integration and cooperation: the local authority must cooperate and integrate with local partners. Delegating these functions would not be compatible with meeting its duties to work together with other agencies. However, the local authority should take steps to ensure that authorised parties cooperate with other partners, work in a way which supports integration, and is consistent with its own responsibilities.
• Adult safeguarding: there is a legal framework for adult safeguarding, including the establishment of a local Safeguarding Adults Board (SAB), carrying out safeguarding adults reviews and making safeguarding enquiries. Since the local authority must be one of the members of SABs and it must take the lead role in adult safeguarding, it may not delegate these statutory functions to another party. However, it may commission or arrange for other parties to carry out certain related activities
• Power to charge: the Care Act gives the local authority the power to charge people for care and support in certain circumstances. Local policies relating to what can and cannot be charged for is the decision of the local authority, therefore it cannot delegate this decision to outside parties. However, it may commission or arrange for other parties to carry out related activities.

4. What is the Difference between Delegating a Statutory Care and Support Function and Commissioning other related Activities?

For those functions which may not be delegated (outlined in Section 3, Which care and support functions may not be delegated?), as well as other functions which may be delegated, the local authority may wish to use outside expertise to assist in carrying out practical activities to support it in discharging those functions, rather than fully or formally delegating the function itself to be carried out by another party.

There can be some uncertainty about the difference between delegation of a statutory care and support function and commissioning, arranging or outsourcing other procedural activities relating to a function. The local authority should seek legal advice about whether the activity it is seeking to commission another party to undertake is a legal function or not.

For example, as set out above local authorities may not delegate its functions relating to establishing Safeguarding Adults Boards, making safeguarding enquiries or arranging safeguarding reviews. However, the enquiry duty is for local authorities to make enquiries or cause them to be made, so a local authority can still have arrangements whereby NHS or others are asked to undertake the enquiries where necessary. So while a local authority can ask others to carry out an actual enquiry, it cannot delegate its responsibility for ensuring that this happens and ensuring that, where necessary, any appropriate action is taken.

Another example is the local authority’s function which allows it discretion over charging people for care and support. The local authority itself must decide its charging policies. However, it may commission an external agency to carry out the administration, billing and collection of fees for care and support on its behalf. These activities may not be classed as care and support functions even though they are related to the charging function.

5. Conflicts of Interest

There might be instances where there is the potential for a conflict of interest when delegating functions. For example, when the same external organisation carries out care and support planning, but also provides the resulting care and support that is set out in the plan. The local authority should consider whether the delegation of its functions could give rise to any potential conflict and should avoid delegating its functions where it deems there would be an inappropriate conflict.

The local authority should consider imposing conditions in its contracts with delegated parties to mitigate against the risk of any potential conflicts. For example, it may choose to delegate care and support planning, but retain the final decision making, including signing off the amount of the personal budget (see Care and Support Planning and Personal Budgets). The local authority should also consider including conditions that allow the contract to be revoked at any time, if having authorised an external party to exercise its functions, a conflict becomes apparent.

6. Conflict of Interest relating to making Direct Payments

The local authority has a number of functions relating to the provision of direct payments. These functions include determining whether someone is capable of managing a direct payment, being satisfied that the direct payment is being used in a way that is meeting the person’s needs, and monitoring this periodically. The local authority may choose to delegate these functions. For example, where an authorised external party is carrying out care and support planning, it may decide that the direct payment functions could also usefully be delegated to that party.

The local authority can also make direct payments to people, that is, paying them money to meet their care and support needs. This function may also be delegated to an external party. However, where the local authority delegates its functions relating to assessment of needs or calculation of personal budgets to an external party, it should not allow that same party to make direct payments. In these cases, the actual payment of money should be made directly from the local authority to the adult or carer. This is because it is not appropriate for an external party to determine both how public funds are to be spent, as well as handling and those funds. This is in line with standard anti-fraud practice.

