Short and Long Term (SALT) Return

Short and Long Term (SALT) Return

Short and Long Term (SALT) Return

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 1 Short and Long Term (SALT) Return Guidance For use in 2014-15 alongside:  Equalities and Classifications (EQ-CL) Framework

Short and Long Term (SALT) Return

We are the trusted national provider of high-quality information, data and IT systems for health and social care. Author: Adult Social Care Statistics team, Health and Social Care Information Centre Contact: salt@hscic.gov.uk Version: V1.5 Date of publication: September 2014 www.hscic.gov.uk enquiries@hscic.gov.uk @hscic

Short and Long Term (SALT) Return

Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. 3 Revision History Version Date Summary of Changes 1.0 May 2013 Original Version 1.1 July to September 2013 Various enhancement and corrections as a result of local authority feedback and SALT Technical Group decisions. 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

Short and Long Term (SALT) Return

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

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 5 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.

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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 7 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

8 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 9 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

10 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 11 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

12 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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) website1 . 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

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 13 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.

14 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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: salt@hscic.gov.uk

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 15 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+

16 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 17 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 the year (April 1 st – March 31 st ) 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.

18 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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 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.

Planned Entry (Transition) These are requests for clients moving from children’s social care into potential support from adults. See STS001 FAQ 10 for further detail on transition.

Discharge from Hospital These are requests relating to clients who are being referred for support following a planned or an emergency admission to hospital. Diversion from Hospital These are requests relating to clients who are being referred for support as a means of 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 / Other route These are requests from clients (or on behalf of clients) based in the community, residential / nursing care or any other route of access.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 19 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.

20 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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 Support to Maximise Independence Includes all episodes of support provided that are intended to be time limited, with the intention of maximising the independence of the individual and reducing / eliminating their need for ongoing support by the CASSR. At the end of the support a review or 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 (eligible services) Long Term support encompasses any service or support which is provided with the 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 Support Should be used where a Local Authority decides to provide an ongoing service such as 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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 21 Short Term Support (Other) Includes all episodes of support provided that are intended to be time limited without 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 / Signposted to other support A ‘universal service’ is any service or support (other than those above) for which there is no test of eligibility and no requirement for review. Signposting indicates that the client 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 Provided (any reason) The client may have low-level needs which cannot be supported by the CASSR and there is no universal service which will help them 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.

22 Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. 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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 23 Most recent request response date Most recent request (response) Prior request response date Prior request (response) Earlier request response date Earlier request (response) Request last year response date Request last year (response) WHAT TO COUNT: Table 1a/b WHAT TO COUNT: Table 2a/b 25.03.2015 Long term support 02.01.2015 ST-Max - Both requests Prior request (within 6 months of the most recent request) 25.03.2015 Long term support 02.01.2015 ST-Max 02.05.2014 ST-Max - - All three requests Prior request only (within 6 months of the most recent request) 25.03.2015 Long term support 02.01.2015 ST-Max 09.07.2014 ST-Max - - All three requests Prior and earlier requests (the earlier request response occurs less than 6 months before the prior request response, and the prior request response occurs within 6 months of the most recent response date) 25.03.2015 Long term support 02.01.2015 ST-Max 09.11.2014 Short term support (OTHER) - - All three requests Prior request only (because the earlier request did not result in short term support to maximise independence) 25.03.2015 Long term support 02.01.2015 Signposted to other services 09.11.2014 No support (client not eligible) - - All three requests Nothing (the prior and earlier requests were within 6 months but neither had a sequel of short term support to maximise independence) 25.03.2015 Long term support 19.08.2014 ST-Max 14.06.2014 ST-Max 15.03.2014 Universal services Most recent, prior and earlier requests only Earlier request only (this occurred less than 6 months before the prior request.

The most recent request was a long time afterwards and outside of the 6 months window) 25.03.2015 Long term support 19.08.2014 Signposting 27.05.2014 ST-Max 15.03.2014 ST-Max Most recent, prior and earlier requests only Request from last year only (this occurred within 6 months of the earlier request) [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.

24 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 25 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.

26 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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).

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 27 The following examples may assist with understanding how presenting issues are dealt with in SALT: Client A is referred to social services by their GP after their carer is admitted to hospital. A day later a further request for support is made by a relative. Only one of these requests for services is recorded in STS001. Client B is referred to social services by A&E after a fall. They go on to receive short term care to maximise independence. Two months later they suffer a further fall and are again referred to social services after a fall and go on to receive short term care to maximise independence.

Whilst there is some similarity between the requests for support both requests necessitate an assessment of needs, and are therefore reported in STS001.

Inevitably some ‘rules of thumb’ will be drawn up by CASSRs for the purposes of automating the count for STS001. Note of these rules should be made in the end section of the on-line collection tool 11) How should I record referrals in STS001 if they are received via a council’s contact centre, not directly to social services? It does not matter who receives the initial contact. Unlike RAP, ‘referral source’ is not collected in SALT. The ‘route of access’ for clients, or their representatives, calling a contact centre is the same as if they contacted the social care department directly and will reflect their circumstances at the time of contact (e.g.

if they have just been discharged or are about to be discharged from hospital the route of access is ‘discharge from hospital’ regardless of who makes the call or where the call is handled).

12) Could you clarify if referrals related to carers should be recorded? STS001 is concerned with requests for support relating to new clients only. It does not include carers unless those carers are requesting (or someone is requesting for them) support for their own social care needs (rather than their caring needs). 13) Should work with out of area clients be recorded in STS001? If you receive requests for support relating to clients from another area and work with those clients at your expense, then count them in your figures. If the other area pays for the work, do not include them. Similarly, count requests for support relating to your local clients who were seen by another CASSR only if you pay for the work.

This will probably require details for such clients to be recorded on your own client database in order to be accurately counted. With regard to the sequels recorded, if it is decided that support will be provided by another CASSR (or agency) but not funded by you, then you should record these clients under ‘no services provided – any reason’. 14) Can you please clarify how to report the following? A client not in receipt of any services at time of request for support, i.e. new client, is classed as ‘End of Life’ and subsequently an assessment and proposed care plan is developed. Does it really depend on when the services start, i.e.

would you expect to see the client appear in the ‘End of Life’ column on STS001 and move to the LTS column once service provisions were up and running? As this is a new client, making a request for support, then this person would appear in STS001 with a sequel of 'End of Life' if the decision to provide such support was reached prior to the year-end (31st March). In a clear 'End of Life' case, the sequel would probably be known very early on, possibly before the assessment was even completed. Depending on how this is recorded in your client database, the client can be included in SALT STS001 if the sequel is captured on the database before or on 31st March.

