Question 1: How have the review timescales been determined?
The protocol requires assessors to review all one-to-one support after an initial period of two weeks (or one week for people new to a care setting). Thereafter, ongoing review dates for all one-to-one support should be based on each person’s individual needs, for example ongoing weekly reviews may be appropriate for people when settling into a new service. Evidence from practice, shared by assessors and providers, suggests that changes in a person’s presentation and the impact of the support can often become evident during this period, and therefore a review should be prompted to ensure the appropriate level of support is in place. Whether or not the additional support continues will be based on the evidence provided as part of the review.
Question 2: Do you foresee any resource impact or challenges within North Yorkshire Council assessment teams to implement the protocol?
The checklist will be integrated into standard ‘business as usual’ review processes and therefore should not require additional resource to implement.
Question 3: The council does not have specialist social care teams which means some social workers are not experienced in working with people with specialist care needs. Is there a plan to address this?
The council’s social care teams are currently under-going a significant restructure. The restructure moves away from general locality-based teams to teams that are structured around the needs of the person and develops specialist service areas such as Preparing for Adulthood. Case load sizes will also be reflective of the differing level of need within each service area.
Question 4: Are the expectations around the element of one-to-one within the base fee documented within the protocol?
Yes. The protocol sets out the expectations around base rate services, including elements of one-to-one care. These are based on need and vary by framework, commissioned model and commissioning authority.
Question 5: Is there a plan to review existing packages of care that include additional one-to-one support?
Existing packages will be reviewed in line with ‘business as usual’ processes; such as during scheduled annual reviews or if there is a change in need. We would encourage providers to contact the commissioning authority to request a review if they are providing additional one-to-one support to anyone who they feel no longer requires this support. The protocol will apply to new packages with immediate effect.
Question 6: Will the one-to-one protocol apply to older adults living at home who need one-to-one care visits for personal care?
Home-based support is by default one-to-one and assessed based on need. The checklist should still be considered, but the protocol primarily targets residential and nursing care, community based support and supported living settings.
Question 7: Should care provision take a more holistic approach by including live-in care when it better supports personalisation and individual needs?
The overarching theme of the one-to-one protocol is a strong endorsement of person-centred, least restrictive, and collaborative care. While live-in care is not explicitly named as a central component of the protocol, the principles discussed throughout the session strongly support its inclusion when appropriate.
Question 8: Has an equality impact assessment been completed to assess the effect of the introduction of the one-to-one protocol on people in receipt of support?
An equality impact assessment has been completed. The protocol aims to improve outcomes for people by promoting dignity, independence, and choice by avoiding unnecessary restrictions. The protocol makes sure additional support is assessed and arranged consistently, proportionately, impartially and promptly through collaborative working.
Question 9: Has the impact to different sectors of the social care market been considered?
The protocol applies across all social care provision. It promotes the least restrictive approach ensuring the right level of care is provided at the right time. This approach has benefits for providers enabling person-centred care planning and efficient staff deployment based on assessed needs.
Question 10: Will the one-to-one protocol be able to support requests for short term support to aid transitions to new placements?
Yes, the one-to-one protocol is designed to support short-term interventions, including those that aid transitions to new placements. This is done through evidencing of need via the One-to-one checklist (Appendix A) and with built-in flexibility, review mechanisms, and a person-centred approach.
Question 11: Can the ICB guarantee a meeting to decide within three days?
For urgent out-of-hours requests, the ICB will consider retrospective funding for up to three days, provided there is documented clinical evidence justifying the need which is shared with the ICB. Decisions can be made via out-of-panel processes on the same day if necessary.
Question 12: Is there a protocol in place for when individuals supported have a decline in their mental health and there are no hospital beds available in the community?
Often if there is an escalation in presentation or behaviour to avoid admission, in line with national guidance, an urgent and Local Area Emergency Protocol (LAEP) may need to take place, and there may be a need to temporarily increase staffing to support individuals. We would anticipate that mental health services are involved during this period.