7. Further Reading

7.1 Relevant chapters

Care and Support Planning

Personal Budgets

7.2 Relevant information

Chapter 18, Delegation of Local Authority Functions, Care and Support Statutory Guidance (Department of Health and Social Care)

See also Delegation of Local Authority Functions Case Studies, Resources

1. Introduction

People in custody or custodial settings who have needs for care and support should be able to access the care they need, just like anyone else. In the past,  responsibilities for meeting the needs of prisoners were not always clear and this  led to confusion between local authorities, prisons and other organisations, and made it difficult to ensure people’s eligible needs were met. The Care Act 2014 clarifies local responsibilities for people in custody with care and support needs.

Prisoners often have complex health and care needs, and experience poorer health and mental health outcomes than the general population. Research has found higher rates of mental illness, substance misuse and learning disabilities among people in custody than in the general population. Access to good, joined up health and care support services is, therefore, particularly important for these groups.

All adults in custody, as well as offenders in the community, should expect the same level of care and support as the rest of the population. This is crucial to ensure that those in the criminal justice system who are in need of care and support achieve the outcomes that matter to them, and that will support them to live as independently as possible at the end of their detention.

2. Role of the Local Authority

Adults in a custodial setting should be treated as if they are ordinarily resident in the local authority area where the custodial setting is located (see Ordinary Residence chapter). Adults who are bailed to a particular address in criminal proceedings are treated as ordinarily resident in the local authority area where they are required to reside as part of their bail conditions.

Local authorities are responsible for the assessment of all adults who are in custody in their area and who appear to be in need of care and support, regardless of which area they came from at the start of their detention or where they will be released to. If an adult is transferred to another custodial establishment in a different local authority area, responsibility will transfer to the new area. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of such care and support needs. Access to the internet may be limited in prisons and other custodial settings, so it is important to consider the most appropriate format for information and advice to be provided, such as easy read leaflets.

Although not all local authority areas contain prisons or approved premises, all areas will be responsible for ensuring continuity of care for adults with eligible needs who are released into their area with a package of care. Similarly local authorities must support continuity of care for any of their residents moving into custody.

Where prisoners have previously been detained in hospital under sections 47 and 48 of the Mental Health Act 1983 and then transferred back to prison, their right to receive section 117 aftercare should be dealt with in the same way as it would be in the community, apart from any provisions which do not apply in custodial settings, such as direct payments and choice of accommodation.

Section 117(3), as amended by the Care Act 2014, should be used to determine which local authority is responsible for commissioning or providing section 117 aftercare services (see Section 117 Aftercare chapter).

If the person was ordinarily resident in the area of a local authority immediately before being detained in hospital, that local authority will be responsible for the aftercare while the person is in prison and upon their release from prison (see Ordinary Residence chapter). However, if the person was not ordinarily resident in any area immediately before detention, the local authority responsible will be where the person is resident or where they have been discharged (that is, the local authority responsible for the prison to which the person has been discharged). The local authority will be jointly responsible for aftercare with NHS England while the person is in prison. However, the Supreme Court in R (on the application of Worcestershire County Council) v Secretary of State for Health and Social Care [2023] UKSC 31 stated that the section 117 duty will end, for example, if the person concerned “were to die or was deported or imprisoned”.

3. Definitions

Prison: References to prison include young offender institutions (which hold young people aged 15-21 years), secure training centres or secure children’s homes. A reference to a governor, director or controller of a prison includes a reference to the governor, director or controller of a young offender institution, to the governor, director or monitor of a secure training centre and to the manager of a secure children’s home. A reference to a prison officer or prisoner custody officer includes a reference to a prison officer or prisoner custody officer at a young offender institution, to an officer or custody officer at a secure training centre and to a member of staff at a secure children’s home.

Approved premises: These are premises which are approved as accommodation under the Offender Management Act 2007 for the supervision and rehabilitation of offenders, and for people on bail. They are usually supervised hostel type accommodation.

His Majesty’s Prison and Probation Service (HMPPS): is an executive agency, sponsored by the Ministry of Justice. The agency is made up of HM Prison Service, Probation Service and Youth Custody Service.