It is not necessary for the end of life care to have started before capturing this.

As end of life care is not considered to be a long term service, STS001 is the only place that this client would appear in SALT - no LTS measures would be relevant. This Guidance confirms in the section on Hierarchy of Sequels for STS001 above, that, “…While the period of this support may be

28 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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.”.

It is this latter sentence that reinforces the distinction between End of Life and Long Term Support. 15) Please could you provide some additional detail regarding the provision of Blue Badges? In our authority the provision of Blue Badges is no longer dealt with by the Adult Social Care department in our structure; requests and provision are handled by our Customer Contact Centre (either customer facing or via telephone line). I understand from the Guidance that they should be classed as a ‘universal service’ and so should be included within STS001 but am unsure whether or not to include them as the request sits outside of Adult Social Care.

I am in the process of confirming where the funding comes from. Please could you confirm whether or not you would still expect these to be included within the SALT return, dependent on funding source? Secondly should blue badge renewals be included in STS001?

Blue Badge provision should be included within the SALT return, irrespective of funding source if the provision is still arranged by the local authority. Renewals are not new requests for support so in common with the way this was treated in the RAP return Blue Badge renewals would not appear in STS001. 16) What category within STS001 would you expect registrations for the blind / partially sighted or deaf / hard of hearing to appear in? Please note that registrations such as these are not considered to be services for SALT purposes, so registrations for the blind / partially sighted or deaf / hard of hearing would not be recorded as ‘requests for support’ within SALT.

We recognise that registrations may be accompanied by a request for social care assessment / support. In these cases it is the sequel to the request for support rather than the fact of the registration that would be captured for SALT, with the criteria for inclusion being the same as all other requests for support captured for STS001.

17) We have a number of time-limited services that a person can access before assessment (i.e. in the preventative domain). Some of these are designed to help people manage their conditions better, others use volunteers as support in people’s lives, and others are emergency callout services for people who may or may not have long-term services in place. Could you please provide some guidance as to where these services would appear in STS001? SALT STS001 captures the sequel to requests for support for new clients and therefore will encompass a wide range of possible activities. Authorities are encouraged to make an assessment of their local provision and match it to the sequel categories detailed in the SALT Guidance.

Looking at the examples above:  Emergency callout services for example may best sit within ‘Short Term Support – Other’. As the section on Hierarchy of Sequels for STS001 above states: “…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...”.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 29  The examples of a service using a volunteer as support in advance of assessment or a service designed to help people manage their conditions better are best allocated given practitioners’ knowledge of the service. The most important aspects to consider are:  Is the service time limited?  Is the request for support in relation to a new client?  Is the intention to maximise the independence of the individual and reduce / eliminate the need for ongoing support?

Consideration of these points should aid in allocating the service against ‘Short Term Support to Maximise Independence’ or to ‘Short Term Support – Other’.

18) Could you please explain where Day Care would be recorded in the SALT return? Please refer to FAQ 1 for LTS001a in this Guidance. 19) I need some guidance on the minimum information that can be recorded for new contacts requesting support that receive Universal Services / Signposting. The SALT guidance states that 'casual contacts' should be excluded i.e. those where personal details are not taken.

SALT does not seek to be prescriptive in the way that local authorities should collect data within their own systems. It is therefore possible that some authorities may wish to complete detailed management information relating to the nature of requests for support and details of the organisation which contacts are signposted to. It is also possible that authorities may not wish to compile large amounts of data on signposting. The balance between the two will be a local business decision. You are correct though in the way that you identify the capture of personal details in order to differentiate between casual contacts and requests for support that would appear in SALT.

In addition to the data items you list we expect many authorities will allocate unique identifiers to client details held on their systems which should assist in relation to the identification for repeat contacts. 20) How do I treat placements at residential schools/colleges for transition clients? These were previously classified as temporary admissions to residential care in the ASC-CAR return. In SALT they should also be included as a response to request for support in STS001, bearing in mind that such requests and placements for transition clients made before their 18th birthday would only be captured once the person turned 18 (see FAQ 10 in the STS001 guidance).

The appropriate sequel is "Short Term Support (other)". Such placements would not appear in any of the other SALT measures and will not be counted as 'permanent admissions' to residential care. 21) Is Occupational Therapy and Mental Health work included in SALT? Yes, if it includes a social care component.

Work completed by Occupational Therapists (OT) and Occupational Therapy Assistants (OTA) and paid for by social services should be included in terms of the requests for support and sequels associated with this. If you have joint health and social services teams (operating a partnership under Section 75 Agreements) then work completed by mental health teams should be included, providing this includes a social care element and the work could lead to social care services. As well as applying to SALT measure STS001 this advice covers all other measures within SALT which have the potential to include the work of such teams.

30 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 22) Approved Social Workers from our MH partner Trust carry out a range of assessments. Some of these are solely connected with the clinical needs of the client; others are connected with MH Guardianship. Should these assessments be considered within SALT measure STS001? No, only activity and sequels involving Approved Social Workers which are concerned with the social care needs of the client should be included in SALT 23) Should Adult safeguarding referrals be included? No, all activity relating to safeguarding procedures should be captured in the SAR collections.

However, if as a result of safeguarding work one of the recommendations/further actions is for the vulnerable adult to be referred on for further social care support then this WOULD be included in SALT. Examples could be where a request for support is made to the social care team following safeguarding procedures, which might then lead to further short or long term support (this activity would be captured in the same way as for any other current or new client). 24) Please could you advise me how Supporting People funded care is to be included in the SALT Return?

Two considerations need to be taken into account - firstly does the support contain a social care element? Secondly is the expenditure defined by your authority as social care expenditure? If both these criteria are met then the care can be considered for inclusion in SALT. However, it must also meet the criteria for inclusion in the various measures of the collection. 25) How should we treat '12-week disregard' clients in this measure? The previous collection (ASC-CAR) treated clients whose admission was "subject to a 12-week disregard" as "temporary" for the duration of the 12 weeks. In contrast, SALT captures data on sequels to events in the customer journey, even if the eventual funding arrangements are not yet confirmed.

Admissions to residential or nursing care captured at the time of the sequel to request for support, ST MAX or review should be included if funding for the placement will be initially made using a 12-week disregard arrangement. Permanent admissions are identified in SALT by reference to whether the intention of the admission at this stage is permanence, which includes clients whose admission is subject to a 12 week disregard.

