5 Assessing and meeting needs, and
payments
How to meet needs: Clause 8
166. The
nearest the draft Bill gets to an explanation of what is meant
by care and support is clause 8(1), which gives five examples
of what may be provided by a local authority to meet the needs
of an adult needing care and support, or a carer needing support:
a) accommodation
in a care home or in premises of some other type;
b) care
and support at home or in the community;
c) counselling,
advocacy and other types of social work;
d) goods
and facilities;
e) information
and advice.
167. This
list is a radical departure from existing social care legislation
since it is illustrative rather than exhaustive; the care and
support can be provided to either the carer or the adult needing
care; and support provided under this clause is subject to charging
(a point we consider further below).
168. We
put to the Department of Health that holidays, travel, assistance
to take advantage of educational facilities, and home adaptations,
are all specifically mentioned in the current legislation.[130]
The Department's note of 30 January 2013 makes clear that the
list is illustrative only, and that all of these are intended
to be covered by clause 8. We have been urged to recommend additions
to the list, in particular transport,[131]
employment support services[132]
and equipment.[133]
We do not think this approach is likely to succeed. So long
as the list is short, it is clear that it is illustrative only.
The longer it is, the more likely it is to be interpreted as not
including matters unconnected to those in the list, as indeed
are many of those mentioned by the Law Commission.
169. The
explanatory notes to the draft Bill on the one hand state that
the list is intended to give some general examples, but then go
on to say: "The examples provided are intended to be wide
enough to cover all specific services which may be provided".
This is confusing.
170. The
Department of Health should take the opportunity to review and
revise the explanatory note for clause 8 and subsequent guidance
to make clear that the list is not intended to limit the ways
in which a local authority might meet any eligible needs or agreed
outcomes, removing any possible ambiguity on that point.
Assessing needs: Clauses 9-12
171. The
Law Commission took the approach of putting assessments at the
centre of the legal framework for adult social care,[134]
suggesting that the focus of assessments should "not be on
rating a person's needs but rather how to assist the individual
to achieve well-being within their own resources".[135]
This approach has not been followed in the drafting of the
clauses that cover a person's journey through the formal care
and support system.
172. Some
of our witnesses felt that the draft Bill had not fully captured
the Law Commission's intention that well-being should become the
organising principle around which adult social care is built.
In their written evidence to the Committee Shared Lives Plus described
people's first contact with the care and support system as "often
stigmatising, confusing and requires people to prove their vulnerability
and dependence." They echo the Law Commission's ambition
that the process of assessment should explore "resilience,
coping skills and potential informal support networks". This
leads them to recommend reframing the entitlement to a needs assessment
as an entitlement to access to planning support. The Government
in their White Paper talk about adopting "asset based approaches"
that consider the strengths that people and communities have to
meet and manage their needs.
173. In
their written evidence to us the Joseph Rowntree Foundation applaud
the Government for adopting well-being but go on to say: "At
some points, old-fashioned and narrow language creeps back in".
We agree that the Bill fails fully to follow the logic of adopting
well-being as the overarching principle, and defaults to a more
traditional model of needs assessment. The Department should
amend the draft Bill to support people planning to achieve well-being
within their own resources. The aim should be to frame assessment
as a discussion about the additional support people may need to
maintain or achieve well-being.
174. Clause
9 consolidates, in large measure, the assessment duty currently
found in section 47 of the National Health Service and Community
Care Act 1990. Section 47(3) provides that if it appears
to a local authority when undertaking an assessment that the person
being assessed has a health or housing need, then it is obliged
to bring this need to the attention of the relevant health or
housing authority, invite them to assist in the assessment, and
take into account any services likely to be made available by
that authority. However it appears that the obligations in section
47(3) have not been transposed into the draft Bill.
175. We
put this point to the Department of Health, who replied: "It
is our intention that the duty on local authorities to co-operate
generally and in specific cases will ensure that they work with
partners such as the NHS and housing authorities. The draft Bill
also promotes integration between local authorities and the NHS.
