Duties and powers of the local authority towards someone in Peter’ position, prior to Susan death
The local authority has a number of powers and duties to fulfil for someone with learning disabilities as in Peter’ case. Peter will trigger the duty to carry out a community care assessment under the NHS and Community Care Act 1990 because he will have an appearance of need. The Act states,
“where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such service” (Mandelstam, 2000 p28).
Therefore, consent will not be required in this situation, which will demonstrate one of the powers the local authority may possess. For instance, a simple pre-assessment question may be asked to find out if the person may require service (Mandelstam, 2000). An assessment is then a duty towards individual people imposed on local authorities. Therefore, it is the local authority that makes the final decision on people’ needs and service provision rather than any other person. Policy guidance states that agreement between all parties concerned may not always be possible (DH, 1990). So where conflict arise the care manager assessing the person has the final decision. Assessments should consider holistic needs and would cover issues such as personal care, psychological needs, medication, emotional needs, spiritual needs, cultural needs, personal hygiene, travelling and health and well being.
Another duty of the local authority will come under the Disabled Person’ (Services Consultation and representation) Act 1986. Here, the authority has a duty to decide what service the person may require, informing the person what is happening and what his or her rights are under the Act. (Mandelstam, 2000).
While making the assessment the local authority may need to weigh up three factors. namely the individual’ needs, the needs of other people and the resources available. The criteria of eligibility will then be looked at in terms of resources. The fair access criteria enables local authorities to then deliver services to those in greater need (DH, 2003). For instance, some local authorities may state that they will only offer services to those people who have substantial and critical needs but will not offer it to those with medium and low needs. Peter may fall under the substantial criteria as a person with moderate learning disabilities.
Care management then determines the process used to deliver care. These will be screening, level of assessment, eligibility criteria, eligibility for services, a care plan to meet the identified needs, castings, review (which will be a reassessment of the person’ needs and preferences) and a reappraisal of eligibility for assistance which may be increased, reduced or withdrawn due to the user’ changing needs and the local authority’ changing policies and eligibility criteria (DH, 1990).
Also, the local authority has duties and powers under the National Assistance Act 1948 in respect of welfare services for people who fall into the definition of disability. In the case of Peter the local authority has a duty to maintain registers of disabled people, provide a social work service, provide advice and support, provides facilities for the social rehabilitation and adjustment to disability. The 1948 Act also confers the local authority power to give instructions to people in overcoming the affects of their disability (Mandelstam, 2000).
Finally, under the codes of professional practise, social care workers and social workers have a duty of care to protect the rights and promote the interests of service users and their carers (GSCC, 2002).
Measures Brian might consider following initial visit in light of current policy and practise on income maintenance and protection of adults from abuse
In terms of investigations into financial abuse and income maintenance, it may be a complex situation to charge Liam with financial abuse. Baldwin (1985) identified the heavy cost of caring incurred by families and whether families claim all the benefits which they are entitled such as Disability Living Allowance (Roberts and Lawton, 1999). It is possible that Liam has no other wage coming in apart from Peter’ benefits, which suggests that the family are living on very small incomes. On the other hand, Liam has also shown a degree of inability to manage the household budget effectively. Bewley (1997) observed that since people with learning disabilities do not have direct control of their money as they may lack capacity as in Peter’ case, benefits claimed are seen as part of the family budget. In Peter’ case there has definitely been an inappropriate use of his benefits.
Current policy on protection of adults is contained in the documents No Secrets (DH, 2000), Protection of Vulnerable Adults and Safeguarding Adults policies. These national policies offer guidance around the protection of vulnerable adults from abuse, and the detection and management of investigations. The Protection of Vulnerable Adults (POVA) scheme, also came out of the Care Standards Act (2000). Where harm to vulnerable adults, such as Peter, is suspected, alleged or proved appropriate action should be taken (DH, 2004). There are issues around the fact that Peter’ benefits have been used by Liam to sustain both himself and his son. This raises issues regarding financial abuse, and more specifically the misappropriation of benefits.
There are also issues regarding neglect. Peter does not seem to be receiving the proper care in terms of feeding, personal hygiene and general health and well being which has made Peter irritable. The safeguarding alerting process has been adequate, with Peter’ manager at the resource centre raising the issue regarding the deterioration in Peter’ health and well being with regards his irritability, tearfulness personal hygiene and loss of weight. According to Safeguarding procedures this should have triggered the immediate separation of Peter from his father, while investigations proceed. Liam had been Peter’ appointee with regards drawing out Peter’ benefits. A strategy meeting should take place immediately, by social services after Brian’ initial assessment and fact gathering. The main purpose of this would be to set up a protection plan for Peter and make a decision as to whether Liam is capable of caring adequately for Peter. However, a new carer’ assessment should have taken place after the death of Susan who was Peter’ appointee. This might have enabled social services to support Liam and Peter differently after Susan’ death. It is unlikely this was done, otherwise new issues would have been brought to light, and the change in circumstances monitored, otherwise the community team should have identified the change in Peter’ condition before the resource centre manager notified them.
Theories and concepts used to understand Liam’ situation and behaviour. Suggest interventions to help Liam. What if any evidence base is there of effectiveness
In terms of social work values, more work needed to have been done to understand Liam’ situation and behaviour, which suggests that the care provision was not effective enough, particularly in light of social work code of professional practise in supporting the carer as mentioned above. The death of a family member would have made Liam (and perhaps Peter) anxious, frustrated, depressed, vulnerable and thereby needing support. Issues regarding poverty may also be addressed.
Liam is a carer and one of the intervention’ that will be important is to carry out a carer’ assessment. Under the Carer’ (recognition and services) Act 1995 local authorities have a duty to assess a carer. The assessment of the carer must determine the carer’ ability to provide care, which in this case Liam is unable to do so without support, especially as he is also an elderly carer. However, the Carer’ Act takes into consideration Liam’ needs under the Community Care Act and so is entitled to an assessment in his own right, as a person in need.
