Short and Long Term (SALT) Return
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Short and Long Term (SALT) Return Guidance For use in 2014-15 alongside: Equalities and Classifications (EQ-CL) Framework Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 1
We are the trusted national provider of high-quality information, data and IT systems for health and social care. www.hscic.gov.uk firstname.lastname@example.org @hscic Author: Adult Social Care Statistics team, Health and Social Care Information Centre Contact: email@example.com Version: V1.5 Date of publication: September 2014
Revision History Version Date Summary of Changes 1.0 May 2013 Original Version 1.1 July to Various enhancement and corrections as a result of local authority feedback and September SALT Technical Group decisions. 2013 1.2 26/9/2013 Modification to title of Table 4 for measures STS002a and STS002b, in section ‘Summary of Measures’, to match the SALT Proforma. Amended the name of a significant event in measure LTS002a list of significant events from, ‘SAR Concern’ to ‘Safeguarding Concern’. 15/10/2013 Enhancement of wording in measure LTS001a section ‘On the books’, clarifying who should be included in the measure. 23/10/2013 Revised wording for measure STS001 FAQ 10 on recording services during transfer from children’s to adults’ services. 8/11/2013 Moved paragraph ‘Carers who are also Service Users’ before section ‘Detailed Guidance on Tables’ for measure LTS003. 11/11/2013 Amended measure LTS003, section ‘Who to include / exclude’ paragraph 2, for clarity. 12/11/2013 Additional FAQs (FAQ 16 onwards) for measure STS001. Additional FAQ for measure STS002a. Added FAQ sections for measures LTS001a, LTS002a, and LTS003. Refresh of link to ASCOF 2013 / 14 Handbook of Definitions. Revised wording in ‘Summary of Measures’ section for clarity Added Appendix with supporting diagrams Minor formatting 21/11/2013 Revised wording in section ‘Relationship with ASCOF measures’ for measure STS001. 26/11/2013 Modified title of measure LTS002b for clarity. Removed reference to ‘life event’ when discussing early cessation of short term care to maximise independence. 1.3 12/12/2013 Revised text in measure STS001 ‘Hierarchy of Sequels’ section advising on selection of outcomes. 3/1/2014 Clarified exclusion based on employment status for measure LTS004 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 3
7/1/2014 Revised wording in measure STS002b section ‘Supporting carers’ paragraph 3. 21/1/2014 Removed superfluous text in the definition of ‘No Change in Setting: Level of long term support increased’ in section ‘Sequel to Review’ of measure LTS002a. 10/3/2014 Amended reference to ‘adult placement’ to ‘shared lives’ in relation to SALT measure STS004 10/3/2014 Revised text for clarity in section ’Carers who are also service users’ for measure LTS003 10/3/2014 Additional text in section ‘Who to include / exclude’ for measure LTS003 10/3/2014 Expanded guidance for route of access ‘diversion from hospital’ added to table of routes of access for measure STS001 10/3/2014 Changes to ‘Summary of measures’ to reflect removal of terminology ‘Younger Adults’ and ‘Older Adults’ from SALT pro forma 10/3/2014 Addition of new frequently asked question material: FAQ 10 (revised from FAQ 11 in v1.2), 20 , 21 (revised from FAQ15 in v1.2), 22 and 23 (revised from FAQ 7 in v1.2) for SALT measure STS001, FAQ 2 for SALT measure STS002b, FAQ 2 for SALT measure LTS002a, FAQ 1 for SALT measure LTS001c, FAQ 2 for SALT measure LTS001a 10/3/2014 Expanded guidance for reporting carers services in the sections ‘Who to include / exclude’ and ‘Support Direct to the Carer vs. Support Involving the Cared-for Person’ for SALT measure LTS003 10/3/2014 Addition of appendix 2 relating to the identification of age banding in SALT. Guidance on measures amended to include reference to appendix 2. 10/3/2014 Addition of new ‘Uses of Information’ section within ‘Purpose, overview and background’ 10/3/2014 Minor change to STS001 route of access table to highlight location of guidance on transition 10/3/2014 Amendment to Hierarchy of Sequels table for SALT measure STS001 to improve description of ‘No services provided (any reason)’ 20/3/2014 Revision to advice for inclusion in category ‘unknown’ in LTS004 20/03/2014 Change to the description of measure STS004 to mirror the descriptions elsewhere in the ‘Summary of measures’ 20/03/2014 Removal of STS004 FAQ 3 and amendment to FAQ 2 to remove ambiguity over assessment for services included in measure
V1.4 20/05/2014 Amendment to the way gender is defined on page 55 to match description in the EQ-CL framework 20/05/2014 Amendment to figure 2 to highlight the way sequels of long term support are treated in SALT measures STS001a and STS002 20/05/2014 Significant event ‘ Emergency related to carer’ amended to ‘Issues related to carer’ to reflect feedback that not all carer related reviews result from a sudden or emergency event 20/05/2014 Appendix 1 amended to reflect above changes to significant events. 20/05/2014 Figure 17 added to clarify detail on SALT measure LTS002b table 3 20/05/2014 Addition of FAQ 3 for SALT measure LTS002a 20/05/2014 Addition of FAQ 24 for SALT measure STS001 20/05/2014 Addition of FAQ 5 for SALT measure STS0002a 20/05/2014 Amendment of category utilised within LTS003 ‘No PSR – CARED FOR PERSON NOT RECORDED’ to ‘No PSR – Cared for person not recorded or details not current’. Addition of FAQ 3 for SALT measure LTS003 to reflect this. 20/05/2014 Addition methods of following up clients location on 91st day for SALT measure STS004 added for clarity, reflecting council feedback 09/06/2014 Page 13 – amendment to description of SALT measure LTS004 to remove the implication that the SALT and preceding ASC-CAR tables are ‘equivalent’ 09/06/2014 Page 64 – FAQ1 for LTS002a – question shortened and simplified for ease of reading. No change to the meaning or to the response has been made. 12/06/2014 Amendment to Relationship with ASCOF measures sections throughout to align with the 2014-15 ASCOF Handbook of Definitions 12/06/2014 Amendment to SALT measure LTS004 to remove obsolete reference to assessment and review of clients within the criteria for inclusion in the measure 12/06/2014 Page 74, new content relating to LTS004 to outline the two main differences between LTS004 and the ASC-CAR ‘L’ tables 12/06/2014 Addition of FAQ 25 for STS001 (also referenced in FAQ for STS002a/b and LTS002a) 12/06/2014 Pages 29 and 35, addition of description of sequel ‘Needs identified – but support declined’ omitted from earlier versions of the guidance. V1.5 04/09/2014 Addition of new sentences to clarify reporting within cells labelled ‘total clients in table’ within SALT LTS002 measures. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 5