These provisions will underpin existing practice where local authorities
already contact the NHS or housing authority if they believe a
person has health or housing needs. We would welcome the Committee's
views on this approach." While we welcome the intention,
we believe that a specific provision on the lines of section 47(3)
of the 1990 Act would be more appropriate.
176. The
draft Bill should be amended to provide that if it appears to
a local authority, when undertaking a needs assessment under clause
9 or a carer's assessment under clause 10, that the person being
assessed has a health or housing need or other relevant need,
it should be obliged to bring this need to the attention of the
relevant authority.
177. Clause
10 for the first time imposes on local authorities a requirement
to assess, not just the adult's needs for care and support, but
also the carer's needs for support. This development was described
by Dr Moira Fraser, Director of Policy and Research, Carers Trust,
as "a huge step forward".[136]
We agree. We welcome the fact that for the first time
local authorities will be required to assess whether a carer has,
or is likely to have in the future, needs for support.
178. A
consortium of organisations with an interest in mental health[137]
suggested that where the person having a care and support needs
assessment lacks capacity, the draft Bill currently contains no
requirement to consider the involvement of "those concerned
for the person's care and well-being", as would be expected
under the Mental Capacity Act 2005. They said: "The Bill
should explicitly state that these interested parties should be
involved in the needs assessment process where it relates to an
individual who lacks capacity." We agree.
179. Clause
9(5) lists those who must if possible be consulted by a local
authority carrying out a needs assessment. In the case of a person
lacking capacity, this should include those concerned for the
person's care and well-being in accordance with section 4(7)(b)
of the Mental Capacity Act 2005.
180. A
number of our witnesses had concerns about assessments for those
who were terminally ill. Marie Curie Cancer Care sent us a short
submission confined to the issue of whether a statutory duty on
local authorities to fast-track people with a terminal illness
through assessment of care needs and financial resources could
be included in the draft Bill. They quoted the Palliative Care
Funding Review: "At this time [the end of life], the last
thing individuals and families should be facing are arguments
over funding of the care they need and delays in the provision
of care due to complex systems and procedures". At present,
people who are terminally ill with less than six months to live
can receive instant access to the highest level of welfare benefit
through a DS1500 form, which is issued by the patient's diagnosing
physician, and Marie Curie Cancer Care suggested that "a
completed DS1500 could also be used to trigger a fast-track through
assessment of care needs and financial resources for terminally
ill people." Help the Hospices also made this point.
181. While
a system based on form DS1500 was thus favoured by a number of
our witnesses, we were told by the Motor Neurone Disease (MND)
Association that this proposal "might not work for people
with MND". The Association suggest that end of life care
locality registers or the Electronic Palliative Care Coordination
System (EPaCCS) would be better. However they acknowledge that
EPaCCS is not used universally.[138]
On balance we believe that there is a benefit to be gained from
fast-tracking people through the care and support system. We think
that there should be a statutory duty on local authorities to
fast-track assessments for terminally ill people, other than those
for whom the NHS has continuing healthcare responsibilities. Clause
12(1), which lists the matters relating to needs or carer's assessments
for which regulations must make further provision, should include
provision for fast-tracking needs assessments for terminally ill
people.
182. It
is not clear to us whether the reference in subsection (1)(a)
to the "needs of the family" gives sufficient prominence
to the need to prevent any children from undertaking inappropriate
caring responsibilities. We must ensure that, when carrying out
needs assessments under clause 9, local authorities have regard
to the needs of any children who may provide or be about to provide
care for an adult. Clause 12(1) should be amended to make clear
that local authorities, when carrying out a needs or carer's assessment,
must have regard to the need to prevent any children from undertaking
inappropriate caring responsibilities.
