1. Who this policy applies to

1.1 This policy applies to people who are eligible for adult social care funding to meet their eligible needs. This policy supports DCC Integrated Adult Social Care staff to offer choice to individuals in how their care and support are to be delivered. 

1.2 Where an individual has been assessed as lacking the mental capacity to express choice of care and support package, we must follow the Mental Capacity Act Code of Practice around ‘Best Interests’ decision making. This means consulting with relevant people for their views around the decision, and referring for an Independent Mental Capacity Act Advocate (IMCA) if required. 

1.3 Where a person lacks mental capacity to make decisions around their choice of care and support but has nominated a LPOA for health and welfare, we will involve them in the decision making process and they will be the ‘decision maker’.

2. Promoting Independence

2.1 The Care Act states that we need to consider promoting independence and reducing the needs a person has at every opportunity. The Act emphasises:

 The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer.

2.2 Devon County Councils Promoting Independence Policy will always be applied.

2.3 Wherever possible we will aim to reduce needs that already exist and to prevent or delay the development of additional needs for care and support

3. Care Act Guidance

3.2 In addition to promoting independence, the Wellbeing Principle also states that we are required to consider an individual’s views, wishes, feelings and beliefs:

Considering the person’s views and wishes is critical to a person-centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.

3.2 People are able to express preferences about how their care is delivered, and when commissioning care we will take that into account. This includes the preferred time of day care is received and the gender of the person delivering care. We will not always be able to meet all preferences, but we will ensure that a persons’ care needs are met.

4.0 Ensuring the safety of our staff

4.1 Staff should be able to count on their employers to keep their working environment safe, protect them from abusive behaviour and to maintain an environment where everyone is treated with respect and civility.  

4.2 Occasionally a person who requires support, or their representative, relative or carer intentionally obstructs the provision of a care and support package due to unacceptable or unreasonable behaviours. In these circumstances it may be necessary for us to restrict or remove services and look at alternative provisions for meeting any eligible support needs.

5. The policy

5.1 Choice around care and support packages within best value

Best Value means most appropriately costed care and support package

 5.1.1 We will always take people’s preferences into account and aim to maximise people’s independence.

 5.1.2 Choices that individuals are offered about how their eligible care needs are met must only include the ‘best value’ options where DCC funding is being considered.

5.1.3 The funding made available to support a person will be determined by the most cost-effective care package, and the prospect of successfully increasing independence. This will be based on the local care market, the availability of providers, and cost.

5.1.4 DCC will fund no more than the best value care package that meets eligible needs unless there are exceptional circumstances. For these exceptional circumstances to apply we would expect there to be clear evidence that the more expensive option is likely to have greater impact in reducing dependence on publicly funded care. There should also be a clear timetable for reviewing the care package and for considering reducing the cost of the care package.

5.2 Choice through direct payments

5.2.1 If a person is eligible for social care support from DCC they may choose a direct payment so they can directly arrange support to achieve agreed outcomes. This may include choosing a provider that DCC does not usually work with.

 5.2.2 The value of a direct payment will be no greater than the cost to DCC if it was commissioning the package of care to meet the individual’s eligible needs.

5.2.3 If an individual wants to meet their needs in a way that is more expensive than best value, then the individual will be required to fund the additional amount above best value.

5.2.4 The Care Act 2014 currently restricts DCC from offering direct payments for long-term care in a residential setting.

5.2.5 Direct payments may be offered for short term placements or respite. The Care Act defines short term in this context as:

4 consecutive weeks in any 12-month period, or;

2 or more periods separated by less than 4 weeks which added together total 4 weeks

The DCC Direct Payments Policy is available for more details

5.3 Choice of accommodation to meet Care & Support needs

5.3.1 Individuals receiving adult social care funding are able to choose their accommodation as long as the following conditions are met:

a) It will meet their needs:

If residential or nursing care has been identified as the only appropriate way of meeting a person’s needs then the individual may not choose another type of specified accommodation such as Supported Living or Shared Lives. They may still express a preference for a particular care home to live in, which will be taken into account but may not be offered depending on the other criteria described here.

b) It will cost no more than DCC would usually pay

In the first instance the best value placement within the specified accommodation, available at the time, is identified and offered. If a person’s needs could be met in more than one type of specified accommodation then the cost of the best value type of accommodation will be offered. Should a person choose to commit to a more expensive provision than the identified best value option then a top-up payment will need to be arranged.

c) It is available

The preferred choice of provision must be available and, where DCC is commissioning the support, the provider agrees to deliver the care under DCCs usual terms and conditions.

5.4 Choice of home based or community based care provider

5.4.1 DCC intends that all regulated personal care will be commissioned via direct payments or through the personal care contract for regulated home based care.

5.4.2 Direct payments provide the opportunity for people to make their own care arrangements for their DCC funded care. DCC will inform a person about how they can do this including with their preferred care provider.

 5.4.3 A person can however refuse a direct payment and ask DCC to arrange their care. When a person does this they can still express a preferred choice of provider, and ask that DCC arranges care from them. This applies even if DCC does not currently contract with them (i.e. outside of the personal care contract for regulated home based care).

5.4.4 Receiving a preferred provider will require an exceptional circumstance to be identified and would be subject to the provider being available and willing to agree to DCCs usual terms and conditions. The principles of best value will apply whether a preferred provider is already under contract with DCC or not.

5.4.5 For unregulated care the person will be offered the provider or providers who are able to meet their needs in the most cost effective way.

Policy Details

Version	5.0
Strategic Owner	Keri Storey, Head of Integrated Adult Social Care Operations
Business Owner
Author	James Martin, Policy Manager
Date of Approval and Commencement	June 2017
Last review date	February 2023
Last reviewer	Becki Billing, Senior Policy Officer
Next review date	Quarter 4,  2024/25