04/09/2014 Revision to web link for ASCOF Handbook of Definitions 2014-15 within STS001 section headed ‘How to include equipment’ 04/09/2014 Replacement of obsolete reference to ‘Primary Care Trusts’, addition of ‘data’ in respect to local records of deaths within STS004 09/09/2014 Addition of FAQ 3 for LTS001a 09/09/2014 Amendment and additional text for clarity on the reporting of paid employment in LTS004. 09/09/2014 Addition of FAQ 26 for STS001 09/09/2014 Addition of FAQ 5 for LTS002a 09/09/2014 Addition of FAQ 4 for LTS001a. 15/09/2014 Amendment to the definition of sequel ‘No Services Provided – Needs Identified but Support Declined’ in LTS002a for clarity that this refers to eligible needs. 15/09/2014 Removal of references to the ASCOF Handbook of Definitions 2014-15 not having been published at the time of writing as the document is now available. 22/09/2014 STS001 small amendment for clarity to description of table describing prior requests for support To aid identification of changes in version 1.5 of this guidance new or amended text is highlighted in this colour.
Contents Revision History 3 Contents 7 Table of Figures 11 Purpose, Overview and Background 12 Purpose 12 Overview 12 Background 12 Uses of information collected 14 SALT queries 14 Summary of Measures 15 STS – SHORT TERM SUPPORT 15 STS001 Requests for support for new clients broken down by the different sequels 15 STS002a Short Term support to maximise independence sequels for NEW clients 15 STS002b Short Term support to maximise independence sequels for EXISTING clients 15 STS003 Snapshot Short Term support to maximise independence (temporary measure) 15 STS004 Proportion of older people (65+ who were still at home 91 days after discharge from hospital into reablement / rehabilitation 15 LTS – LONG TERM SUPPORT 15 LTS001a Long Term support anytime in the year 15 LTS001b Long Term support at year end 15 LTS001c Long Term Support for 12+ months at year end 15 LTS002a Clients in receipt of Long Term support (Unplanned reviews and Planned reviews leading to a care home admission) 16 LTS002b Clients in receipt of Long Term support for more than 12 months at the year- end (LTS001c) with a review during the year and the sequel to that review 16 LTS003 Carer support 16 LTS004 Accommodation and Employment Status of working age Learning Disabled clients 16 Changes to the Measure Descriptions since the Consultation 16 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 7
Guidance on Measures 17 STS001 17 General description and business case 17 Detailed Guidance for Data Tables 18 Tables 1a and 1b 18 Tables 2a and 2b 21 Frequently Asked Questions for STS001 25 STS002a 31 General description and business case 31 Detailed Guidance for Data Tables 32 Table 1 32 Tables 2a and 2b 33 Table 3 33 Table 4 33 Frequently Asked Questions for STS002a 35 STS002b 37 General description and business case 37 Detailed Guidance for Data Tables 37 Table 1 37 Tables 2a, 2b and 3 38 Table 4 39 Frequently Asked Questions for STS002b 41 STS003 (temporary measure) 42 General description and business case 42 Detailed Guidance for Data Table 42 STS004 44 General description and business case 44 Detailed Guidance for Data Table 44 Frequently Asked Questions for STS004 46 LTS001a 49 General description and business case 49 Detailed Guidance for Data Tables 50 Tables 1a and 1b 50 Frequently Asked Questions for LTS001a 53 8 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
LTS001b 55 General description and business case 55 Detailed Guidance for Data Tables 56 Tables 1a and 1b 56 Tables 2a and 2b 57 Table 3 57 Tables 4a and 4b 58 LTS001c 60 General description and business case 60 Detailed Guidance for Data Tables 60 Tables 1a and 1b 60 Frequently Asked Questions for LTS001c 61 LTS002a 63 General description and business case 63 Detailed Guidance for Data Tables 64 Tables 1a and 1b 64 Table 2 67 Frequently Asked Questions for LTS002a 68 LTS002b 70 General description and business case 70 Detailed Guidance for Data Tables 70 Tables 1a and 1b 70 Table 2 71 Table 3 71 LTS003 72 General description and business case 72 Detailed Guidance for Data Tables 74 Table 1 74 Table 2 75 Table 3 75 Frequently Asked Questions for LTS003 77 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 9
LTS004 79 General description and business case 79 Detailed Guidance for Data Tables 79 Table 1 79 Table 2 80 Appendix 1: SALT Diagrams 82 Appendix 2: Identification of age banding in SALT measures 92 10 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Table of Figures Figure 1: Customer Pathways through SALT ....................................................................... 13 Figure 2: Customer journey mapped to data recorded for measures. .................................. 19 Figure 3: Summary of SALT collection. ................................................................................ 82 Figure 4: Measure STS001 Tables 1a & 1b. ........................................................................ 83 Figure 5: Measure STS001 Tables 2a & 2b. ........................................................................ 83 Figure 6: Measure STS002a Tables 1, 2a, 2b & 3................................................................ 84 Figure 7: Measure STS002a Table 4.................................................................................... 84 Figure 8: Measure STS002b Tables 1, 2a, 2b & 3................................................................ 85 Figure 9: Measure STS002b Table 4.................................................................................... 85 Figure 10: Measure LTS001a Tables 1a & 1b. ..................................................................... 86 Figure 11: Measure LTS001b Tables 1a, 1b, 2a, 2b, 3, 4a & 4b. ......................................... 86 Figure 12: Measure LTS001c Tables 1a & 1b. ..................................................................... 87 Figure 13: Measure LTS002a Tables 1a & 1b. ..................................................................... 87 Figure 14: Measure LTS002a Table 2. ................................................................................. 88 Figure 15: Measure LTS002b Tables1a & 1b. ...................................................................... 88 Figure 16: Measure LTS002b Table 2. ................................................................................. 89 Figure 17: Measure LTS002b Table 3. ................................................................................. 89 Figure 18: Measure LTS003 Tables 1 & 2. ........................................................................... 90 Figure 19: Measure LTS003 Table 3 .................................................................................... 91 Figure 20: Measure LTS004. ................................................................................................ 91 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 11
