Adult Social Care
Care and support for adults who need extra help to manage their lives and be independent – including older people, people with a disability or long-term illness, people with mental health problems, and carers. Adult social care includes assessment of people’s needs, provision of services or allocation of funds to enable you to purchase your own care and support. It includes residential care, home care, personal assistants, day services, the provision of aids and adaptations and personal budgets.
Abuse is a violation of an individual’s human and civil rights by any other person or persons and may be:
- a single act or repeated acts
- an act of neglect or failure to act
- multiple acts – for example an adult may be neglected and also being financially abused
Supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need.
Adult at risk
An adult at risk is a person over the age of 18 who needs community care services because of mental health issues or other disability, age or illness and who is, or may be, unable to take care of themselves, when faced with significant harm or exploitation. The term replaces ‘vulnerable adult’.
An alerting manager is the person within an organisation, care or support setting designated to make safeguarding adult referrals.
Approved Mental Health Professional (AMHP)
A professional with specialist training who can be called on to arrange for a person to have their mental health assessed. They can decide whether they should be admitted to hospital for their own safety or the safety of others. The approved professional’s main job may be as a social worker, occupational therapist, community mental health nurse or psychologist.
The Care Act 2014 sets out local authorities’ duties in relation to assessing people’s needs and their eligibility for publicly funded care and support.
Under the Care Act 2014, local authorities must:
- carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care
- focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve
- involve the person in the assessment and, where appropriate, their carer or someone else they nominate
- provide access to an independent advocate to support the person’s involvement in the assessment if required
- consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)
- use the new national minimum threshold to judge eligibility for publicly funded care and support.
The assessment and eligibility process is one of the most important elements of the care and support system. The assessment is one of the key interactions between a local authority and an individual, whether an adult needing care or a carer. The process must be person-centred throughout, involving the person and supporting them to have choice and control.
The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. The outcome of the assessment is to provide a full picture of the individual’s needs so that a local authority can provide an appropriate response at the right time to meet the level of the person’s needs.
Housing for older or disabled people, usually privately owned, where you have your own apartment within a larger development, and support (such as help with meals or laundry) is provided to meet your own particular needs.
Best Interests Assessor
An independent person who looks at whether someone who lacks capacity and is in hospital or a care home is there for the right reasons, and whether it is in their best interests to stay there
Best interests decisions
The term ‘best interests’ is not defined in the Mental Capacity Act 2005 but is broadly taken to mean the decision a person would have made for themselves if they had the capacity to do so, respecting their autonomy and individuality as far as is compatible with ensuring their safety, but is case and situation specific and cannot be generalised
Someone who lacks capacity cannot do one or more of the following things:
- understand information given to them
- retain that information long enough to be able to make a decision
- weigh up the information available and understand the consequences of the decision
- communicate their decision – this could be by any possible means such as talking, using sign language, or even simple muscle movements like blinking an eye or squeezing a hand
Care Act 2014
A law passed in England in 2014 that sets out what care and support you are entitled to and what local councils have to do. According to the law, councils have to consider your wellbeing, assess your needs and help you get independent financial advice on paying for care and support
The range of services offered to you as an individual by your council, following an assessment of your needs. It may include day services, aids and adaptations for your home and personal care
A plan for the care of someone who has a particular health condition and will move between services. It sets out in a single document what is expected to happen when, and who is responsible. It is based on evidence about what works best to treat and manage your particular condition
A written plan after you have had an assessment, setting out what your care and support needs are, how they will be met (including what you or anyone who cares for you will do) and what services you will receive. You should have the opportunity to be fully involved in the plan and to say what your own priorities are. If you are in a care home or attend a day service, the plan for your daily care may also be called a care plan
A person who is paid to support someone who is ill, struggling or disabled and could not manage without this help
A person who provides unpaid support to a partner, family member, friend or neighbour who is ill, struggling or disabled and could not manage without this help. This is distinct from a care worker, who is paid to support people
If you are an unpaid carer for a family member or friend, you have the right to discuss with your local council what your own needs are, separate to the needs of the person you care for. You can discuss anything that you think would help you with your own health or with managing other aspects of your life. The council uses this information to decide what help it can offer you.