Within England and Wales, HMPPS are responsible for:

• running prison and probation services;
• rehabilitation services for people leaving prison;
• ensuring the availability of support to stop people reoffending;
• contract managing private sector prisons and services such as:
  • the prisoner escort service;
  • electronic tagging.

Through HM Prison Service they manage public sector prisons and contracts for private prisons in England and Wales. The Probation Service oversees delivery of probation services in England and Wales

Probation Service: The probation service is responsible for working with adult offenders, both in the community and during a move from prison to the community, to reduce reoffending and improve rehabilitation. The probation service sits within HMPSS.

HM Inspectorate of Prisons / Probation: HM Inspectorate of Prisons for England and Wales (HMI Prisons) is an independent body which reports on conditions for and treatment of those in prison, young offender institutions and immigration detention facilities. HM Inspectorate of Probation for England and Wales is an independent body reporting on the effectiveness of work with adults, children and young people who have offended aimed at reducing reoffending and protecting the public.

Prisons and Probation Ombudsman (PPO): The Prisons and Probation Ombudsman investigates complaints from prisoners, those on probation and those held in immigration removal centres. The Ombudsman also investigates all deaths that occur among prisoners, immigration detainees and the residents of approved premises.

4. Information Sharing

See also Case Recording and Information Sharing

Local authorities are responsible for the security of information held on people who are in custodial settings and should develop agreements with partner agencies in line with policies and procedures of Ministry of Justice and HMPPS  which enable appropriate information sharing on individuals, including the sharing of information about risk to the prisoner and others where this is relevant See also Information Sharing Policy Framework (gov.uk)

If a local authority is providing care and support to an adult who is remanded (awaiting trial), sentenced to custody, bailed to an approved premises, or required to live in approved premises as part of a community sentence, the most recent assessment and care and support plan should be shared with the custodial setting and the local authority in which it is based (if different), so that care and support may continue.

Prisons and / or prison health services should inform their local authority when someone they believe has care and support needs arrives at their establishment (see Integration, Cooperation and Partnerships chapter). The local authority may also receive requests for information from managers of custodial settings or the probation service when an adult who has already received care and support in the community is remanded or sentenced to custody. The information requested should be provided as soon as possible.

The local authority and partners in the criminal justice system should put in place  processes for identifying people in custodial settings who are likely to have or to develop care and support needs. This could include when the adult is screened on arrival at the prison or  during health assessments.

5. Assessments of Need

When the  local authority is informed that an adult in a custodial setting may have care and support needs, they must carry out an assessment as they would for someone in the community. The same standards and approach to assessment and decision-making about whether someone has care and support needs (see Assessments chapter) should apply to those in custodial settings as those not in the criminal justice system, bearing in mind that an adult in prison will no longer have the same level of support they may have relied upon in the community. It is likely that there will be complexities for carrying out assessments in custodial settings and consideration should be given to how such assessments will be carried out in the most efficient way for all involved.

The local authority may also combine a needs assessment with any other assessment it is carrying out, or it may carry out assessments jointly with, or on behalf of another organisation, for example prisoners’ health assessments.

Adults in a custodial setting also have a right to self-refer for an assessment. The local authority should provide appropriate types of care and support prior to completion of the assessment, where it is clear the person has urgent needs.

As with adults not in the criminal justice system, if an adult in a custodial setting refuses a needs assessment (see Refusing Assessment, Assessments chapter) the local authority is not required to carry out the assessment unless:

• the person lacks the mental capacity to refuse and the local authority believes that the assessment will be in their best interests; or
• the person is experiencing, or is at risk of, abuse or neglect (see Knowsley Safeguarding Adults Procedures).

Once a local authority has assessed an adult in custody as needing care and support, it must decide if some or all of these needs meet the eligibility criteria.

