Assessment for care and support in England

7. Getting support

Once an assessment has been carried out, the next step is to organise the care and support.

Care and support plans

The outcome of both a care needs assessment and a carer's assessment is a care and support plan. This states the care and support needs, and also outlines how these needs can be met. For example, it may show that a person with dementia needs prompting and support at mealtimes, and therefore that a care worker should visit the person in their home to help them at mealtimes, or that the person with dementia might wish for this support at a local day centre.

A carer's care and support plan may be slightly different, as it may state things needed specifically for the carer, for example manual handling and lifting training or help with having a break. A carer's assessment may also lead to changes in the care plan of the person they care for, as sometimes a carer's need is best met by providing services to the person they care for. An example would be respite (replacement) care, such as a sitting service, which allows the carer to have a break. Although it is there to help the carer, it is actually provided to the person with dementia and therefore forms part of their care plan.

If someone is eligible to have their care needs met by the local authority, their care plan will also mention their 'personal budget', and how much they have been allocated to spend on meeting their needs. For more information see 'Personal budgets and direct payments' below.

How care and support are arranged

The main ways that care and support, including items and equipment, can be arranged are as follows:

  • The local authority provides the support directly.
  • The local authority arranges for a care provider, such as a home care agency to deliver the care.
  • The local authority makes a direct payment to the person or their carer to purchase their own care and support.
  • There may be a combination of the above.

In the past, local authorities would simply have arranged services for people who were eligible. This is still possible, but nowadays they encourage people to choose and organise their own care through a personal budget. For more information see 'Personal budgets and direct payments' below.

The local authority must provide a person with information about where to get care and support locally. This information is available for anyone, regardless of whether they are funding their own care or not and can include advice from an occupational therapist. Local care agencies and charities may also be able to provide this information. Some of these pay for a brokerage scheme to help people find the support they want (see section on brokerage below). The Care Quality Commission lists all registered domiciliary (home) care agencies (see 'Other useful organisations' below).

Some services, such as community nursing, are arranged through the GP, either directly or after discussion with social services.

Personal budgets and direct payments

A personal budget is the amount that the local authority calculates as being necessary to meet someone's needs. A financial assessment will be carried out to decide how much the person will contribute to their personal budget themselves.

The person or their carer may choose to be given a 'direct payment' from the local authority so they can arrange services themselves. Direct payments offer more choice and flexibility when choosing services to meet care needs. Managing them can sometimes be complicated, so the local authority must be satisfied that the person is willing and able to manage a direct payment, either alone or with assistance. If necessary, the local authority must help the person managing the direct payment to find local support services. These support services may come from voluntary or charitable organisations. For people with dementia, a family carer can be the person who manages the direct payment - this option offers the same choice and flexibility.

A personal budget might also be managed through an Individual Service Fund, a user-controlled trust or a suitable person. 

Brokerage service

In some parts of the country, people with dementia and their carers may be able to seek assistance from organisations that provide an independent 'brokerage service'. These services help people to take part in and understand the care planning process, and can also get involved in various aspects of this process, including the writing of the care plan and considering what is available.