Care Quality Commission (CQC)
The independent regulator of health and social care in England. It ensures health and social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve. It monitors, inspects and regulates services to make sure they meet fundamental standards of quality and safety. It publishes its findings, including performance ratings to help people choose care.
A meeting that is usually held when you are believed to be at risk of harm or abuse. The purpose is to discuss your situation and decide on a course of action to keep you safe. It will be attended by people who know you, such as your GP, community nurse or social worker. You (or your representative) should also be invited to the meeting
Coercive control is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. This controlling behaviour is designed to make a person dependent by isolating them from support, exploiting them, depriving them of independence and regulating their everyday behaviour.
The voluntary and continuing permission of the person to an intervention based on an adequate knowledge of the purpose, nature, likely effects and risks of that intervention, including the likelihood of its success and any alternatives to it
Continuing Healthcare (CHC)
A package of on-going care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Such care is provided to individuals aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. Eligibility for NHS CHC places no limits on the settings in which the package of support can be offered or on the type of service delivery
Court of Protection (CoP)
An English court that makes decisions about the property, finances, health and welfare of people who lack mental capacity to make decisions for themselves. The court can appoint a ‘deputy’ to make ongoing decisions on behalf of someone who lacks capacity. It is also able to grant power of attorney
Cuckooing is when criminals take over the homes of vulnerable people and use them as a base to deal drugs in the area.
Who are the victims of cuckooing?
Victims of ‘cuckooing’ are often drug users but can include older people, those suffering from mental or physical health problems, female sex workers, single mums and those living in poverty. Victims may suffer from other forms of addiction, such as alcoholism.
Once they gain control, gangs move in with the risk of domestic abuse, sexual exploitation and violence. Children as well as adults are used as drug runners.
It’s common for gangs to have access to several addresses. They move quickly between vulnerable people’s homes for just a few hours, a couple of days or sometimes longer. This helps gangs evade detection.
These gangs may use accommodation in rural areas, including serviced apartments, holiday lets, budget hotels and caravan parks.
Some vulnerable adults may be forced to leave their homes, making themselves homeless and leaving the gangs free to sell drugs in their absence.
What are the signs of cuckooing?
- Have you noticed more people calling or staying at an address? Sometimes at unsociable hours?
- Have you noticed a neighbour has not been seen for a while?
- Are there suspicious smells coming from an address?
- Are there suspicious or unfamiliar vehicles outside the address?
- Are there new or regularly changing residents (e.g. different accent compared to local accent)?
Look out for your neighbours and report suspicions anonymously online to Crimestoppers or by calling 0800 555 111. No personal details are taken, information cannot be traced or recorded and you will not go to court or have to speak to police when contacting Crimestoppers.
Director of Adult Social Services (Local Authority)
Deprivation of Liberty Safeguards (DoLS)
Legal protection for people in hospitals or care homes who are unable to make decisions about their own care and support, property or finances. People with mental health conditions, including dementia, may not be allowed to make decisions for themselves, if this is deemed to be in their best interests. The safeguards exist to make sure that people do not lose the right to make their own decisions for the wrong reasons.
Read more about DoLS in our Putting the Mental Capacity Act into Practice section
Money that is paid to you (or someone acting on your behalf) on a regular basis by your local council so you can arrange your own support, instead of receiving social care services arranged by the council. Direct payments are available to people who have been assessed as being eligible for council-funded social care.
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: psychological, sexual, financial or emotional
Duty of Candour
When something goes wrong with the health or social care that is provided to you, the organisation that provides the care has a legal duty to be open with you, to explain what has happened and to apologise to you
Eligibility (for care and support)
The national eligibility criteria set a minimum threshold for adult care and support needs and carer support needs which local authorities must meet. All local authorities must comply with this national threshold. Authorities can also decide to meet needs that are not deemed to be eligible if they chose to do so. The eligibility threshold for adults with care and support needs is set out in the Care and Support (Eligibility Criteria) Regulations 2015 (the ‘Eligibility Regulations’). The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.