183. Some
witnesses did not believe that local authorities should have the
power to combine the needs assessments of an adult needing care
with their carer's needs assessment. Self Direct thought "this
would have the potential in some instances for the person who
needs support to lose their individual identity and to lose control
of the support they need". But other witnesses, particularly
carers' organisations, welcomed the power to combine the assessments.
Dame Philippa Russell, the Chair of the Standing Commission on
Carers, said: "I warmly welcome the wholefamily assessment.
It will help us resolve some of the issues that have arisen around
young carers, parent carers and, also, the quite natural disagreements
or differences of opinion that can arise between the person needing
care and support and the carer."[139]
184. We
support the possibility of combining a needs and carer's assessment
under clause 12(3), particularly to underpin whole-family assessment,
and we believe that the requirement for agreement of the adult
needing care and of the carer provide sufficient protection for
the adult.
Eligibility: Clause 13
185. In
their written evidence Scope told us that eligibility is "the
most critical aspect to the whole Bill since it determines who
will and will not get vital support, both to carry out essential
day-to-day tasks like washing, dressing and eating, and to work,
study and contribute to the local community." Quite simply,
the eligibility threshold determines whether a person is able
to seek state-funded support or have a care account to meter their
care costs up to the cap.
186. Marc
Bush, the Head of Research and Public Policy at Scope, told us
that "the recent modelling that the PSSRU[140]
has done has shown that, if we take moderate level needs, there
are 36,000 people within the system of working age who, if the
reforms go through as they are currently set, would fall out of
the care system. There are 69,000 workingage disabled adults
in England who have already fallen out of the care system because
of the changes to eligibility
"[141]
He thought that "if you do not meet need early, people's
needs escalate and the costs escalate. We know that there is a
direct correlation between councils having to ration their resources
and therefore heighten the eligibility so that it is further towards
substantial and critical, and that having a direct effect on the
escalation of need."[142]
187. Sue
Brown, the Head of Public Policy at Sense, said: "The Care
and Support Alliance, and pretty much the entire sector, would
like to see a threshold that is probably roughly equivalent to
the current moderate band. The important thing to remember is
"moderate" means moderate; "moderate" does
not mean low. If you have a need that is moderate and is not being
met, that is having a significant impact on your life."[143]
Alex Fox saw the draft Bill as "an opportunity to describe
more clearly what an acceptable level of well-being is, and to
base eligibility on whether or not the impact of a longterm
condition or impairment takes somebody below that level of well-being
"[144]
188. Clause
13(1) of the draft Bill reads: "(1) Where a local authority
is satisfied on the basis of a needs or carer's assessment that
an adult has needs for care and support or a carer has needs for
support, it must (a) determine whether any of the needs meet the
eligibility criteria, and (b) if any of them do, consider what
could be done to meet those that do." This does not of course
say anything about what the eligibility criteria should be. The
clause is currently drafted to require the Secretary of State
to make regulations about the local authorities' exercise of that
duty, but gives him a very broad exercise of his discretion. We
have already recommended[145]
that, in making regulations, the Secretary of State should have
regard to the duty of local authorities to promote individual
well-being. We recommend that clause 13(2) should be amended to
make it a specific requirement for the Secretary of State, when
making regulations concerning eligibility, to have regard to this
duty. We are glad to note that these regulations will be subject
to affirmative resolution.[146]
THE NATIONAL MINIMUM ELIGIBILITY THRESHOLD
189. There
is nothing in clause 13, or in the notes to it, to suggest that
the regulations will be used to introduce a new national minimum
threshold; on the contrary, the regulations can provide that the
levels of need are to be set either by individual local authorities
for their areas, or by reference to levels of need specified in
the regulations. However in the White Paper the Government made
the following commitment: "From 2015 we will introduce a
national minimum eligibility threshold. Once implemented, local
authorities will be free to set their eligibility threshold at
a more generous level, but will not be able to tighten beyond
the new national minimum threshold".[147]
Such a threshold is desirable in any event; without it,
implementation of the Dilnot recommendations would not be possible.