26) The SALT guidance describes professional support as time-limited and suggests reporting it as ‘short term support (other)’. Could you advise as to what the time limit is? Support that is time limited in SALT (such as ST-Max, short term support -other) does not have a specific time limit but in all cases there will be an expectation of roughly when the support will end. Rules over length of provision will differ between authorities and so it is for local authorities to determine whether there is a specific end point in mind for the intervention. In the case of professional support, which used to be captured in RAP, most will be time limited.

That might be three months or two weeks, depending on the individual circumstances of the client. But if there is a clear end-point in mind (to help the client into employment, to provide short-term counselling etc.) then it would be classed as 'short term support' (other). In other cases where support is minimal but continues for a long period of time and is open ended in scope (e.g. a weekly phone call to the client to check that they have no issues requiring further intervention) then this would go under 'ongoing low level support'.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 31 STS002a Of new clients where the sequel to a request for support was ‘Short term Support to Maximise Independence’ (STS001) a breakdown of what followed the period of short term support. Period 01/04/2014 – 31/03/2015 (all tables) General description and business case This measure tracks the sequel to a limited period of short term support and will provide some indication of the outcomes of services intended to maximise the independence of new clients, especially when considered in conjunction with measure STS001 (tables 2a and 2b look at ‘repeat requests’).

Tracking the sequels to short term services will give an idea of the effectiveness of preventing longer- term reliance on social care. When benchmarked, differences between local authorities can be examined so that best practice can emerge and be shared, resulting in wider improvements. Data from this measure is needed for ASCOF measure 2D which looks at what proportion of new clients provided with short term support to maximise independence required no ongoing social care support. The data is also needed as part of the calculation for ASCOF Measure 2A (number of new permanent admissions to residential and nursing care), data previously captured from the ASC-CAR S3 table.

Who to include / exclude? For clients to be included in STS002a the following criteria must apply:  The measure is for new clients only  The measure only includes clients aged 18 and over at the time their request for support was made  Clients in this measure must have appeared in measure STS001 either in this or the previous year  The sequel to support must be known although service provision or other arrangements might take some weeks or even months to set up  Each instance of short term support to maximise independence with a known sequel should be included, including multiple instances for the same client This measure only includes new clients, i.e.

clients not in receipt of long term support at the time the request for support was made. A person who previously received long term support which had ceased before the new request was made should be included as a new client. There will be some clients recorded in measure STS001 as having a sequel of ‘Short term support to maximise independence’ whose period of short term support is still in progress at year-end, or, if the year has ended, the sequel may not yet be known. These would be captured in next year’s STS002a data. Consequently, some clients who were included in STS001 for the previous year but whose sequel to support was only known this year, will also be included (see Transitional Arrangements, below, for details of what to do in the first year of SALT).

32 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Detailed Guidance for Data Tables Table 1 Route of Access Please see measure STS001 for details on this. Sequel to Short Term Support The sequels are similar to those as in measure STS001, except for additional categories concerning ‘Early cessation of service’ and ‘No Service Provided’. ‘Early cessation of service (NOT leading to long term support)’ This should be used where the period of short term support was cut short in an unplanned way (e.g. because of a health issue, client moving out of the local area etc.) where this does not result in long term support provision by the CASSR.

‘Early cessation of service (leading to long term support)’ This is used if a client’s short term support ceased unexpectedly before the planned end date and this resulted in provision of long term services. These two categories are only applicable where a sudden change in circumstances prevents a period of short term support being completed. For other instances, e.g. where the short term support is ineffective and it is decided to stop provision earlier than usual, then the sequel should be recorded in the same way as if the short term service period had been completed.

‘No services provided – needs identified but self-funding’ This category applies to clients for whom it can be identified that they or their carer(s) intend to purchase support privately and are withdrawing from assistance offered by the CASSR, including care planning support, annual reviews etc.

This will help gather intelligence nationally on the numbers of self-funders who would otherwise have been supported by a local authority. It is accepted that it may not always be possible to find out a client’s intention if they decline local authority support. 'No services provided - Needs identified but support declined' This category applies to clients where local authority support was offered on the basis of eligible needs, but the client declined such support (for any reason except that they will be self-funding). This may occur when clients wish to try and remain independent without any outside help, or for any number of other reasons unconnected with their self-funding status.

Self-funded client vs. Full-cost client In SALT, there is a difference between ‘self-funders’ and ‘full-cost client’. Self-funded client are identified in the sequels to short term services and you should use the definitions below to help identify them. Full-cost client A full-cost client is one who pays the full direct costs of the services they receive but whose support is arranged by the CASSR which includes regular reviews, support planning etc. These clients should be INCLUDED in all the SALT measures.

Self-funded client A self-funded client is one who pays the full direct cost of the services they receive and they decide not to take up any offer of support planning / care management (e.g.

regular reviews) offered by the local authority. Where More than One Sequel Applies As for measure STS001, there can only be one sequel for each provision of short term support and there is a hierarchy that determines which sequel you should choose if more than one applies. The order in the proforma, when read from left to right, is the order in which you should identify the most relevant outcome.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 33 Short term Support followed by Short term Support Measure STS001 distinguishes between short term support for the purpose of maximising the client’s independence and other forms of short term support that do not play a role in ‘rehabilitation’ or ‘reablement’. This measure includes the sequel ‘Short Term Support (other)’ to allow for the outcome of a ‘non-reablement’ period of support. If the sequel is another period of ‘reablement’ then, for SALT purposes, the period of short term support is not complete and a sequel should only be recorded in measure STS002a when that support comes to an end.

Short term and Long term Support in the same year It is possible that clients will be in receipt of a long term service and then be referred for a short term intervention designed to maximise their independence. Such cases should be captured in measure STS002b and NOT in this measure (which is for new clients only). Tables 2a and 2b Primary Support Reason The Primary Support Reason (PSR) is essentially why the individual requires social care support and is fully described in the EQ-CL Framework document.

Only one PSR can be chosen per sequel to short term support. This should be identified and recorded at the point of assessment and any changes recorded during subsequent reviews.

Secondary support reasons could be captured locally if useful in supporting service commissioning, etc. Table 3 Support from Carer As defined in the EQ-CL Framework, clients may have support provided by an unpaid carer. This includes support from family, friends and neighbours where the client has identified ‘there is someone who helps me.’ For this measure there is a need to distinguish between clients who have an identified carer from those who do not. Carers should be identifiable from the client database used by the CASSR (i.e. there is the potential to report details about the carer(s) linked to clients).

It is not necessary for the carer to be in receipt of support for their caring role and they will not necessarily have been assessed or reviewed for support during the year. One way to ensure all carers are identified may be to flag individuals as having a ‘Carer Role’. This will allow easy cross referencing of carers’ services and social care services for the same individual.