In considering whether an adult with care and support needs has eligible needs, local authorities must consider whether:
- the adult’s needs arise from or are related to a physical or mental impairment or illness
- as a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes:
- inability to achieve the outcome without assistance
- able to achieve the outcome without assistance but doing so causes the adult significant pain, distress or anxiety
- able to achieve the outcome without assistance, but doing so endangers or is likely to endanger the health or safety of the adult, or of others
- able to achieve the outcome without assistance but takes significantly longer than would normally be expected
- as a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult’s wellbeing
An adult’s needs are only eligible where they meet all 3 of these conditions
A way of helping you to become more independent by gaining the ability to move around and do everyday tasks for yourself. You may be offered an enablement service if you have lost some daily living skills because of poor health, disability or a hospital stay
An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place. An enquiry could range from a conversation (with the adult or if they lack capacity/ have substantial difficulty in understanding the enquiry their representative or advocate) prior to initiating a formal enquiry under section 42, right through to a much more formal multiagency plan or course of action.
Female Genital Mutilation (FGM)
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons (Source: WHO).
FGM is illegal in the UK. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. The FGM duty came into force on 31 October 2015.
It is an offence to:
- perform FGM (including taking a child abroad for FGM)
- help a female to perform FGM on themselves in or outside the UK
- help anyone perform FGM in the UK
- help anyone perform FGM outside the UK on a UK national or resident
- fail to protect a child for whom you’re responsible from FGM
Anyone who performs FGM can face up to 14 years in prison.
Anyone found guilty of failing to protect a child from FGM can face up to 7 years in prison.
‘Forced marriage’ is a term used to describe a marriage in which one or both parties are married without their consent or against their will. It differs from an arranged marriage, in which both parties consent to assistance of their parents or a third party in identifying a spouse. A marriage in which one or both partners lack the capacity to consent to marriage is a forced marriage
This term comes from a 1938 stage play, Gas Light, in which a husband attempts to drive his wife crazy by dimming the lights (which were powered by gas) in their home, and then he denies that the light changed when his wife points it out. It is an extremely effective form of emotional abuse that causes a victim to question their own feelings, instincts, and sanity, which gives the abusive partner a lot of power. Once an abusive partner has broken down the victim’s ability to trust their own perceptions, the victim is more likely to stay in the abusive relationship.
There are a variety of gaslighting techniques that an abusive partner might use:
- Withholding: the abusive partner pretends not to understand or refuses to listen.
- Countering: the abusive partner questions the victim’s memory of events, even when the victim remembers them accurately.
- Blocking/Diverting: the abusive partner changes the subject and/or questions the victim’s thoughts.
- Trivialising: the abusive partner makes the victim’s needs or feelings seem unimportant.
- Forgetting/Denial: the abusive partner pretends to have forgotten what actually occurred or denies things like promises made to the victim.
Gaslighting typically happens very gradually in a relationship. Often the abusive partner’s actions may seem harmless at first. Over time, however, these abusive patterns continue and a victim can become confused, anxious, isolated, and depressed, and they can lose all sense of what is actually happening. Then they start relying on the abusive partner more and more to define reality, which creates a very difficult situation to escape.
Hate crime is defined as any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability. This definition is based on the perception of the victim or anyone else and is not reliant on evidence. In addition, it includes incidents that do not constitute a criminal offence
Health and Wellbeing Board
Every council area in England has a Health and Wellbeing Board to bring together local GPs, councillors and managers from the NHS and the council. Their job is to plan how to improve people’s health and make health and social care services better in their area
A national organisation that represents people who use health and care services in England. It is independent, and exists to gather and represent the views of the public, but does not have the power to change how things are done. It reports problems and concerns to the Care Quality Commission, which has the power to make changes. There is a local Healthwatch in every council area, including Healthwatch Somerset.