190. In
reply to a question whether it was the Government's intention,
having regard to resources, to have a national threshold as the
minimum people could expect across the country, the Secretary
of State replied unequivocally "Yes"; though he was,
understandably, not prepared to commit himself to what that threshold
would be.[148] The
Dilnot Commission recommended that, as a minimum, it should be
"substantial" under the FACS system,[149]
but the evidence we have quoted above shows that many of those
most closely involved believe this would be too high a threshold.
191. We
are glad that the Secretary of State confirmed the Government's
intention to set a national minimum eligibility threshold. The
Government should put this beyond doubt by redrafting clause 13
to make this policy explicit. We also suggest that the Government
should consider whether the regulation-making power in clause
13 provides an opportunity to establish criteria that would clarify
the boundary between eligibility for local authority funded care
and support and NHS funded continuing care.
Charging: Clause 14
192. When
meeting an adult's needs for care and support under clauses 17-18,
or a carer's needs for support under clause 19, local authorities
are given by clause 14 a power to impose charges. Sue Bott expressed
her concern: "We have seen charges go up enormously over
the last few years. Inflation does not enter into it. We have
seen a situation of hyper-inflation with regard to the setting
of charges".[150]
193. At
present primary legislation stipulates (in relation to non-residential
services) that a local authority cannot charge for a service more
than it appears to them to be "reasonably practicable"
for the person to pay.[151]
This statutory protection is not present in clause 14.
We put this to the Department of Health. They replied that what
it was "reasonable" to charge was never defined, but
said that in future, to ensure that charges for care and support
are reasonable, regulations must specify an amount below which
an adult's income must not fall after charges have been deducted.[152]
We note however that the courts and the Local Government
Ombudsman have found the requirement in primary legislation of
"reasonableness" to be of value in cases concerning
the level of such charges.[153]
194. As
we have explained in paragraph 166, support under clause 8 can
include not just care and support as this is usually understood,
but information, advice, advocacy, and other matters. The Department
told us that they did not intend to require local authorities
to charge for types of support which had previously been provided
free. Local authorities would retain a discretion to charge or
not to charge for a wide range of types of care support, but would
not be able to impose charges for any types specified in regulations
under clause 14(4). These regulations would require that types
of support which are currently provided freefor example,
equipment and minor adaptationsshould continue to be provided
without charge. It was not clear to us whether local authorities
would be able to charge for needs assessments. They are currently
not able to, and the Department of Health assured us that the
draft Bill would not change this.[154]
They undertook to consider whether more could be done to make
this clear on the face of the draft Bill.
195. Our
final concern was that there was now the potential for carers
to be charged for a wide range of local authority interventions.
At present most local authorities do not charge carers for carers'
services. We wondered whether it was the intention that carers
should now be charged for support that gave them respite from
their unpaid caring roles. The Department explained that although
local authorities do at present have a power to charge carers
for the support they receive, most do not charge for most types
of support, reflecting the critical contribution which carers
make to the well-being of those they care for. The draft Bill
did not set out to change this position. It consolidated the existing
discretion to charge, but did not presume or intend that charging
for carers' support would become usual practice. The Department
added: "In particular, the draft Bill makes clear that meeting
a carer's needs may involve providing a service direct to the
person they care for, rather than direct to the carer (for instance,
replacement care, in order to allow the carer to have a break).
In these cases, the local authority must assess the resources
of the person cared for, on the principle that the person directly
receiving the service would pay any chargeeven if provided
in order to meet the carer's needs. The person to whom the service
is provided must agreeand where this is not the case, the
draft Bill requires the local authority to consider alternative
arrangements."
196. We
remain concerned that the combination of a general discretionary
power and an open ended regulation making power could have unintended
consequences and lead to charging creeping into more areas. The
Department of Health's reassurances are welcome, but we believe
that for the avoidance of doubt it should be made clear in
clause 14 that where charges are imposed they should be limited
to what it is "reasonably practicable" for the person
to pay. Clause 14 should also be amended to make clear that local
authorities cannot simply charge the carer for services provided
to the person cared for.