Where an adult  does not meet the eligibility criteria, they must be given written information about:

• what can be done to meet or reduce their needs and what services are available; and
• what can be done to prevent or delay the development of needs for care and support in the future.

5.1 Eligibility

The threshold for the provision of care and support does not change in custodial settings and will be the same as set out in the Eligibility chapter. When an adult  is in a custodial setting, this should not in any way affect the assessment and recording of their eligible needs. However, the setting in which the care and support will be provided is likely to be different from community or other settings, and this should be taken into account during the care planning process when agreeing how to best meet the adult’s care and support needs. The extent and nature of their needs should be identified before taking into account the environment in which they live. If a safeguarding issue is identified, the prison or approved premises management should be notified in line with HM Prison and Probation policy on adult safeguarding.

5.2 Information

See also Information and Advice chapter

For any of the adult’s needs that are not eligible, the local authority must provide information and advice on how those needs can be met, and how they can be prevented from getting worse. It is good practice to copy this information to managers of custodial settings, with the adult’s consent, as this will help them manage their needs.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of care and support needs (see Preventing, Delaying or Reducing Needs chapter). Low level preventative support and information and advice can help adults in custody maintain their own health and wellbeing.

5.3 Choice of accommodation

The right to a choice of accommodation does not apply to those in a custodial setting except when an adult is preparing for release or resettlement in the community.

It is important that, where appropriate, adults in custodial settings are supported to maintain links with their families, as long as this in the best interests of the adult and there are no public protection requirements or safeguarding children concerns which may limit or prohibit family or other personal contact. While it may not always be possible or appropriate to involve family members directly in assessment or care planning, the adult should be asked whether they would like to involve others in these processes.

If it is not possible to involve families directly, the local authority should ask the adult if they would like others to be informed that an assessment is taking place, and the outcome of that assessment and any  care and support plan.

6. Carers Assessments

Prisoners, residents of approved premises or staff in prisons or approved premises will not take on the role of carer as defined by the Care Act and should therefore not in general be entitled to a carer’s assessment.

7. Charging and Assessing Financial Resources

As in the community, adults in custodial settings will be subject to a financial assessment to decide how much they may pay towards the cost of their care and support (see Charging and Financial Assessment). Where it is unlikely the adult will be required to contribute towards the cost of their care and support, ‘light touch’ financial assessments can be carried out. If the adult does not meet the eligibility threshold for local authority support, but wants to purchase care services, this request should be referred for decision to HM Prison and Probation Service.

8. After the Assessment

The local authority should ensure that all relevant partners are involved in care and support planning and take part in joint planning with health partners.

Where a local authority is required to meet needs for care and support, a care and support plan must be prepared. The adult should be involved this process. The local authority should also involve others concerned with the adult’s health and wellbeing, including prison staff, probation offender managers, staff of approved premises and health care staff, to ensure integration of care as well as what is possible within the custodial regime. Any safeguarding issues should be addressed in the care and support plan (see also Section 14, Safeguarding Adults at Risk of Abuse or Neglect).

While every effort should be made to put adults in control of their care and for them to be actively involved and able to influence the planning process (see Care and Support Planning), it should be explained that the custodial regime may limit the range of care options available and some, such as direct payments, do not apply in a custodial setting. Where an adult’s ability to exercise choice and control is limited in this way, this should be discussed with them and recorded as part of the care planning process. However, the plan must contain the different elements outlined in the Care and Support Planning chapter, including the allocated personal budget. This will ensure that the adult is clear about the needs to be met, the cost of meeting those needs and how, if applicable, being in custody means their choice and control is limited.

The local authority should seek consent from the adult so that their care plan can be shared with other providers of custodial and resettlement services including custodial services, the probation service, prison healthcare providers and managers of approved premises as relevant. For residents of approved premises, the local authority should always liaise with the responsible Offender Manager in probation services.