Carers who have themselves received short-term support to maximise independence (i.e. they are both a new client and a carer) should be counted here for the purposes of this measure. They may themselves have their own carer (e.g. in the case of a husband and wife who care for each other and both receive social care support – each is a client and a carer). For this reason, councils should not rely on the Primary Support Reason – Social Support – Support to Carer as the means of identifying carers because it would miss clients who also act as carers.

Paid care workers funded by direct payments or provided as part of a commissioned service are not relevant and should be excluded.

Table 4 For clients who are going on to receive long term support, the setting of that support should be given. Only one setting can be chosen per sequel to short term support. Note that the Support Setting categories are identical to those used in the Long Term Support section of SALT (e.g. measure LTS001b). It is assumed that although the exact details of a care package being set up following a period of short term support may take some time to finalise, the sequel will be known and recorded when the

34 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. client’s final short term support review or subsequent Community Care Assessment determines their eligible needs. It is accepted this may take several weeks to determine in some cases. This may mean clients whose short term support ended in one reporting year may have their sequel recorded in the following year. Where the sequel is not determined by 31st March, include these cases in the next year’s return. Note that the ‘residential’ and ‘nursing’ sequels here indicate 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.

Calculation of age in SALT measure STS002a 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 ASCOF measure 2D will use the data from this measure to calculate the outcome of short term services: sequel to support. This could also be used by councils with SALT measure STS001, looking at clients who returned within 6 months to request (and be given) further short term support or long term services Data from Table 4 is also used for ASCOF indicator 2A (permanent admissions to residential and nursing care).

For more details on the definition and calculation of both measures, see the ASCOF Handbook of Definitions published by the Department of Health.

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 sequels in Tables 1, 2a+2b (combined) and 3 should be identical. Between measures In Year 2 of SALT: Rule 2: the total number of outcomes in each of Table 1, 2a+2b (combined) and 3 should be within 5% of the sequels to requests for support of ‘Short term support to maximise independence’ in Tables 1a and 1b (combined) from measure STS001*.

The total of Table 2a should be within 5% of Table 1a of STS001, and Table 2b should be within 5% of STS001 Table 1b. 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 be amended depending on first year results.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 35 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. For SALT measure STS002a (and 2b) the short term support may have occurred at the end of 2013- 14 with the sequel only being known after April 1st 2014. Councils are therefore encouraged to develop systems that will allow them to begin capturing episodes of Short Term Support to Maximise Independence during 2013-14.

Short Term Support to Maximise Independence is time-limited, typically 10 weeks or less, therefore recording capability would need to be in place from about January 2014 in order that the sequels occurring in 2014-15 can be fully captured. Councils who are not able to begin recording of short term support episodes in this way will find the total number of cases captured in STS002a is lower than the number of requests for support resulting in Short Term Support to Maximise Independence in STS001. Councils who do not have the complete set of data should comment on how complete their data is using the end section of the online return.

Note there are no ‘transition’ issues with Primary Support Reason in this measure, as the measure only applies to new clients. PSR should be collected for all new clients from the start of the 2014-15 performance year. Frequently Asked Questions for STS002a 1) What does ‘early’ mean in Early Cessation of Service for STS002a? At what point should I consider the reablement service we provided to be completed? To be counted as an ‘early cessation’, a change in the client’s circumstances must force the reablement service to be ended prior to its scheduled end date. An obvious instance would be if the client passed away.

It does not matter at what point the cessation occurred. A short term service which has a revised end date because it did not work as planned does NOT constitute an ‘early cessation’ for SALT purposes, because the end date was changed in a planned way. So short term services which do not achieve their goals of reducing ongoing dependency should be recorded as completed, with the appropriate sequel, even if they end earlier than originally anticipated. Version 1.2 of the SALT guidance has removed the reference to ‘life event’ when discussing early cessation of short term care to maximise independence.

This recognises that some clients may request that the care stops but this may not be indicative of a ‘life event’ but rather of personal choice.

2) Can rehabilitation work done by rehabilitation workers in a health or joint health / social care team be included in STS002a? Clients can only be included in STS002a if they also appear in STS001 either in this year or a previous year. This means the request for support has to be received by the CASSR who then decide to commission or provide a short term service to the client with the aim of maximising independence. If the request for support went to a health team who were not considering social care needs, then this would not be relevant to STS001 or STS002a.

3) Should work with out of area clients be recorded in STS002a? If you provided short term support to maximise independence relating to clients from another area at your expense, then count them in your figures.

If the other area pays for the work do not include them. Similarly, count local clients who were provided with short term support by another CASSR only if you pay for the work. This will probably require details for such clients to be recorded on your own client database in order to be accurately counted.

36 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 4) Could you please explain where Day Care would be recorded in the SALT return? Please refer to FAQ 1 for LTS001a in this Guidance. 5) In our council a number of clients move directly from reablement care (ST-MAX) to CHC funded care. We retain care management but the care is funded by health. Which sequel should we choose to reflect this care? We don’t expect that there will be many clients who move directly from ST-MAX to CHC funded care, but it is certainly possible. Similarly not all councils will care manage CHC funded care.

The appropriate sequel to choose would be ‘no services provided – universal services / signposted to other services’ Whilst you retain care management the fact that health are funding the care combined with the way that CHC funding may be time limited means that the sequel ‘Long term support (any setting)’ would not be appropriate. Future development of the SALT return may look to incorporate a new sequel that acknowledges joint working with health.

6) How should we treat '12-week disregard' clients in this measure? Please refer to FAQ 25 for SALT measure STS001.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 37 STS002b Of existing clients who have received ‘Short term Support to Maximise Independence’ a breakdown of what followed the period of short term support. Period 01/04/2014 – 31/03/2015 (all tables) General description and business case This measure is very similar to STS002a except that:  There is no explicit link to any other STS or LTS measure (unlike STS002a which links to STS001)  Only existing clients should be included, i.e.

those in receipt of long term support at the point of the decision to provide a period of short term support to maximise independence (they will appear in measure LTS001a) Some clients being referred for short term support will have been identified through review, and will appear in the LTS002 measures with an outcome of ‘short term support to maximise independence’. Others will have been identified through other means, without formal review. Regardless of the route of access, the outcomes of these existing clients receiving short term support are of interest, and can be compared to those outcomes for new clients in measure STS002a.