Deferred payments: Clause 16
197. A
deferred payment agreement between an adult needing care and the
local authority providing the care allows the adult to defer payment,
the payment being secured on the adult's home. It is thus potentially
a complex agreement, and is likely to be seen as such by adults
in a vulnerable position. They should not enter into such an agreement
without financial advice. Just Retirement, a specialist provider
of financial services for people in retirement, argued in their
written evidence: "For the same authority which has a duty
of care to a vulnerable adult to be providing financial advice
and information about a financial product which it is offering
(in the form of an interest-bearing loan secured against the individual's
home) to pay for care services represents a potential conflict
of interest. This conflict is exacerbated if the care for which
the loan is made is directly provided by the LA and the level
of charges are also determined by the LA." A similar argument
was put forward by the Society of Later Life Advisers (SOLLA).
198. Our
recommendation[155]
that clause 2(2) should be amended to ensure that the adult is
informed of the importance of independent financial advice from
an adviser regulated by the Financial Services Authority, and
is advised how to obtain it, is of particular importance in the
case of deferred payment agreements.
CHARGING INTEREST
199. Care
and Repair England highlighted a general concern about proposals
to add to the deferred payment interest, plus administrative charges,
plus interest on those charges, thereby resulting in what they
called a 'snowballing' level of debt accruing on the value of
the home owned by the adult needing care. We think it reasonable
that interest at a rate governed by regulations under clause 16(4)
should be charged on the amount of the adult's payment which is
deferred, since this otherwise becomes an interest-free loan.
We also think it right that a charge should be imposed to cover
the local authority's administrative costs (limited to what is
allowed by regulations under clause 16(6)(a)). But we think it
excessive that the adult should pay interest on administrative
costs, some of which may have been incurred many years previously.
We recommend that clause 16(4)(c) should be deleted.
Self-funders: Clause 17
200. Clause
17(3) entitles self-funding adults who have the requisite mental
capacity to require their local authority to meet their needs
(subject to paying for this). Given that a substantial proportion
of adults with care and support needs are currently self-funding,
the extension of local authority responsibility to such persons
is likely to have significant resource implications. The likelihood
of such persons seeking local authority involvement will be increased
as a result to the Government's plans to implement the Dilnot
proposalsfor the reasons we outline in Chapter 2.
201. In
contrast to clause 17(3) (which concerns the rights of self-funding
adults who have the requisite mental capacity), clause 17(4) creates
a substantial additional hurdle for a self-funder who lacks the
requisite mental capacity. Such a person would not in general
have the right to require their local authority to meet their
needs (subject to paying for this) if they had (for example) a
Lasting Power of Attorney (LPA)even if the attorney is
unwilling or unable to make the care arrangements. Even if there
is no attorney or equivalent, the clause 17(4) duty would not
arise if the local authority decided that someone (for example
a family "carer") was "in a position" to provide
support on the person's behalf. We consider that it is wrong in
principle to place a person with impaired mental capacity in such
a disadvantaged position, and we put our concern to the Department
of Health. In a note of 30 January the Department responded, stating
that it "takes on board these comments, and will consider
whether any changes are necessary. It is not the Government's
intention to create a disparity." We welcome this undertaking
to look again at the drafting of this clause.
Personal budgets and resource
allocation systems
202. Beyond
the question of reasonable cost we did not receive much evidence
during our inquiry on the introduction of a statutory footing
for personal budgets. In Chapter 2 we discussed the implications
of introducing a capped cost scheme and the use of notional costs
to meter a person's progress towards the cap. We anticipate that
resource allocation systems (RAS) will be used to determine what
the notional cost should be, and recommend that these arrangements
should be governed by regulations made under the new statute.
