LTS002a

Those clients receiving long term support recorded in LTS001a who received an unplanned review during the year.

PLUS planned reviews for those clients that led to a care home admission

Period 01/04/2021 – 31/03/2022 (all tables).

None identified. 

This measure tracks the sequel to an unplanned review of long term support as well as recording planned reviews leading to a care home admission. Measure LTS002b includes a fuller account of planned reviews for those clients who have been receiving long term support for more than 12 months.

When benchmarked, differences between local authorities can be examined to see how demands and responses to those demands differ, as well as giving an indication of how levels of need change once clients are ‘on the books’. It is recognised that changes in care packages (including care being ended) are sometimes made outside of a formal review.

Such changes are not captured by the measure. The data in this measure is not intended to provide any sort of indication of what proportion of clients have been reviewed during the year.

Unplanned reviews will be prompted by a change in client circumstances and a resulting request made to the local authority (either by the client or someone acting on their behalf) to review client care needs.

Unplanned reviews are those triggered by significant events as opposed to planned, scheduled reviews which occur routinely, usually annually. Initial reviews completed a few weeks after a new care package is provided are included in the definition of ‘planned’ reviews.

Having an account of unplanned reviews for all clients who have received services during the year allows a better understanding of the resource demands placed on local authorities due to unforeseen events. More than one unplanned review may be triggered during the year, so this measure provides a count of activity as well as a count of clients. This measure tracks both the trigger for the review (the ‘significant event’) and the immediate sequel to that review (for example a move to residential care, an increase in care provision, etc.).

Tracking the sequels to unplanned reviews will show the proportion of existing clients who are referred for ST-Max (often termed ‘reablement’) following a change in circumstances.

This measure may also provide useful intelligence for preventative work (e.g. it may influence practice in adult safeguarding or lead to changes in how planned reviews are conducted). The measure can give an insight into whether the initial care planning for long term support is working well or not (e.g. insufficient or poorly planned support may lead to frequent unplanned reviews).

Planned reviews that result in a care home admission (Table 2) are also captured in order to support ASCOF measure 2A (Long term support needs met by admission to residential and nursing care homes, per 100,000 population). The significant events leading to care home admission can also be analysed.

For clients to be included in LTS002a, the following criteria must apply:

• only clients with reviews of long term support needs should be included – ‘reablement reviews’ or other reviews or checks of preventative services such as equipment, should be excluded
• each unplanned review with a known sequel should be included, with more than one review in a year possible
• the sequel to review must be known during the year (1st April to 31st March) even though service provision or other arrangements might not yet have been set up. There should be one sequel for each review counted
• planned reviews should only be included in Table 2 and only where the outcome of the review was to make a long term placement in residential or nursing care

A ‘review’ is a full re-examination of client needs and must include a (formal) reassessment and direct contact with the client. A review cannot be completed without input from the client (and/or the client’s representative), as it should be a re-assessment of their need for social care services. A potential outcome of a review must be the offering of new or continuation of current services as well as services being ceased. Note, however, that closing down case files or checking that services have stopped following the death of a client does not count as a review for SALT purposes. Similarly, reviews that are not completed before a client dies (or for any other reason) should not be included.

This measure only includes clients counted in LTS001a, i.e. clients in receipt of long term support at some point during the year. A person who previously received long term support which had ended before the start of the year should not be included in LTS001a and not be eligible for inclusion here.

There will be some clients recorded in measure LTS001a having long term support whose review is still in progress at year-end, or if completed, the sequel may still not be known.

These clients should not be included in this year’s data but captured in next year’s SALT data if they remain in receipt of long term support until 1 April.

Carers who themselves received long term support for social care needs (i.e. they are also being treated as service users) are included in this measure (in line with measure LTS001a).

Tables 1a (i), 1a (ii) and 1b (i), 1b (ii)

Following a mandatory reporting change in 2017-18 reviews are now reported based on the long term support setting for each client. The sequels differ depending on each setting. This allows a more straightforward interpretation of the data concerning changes following review (such as moves between residential and nursing care) and removes the irrelevant sequels from each setting.