However, it is recognised that efforts to ‘re-enable’ or rehabilitate existing clients may be very different in nature to those programmes set up for potential clients contacting the council for the first time. Detailed Guidance for Data Tables The proformas for this measure are identical for measure STS002a. The guidance below will therefore repeat the relevant sections from that measure. Table 1 Route of Access Please see measure STS001 for details on this. Note that ‘Planned Entry (transition)’ does not appear as a route of access in measure STS002b because this applies to new clients only (i.e.

those who are not currently in receipt of adult community care long term support). Sequel to Short Term Support The sequels are similar to those as in measure STS001, except for additional categories concerning ‘Early cessation of service’ and ‘No Service Provided’. ‘Early cessation of service (NOT leading to long term support)’ This should be used where the period of short term support was cut short in an unplanned way (e.g. because of a health issue, client moving out of the local area etc.) where this does not result in long term support provision by the CASSR.

‘Early cessation of service (leading to long term support)’ This is used if a client’s short term support ceased unexpectedly before the planned end date and this resulted in provision of long term services. These categories are only applicable where a sudden change in circumstances prevents a period of short term support being completed. For other instances, e.g. where the short term support is ineffective and it is decided to stop provision earlier than usual, then the sequel should be recorded in the same way as if the short term service period had been completed.

‘No services provided – needs identified but self-funding’

38 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. This category applies to clients for whom it can be identified that they or their carer(s) intend to purchase support privately and are withdrawing from assistance offered by the CASSR, including care planning support, annual reviews etc. This will help gather intelligence nationally on the numbers of self-funders who would otherwise have been supported by a local authority. It is accepted that it may not always be possible to find out a client’s intention if they decline local authority support. 'No services provided - Needs identified but support declined' This category applies to clients where local authority support was offered on the basis of eligible needs, but the client declined such support (for any reason except that they will be self-funding).

This may occur when clients wish to try and remain independent without any outside help, or for any number of other reasons unconnected with their self-funding status.

Self-funded client vs. Full-cost client There is a difference in SALT between ‘self-funders’ and ‘full-cost client’. Self-funded client are identified in the sequels to short term services and you should use the definitions below to help identify them. Full-cost client A full-cost client is one who pays the full direct costs of the services they receive but whose support is arranged by the CASSR which includes regular reviews, support planning etc. These clients should be INCLUDED in all the SALT measures.

Self-funded client A self-funded client is one who pays the full direct cost of the services they receive and they decide not to take up any offer of support planning / care management (e.g.

regular reviews) offered by the local authority. Where More than One Sequel Applies As for measure STS001, there can only be one sequel for each provision of short term support and there is a hierarchy that determines which sequel you should choose if more than one applies. The order in the proforma, when read from left to right, is the order in which you should identify the most relevant outcome.

Short term Support followed by Short term Support Measure STS001 distinguishes between short term support for the purpose of maximising the client’s independence and other forms of short term support that do not play a role in ‘rehabilitation’ or ‘reablement’. This measure includes the sequel ‘Short Term Support (other)’ to allow for the outcome of a ‘non-reablement’ period of support. If the sequel is another period of ‘reablement’ then for SALT purposes the period of short term support is not complete and a sequel should only be recorded in measure STS002b when that support comes to an end.

Short term and Long term Support in the same year It is possible that clients will be in receipt of a long term service and then be referred for a short term intervention designed to maximise their independence.

Such cases should be captured in this measure and NOT in measure STS002a (which is for new clients only). Tables 2a, 2b and 3 Primary Support Reason The Primary Support Reason is essentially why the individual requires social care support and is fully described in the EQ-CL Framework guidance. Only one category can be chosen per sequel to short term support. This should be identified and recorded at the point of assessment and any changes recorded during subsequent reviews. Secondary support reasons could be captured locally if useful in supporting service commissioning, etc.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 39 For existing clients the recording of PSR should occur at the point of being assessed for provision of short term support to maximise independence. It is expected that this information will be captured on an ‘as needed’ basis for the purpose of this measure, rather than all clients receiving long term support being arbitrarily or automatically assigned a PSR at the beginning of the year. Within SALT it is expected that in some instances a different PSR may be reported in relation to Short Term Support than is reported in relation to the client’s Long Term Support services.

Support from Carer As defined in the EQ-CL framework, clients may have support provided by an unpaid carer. This includes support from family, friends and neighbours where the client has identified ‘there is someone who helps me.’ For this measure there is a need to distinguish between clients who have an identified carer from those who do not. Carers should be identifiable from the client database used by the CASSR (i.e. there is the potential to report details about the carer(s) linked to clients). It is not necessary for the carer to be in receipt of support for their caring role and they will not necessarily have been assessed or reviewed for support during the year.

One way to ensure all carers are identified may be to flag individuals as having a ‘Carer Role’. This will allow easy cross referencing of carers’ services and social care services for the same individual.

Carers who have themselves received short-term support to maximise independence (i.e. they are both an existing client and a carer) should be counted here for the purposes of this measure. Carers may themselves have their own carer (e.g. in the case of a husband and wife who care for each other and both receive social care support – each is a client and a carer). For this reason, councils should not rely on the Primary Support Reason – Social Support – Support to Carer as the means of identifying carers because it would miss clients who also act as carers. Paid care workers funded by direct payments or provided as part of a commissioned service are not relevant and should be excluded.

Table 4 For clients who are going on to receive long term support, the setting of that support should be given. Only one setting can be chosen per sequel to short term support. Note that the Support Setting categories are identical to those used in the Long Term Support section of SALT (e.g. measure LTS001b). It is assumed that although the exact details of a care package being set up following a period of short term support may take some time to finalise, the sequel will be known and recorded when the client’s final short term support review or subsequent Community Care Assessment determines their eligible needs.

It is accepted this may take several weeks (or even months) to determine in some cases. This may mean clients whose short term support ended in one reporting year may have their sequel recorded in the following year. Where the sequel is not determined by 31st March, include these cases in next year’s return. Note that the ‘residential’ and ‘nursing’ sequels here indicate 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.

Calculation of age in SALT measure STS002b 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.

40 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Relationships and Data Validation Relationship with ASCOF measures Data from Table 4 is used for ASCOF indicator 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.

It is recognised that efforts to ‘re-enable’ or rehabilitate existing clients may be very different in nature to those programmes set up for potential clients contacting the council for the first time, so data from STS002b is not utilised in the new ASCOF measure 2D The Outcome of short term services : sequel to service.

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 sequels in Tables 1, 2a+2b (combined) and 3 should be identical. Between measures It is possible that all existing clients receiving a short term intervention will have been arranged on the basis of a review, and it is possible that more reviews have been done with an identified outcome of short term support than the number of completed episodes of short term support captured in this measure.

See Rule 2.