Purpose, Overview and Background Purpose This document gives the specifications for the Short and Long Term Return (SALT). Overview The SALT data collection is a set of measures produced through consultation with stakeholders as part of the Zero Based Review (ZBR) of social care data collections. It comprises two main sections, short term support (described in the Guidance as ‘STS’ measures) and long term support (described as ‘LTS’ measures). It also derives some of its structure from the Equalities and Qualifications (EQ- CL) Framework. This SALT document should be read alongside the EQ-CL Framework, which establishes a set of data ‘standards’ and timeframes for the collections, and also addresses issues common to all three collections (ASC-FR, SALT and SAR) identified in the 2012 ZBR Consultation. The EQ-CL Framework contains the full definitions attached to Primary Support Reasons (PSRs) and support settings and is included on the Health and Social Care Information Centre (HSCIC) website 1. Background The Health and Social Care Information Centre (HSCIC) was asked to develop and consult on new proposals for adult social care data collections, taking account of the changing context of social care. This request came from the Outcomes and Information Development Board (OIDB), which is jointly chaired by the Department of Health (DH) and the Association of Directors of Adult Social Services (ADASS). During 2011 a number of stakeholder groups were established with members from the Health and Social Care Information Centre, secondees to the ZBR Programme, a range of local authorities from across the country, the Department of Health, Skills for Care and others. They considered what council level adult social care data should be collected nationally to meet the changing requirements. This programme was known as the 'Zero Based Review'. The stakeholders collaborated to develop proposals for three new national collections, namely the Safeguarding Adults Return (SAR), Short and Long Term support (SALT), and Finance return (ASC- FR), which would replace the existing Abuse of Vulnerable Adults (AVA), Referrals, Assessments and Packages of care (RAP), Adult Social Care Combined Activity (ASC-CAR) and Personal Social Services Expenditure (PSSEX1) collections. A new standards framework, called the Equalities and Classifications (EQ-CL) Framework, was designed to support the three new collections by setting out common data items, data standards and timeframes. The HSCIC and the stakeholder groups considered whether national minimum data requirements were met by the proposals and whether the size and complexity of the proposed data collections appeared feasible. A consultation was launched in the summer of 2012 and ran for 8 weeks, asking for feedback on the proposals. Although the significant majority of responses were broadly supportive of the proposals, concerns were raised regarding timescales involved in order to implement all three collections. Development of SALT has taken into account this and other concerns which were raised in the consultation. The SALT stakeholder group, working alongside colleagues in the ASC-FR and EQ-CL groups, used the consultation responses to help produce the final collection presented here. The result is a true co- production of the different stakeholders, taking into account local as well as national requirements. 1 http://www.hscic.gov.uk/socialcarecollections2015 12 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
The HSCIC would like to recognise the vital contribution made by local authority representatives who gave up their time to ensure that the measures in SALT were relevant and focussed on the priorities facing adult social care. The diagram below outlines the types of information collected by the SALT Return. Figure 1: Customer Pathways through SALT SALT has been designed to track customer journeys through the social care system, demonstrated by the arrows which represent the ways in which clients can move between different forms of support. Support to carers is also vital to and is referenced in both the long and short term sections of the return, as well as having its own measure. Following a request for support, clients may be provided with a period of short term support designed to maximise their independence (e.g. a ‘reablement service’) or be referred directly for long term support (e.g. an emergency care home admission) or receive support such as ongoing low level support (e.g. an item of assistive equipment). Short Term Support to Maximise Independence is intended to be time-limited with the aim of ensuring clients become as independent as possible, ending with a formal assessment or review to determine what will follow. Long term support encompasses support provided with the intention of maintaining quality of life for an individual on an ongoing basis. The emphasis is on recording key events and the sequels to those events. The 'STS' and 'LTS' measures in SALT should not be thought of as counts of short term and long term services. Those familiar with RAP and ASC-CAR should therefore read this Guidance carefully and get in touch with any queries. The measures were designed to be useful at both a local and national level. SALT will provide a much richer national picture of short term preventative services than was possible in the RAP and ASC-CAR returns. The dataset should allow for easier integration with survey and other outcome measures and sharing of best practice through benchmarking. Please note that over the past year the collections have taken account of a range of feedback and there have been revisions to plans at various points. It is therefore important to consider these new materials even if you have looked at earlier versions in some detail. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 13
In July 2013 councils received funding from the Department of Health to prepare for the implementation of the new collections. Along with changes needed for EQ-CL an important aspect of this is setting up client databases so that cases can be tracked over time – recording the significant events and sequels to those events. This means some requests for support and provision of support may have occurred in the prior performance year. In some measures data from the previous performance year is explicitly referenced. Tables where this is required are optional for the first year but in order to ease the transition and obtain as complete a dataset as possible it is recommended councils prioritise development work for those measures. Please see the detailed guidance for each measure for more details. Uses of information collected The new SALT return is intended to offer scope for genuine comparability between CASSRs, and reliable aggregation to provide national and regional overviews. The information is required for: Providing data on council activity for use within the Adult Social Care Outcomes Framework (ASCOF) o Monitoring the uptake of Self Directed Support, direct payments and personal budgets o Monitoring permanent admissions to residential and nursing care o Providing data on support for carers o Providing data on employment and accommodation status for adults with learning disabilities o Proving data on outcomes for older people discharged from hospital into rehabilitative / reablement settings Providing new data on the outcomes for customers in receipt of short term care to maximise independence, an area that has not previously been subject to local, regional and