The purpose of the carer’ assessment is to discuss with the community team, the help needed with caring, and also to balance caring with other aspects of the person’ life, and maintain the carer’ health and well being. The carer’ assessment would have identified whether Liam was able and willing to take over the main carer’ role from Susan. From the assessment Liam would have been able to get further information regarding benefits and would receive support from a carer’ group (Directgov, 2009 [online]).
It appears Liam is himself in need of care particularly in light of alcohol misuse. The NHS Act 1977 states that local authorities have the power to make arrangements for the provision of services for people who are alcoholic. In this regard an intervention which would support Liam would be for the community team to refer Liam to the community drug and alcohol team, if Liam so wishes. However, this should be made compulsory if Liam wants to continue caring for Peter. The drug and alcohol team would provide specialist assessments of Liam’ condition, give advice, information, counselling, and access to rehabilitation and treatment services. There could also be liaison work with other community based services which run counselling and therapy programmes, motivational intervention programmes and after care support programmes (Richmond council, 2008).
Liam could have been able to receive support from a bereavement counsellor within the community team to help him through the loss of his wife, which led to over drinking and the deterioration of his psychological well being. Oswin (2000) states that despite all the positive changes in care services and support many are still not receiving the support they require following bereavement, and their emotional needs in particular is neglected (Arthur, 2003). Read (2005) lays down a continuum of support needed for a bereaved person. First, the opportunities to explore loss, death, change and grief as part of an education, participating in developing a healthy response to grief, creatively communicating and exploring the facts surrounding death, knowing when to refer on and therapeutic interventions involving assessment, counselling and psychotherapy. This continuum should have taken place for not just Liam but Peter as well, before during and after the death of Susan which would have helped father and son appreciate the emotional and psychological complexities of death. This would have helped Liam in developing effective coping strategies and may have ultimately reduced the further need of more therapeutic interventions.
Liam will also need home help to support with domestic duties. The issue of home help is described in the NHS Act 1977 which states that local authorities have a duty to provide or arrange for the provision of home help.
Approach taken with Peter to reach an understanding of his situation, identifying the main problems and develop some options to address them. How issues of capacity, choice and risk management feature in each alternative
An option is to ensure that the principles of valuing people with learning disabilities are one that will be enjoyed by Peter. These principles are choice, rights, independence and inclusion (DH, 2001). The issue regarding choice appear more in national policies and guidance rather than in legislation. DH (1990) states that genuine choice and the participation of users and carers in the assessment process should take place.
Another option I would need to address issues relating to home care, carer’ ability to support or coordinate support for Peter. While legislation does not state that it is preferable for people to remain in their own homes rather than in residential placements, policy guidelines states that the preferred aim for community care is support for the person in their own home. This will also depend on people’ choices and the resources available to support a person in their own home taking into consideration that Liam also need support. The local authority has the power to opt for residential care if it is cheaper, regardless of the person’ preferences according to the Lancashire case. (Mandelstam, 2000).
Care professionals must promote the independence of service users while protecting them as far as possible from danger or harm (GSCC, 2002). Risk assessment is essential to providing a safe and fulfilled life for disabled people. Identification of risks will be essential in developing Peter’ plans. For people with learning disabilities these will include care plans (by the care manager), person centred plans and Health Action Plans (Titterton, 2005). Peter will be at risk where he may not have the communication and intellectual skills to articulate his concerns to health and social care services and staff, and would require the support of professionals to help him. It is therefore important for these professionals to develop the skill, ability and expertise to support someone in Peter’ position. Research has shown that people with learning disabilities are exposed to a number of risks relating to lifestyle choices. One of such studies was carried out by Robertson et al (2000). They looked at a group of 500 learning disabled people in a variety of accommodation and discovered unsuitable choices leading to obesity, poor nutrition and low levels of physical activity compared to the general population. The issue of people with learning disabilities making informed choices become important, and trained professionals are on hand to support people like Peter with education, information and training.
Gates (2006) states that risk management should be supportive rather than a hindrance to the provision of good quality services. Consequently, completion of risk assessments assists in identifying risks towards Peter and others. Risk management should therefore minimise the risk to the individual and others but also strike a balance between safety and quality of life. (Douglas, 1992). Risk Management and assessments still need to be as person centred as possible, involving the person in all aspects, and also involving significant others (Langan, 2004). A Person centred approach to risk assessments will still enable Peter to make his own decisions and choices regarding his life.
It is important to tackle the issue of adult protection with that of person centred risk planning because disabled people will be more at risk of abuse while being enabled to take more risks and mange their own affairs a lot more than ever before. This is the intention of the new DH (2007) Valuing people Now document.
While their is a potential problem between professional conflict and law with the promotion of choice for individual clients in practise, “the answer to the dilemma lies in the whole process of assessment, care planning and evaluation of risks” (Gates, 2006, p117). All stages of the risk process have to be clearly documented communicated and justifiable. Peter may lack the capacity to understand fully some decisions that may need to be made in everyday life.
The law (the Mental Capacity Act 2005) is clear that adults with learning disabilities who has the capacity to consent can and do make decisions even though these may not always fit with what others think is safe or right.
Working together in a multi disciplinary fashion should produce a reliable and effective assessment of risk (Winchcombe, 2001). Peter needs support to identify what he needs to manage his life safely and independently, which involves considering risks; otherwise we may be denying him the right to take responsibility and control in this aspect of his life.
Arthur, A (2003) The Emotional Life of People with Learning Disabilities. British Journal of Learning Disabilities 31:1, 25-30.
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