Rule 2: the total number of sequels following reviews of ‘Short term support to maximise independence’ in measure LTS002(a+b) should not exceed the number of clients in any Table 1, 2a+2b (combined), 3 or 4 by more than 5%*. * Note that the 5% rules above are suggestions and may be amended depending on first year results. Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document. 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.

For SALT measure STS002b (and 2a) the short term support may have occurred at the end of 2013- 14 with the sequel only being known after April 1st 2014. Councils are therefore encouraged to develop systems that will allow them to begin capturing episodes of Short Term Support to Maximise Independence during 2013-14. Short Term Support to Maximise Independence is time-limited, typically 10 weeks or less, therefore recording capability would need to be in place from about January 2014 in order that the sequels occurring in 2014-15 can be fully captured. Councils who do not have the complete set of data should comment on how complete their data is using the end section of the online return.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 41 Frequently Asked Questions for STS002b 1) Do clients have to be referred to a short term service via a planned or unplanned review? No. Clients may be referred for short term interventions for a number of reasons and at various points, not necessarily from a review. But, to appear, in STS002b they must currently be in receipt of social care services at the time of the decision to provide short term support and this would mean they will appear as a service user in measure LTS001a.

2) When the existing clients reported in STS002b receive ST-MAX their long term packages of care may either continue or in some instances be suspended during the period of ST-MAX.

Please could you give some advice on how the outcomes of ST-MAX for these clients should be reported in STS002b? You are correct in assuming that it is possible for long term support services to continue while the short term support to maximise independence "ST-MAX" is being provided. If the outcome of the ST- MAX is to return to that long-term service package, then you would indeed choose the sequel 'Long Term Support (any setting)'. In a slightly different scenario, if the long term service was suspended during ST-MAX, but resumed on its completion, then the same sequel would apply. 3) How should we treat '12-week disregard' clients in this measure? Please refer to FAQ 25 for SALT measure STS001.

42 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. STS003 (temporary measure) Snapshot count of clients receiving ‘Short Term Support to Maximise Independence’ at the year-end (31st March) with an estimate of how many would have been counted in previous years for RAP table P2s. Period 31/03/2015 General description and business case This measure is intended as a ‘volume’ measure, indicating how much short term support to maximise independence is provided at any given time.

This measure ensures we have a robust snapshot measure of services in place on 31st March across the short as well as long term service domains (STS003 is therefore equivalent to LTS001b in the Long Term Support measures).

Previously clients in receipt of a short term service on the 31st March may have been included in the RAP P2s form, but many would have been excluded (on the basis of not having received a Community Care Assessment and not being FACS eligible). To aid time series analysis we are also requesting (for at least one year) an estimate of what proportion of clients in receipt of short term support to maximise independence would have previously been included in the P forms of the RAP return.

Who to include / exclude? For clients to be included in STS003 the following criteria must apply:  The return is for adults aged 18 and over only  Short term support to maximise independence must have been in place on the 31 st March  Other forms of short term support should be excluded The definition of ‘short term support to maximise independence’ is the same as that used for measure STS001 and STS002. Detailed Guidance for Data Table Estimate or count of clients who would previously have been counted in RAP P2s This could be an estimate or a more precise calculation depending on what local systems will allow.

The purpose is purely to try and understand what proportion of the data previously submitted through RAP included short term support.

Note the following: - If all short term support services from your local authority are provided outside of the FACS (Fairer Access to Care) eligibility criteria, then you can enter ‘0’ into this column, as none of these services would previously have appeared in P2s. Calculation of age in SALT measure STS003 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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 43 Relationships and Data Validation Note the rule given below is 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. Relationship with ASCOF measures None. Data Validation Within the measure None. Between measures Rule 1: the total number of clients should not exceed the number of sequels counted in STS002a plus STS002b.

Transitional Arrangements There are no transitional issues associated with this measure, although it is accepted that estimates may be required. Details of any methods used to estimate data can be given in the end section of the online SALT return.

44 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. STS004 Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. Period: Hospital discharges between 01/10/2014 – 31/12/2014 with 91 day follow-up.

General description and business case This measure collects data on the benefit to clients from reablement / rehabilitation services following a hospital episode. It captures the joint work of social services and health staff and services commissioned by joint teams as well those commissioned by social services only. This is essentially the same measure as I1 in the old ASC-CAR return. The information collected through this measure is essential for commissioning and planning and the monitoring of joint working arrangements. It is used in answering parliamentary questions and ministerial briefings.

The data is used to feed into the rehabilitation / reablement ASCOF measure 2B.

Who to include / exclude? For clients to be included in STS004 the following criteria must apply:  Clients are aged 65 or over at the date of discharge  Clients would otherwise face an unnecessarily prolonged stay in acute in-patient / community hospital care, or be permanently admitted to long term residential or nursing home care, or potentially use continuing NHS inpatient care.  The service is a short term intervention typically lasting no longer than 6 weeks, and frequently as little as 1-2 weeks or less, has a planned outcome of maximising independence and enabling clients to resume living at home.

 Clients are provided with care services on the basis of either a joint multidisciplinary assessment from NHS and social care services or an assessment from social care services only, resulting in an individual support plan that involves active therapy, treatment or opportunity for recovery. Detailed Guidance for Data Table Reablement / rehabilitation services should not solely comprise the provision of, for example, an item of equipment, wound nursing or provision of meals on wheels or getting up / putting to bed services, nor simply restarting of service(s) already in place at the time of admission to hospital unless the service(s) were short term with an intention to maximise independence.

The measure covers both residential and non-residential short term services intended to maximise independence.

Discharges A hospital discharge is defined as an individual who has been formally admitted to hospital (rather than an individual who has attended A&E) and then discharged. The length of time between admission and discharge will vary from a few hours (e.g. in a clinical decision unit) to days or weeks. This table is based on the total number of discharges with a rehabilitation plan agreed jointly by the NHS and CASSR or CASSR only, where the objective is to see the patient return home within the reporting period, not the unique number of people who have been discharged who meet these criteria over the period.

Double counting If an individual has had more than one discharge to rehabilitation services during the reporting period, then include each discharge. In these cases it is important to make sure that if they also have multiple reviews then the correct review is also attached to each discharge.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 45 Collection Period The number of discharges is collected during the period 1st October to 31st December. These people are then contacted during the period 1st January to 31st March (to make it consistent with above) to see if they are still living at home.

This could be done via a formal process, such as a review, or could be done informally, e.g. via a telephone call to the service user. Start date This is the date the joint rehabilitation services started, therefore the first day is recorded as day 1, not day 0.