However, this still leaves the question of those in receipt of
local authority support and what role, if any, RAS should play.
203. In
response to our web forum a number of people raised concerns about
how eligible needs are met. One said: "After an assessment
is done [it is] referred to a panel who have no knowledge of the
persons involved and report back on their findings. This is where
finance rules supreme and goal posts are moved to make it easier
for the panel to refuse to give more care help. There should be
national standards to adhere to as the duty of care is the thing
that is lost in the decision making."
204. The
draft Bill confirms the pre-eminence of the duty to meet eligible
needs, and clause 25(1)(a) requires the local authority to record
in the personal budget the amount it assesses as the cost of meeting
those needs. It is how those costs might be calculated that is
left unclear. That is where RAS comes in. We note that some of
the proponents of RAS have begun to question the secretive way
in which they are developed and applied and expressed concern
about their growing complexity[156].
As we say in Chapter 2, some of these issues were raised during
the Law Commission's work; however the Department in its summary
of the responses to the draft Bill[157]
report only welcome for personal budgets and make no reference
to how the costs are calculated. We therefore recommend that the
Government should review the efficacy of RAS and ensure that the
code of practice or guidance makes clear that the development
and application of any methodology for calculating the cost of
meeting eligible needs is transparent, has regard for the well-being
principle, and is subject to the duty to meet eligible needs.
Additional cost under Clause
27
205. Clause
27 deals with the additional chargethe "top-up"which
a local authority may levy for providing an adult's preferred
accommodation where the cost exceeds the amount of the person's
personal budget. The cost may be paid by a third party, usually
the family"third party top-ups". As with deferred
payment agreements, some of our witnesses had concerns about the
need for and availability of independent financial advice. Independent
Age said: "[We] received over 200 calls to our Advice Service
in the past year on this subject. It is vital that the new legislation
ensures that families only agree to pay a third party top-up when
they have made a genuine choice to pay for more expensive accommodation.
We believe that the draft Bill must ensure that the rights of
these individuals and their families are protected more effectively
than at present." [158]
206. Independent
financial advice from an adviser regulated by the Financial Services
Authority is as important in the case of additional cost under
clause 27 as it is in the case of deferred payments.
207. We
are not satisfied that clause 27, as currently drafted, provides
sufficient protection from improper practices of the type highlighted
by Independent Age (among others). The amount of a person's
personal budget is specified by clause 25(1)(a) as "the amount
that the local authority assesses as the cost of meeting those
of the adult's needs which it is required or decides to meet
".
We were concerned that the wording of clause 25(1)(a) might enable
a local authority to come up with a relatively arbitrary figure
(produced, for example by a computerised resource allocation system)
and then require a top-up for all care costs above this figure.
Such a figure, being an amount assessed by the local authority,
would appear to satisfy the requirements of the clause. We were
in particular concerned that this clause differs from the current
requirement (in relation to direct payments) that the amount be
that which the "the authority estimate to be equivalent to
the reasonable cost of securing the provision of the service concerned",[159]
the difference being the absence of the word "reasonable"
which has been considered of importance by the courts when considering
amounts generated by resource allocation systems.[160]
We put our concerns to the Department of Health. In response they
advised us that the "personal budget represents the amount
which the local authority assesses as the cost of meeting the
adult's needs. It is therefore an amount which is sufficient to
meet those needs." We do not find this response reassuring.
Clause 25 contains neither the word "reasonable" (which
appears in the current legislation) nor the word "sufficient".
We believe that this omission creates an opportunity for the current
malpractice in relation to top-ups to continue under the new legal
regime.
208. Clause
25(1)(a) should be amended to make clear that the amount of a
personal budget should be equivalent to the reasonable cost of
securing the provision of the service concerned in that local
area.
Direct payments: Clauses 28-30
209. Direct
payments to persons in need, allowing them to have more control
over the services they buy and the priorities they accord to them,
are likely to become a much bigger feature of social care in the
future. We welcome the opportunity taken in the draft Bill to
clarify important aspects of the policy, and to ensure that the
expansion is in the right direction.