national benchmarking Providing new data on the sequels to requests for support for new clients Providing an evidence basis to allow councils to plan resources and to help to develop policies on resource allocation Enabling CASSRs to monitor their own provision, develop local performance indicators and make comparisons between their own and other CASSRs Answering Parliamentary Questions and contributing to ministerial briefing Answering a range of requests from external customers, for example Freedom of Information requests SALT queries If you have any queries, please send them to the following e-mail address: firstname.lastname@example.org 14 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Summary of Measures STS – SHORT TERM SUPPORT STS001 Requests for support for new clients broken down by the different sequels Table 1a: Age band 18-64 Table 1b: Age band 65+ Table 2a/b: Repeat sequels of Short Term Support to Maximise Independence STS002a Short Term support to maximise independence sequels for NEW clients Table 1: Sequels by Route of Access Table 2a: Sequels by Primary Support Reason (18-64) Table 2b: Sequels by Primary Support Reason (65+) Table 3: Sequels by Carer Support Table 4: Short term support to maximise independence leading to long term support STS002b Short Term support to maximise independence sequels for EXISTING clients Table 1: Sequels by Route of Access Table 2a: Sequels by Primary Support Reason (18-64) Table 2b: Sequels by Primary Support Reason (65+) Table 3: Sequels by Carer Support Table 4: Short term support to maximise independence leading to long term support STS003 Snapshot Short Term support to maximise independence (temporary measure) Table 1: By Age Band Equivalent to STS vs. RAP P2s STS004 Proportion of older people (65+ who were still at home 91 days after discharge from hospital into reablement / rehabilitation LTS – LONG TERM SUPPORT LTS001a Long Term support anytime in the year Table 1a: Age band 18-64 Table 1b: Age band 65+ LTS001b Long Term support at year end Table 1a: By Primary Support Reason (18-64) Table 1b: By Primary Support Reason (65+) Table 2a: By Reported Health condition (18-64) Table 2b: By Reported Health condition (65+) Table 3: By Carer Support Table 4a: By Ethnicity & Gender (Males) Table 4b: By Ethnicity & Gender (Females) LTS001c Long Term Support for 12+ months at year end Table 1a: Age band 18-64 Table 1b: Age band 65+ Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 15
LTS002a Clients in receipt of Long Term support (Unplanned reviews and Planned reviews leading to a care home admission) Clients from LTS001a only Table 1a: Unplanned Reviews (18-64) Table 1b: Unplanned Reviews (65+) Table 2: Planned Reviews leading to a change in setting LTS002b Clients in receipt of Long Term support for more than 12 months at the year-end (LTS001c) with a review during the year and the sequel to that review Clients from LTS001c only Table 1a: Unplanned Reviews (18-64) Table 1b: Unplanned Reviews (65+) Table 2: Planned Reviews (18-64 & 65+) Table 3: Total planned and unplanned (Tables 1a/b & 2) NB: Tables 1a/b & 2 count events. Table 3 counts clients. LTS003 Carer support Table 1: By Age Group of carer Table 2: By Primary Support Reason of cared for person Table 3: By method of Assessment or Review LTS004 Accommodation and Employment Status of working age Learning Disabled clients Related to ASC-CAR tables L1 & L2 for ASCOF 2013/14 measures 1E & 1G Changes to the Measure Descriptions since the Consultation Please note that since the consultation the naming of the measures has changed. The changes are shown below. Previous Identifier New Identifier Short Term Support REA001 STS001 REA002a and b STS002a and b REA003 STS003 REA005 STS004 Long Term Support PSS001a, b, c LTS001a, b, c PSS002a, b LTS002a, b PSS003 LTS003 PSS007 LTS004 16 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Guidance on Measures STS001 Numbers of requests for support received from NEW CLIENTS, broken down by the different sequels to that request. Period 01/04/2014 – 31/03/2015 (Tables 1a and 1b) Period 01/09/2013 – 31/03/2015 (Tables 2a and 2b) General description and business case This captures the level of demand for social care services from new clients. Tracked over time, this will help with future demand prediction, human resource planning and commissioning. Clients previously in receipt of short term services intended to maximise their independence (which may be termed ‘reablement’) who return with further requests for service are also captured within a period of 6 months (even if this occurred in the previous year). This will help determine (in conjunction with measures STS002a and STS002b) whether ‘reablement’ type interventions help prevent further demands on social care services and gives basic details of the nature of ongoing support required. When benchmarked, differences between local authorities can be examined so that best practice can emerge and be shared, resulting in wider improvements. The information is important for aligning costs with activity, to establish the balance between short term interventions and long term services (covered in the ‘LTS’ measures) and to identify the cohort for who short term services were offered. Who to include / exclude? The intention is to count the sequels of requests for support (contacts from new clients or their representative, or someone acting on their behalf) being made in relation to the provision of adult social care services, excepting ‘casual contacts’ (see EQ-CL Glossary) and matters relating to adult safeguarding procedures, which are dealt with by the SAR collection. Sequels are the substantive actions taken in relation to the request for support. For clients to be included in STS001 the following criteria must apply: STS001 is concerned with numbers of requests for support, not numbers of clients Requests may come from, or be made on behalf of, new clients The return is for adult clients aged 18 and over only at the time of request Requests for support are only included where the sequel to that request has been determined during st st the year (April 1 – March 31 ) Note that although this measure is about requests for support, the sequels for these clients may not be known until weeks or even months later. It may require a full Community Care Assessment and commissioning of a suitable long term care package before this sequel is known. This may mean clients whose request was made in one reporting year only have a clear sequel in the following year. Clients that have requested support but where the response to that request is not determined by 31st March should be included in the following year’s return. Note in the first year of the SALT collection it may not be possible for councils to check back through records for previous years. Tables 2a and 2b are therefore voluntary for the first year. Please see ‘Transitional Arrangements’ below for more details. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 17