Measuring time 3 months is defined as 91 days, based on calendar days, not working days. Type of hospital Discharges of those aged 65 and over from both acute and community hospitals should be included (discharges from psychiatric units and EMI units should be excluded). Councils and NHS partners may, however want to extend the local reporting process to cover these discharges and / or instances where a joint rehabilitation plan is arranged to avoid admission to hospital. The start date will be the day the discharge from the last hospital in the sequence of placements in hospitals ends. Some examples are: (i) A person may be first admitted to an acute bed, then transferred to a community hospital bed, and then discharged to rehabilitation / reablement service in a care home.

The start date will be the day the person is discharged to rehabilitation / reablement service in a care home. (ii) A person may be first admitted to an acute bed, then transferred to a community hospital bed, sent back for final checks in an acute bed and then discharged to rehabilitation / reablement service. The start date will be the day the person is discharged to rehabilitation / reablement service.

Multi-disciplinary assessment This is defined as where both the health and social care needs of the individual have been assessed. This assessment may have been done jointly by health and social care staff, social care staff only or health staff only. The key element is that both the health and social care needs of the individual have been assessed. Living at home This is defined as those people living in their own home in the community, including in extra care housing or a shared lives scheme setting. Those people who are in hospital (other than for a brief episode of care from which they are expected to return home) or are in a registered care home (other than for a brief period of respite care from which they are expected to return home) are not considered to be living at home.

Person not known to social services and requiring following up These are discharges where social services have no details of the person 91 days after discharge, e.g. the person is not listed on the social care records or on the books to receive social care services. In these cases social services have to use a variety of methods to trace these cases, for example:  social care records – checking, for instance, for packages of care in place at the 91st day  writing to or telephoning clients on the 91st day to identify their location  liaison with operational social work staff to identify the 91st day location  data from health partners involved in the delivery of reablement / intermediate care which may identify clients who are in receipt of further episodes of care at the 91st day

46 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.  patient registrations from NHS partner organisations  address details from GPs  benefits data from housing team  details of deaths from local data When the person cannot be traced For discharges where the person cannot be traced after 91 days, they should be included in the first row (Number of discharges in period to rehabilitation where the intention is for the patient to go back home) but not in the second row (Number of above discharges where person was still at home 91 days later). In other words, clients who cannot be traced should be assumed to NOT still be at home.

Calculation of age in SALT measure STS004 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 STS004 does not explicitly relate to any of the other SALT measures because it has been drawn from the old ASC-CAR return. There are no ‘consistency checks’ made with the other SALT measures for this reason.

Relationship with ASCOF measures Data from measure STS004 is used for ASCOF indicator 2B (proportion of older people, 65 and over, who were still at home 91 days after discharge from hospital into reablement / rehabilitation services). For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health. 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 number of clients still at home after 91 days must not be greater than the total number of people discharged.

Between Measures None. Transitional Arrangements There are no transitional issues as this measure is taken directly from ASC-CAR with no changes from 2013-14. Frequently Asked Questions for STS004 1) What is the time period for reporting data in STS004? In 2014-15 the data collected in this measure should relate to hospital discharges between 1st October 2014 and 31st December 2014. They should be followed up to see if they are still living at home during 1st January 2015 to 31st March 2015.

Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. 47 2) Should people who receive services only from health be included in the return? If a person has had a joint assessment, where both their health and social care needs are assessed, or an assessment just from social care services only, and they go on to receive a service from social care only, health only, or health and social care, then they should be included on the return. The important element for inclusion is that there must be a social care element to the assessment. 3) If the rehabilitation is provided jointly, with the majority provided by a PCT and only 10% by social services, should councils only include 10% of cases?

No. They should include all cases as it is a joint indicator. The individual must though have had a multi-disciplinary assessment, and have received services aimed at rehabilitation / reablement with an expectation that the patient will return home. 4) What if the individual is still receiving joint rehabilitation after 91 days within their own home? Are they counted in the numerator? If the individual has re-entered intermediate care before the 91 days and is still there on the 91st day then they should be counted as “at home” on the 91st day (and therefore included in the numerator), if the total new period for which they are in intermediate care (i.e.

from readmission to the 91st day) could be described as a “brief episode of care” and the individual is expected to return home. 5) How should an individual be treated who re-entered into intermediate care before the 91 day follow up and was discharged before the 91st day without a new jointly assessed enablement plan, but kept the original plan?

If the client is discharged back home before the 91 day period and remains on the current enablement plan from their previous hospital admission, then the new discharge should not be counted in STS004 as there is not an enablement plan specific to this particular hospital discharge. You should judge the 91st day location for the first discharge as if the second discharge is not one that is valid for the return. 6) How should an individual be treated who re-entered into intermediate care before the 91 day follow up and was discharged before the 91st day with a new jointly assessed enablement plan in place upon discharge?

If the client is readmitted to hospital before the 91 day follow up and is discharged with a new jointly assessed enablement plan upon discharge, then this discharge would be counted within STS004 as this is a discharge with a new care plan associated with it, from which there should be a new 91 day follow up. However, the original discharge should not be counted as being at home 91 days later as this has not been achieved on the original enablement plan, but it should be counted as a discharge (i.e., the denominator for the outcome measure).

7) Should those people who died during the 91 days be excluded altogether from numerator and denominator? No, they should be included in the denominator but not reported in the numerator.

48 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 8) There are sometimes occasions where there are not enough reablement beds for clients (who are flagged to receive reablement services) to move into immediately when they are discharged from hospital. These clients can be moved into ‘regular’ care home beds and may start their reablement services a couple of weeks (or more) after their hospital discharge. In these cases should the start date of the 91 day period for STS004 (and ASCOF 2B) be the date of hospital discharge or the start of the reablement? As ASCOF measure 2B is trying to measure the outcome of the rehabilitation service, the clock should start when the person starts their rehabilitation service.

It would be helpful if you could include information within the Comments section at the end of the return about the number of hospital discharges that are delayed in this way.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 49 LTS001a The number of people accessing long term support during the year to 31st March by Primary Support Reason, Age Band, Support Setting and Mechanism of Service Delivery. Period 01/04/2014 – 31/03/2015 General description and business case This is a ‘through the year’ measure of supported clients where the support is ‘long term’.

Long Term support encompasses services provided with the 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 are subject to regular review. Breakdowns by Primary Support Reason and age band allow analysis of these specific groups. Mechanism of service delivery will allow investigation of the differing ways that personal budgets are being delivered while Support Setting gives information on the balance of residential / community services. This ‘through the year’ measure helps identify the ‘turnover’ of clients in receipt of long term support.