210. The
Standing Commission on Carers was one of several witnesses who
sought clarification on whether the person receiving a direct
payment will be able to use it as the equivalent of a personal
budget either for "whole family" purposes or to compensate
another family member for loss of earnings. They told us that
this was commonplace in some European countries. Shared Lives
Plus[161] argued that
there should be a presumption that individuals can spend their
direct payments how they like to achieve the desired outcomes.
We agree that the purposes for which direct payments can be
used should be clarified, and the presumption should be that individuals
can spend their direct payments as they like to achieve the agreed
outcomes. We would prefer to see this in the draft Bill itself.
If it has to be included in regulations under clause 30, they
should be subject to affirmative resolution.
211. Since
the introduction of direct payments there has been a requirement
that they are spent on services provided in the independent sector.
Whatever the reasons for this policy we question whether it is
consistent with the well-being principle established in the draft
Bill. People in receipt of a direct payment should be in control
and able to exercise choice. With the draft Bill introducing a
duty on local authorities to promote diversity and quality in
the provision of services there is no longer a need to restrict
how direct payments may be used. The Department of Health should
lift the ban on direct payments being used to pay for local authority
direct services if the individual so chooses.
212. Direct
payments are another area where independent financial advice will
be essential both when the payments are first arranged, and subsequently.
130 Chronically Sick and Disabled Persons Act 1970,
section 2. Back
131
Society of Later Life Advisers (SOLLA), written evidence. Back
132
National Autistic Society, written evidence, paragraph 35. Back
133
College of Occupational Therapists, written evidence, paragraphs
13-15. Back
134
Report, paragraph 5.3. Back
135
Report, paragraph 5.6. Back
136
Q 153. Back
137
Mind, Rethink Mental Illness, the Mental Health Foundation, the
Centre for Mental Health and the Royal College of Psychiatrists. Back
138
Letter from the Motor Neurone Disease Association to the Chairman
of 6 March 2013. Back
139
Q 152. Back
140
The London School of Economics Personal Social Services Research
Unit. Back
141
Q 185. Back
142
Q 178. Back
143
Q 209. Back
144
Q 187. Back
145
Paragraph 83. Back
146
Clause 79(4)(a). Back
147
Caring for our future: reforming care and support, Cm 8378, page
32. Back
148
Q 326. Back
149
The definitions of 'low', 'moderate', 'substantial' and 'critical'
needs are set out in Department of Health Guidance at www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113154 Back
150
Q 210. Back
151
Section 17 of the Health and Social Services and Social Security
Adjudications Act 1983. Back
152
Note of 30 January 2013. Back
153
R v. Calderdale DC ex parte Houghton (1999) 2 CCLR 119,
and complaints 99/C/02509 and 02624 against Gateshead, 28 February
2001. Back
154
Supplementary evidence of 15 February 2013. Back
155
Paragraph 91. Back
156
An Apology, Simon Duffy, http://www.centreforwelfarereform.org/library/authors/simon-duffy/an-apology.html Back
157
https://www.wp.dh.gov.uk/publications/files/2012/12/Summary-of-consultation-responses-CS-Bill.pdf Back
158
Written evidence, paragraph 7. Back
159
Section 57(4)(a) of the Health and ?Social ?Care ?Act ?2001, and
Regulation 9(3)(a) of the Community Care, Services for Carers
and Children's Services (Direct Payments) (England) Regulations
2009, SI 2009/1887. Back
160
"Reasonableness" was central to the judgment of the
Supreme Court in R (KM) v. Cambridgeshire County Council
[2012] UKSC 23 - eg paragraphs 9, 21, 38 and 40 - and see also
R (Savva) v Royal Borough of Kensington and Chelsea [2010]
EWCA Civ 1209. Back
161
Written evidence, paragraph 7. Back
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