This measure only includes requests for support relating to new clients. For SALT the definition of ‘new’ is that the client is not in receipt of any long term support at the time the contact was made. For a fuller definition of ‘long term support’ see the EQ-CL Glossary and read the guidance for the Long Term Support measures (LTS001-004) later in this document. Note that a person who previously received long term support which ceased before the request was made, is considered a new client and should be included. All requests for support relating to social care needs are included even if this comes from someone other than the client (e.g. a carer or family member). CASSRs do need to identify whether a particular request is for social care needs or carer support needs. CASSRs should only include requests for support here that relate to social care needs (carer support is captured in measure LTS003). If multiple requests for support are made within a short period of time for the same client and same presenting issue, then there should be only one request counted. If subsequent requests are received for that client then that client may be included in the tables multiple times as long as the sequels to those requests occur in the current year (1st April – 31st March). It is recognised that determining whether a client contact is for the same or a different presenting issue may be difficult and technical solutions to this will vary between authorities. Comments on any ‘rules of thumb’ you have used to collect this data should be written in the feedback section at the end of the online return. Note that the measure includes work done in a contact centre where suitably trained staff are handling the initial requests for access to services. CASSRs will need to ensure that any data captured by a contact centre can be reported on for SALT purposes. Detailed Guidance for Data Tables Tables 1a and 1b Individuals aged 18-64 on 31st March should be included in Table 1a. Older clients should appear in Table 1b. Route of Access Planned Entry These are requests for clients moving from children’s social care into potential support (Transition) from adults. See STS001 FAQ 10 for further detail on transition. Discharge from These are requests relating to clients who are being referred for support following a Hospital planned or an emergency admission to hospital. Diversion from These are requests relating to clients who are being referred for support as a means of Hospital preventing admission to hospital. Diversion will include some kinds of falls prevention and falls response services, as well as reablement type services aimed at avoiding hospital admission. It is intended to pick up those referrals made specifically to prevent admission to hospital. Councils will have well-defined programmes for preventing admissions, such as reablement. The request is likely to be made by a health professional wanting to access a particular service, where prevention of hospital admission is a specific outcome sought, rather than a request for support made for or by someone in the community who is not at risk of hospital admission, despite their presenting needs. Community / These are requests from clients (or on behalf of clients) based in the community, Other route residential / nursing care or any other route of access. Response to Request for Support This is the sequel identified as the response made to the client in terms of any type of support provided. This includes decisions to provide short term interventions or long term services, as well as issuing equipment or signposting to universal or voluntary sector services. 18 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Each request for support can only have one sequel counted. Because SALT is built around tracking client ‘journeys’ through social care, there is a need to choose the most relevant outcome. Where more than one response is actually made, CASSRs should refer to the diagram and instructions below. The diagram is best understood if you consider how you would treat an individual client in measure STS001. The shaded area concerns follow-up in STS002a for those who received short term support to maximise independence (‘ST-MAX’ in the diagram). Figure 2: Customer journey mapped to data recorded for measures. When working out how to treat a new client’s request, consider first whether they are going to be offered short term support to maximise their independence (this may occur in any setting, such as the client’s own home, or even a residential home). If they are, record this outcome. This client would next appear in SALT measure STS002a, looking at the outcome of that short term support. If not offering ‘ST-Max’, check to see whether the client was, as an eventual response to the initial request for support, provided with long term support. This may occur only after considerable assessment and commissioning activity. Any clients with outcomes that include long term support should be counted in this category. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 19
Hierarchy of Sequels One of the outcomes should be selected from the following table, choosing the first which applies according to the order in which they appear, from top to bottom. Short Term Includes all episodes of support provided that are intended to be time limited, with the Support to intention of maximising the independence of the individual and reducing / eliminating Maximise their need for ongoing support by the CASSR. At the end of the support a review or Independence assessment for ongoing care will take place to determine what will follow. Note that there is no requirement to know what will follow in order to be counted in this measure. While episodes of 'respite care' may also be ‘time limited’, the support is usually provided as part of a longer term support package for a client, is commissioned only because of the existence of a carer who needs support, and in SALT is considered a carers service and should therefore be excluded. Any support provided to existing clients should be excluded, as these are not new clients. Emergency support (i.e. not reablement but a crisis support service) should be included in the Short Term Support (Other) category, and not in this one. Long Term Support Long Term support encompasses any service or support which is provided with the (eligible services) intention of maintaining quality of life for an individual on an ongoing basis, and which has been allocated on the basis of eligibility criteria / policies (i.e. an assessment of need has taken place) and is subject to regular review. This category is further split into the primary settings in which an individual receives services: Community will apply to those who live independently (including those in small group homes, sheltered housing or warden supported accommodation) who receive home or community based services. Residential will apply to those clients who live in registered care homes, even if they are in receipt of some community based services. Nursing will apply to those clients who live in registered care homes where nursing services are also provided. Note that the categories ‘residential’ and ‘nursing’ should be used for placements that are intended to be permanent. Trial placements for a fixed period in order to assess suitability are included in this, as 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, and should be counted in the ‘Community’ category. End of Life EOL care is considered to be any episode of social care support provided as part of palliative care, and which is intended to support the individual until the care is no longer required. While the period of this support may be short, it falls outside the definition for ‘short term support’, both because the time period for the provision of the support may not be known, and because there is no expectation to review any need for further service at the end of the period. Ongoing Low Level Should be used where a Local Authority decides to provide an ongoing service such as Support the provision of a minicom line / telecare, but no other service needs have been identified. Such services will be based in the community. All equipment and adaptations (including those with ongoing costs for maintenance and safety checks) should be included in this category as described above. This category doesn’t suggest services are limited or ‘minor’ in scope but it does suggest that they may continue ‘in the background’ supporting clients with minimal attention required by the local authority. 20 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Short Term Includes all episodes of support provided that are intended to be time limited without Support (Other) intending to maximise independence / reduce the need for ongoing support. An example of this might be a short term intervention for a younger adult with impaired mobility recovering from an operation, who is expected to make a full recovery without any additional intervention. Emergency support provided for all new clients should be included in this category, while emergency support provided to existing clients should be excluded, as this will be part of ongoing Long Term support. Universal Services A ‘universal service’ is any service or support (other than those above) for which there is / Signposted to no test of eligibility and no requirement for review. Signposting indicates that the client other support will not be supported by the CASSR and there is no universal service which will help them. Details are therefore given of other organisations (e.g. in the voluntary sector) that might be able to provide assistance. No Services The client may have low-level needs which cannot be supported by the CASSR and Provided (any there is no universal service which will help them reason) This will also apply if the client dies or for some reason the process of assessing needs is terminated (if just temporarily suspended, wait until the assessment process has re- started and reached a conclusion before entering data here). Selecting this sequel should not be seen as reflecting negatively on the local authority but more about the nature of the request for support or client circumstances Again, any clients whose request was made in the previous reporting year but where the response was only determined this year, should be included (although in the first year of SALT this will not always be possible – see ‘Transitional Arrangements’ below). Clients who have requested support but where the response to that request was not determined before 31st March should not be included until next year. Arrangements vary between CASSRs as to the means by which clients can access short and long term support at the point of contact. Regardless of the process and eligibility criteria applied, CASSRs should be able to identify the appropriate sequel to the request for support, although this may require tracking of case files over time (perhaps several weeks). How to include Equipment In a change and simplification from the RAP return, all provision of equipment and adaptations should be counted in SALT as 'Ongoing Low Level Support' even if it needs to be maintained over time (e.g. through ongoing maintenance contracts, safety inspections etc.). In the ASC-FR return equipment is treated separately and will be appropriately accounted for, but in SALT, checks on safety and maintenance do not constitute ‘long term support’ if the client has no other services (such as ongoing home care, etc.). This also helps with the interpretation of the ASCOF indicator 1C on personal budgets, as within the revised definition from 2014-15 onwards clients with equipment and adaptations only are not expected to be in the denominator (please see the ASCOF Handbook of Definitions for more details). Tables 2a and 2b These tables are intended to capture instances of short term support to maximise independence, for requests recorded in Tables 1a and 1b where either short or long term support was provided. (In the proforma, requests captured in the green highlighted columns are the ones that need to be checked). The intention is to be able to help assess how effectively short term support is preventing subsequent re-referral and admission to long term services and to pick up repeated short term interventions. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 21
Prior Requests for Support For each request in Tables 1a and 1b with a response of Long Term Support or Short Term Support to maximise independence (columns are shaded green although this may change in the final proforma) count any prior requests from those clients which also resulted in short term support to maximise independence (the CASSRs should count as many prior instances as there are for each entry in Table 1a/b although there’s a limit as to how far it is necessary to go back – see below). Note that the prior request is only relevant if the response to it occurred within 6 months of an entry in Tables 1a and 1b. Because Tables 1a and 1b capture the response to each request, the 6 month check is applied to the dates of response, rather than the dates of contact. Responses to requests made in the previous year (i.e. before 1st April) should be included if they fall within the 6 month window, but see ‘Transitional Arrangements’ below for guidance on what to do in the first year of SALT. In all cases these checks are only relevant for new clients (i.e. at the time of request, the client was not in receipt of long term support). Therefore, all the repeat requests captured in tables 2a and 2b will also appear in Tables 1a and 1b, either this or the previous year. Please see the table below for some examples of how these rules would work in practice. Many other combinations are possible, but this should give a clearer understanding of how to handle potential combinations of support requests. Note that in the first year of the SALT collection councils may not be able to check back through records for the previous year. This means that Tables 2a and 2b are voluntary for the first year. See section on ‘Transitional Arrangements’ below for more details and suggestions. The table that follows shows some examples - prior responses to requests highlighted