Care provided in your own home by paid care workers to help you with your daily life. It is also known as domiciliary care. Home care workers are usually employed by an independent agency, and the service may be arranged by your local council or by you (or someone acting on your behalf)
Independent Domestic Violence Advisors
Independent Mental Capacity Advocates (IMCAs)
Independent Mental Capacity Advocates (IMCAs) are a legal safeguard for people who lack the capacity to make specific important decisions, including making decisions about where they live and about serious medical treatment options. IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person
A person who acts as a single point of contact for you, helps coordinate your care and can give you information and advice
A term that is used to describe a brain impairment that may make it difficult for someone to communicate, to understand new or complex information, or to learn new skills. The person may need help to manage everyday tasks or live independently. Learning disability starts in childhood and has a lasting effect on a person’s development. It can affect people mildly or severely
Mental capacity in the context of adult safeguarding is the ability of a person to:
- Understand the implications of their situation
- Take action themselves to prevent abuse
- Participate to the fullest extent possible in decision making about interventions involving them, be they life-changing events or everyday matters
Read more about Mental Capacity in our Putting the Mental Capacity Act into Practice section
Mental Capacity Act
The Mental Capacity Act (2005) is a law that is designed to protect people who are unable to make decisions about their own care and support, property or finances, because of a mental health condition, learning disability, brain injury or illness. ‘Mental capacity’ is the ability to make decisions for yourself. The law says that people may lose the right to make decisions if this is in their best interests. Deprivation of Liberty Safeguards are included in the law, to make sure that people are treated fairly
Read more about Mental Capacity in our Putting the Mental Capacity Act into Practice section
Modern slavery encompasses slavery, human trafficking, forced labour, and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment
Multi-Agency Public Protection Arrangements (MAPPA)
Multi-Agency Public Protection Arrangements (MAPPA) are arrangements in every geographical area (primarily, in relation to violent offenders on licence or mental health orders and all registered sex offenders) to reduce the risks posed by sexual and violent offenders in order to protect the public, including previous victims, from serious harm. Forced marriage, honour-based violence, human trafficking, exploitation by radicalisers who promote violence and hate crimes are all likely to fall within the remit of MAPPA
Multi-Agency Risk Assessment Conference (MARAC)
The Multi-Agency Risk Assessment Conference (MARAC) is a regular multi-agency meeting held in each local authority, with representation from local police, probation, health, children and adults safeguarding, housing practitioners, substance misuse services, Independent Domestic Violence Advisers (IDVAs) and other specialists from the statutory and voluntary sectors who meet to share the information that they have about an adult at risk of domestic violence and develop a coordinated action plan
When you are mistreated by not being given the care and support you need, if you are unable to care for yourself. It may include not being given enough food, or the right kind of food, being left without help to wash or change your clothes, or not being helped to see a doctor when you need to
In social care, an ‘outcome’ refers to an aim or objective you would like to achieve or need to happen – for example, continuing to live in your own home, or being able to go out and about. You should be able to say which outcomes are the most important to you, and receive support to achieve them
Outline Strategy Plan (OSP)
When a referral received by triage is identified as requiring an enquiry, triage will outline the scope of the enquiry and any immediate action that is required
Section 26 of the Counter-Terrorism and Security Act 2015 (the Act) places a duty on certain bodies (“specified authorities” listed in Schedule 6 to the Act), in the exercise of their functions, to have “due regard to the need to prevent people from being drawn into terrorism”. The aim of the Prevent strategy is to reduce the threat to the UK from terrorism by stopping people becoming terrorists or supporting terrorism. The 2011 Prevent strategy has three specific strategic objectives:
- respond to the ideological challenge of terrorism and the threat we face from those who promote it
- prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support
- work with sectors and institutions where there are risks of radicalisation that we need to address
The term ‘prevention’ or ‘preventative’ measures can cover many different types of support, services, facilities or other resources. There is no single definition for what constitutes preventative activity. This can range from wide-scale whole-population measures aimed at promoting health, to more targeted, individual interventions. These may be aimed at improving skills or functioning for one person or a particular group or lessening the impact of caring on a carer’s health and wellbeing. It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it will be vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible.