Individuals aged 18 to 64 on 31st March should be included in Table 1a (i) and 1a (ii). Older clients should appear in Table 1b (i) and 1b (ii).

Because clients can have more than one review during the year, a total number of clients reviewed in each setting should also be calculated and entered at the bottom of each table, within the cell labelled ‘Total clients in table’. This is required for all the review tables in SALT. The total number of clients in a prison setting must be added for tables 1a (i) and 1b (i). Enter zero if there were no clients reviewed in prison by your local authority. For those councils where there is no prison in the area, the cells should be left blank.

The sequels have been ordered so that the biggest changes to a client’s care package, involving a change of setting (move to / from nursing or residential care) appear first when reading the data return workbook from left to right (or the table below from top to bottom). Rather like in the STS measures, there is hierarchy whereby the first relevant sequel should be chosen for each unplanned review counted. The sequel to review should reflect the changes made to client’s support following the review, not anything that occurred before it.

In some cases, the sequel recorded may not match what ultimately happens, e.g., following a decision to place in residential care and all preparations being made, a client may die shortly before the move takes place. If the sequel of ‘move to residential care’ was captured in the client database before the client died, then this is still acceptable for SALT purposes. There is no expectation that local authorities will go back and double-check all the sequels recorded although every effort should be made to faithfully capture sequels reflecting the actual circumstances as far as they could be determined following completion of the review.

The terms ‘Change in Setting’ and ‘No Change in Setting’ are used in the data collection spreadsheet to help group the sequels. In the context of reviews in residential and nursing care, moves between residential and nursing homes are captured but not considered a ‘change in setting’ for SALT purposes.

The table below gives more detail on each setting and the sequels which apply. Sequels are ordered in a hierarchy in the same way as the data return workbook when reading the table below from top to bottom.

Prison

All sequels

All unplanned reviews in prison must be captured under the prison setting. There is no need to record different sequels for these reviews. For those councils where there is no prison in the area, the cells should be left blank.

Nursing and residential setting

Move to community

Where a client is reviewed in a residential/nursing setting, but the conclusion is that they will move back into the community (including cases where a home is going to be deregistered and the client will continue to live there) then this option applies. Moves to supported living arrangements from registered care homes will also be captured here if the move is the outcome of a review.

Short Term Support to Maximise Independence

Support provided that is intended to be time limited, with the intention of maximising the independence of the individual and reducing/eliminating the need for ongoing support by the local authority. These clients will appear in STS002b in this or the following year.

Move to nursing care

Choose this if a client based in residential care is now moving to registered nursing care (in previous years this was recorded as an increase in the level of care).

Move to residential care

Choose this if a client based in nursing care is now moving to residential care (in previous years this was recorded as a decrease in the level of care).

No change to long term support

Despite a change in client circumstances, the review does not result in a move between residential and nursing care, or to the community. Changes in support within residential or nursing settings (including moves between homes within those categories) are always recorded as ‘No Change in Long Term Support’ within SALT.

All long term support temporarily suspended

Changes in client circumstances may result in suspension of care, where the client remains on the books following an emergency hospital admission.

All long term support ended

This may apply either if a client dies immediately following review, or if the client is going to be supported through other means (e.g. by family or private provision). This also includes cases where funding is taken over by the NHS and end of life cases. Clients who die before the review is completed should not be included in LTS002a.

Community setting

Move to nursing care

Choose this if a community based client is now moving to registered nursing care.

Move to residential care

As above but for registered homes that do not offer nursing care.

Short Term Support to maximise independence

Support provided that is intended to be time limited, with the intention of maximising the independence of the individual and reducing/eliminating the need for ongoing support by the local authority. These clients will appear in STS002b in this or the following year.

Level of long term support increase

Although this measure does not capture the degree of increase in care support, it should be possible for local authorities to record the direction of changes to packages.

No change in long term support

Despite a change in client circumstances, the review does not result in any significant change to the level of long term support being made.