8.1 Equipment and adaptations

If an adult needs equipment or adaptations to meet their care and support needs, this should be discussed with the prison, approved premises and health care service partners to identify which agency is responsible for providing them. Where this relates to fixtures and fittings (for instance a grab rail or a ramp), it will usually be for the prison to deliver this. But for specialised and moveable items such as beds and hoists, it may be the local authority that is responsible. Aids for adults are the responsibility of the local authority, whilst more significant adaptations would the responsibility of the custodial establishment (see Adult Social Care Prison Service Instruction).

Care and support plans for those in custodial settings are reviewed in the same way   as all other plans (see Review of Care and Support Planning). The local authority should also review an individual’s care and support plan each time they enter custody from the community or are released from custody.

9. Direct Payments

Direct payments do not apply in prisons and approved premises and cannot be made to people in custodial settings.

Adults living in bail accommodation or approved premises who have not yet been convicted are entitled to direct payments, as they would have been whilst in their own homes (see Direct Payments chapter).

10. Continuity of Care and Support when an Adult Moves

Adults in custody with care and support needs must have continuity of care if they are moved to another custodial setting or when they are being released from prison and moving back into the community (see Continuity of Care). Adults in custody cannot be said to be ordinarily resident there because the concept of ordinary residence is based on the person living there voluntarily. This means they might be ordinarily resident where they previously resided. However, it is the local authority where the custodial setting is situated which is responsible for assessments and services, while the adult is in custody. When an adult is being released from prison, their ordinary residence will generally be in the local authority area where they intend to live on a permanent basis (see Section 11, People Leaving Prison: Ordinary Residence).

There will be circumstances where the process to ensure continuity of care will need to differ, for example when a prisoner is moved between establishments or when they are released in another area because of the nature of their offence. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice, and adults can be moved between different custodial settings. In such cases, the Governor of the prison or a representative, should inform the local authority in which the prison is located (the first authority) that the adult is to be moved or is being released to a new area. If this is a move to a custodial setting or release into the community in the same authority, then the first authority will remain responsible for meeting the adult’s care and support needs. Where the new custodial setting or the community, if being released, is in a different local authority area (second authority), the first authority must inform the second authority of the move once it has been told by the prison.

The prison, both local authorities and where practicable, the adult, should work together to ensure that the adult’s care and support is continued during the move. It is good practice for the first and second local authority (and the transferring and receiving prisons where appropriate) to have a named member of staff to lead on arrangements for individuals during the transfer. Both local authorities must share relevant information (see also Continuity of Care chapter), including the adult’s care and support plan.

The second authority should assess the adult before they are moved, but this may not always be possible (for example, if they were informed of the transfer at short notice). In such circumstances the second authority must continue to meet the care and support needs that the first authority was meeting until it has carried out its own assessment.

11. People Leaving Prison: Ordinary Residence

The Care Act states that, in most circumstances, a person’s ordinary residence is retained where they have their needs met in certain types of accommodation in another local authority area. However, this does not apply to people who are leaving prison.

Therefore, where an adult requires a specified type of accommodation (see Ordinary Residence) to be arranged on release from prison  to meet their eligible needs, the local authority should start from an assumption that they remain ordinarily resident in the area in which they were ordinarily resident before the start of their sentence.

However, deciding an adult’s ordinary residence on release from prison will not always be straightforward, and each case must be considered on an individual basis. For example, it may not be possible for an adult to return to their prior local authority area due to the history of their case and any risks associated with them returning to that area.

In situations where an adult is likely to have needs for care and support services on release from prison or approved premises and their place of ordinary residence is unclear and / or they express an intention to settle in a new local authority area, the local authority to which they plan to move should take responsibility for carrying out their needs assessment.

Given the difficulties associated with deciding ordinary residence on release, prisons or approved premises, the probation service and the local authority providing care and support should initiate joint planning for release in advance. Early involvement of all agencies, particularly the probation service, should ensure that the resettlement plan is workable in the local authority area where the adult will live.