with grey ellipses are those captured for SALT table 2a/2b, whilst the prior responses to requests shown in bold should not be captured in SALT table 2a/2b. The italicised dates represent dates of responses to prior requests for support which should not be captured in SALT table 2a/2b. 22 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Most Most Prior Prior request Earlier Earlier Request Request WHAT TO WHAT TO COUNT: recent recent request (response) request request last year last year COUNT: Table 2a/b request request response response (response) response (response) Table 1a/b response (response) date date date date Prior request (within 6 Long term Both 25.03.2015 02.01.2015 ST-Max - - - - months of the most support requests recent request) Prior request only 25.03.2015 Long term All three (within 6 months of 02.01.2015 ST-Max 02.05.2014 ST-Max - - support requests the most recent request) Prior and earlier requests (the earlier request response Long term occurs less than 6 25.03.2015 support All three months before the 02.01.2015 ST-Max 09.07.2014 ST-Max - - requests prior request response, and the prior request response occurs within 6 months of the most recent response date) Prior request only Short (because the earlier 25.03.2015 Long term term All three request did not result 02.01.2015 ST-Max 09.11.2014 - - support support requests in short term support (OTHER) to maximise independence) Nothing (the prior and No earlier requests were Signposted support within 6 months but Long term All three 25.03.2015 support 02.01.2015 to other 09.11.2014 (client - - requests neither had a sequel of services not short term support to eligible) maximise independence) Earlier request only (this occurred less than Most 6 months before the recent, prior request. The Long term Universal prior and 25.03.2015 19.08.2014 ST-Max 14.06.2014 ST-Max 15.03.2014 most recent request support services earlier was a long time requests afterwards and outside only of the 6 months window) Most recent, Request from last year Long term prior and only (this occurred 25.03.2015 19.08.2014 Signposting 27.05.2014 ST-Max 15.03.2014 ST-Max support earlier within 6 months of the requests earlier request) only [NOTE: ST-Max = Short Term Support to Maximise Independence] Route of Access The definition is the same as for Table 1a and Table 1b above. Calculation of age in SALT measure STS001 Please refer to the table in Appendix 2: Identification of age banding in SALT measures for confirmation of how age banding should be identified for this measure. Relationships and Data Validation Relationship with ASCOF measures Data from Tables 1a and 1b is used for ASCOF measure 2A (Permanent admissions to residential and nursing care). For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 23
Previous versions of this section of the SALT guidance discussed the way that tables 2a and 2b could be used to calculate what proportion of new clients going on to receive short term support to maximise independence or long term support had previously received a period of short term support to maximise independence. By extension this could provide a context for a measure of what percentage of clients receiving short term support to maximise independence do not require ongoing support. It is not now expected that the ASCOF placeholder 2E on the effectiveness of reablement services will reference tables 2a and2b, but local authorities are encouraged to utilise this data in their consideration of the short term care to maximise independence. Data Validation Note the rules given below are not the complete or final set of validation checks that will be applied by the final HSCIC collection system. Councils should ensure their data at least meets the conditions below. The HSCIC will confirm the full set of validation checks in an update to this Guidance. Within the measure Rule 1: the total number of requests for support in Table 2a cannot exceed the number recorded in Table 1a. Similarly, Table 2b cannot exceed Table 1b. Between measures Rule 2: the total number of sequels to requests for support of ‘Short term support to maximise independence’ in Tables 1a and 1b combined should be within 5% of the total number of outcomes of ‘Short term support to maximise independence’ captured in measure STS002a Tables 1, 2a, 2b, 3 and 4*. The total of Table 1a should be within 5% of STS002a Table 2a, and Table 1b should be within 5% of STS002a Table 2b. The totals are unlikely to be equal because clients referred for short term support in measure STS001 may not have come to an end of that support before the return is needed on 31st March. Others will have ended their short term services within the year (appearing in measure STS002a) but had the decision to provide that support made in the previous year (and therefore do not appear in this year’s STS001). * Note that the 5% rules above are suggestions and may not be applied or be changed depending on first year results. Transitional Arrangements During 2013-14 councils will be preparing for the new collections. Along with changes needed for EQ-CL an important aspect of this is setting up client databases so that cases can be tracked over time – recording the significant events and sequels to those events. This is particularly important for measure STS001. Tables 2a and 2b are voluntary for the first year, but in order to get as good a data collection as possible councils are encouraged to develop systems that will allow them to check back for prior requests for support. This means in order to get complete data for this measure, provisions of short term support intended to maximise independence would need to be captured on the client database from September 2013. For councils where the complete set of data is not available, partial data can still be used where available to populate Tables 2a and 2b. Comments reflecting the extent to which a complete dataset was available should be made in the end section of the online return. 24 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