Level of long term support decreased

In some cases, unplanned reviews may reveal not all support being provided was actually needed and reductions are made

All long term support temporarily suspended

Changes in client circumstances may result in suspension of care, where the client remains on the books following an emergency hospital admission.

All long term support ended

This may apply either if a client dies immediately following review, or if the client is going to be supported through other means (for example by family or private provision). This also includes cases where funding is taken over by the NHS and end of life cases. Clients who die before the review is completed should not be included in LTS002a

This measure needs to capture the numbers of clients who, following review, are deemed suitable for a period of short term support that is intended to maximise their ongoing independence and reduce reliance on long term services. In such cases, it will not be clear what the ultimate outcome for those clients will be. Their cases will appear in measure STS002b either this year or next year, with the sequels of short term support recorded.

For the purposes of LTS002, provision of this support is captured in the table without any assumptions made about where the short term support will take place or where the client will be following that support. Nevertheless, record the client in the appropriate setting, reflecting where their long term support was being provided at the time of review.

This table is needed to provide a full account of reviews taking place in the community that result in admission to residential and nursing care homes. Typically permanent placements would be made in response to a change of client circumstances and unplanned review, but there will be occasions when a planned review highlights increased client needs that were unknown to the local authority. In such cases where a residential or nursing care admission results and where the intention is that the placement be ‘permanent’ (i.e. there is no planned end date determined in advance of the placement), include these cases in the table. Trial placements for a fixed period in order to assess suitability are included in this (because the expectation would be for clients to remain in long term care home support) but short term temporary stays in which the client has a planned return to a community setting are not.

There will be some double counting of clients in Table 2 with clients in measure LTS002b, as some of them may have been receiving community based support for more than a year on 31st March. This table is still needed however for those newer clients whose admissions are relevant to ASCOF measure 2A (Long term support needs met by admission to residential and nursing care homes per 100,000 population).

Admissions to residential or nursing care as collected in table 2 do not apply to individuals detained in a prison setting or who are already in residential or nursing care.

Significant events

The significant events being captured have been simplified since 2016-17 but are derived from the categories previously in use. In addition, the ‘provider failure’ category introduced in 2017-18 is now mandatory. These revised categories make interpretation of the data more straightforward and reduce the complexity of recording and reporting this information.

The information below gives some guidance on what the significant events mean. Only ONE significant event should be chosen per unplanned review. Choose the one that best seems to represent the situation. If none of them apply, the ‘Other Reason’ category should be used.

Hospital (planned and unplanned episodes

If an expected (planned) or unexpected (unplanned) admission to hospital or treatment in hospital is required, this may prompt a review of care needs when the client is fit for discharge. This category combines the old ‘planned’ and ‘unplanned’ events.

Carer related

Changes in the capacity or ability of the carer to provide support to the client may result in an unplanned review of the client being required. This may be a temporary issue relating to the carer, but the local authority is required to review the client to cover the gap in support.

Safeguarding concern

Although measures LTS002a and b are not concerned with details of the safeguarding process (safeguarding referrals are captured in the SAC collection and not SALT), a safeguarding alert may trigger an unplanned review of the client’s social care needs.

Other reason

This includes all other reasons (but see the voluntary category of ‘change in commissioning arrangements’, below).

It encompasses the remaining significant events from 2016-17 (‘Change of residence’, ‘Fall’, ‘Bereavement’, ‘Change in Client Condition’ and ‘Other Accident/Incident’) as well as any other reasons for an unplanned review being required.

Provider failure

There is a need to better understand how services at risk of failure or due to cease commercial operations prompt the need for reviews of supported clients. This category will help to improve understanding of the extent of the issue.

Change in commissioning arrangements (voluntary)

Feedback suggests that there is also a need to understand how changes in the arrangements between commissioners and providers impact on the need for reviews for supported clients. This category can capture these events.

If you are not recording this voluntary category, allocate any reviews in relation to Change in Commissioning Arrangements as ‘Other Reason’.