12. End of Life Care

See also End of Life Care chapter

The provision of care and support for those in custodial settings also applies to those who reach the end of their life whilst in prison. Some adults will transfer to a local hospital, hospice or care home or move to an alternative prison for palliative care. In these cases, responsibility for care and support will pass to the NHS or new local authority, once the adult arrives at the new location. Approved premises are not usually a suitable location for the provision of end of life care.

Prison managers and health care providers should consider informing local authorities when a prisoner receives a terminal diagnosis, or their condition deteriorates significantly. The adult’s consent to share such information should be obtained where possible.

Where it is not possible to obtain consent to share the information, managers of custodial settings and health care providers should make an individual assessment and consider the legal basis for sharing information (see Data Protection chapter).

Local authorities should work with the prison healthcare provider to ensure that the care and support needs of the prisoner are met throughout the provision of their end of life care.

13. NHS Continuing Healthcare

See also Continuing Healthcare (NHS) chapter

NHS Continuing Healthcare (CHC) is arranged and funded by the NHS and provided to adults who have been assessed as having a ‘primary health need’. It is provided to people aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. NHS Continuing Healthcare is not dependent on a person’s condition or diagnosis but is based on their specific care needs.

14. Safeguarding Adults at Risk of Abuse or Neglect

See Knowsley Safeguarding Adults Procedures

Local authority staff and staff working in custodial settings must understand what to do where they have a concern about abuse and / or neglect of an adult in custody. Prison and probation staff may approach the local authority for advice and assistance with adult safeguarding concerns, but the local authority does not have the legal duty to lead safeguarding enquiries in any custodial setting.

15. Transition from Children’s to Adult Care and Support

Local authorities should have processes to identify young people in young offender institutions, secure children’s homes, secure training centres or other places of detention as well as young people in the youth justice system, who are likely to have eligible needs for care and support as adults, and who are approaching their eighteenth birthday. These young people should receive a transition assessment when appropriate (see Transition to Adult Care and Support).

This also applies where a young person moves from a young offender institution to an adult prison, which may change which e local authority responsible for them. A request for an assessment can be made on the young person’s behalf by the professional responsible for their care in the young offenders’ institution, secure children’s home or secure training centre.

16. Care Leavers

If a young person is entitled to care and support services as a care leaver, this status remains unchanged while they are in custody, and the local authority that looked after the young person retains responsibility for providing leaving care services during their time in custody and on release.

Local authorities have a duty to provide personal adviser (PA) support to all care leavers up to age 25, if they want this support.

17. Independent Advocacy Support

Adults in custody are entitled to the support of an independent advocate during needs assessments and care and support planning and reviews of plans, if they would otherwise have significant difficulty in being involved in the process. It is the local authority’s duty to arrange an independent advocate, as they would for an individual in the community (see Independent Advocacy).

The local authority should agree with managers of custodial establishments how the advocacy scheme will work in their establishments.

18. Complaints and Appeals

Anyone who is unhappy with a decision made by the local authority can make a complaint about that decision. The local authority should provide information to the adults’ custodial settings on how the adult can complain about the provision of their care and support services (see Complaints).

19. Investigations and Inquests

The Prisons and Probation Ombudsman (PPO) conducts investigations in prisons following complaints about prison services, as well as deaths in custody or other significant events. The PPO will commission a relevant body to assist their investigations where it is felt that an aspect of care and support provision has contributed to the event. The local authority should cooperate with any investigations as required.

Local authorities should cooperate with and attend any inquests that are held following a death in custody, where requested to do so or if they have relevant information.

20. Further Reading

20.1 Relevant chapters

Ordinary Residence

Assessment

20.2 Relevant information

Chapter 17, Prison, Approved Premises and Bail Accommodation, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Introduction

Under the Care Act 2014, the local authority has a duty to carry out their care and support responsibilities – including carer’s support and prevention services – with the aim of joining up services with those provided by the NHS and other health related services, for example, housing or leisure services.

The duty applies where the local authority considers that integration of services would promote the wellbeing of adults with care and support needs – including carers, contribute to the prevention or delay of developing care needs, or improve the quality of care in the local authority’s area.