Principal Social Worker
Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:
- lead and oversee excellent social work practice
- support and develop arrangements for excellent practice
- lead the development of excellent social workers
- support effective social work supervision and decision making
- oversee quality assurance and improvement of social work practice
- advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice
- function at the strategic level of the Professional Capabilities Framework
A way of helping you remain independent, by giving you the opportunity to relearn or regain some of the skills for daily living that may have been lost as a result of illness, accident or disability. It is similar to rehabilitation, which helps people recover from physical or mental illness
A request for an assessment of a person’s needs, or for support from a social care organisation. A referral to adult social care may be made by your GP, another health professional or anyone else who supports you. You can also refer yourself, or a member of your family, by contacting the adult social care department
A service giving carers a break, by providing short-term care for the person with care needs in their own home or in a residential setting. It can mean a few hours during the day or evening, ‘night sitting’, or a longer-term break. It can also benefit the person with care needs by giving them the chance to try new activities and meet new people
When you receive a re-assessment of your needs and you and the people in your life look at whether the services you are receiving are meeting your needs and helping you achieve your chosen outcomes. Changes can then be made if necessary
An assessment of your health, safety, wellbeing and ability to manage your essential daily routines. You might also hear the term risk enablement, which means finding a way of managing any risks effectively so that you can still do the things you want to do
Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action
Safeguarding Adults Board (SAB)
Each local authority must set up a Safeguarding Adults Board (SAB). The main objective of a SAB is to assure itself that local safeguarding arrangements and partners act to help and protect adults in its area who:
- have needs for care and support and
- are experiencing, or at risk of, abuse or neglect and
- as a result of their care and support needs are unable to protect themselves from either the risk of or experience of abuse or neglect
Safeguarding Adults Review (SAR)
Safeguarding Adults Boards must arrange a SAR when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult. SABs must also arrange a SAR if an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect. SARs should seek to determine what the relevant agencies and individuals involved in the case might have done differently that could have prevented harm or death. This is so that lessons can be learned from the case and those lessons applied to future cases to prevent similar harm occurring again. Its purpose is not to hold any individual or organisation to account
A form or questionnaire that you complete yourself, either on paper or online, explaining your circumstances and why you need support. A social care worker or advocate can help you do this. If your council asks you to complete a self-assessment form, it will use this information to decide if you are eligible for social care services or if you need a full assessment by a social worker
A professional who works with individual people and families to help improve their lives by arranging to put in place the things they need. This includes helping to protect adults and children from harm or abuse, and supporting people to live independently. Social workers support people and help them find the services they need. They may have a role as a care manager, arranging care for service users. Many are employed by councils in adult social care teams; others work in the NHS or independent organisations.
‘Think Family’ means securing better outcomes for children, young people, adults and families by coordinating the support they receive from services
The process by which young people with health or social care needs move from children’s services to adult services. It should be carefully planned, so that there are no gaps in the care young people receive. Young people and their families should be fully involved in the planning process
Organisations that are independent of the Government and local councils. Their job is to benefit the people they serve, not to make a profit. The people who work for voluntary organisations are not necessarily volunteers – many will be paid for the work they do. Social care services are often provided by local voluntary organisations, by arrangement with the council or with you as an individual. Some are user-led organisations, which means they are run by and for the people the organisation is designed to benefit – e.g. disabled people
‘Wellbeing’ is a broad concept, and is described as relating to the following areas in particular:
- personal dignity (including treatment of the individual with respect)
- physical and mental health and emotional wellbeing
- protection from abuse and neglect
- control by the individual over day-to-day life (including over care and support provided and the way it is provided)
- participation in work, education, training or recreation
- social and economic wellbeing
- domestic, family and personal
- suitability of living accommodation
- the individual’s contribution to society
It means being in a position where you have good physical and mental health, control over your day-to-day life, good relationships, enough money, and the opportunity to take part in the activities that interest you
Whole Family approach
The intention of the whole family approach is for local authorities to take a holistic view of the person’s needs and to identify how the adult’s needs for care and support impact on family members or others in their support network