Frequently Asked Questions for STS001 1) Why isn’t ‘short term support to maximise independence’ just called ‘reablement’? There is no nationally agreed definition for what constitutes ‘reablement’. Local authorities will be offering a range of services that are of short duration (typically being provided for a few weeks) and have the explicit aim of trying to minimise the person’s use of ongoing social care services, i.e. maximise independence and the improved level of independence should continue even after the service is removed (some ongoing support may still be required of course). This is why equipment or telecare should not be seen as a ‘Short term support to maximise independence’ in SALT – it remains with the client and provides low level support on an ongoing basis, but without it, the client would lose whatever benefits the service provides. 2) How long should I wait to determine the outcome of a 'request for support' before recording on STS001? Each client’s case is different and before recording on STS001, the sequel needs to be clear. This may mean waiting several weeks for the outcome of a full Community Care Assessment. If the sequel is not known before the year end (31st March) then that request for support should be counted in the following year. 3) Where do we include the provision of blue badges? Blue badges are ‘universal services’ and this sequel should therefore be recorded for STS001. Remember though that only one sequel can be recorded. If several sequels apply to any particular request for support, there is a hierarchy for determining which sequel to count for STS001. The hierarchy is the same as the ordering of columns (from left to right) within the STS001 tables (refer to the section on Hierarchy of Sequels for STS001 above). 4) Where do we include the provision of National Bus and / or Freedom Passes? National Bus and Freedom passes are not seen as social care support which matches the way they were considered within the previous RAP collection. For SALT the sequel of ‘no service provided’ would apply – i.e. the request for support is captured, but the sequel does not suggest any social care support has been given. 5) For some basic services such as the issue of a blue badge, or registration as disabled, we often have a waiting list. When do we record their ‘sequel’ in STS001? When the sequel is known (i.e. at the point of placing them on a waiting list) it can be recorded for STS001 purposes. 6) Where do we record contacts and referrals with the outcome of “No Further Action”? If a client is NOT given information, advice or any sort of social care service following the request for support (whether an assessment is needed or not), they would be recorded in STS001 as ‘no service provided’ if their details had been recorded on the social care database. It is accepted that many ‘casual contacts’ (for example, people dropping in to pick up a leaflet) will not be captured and do not need to be captured for SALT purposes. In some CASSRs the defining difference will be whether the reception staff consider it worth taking some personal details from the individual or not (a casual contact). In others the difference will be whether or not reception staff take the individual through some form of screening process. The key is whether or not a request for support leads to information and / or advice or other action such as signposting. Taking some personal details from a new contact and giving them information on the range of services that might be relevant should be recorded in STS001. Simply responding to a request for the phone number of an area office would be a casual contact. Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 25
7) Where do we record ‘professional support’ now? In most cases it is expected that professional support would be time-limited and fit under the sequel ‘short term support (other)’. If for some reason (see FAQ 9 below) it is expected to continue for more than a few weeks, ‘Ongoing Low Level Support’ could be chosen instead. In most cases anyone going on to receive a Community Care Assessment and receive services on the basis of eligibility criteria will be receiving more than just professional support, but if this was the ONLY service in the care / support plan then ‘long term support (eligible services)’ could be selected. This may be most relevant to clients receiving mental health support. 8) Where do we include support services provided to clients receiving welfare benefits, for example tribunal representation? These clients are not necessarily assessed and are not given care / support plans. Again, remember that only one sequel can be counted for each request for support. Providing information and advice on welfare benefits at a general level, or providing a one off piece of assistance in assessing possible individual eligibility will be counted in STS001 with the sequel ‘universal services’. If the case is passed on for further assessment leading to ongoing social care support provided by the CASSR, such as assistance in gaining due benefits (e.g. providing help at a tribunal) or handling financial matters then this should be treated as either ‘short term support (other)’ if the support will be given for no more than a few weeks, or ‘Ongoing Low Level Support’ if it is expected to continue beyond that. Because no support plan is provided, this type of intervention would not be counted as ‘long term support (eligible services)’. 9) If a child becomes 18 during the reporting year and transfers from Children’s Services to Adults’ Services, are they regarded as a “new client” for SALT and therefore recorded as a ‘request for support’ to the adult team, or are they considered to already be “on the books” of the CASSR and therefore not a “new client”? We recognise that authorities will have a variety of arrangements in place for dealing with transition between children’s and adults teams. In many instances this process will be underway well before the client’s 18th birthday; equally some individuals may not transfer until after their 18th birthday. Transition from children’s to adult’s services should be treated as a request for support from a new client and dealt with within SALT as follows: If the formal transfer of services occurred in advance of (or on) their 18th birthday then the client should start to be reported in SALT once they have turned 18. Their 18th birthday should be treated as a ‘request for support’ and be reported in SALT measure STS001 (Route of access = Planned entry (transition)), with any eligible services or review captured at that point in the LTS measures. Their 18th birthday should be recorded for use within SALT LTS001c when considering clients who have accessed long term support for more than 12 months. If the formal transfer of services occurs after the clients 18th birthday then this should be treated as the ‘request for support’ and reported within SALT measure STS001, with any eligible services or review also captured at that point in the LTS measures. Again this date should be recorded for us within SALT LTS001c. In some cases this formal transfer may occur months or even years after the clients 18th birthday. Authorities will need to consider locally how they track transition of such cases. 10) What if two contacts are made by the same client (regarding the same problem)? In RAP this would have been recorded as two separate contacts, as long as the client was still ‘new'. In SALT, what matters is whether any additional contacts are being dealt with as part of the same screening/assessment process. If they are, then there would still be just one request for support with one sequel recorded. After the assessment processes are completed and a sequel has occurred a new contact is received which necessitates a new screening/assessment process to be started then this should be recorded as a separate request for support in SALT, with its own sequel recorded (even if the sequel turns out to be the same as for the earlier contact). 26 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.
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