2. Integrating Care and Support with other Local Services

There is a requirement that:

• the local authority must carry out its care and support responsibilities with the aim of promoting greater integration with NHS and other health related services;
• the local authority and its relevant partners must cooperate generally in performing their functions related to care and support; and supplementary to this
• in specific individual cases, the local authority and its partners must cooperate in performing their respective functions relating to care and support and carers wherever they can.

This applies to all the local authority’s care and support functions for adults with needs for care and support and for carers, including:

• preventing needs (see Preventing, Reducing or Delaying Needs);
• providing information and advice (see Information and Advice);
• shaping and facilitating the market of service providers (see Market Shaping and Commissioning of Adult Care and Support), safeguarding (see Adult Safeguarding);
• cross border placements (see Cross Border Placements);
• transition to adult care and support (see Transition to Adult Care and Support).

The local authority is not solely responsible for promoting integration with the NHS, and this responsibility reflects similar duties placed on NHS England and the local Integrated Care Board (ICB) to promote integration with care and support. There is also an equivalent duty on local authorities to integrate care and support provision with health related services, for example housing.

3. Strategic Planning

3.1 Integration with health and health related services

To ensure greater integration of services, the local authority should consider the different mechanisms through which it can promote integration, for example:

• planning: using adult care and support and public health data to understand the profile of the population and the needs of that population, for example, using information from the local Joint Strategic Needs Assessments (JSNA) to consider the wider need of that population in relation to housing (see Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies);
• commissioning: utilising JSNA data, joint commissioning can result in better outcomes for populations in the local area. This may include jointly commissioned advice services covering healthcare and housing, and services like housing related support that can provide a range of preventative interventions alongside care;
• assessment and information and advice: this may include integrating an assessment with information and advice about housing options on where to live, and adaptations to the home, care and related finance to help develop a care plan, and understand housing choices reflecting the person’s strengths and capabilities to help achieve their desired outcomes;
• delivery or provision of care and support: this is integrated with an assessment of the home, including general upkeep or scope for aids and adaptations, community equipment of other modifications could reduce the risk to health, help maintain independence or support reablement or recovery.

Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies are, therefore, key means by which local authorities work with Integrated Care Boards to identify and plan to meet the care and support needs of the local population, including carers.

4. Cooperation of Partner Organisations

Cooperation between partners should be a general principle for all those concerned, and all should understand the reasons why cooperation is important for those people involved. There are five aims of cooperation relevant to care and support, although the purposes of cooperation should not be limited to these matters:

1. promoting the wellbeing of adults needing care and support and of carers;
2. improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
3. smoothing the transition from children’s to adults’ services;
4. protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect;
5. identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.

4.1 Who must cooperate?

The local authority must cooperate with each of its relevant partners, and the partners must also cooperate with the local authority, in relation to relevant functions. There are specific ‘relevant partners’ who have a reciprocal responsibility to cooperate. These are:

• other local authorities within the area (in multi-tier authority areas, this will be a district council);
• any other local authority which would be appropriate to cooperate with in a particular set of circumstances (for example, another authority which is arranging care for a person in the home area);
• NHS bodies in the authority’s area (including the primary care, ICBs, any hospital trusts and NHS England, where it commissions health care locally);
• local offices of the Department for Work and Pensions (such as Job Centre Plus);
• police services in the local authority areas and prisons and probation services in the local area.

There may be other persons or bodies with whom a local authority should cooperate, in particular independent or private sector organisations for example care and support providers, NHS primary health providers, independent hospitals and private registered providers of social housing, the Care Quality Commission and regulators of health and social care professionals.

5. Further Reading

5.1 Relevant chapters

Preventing Needs for Care and Support

Market Shaping and Commissioning of Adult Care and Support

Adult Safeguarding

Transition to Adult Care and Support

5.2 Relevant information

Chapter 15, Integration, Cooperation and Partnerships, Care and Support Statutory Guidance (Department of Health and Social Care)