The information is important for aligning costs with activity, to establish the balance between short term interventions (covered in the ‘STS’ short term measures) and long term services and to help identify the cohort for whom personalised services could be delivered.

Who to include / exclude? For clients to be included in LTS001a the following criteria must apply:  The support is provided or commissioned by social services or an NHS health partner under Section 75 Agreements and must be part of a care / support plan following a Community Care Assessment This return is confined to adults aged 18 and over who were ‘on the books’ to receive long term support during the period, 1st April to 31st March. On the books A client is deemed to have been 'on the books' for services if there was an allocation of services for that client which were provided on the basis of eligibility criteria / policies (i.e.

an assessment of need had taken place) and was subject to regular review. A person who previously received services during the previous period 1st April to 31st March which had ceased by April of the reporting year would not be considered to be 'on the books' and should not be recorded here. It is recognised that social services provide other preventative services to people in the community, for example through grants or service agreements. In the LTS measures only those clients who have been assessed by the CASSR or by a legally delegated NHS health partner under Section 75 Agreements and receive support specified in their care / support plan can be included in the long term (LTS) measures.

Note that some forms of long term support that previously qualified for the RAP ‘P’ forms are no longer counted in the LTS measures. This includes all provision of equipment and adaptations. The major changes are shown below.

50 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Was counted in RAP ‘P’ forms If provided as a sequel to a request for support, count in SALT as: Equipment and Adaptations (whether in P2s or P2f) Ongoing Low Level Support Professional Support Ongoing Low Level Support or Short term Support (other) depending on nature of provision.

Exceptionally, could count as long term support (eligible services). This would likely be most relevant to clients receiving mental health support.

Short term residential not respite Short Term Support (other) Carers who are themselves in receipt of services following assessment of eligibility (i.e. are seen as service users as well as carers supported to care) are included in this measure. Services for carers in their caring support role are captured in measure LTS003. CASSRs should therefore identify whether a service is for the client or for the carer. Where the service is for both the client and the carer, CASSRs need to make a judgement as to who benefits the most.

There should be no double counting - individuals should be counted only once, i.e.

the sum of rows and columns equals the number of clients in that row / column. This is unlike the old RAP return, where multiple components of service could be recorded for a single client. Detailed guidance is provided below. Full-cost and self-funding clients In a significant change from the RAP return, clients who pay the full costs of their care are included if they decide to work with the CASSR to plan their support, the CASSR commissions the care and then reviews it on an ongoing basis. Such ‘full cost’ clients are still being supported by the council, and there is obviously an interest and mechanism (the annual review etc.) for determining whether good social care outcomes are being achieved.

Self-funded clients are still excluded from the collection (see below).

Full-cost client A full-cost client is one who pays the full direct costs of the services they receive but whose support is arranged by the CASSR which includes regular reviews, support planning etc. These clients should be INCLUDED in all the SALT measures. Self-funded client A self-funded client is one who pays the full direct cost of the services they receive and they decide not to take up any offer of support planning / care management (e.g. regular reviews) offered by the local authority. They should be excluded from the LTS measures (but may appear in the STS measures) because there is no way to reliably track their social care outcomes.

Other clients whose support bears no resource cost implications to the CASSR for its social care components (e.g. Supporting People, s256 and health funded clients) are excluded from the measure.

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. Personal Budget The definition of a ‘personal budget’ is that:  The person (or their representative) has been informed about a clear, up front allocation of funding, enabling them to plan their support arrangements.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 51  There is an agreed support plan making clear what outcomes are to be achieved with the money.

 The person (or their representative) can use the money in ways and at times of their choosing. Direct Payment SALT defines direct payments as monetary payments made by CASSRs directly to adult clients aged 18 and over and carers (aged 16 and over) of adults, who have been assessed as needing certain services, in lieu of social service provisions.

A direct payment has the following key features: i. An individual (or a ‘suitable person’ acting on behalf of the individual) receives and manages money from the CASSR, provided in lieu of social care services ii. Arrangements are made by the individual to achieve their agreed outcomes Importantly, the person to whom the direct payment is made must have control over how services are delivered. Vouchers or similar ‘credits’ are not direct payments. For further information about direct payments, including revised guidance on the eligibility of certain individuals to receive such services (from 9 November 2009), please see Guidance on direct payments for community care, services for carers and children's services: England 2009, available on the Department of Health website2 .

Support Setting / Delivery Mechanism This should be worked out for each client from left to right as it appears on the proforma. In other words, the first support setting / category which applies should be chosen. This is like the hierarchy used in the STS measures. For example, if a client is supported in either residential or nursing care (not including short term placements) at any point of the year then they should be counted in the residential or nursing columns, regardless of any services received in the community. In other words, the clients who appear in the Community columns should have only received community-based services during the year, excluding any temporary stays in residential or nursing care, whether for respite purposes or not.

A client may be receiving community-based services for part of the year and then move into residential / nursing care, or vice-versa. In this scenario the client should be counted as residential / nursing care, even if the move occurs on the last day of the year. An exception is where the placement is temporary for a pre-defined period (e.g. to provide respite to a carer) and the client is going to move back to a community setting at the end of this period. In such cases, they should be recorded as being in a community setting.

Clients that move from residential care into the community, or where their home is deregistered, should still be counted in LTS001a as being in their residential or nursing care.

The setting as at 31st March may have changed, and be reflected differently in measures LTS001b and c. The hierarchy works similarly with direct payments and personal budgets. If a client was based in the community during the year and their support comprised direct payments and the council arranged support (e.g. a ‘mixed’ personal budget), then they should be added as ‘part direct payment’, since that is the first category in the proforma that applies.

Some clients living in care homes may simultaneously receive community based services (e.g. attendance at day centres). For SALT purposes these clients should be counted as in residential or 2 http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/SocialCare/Soc ialcarereform/Personalisation/Di rectpayments/DH_076522

52 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. nursing care. If a group of people live together independently with a shared tenancy agreement then any services they receive should be classified as community-based.

If a person moves between residential and nursing care during the year count them as in nursing care. If a person moves between residential or nursing care and a community setting during the year, count them as in residential / nursing care. The following table has fuller explanations of each support setting / delivery mechanism, in the order they appear in the proforma. Each client should appear only once in each table of LTS001a. HOW TO COUNT EACH CLIENT Support Setting / Delivery Mechanism Explanation First, consider whether a client should be counted as being in a residential / nursing setting Residential Nursing Include supported residents in - Local authority staffed care homes for residential care - Independent sector care homes for residential care - Registered care homes for nursing care - Those whose care is commissioned by local authorities following the Valuing People Now (VPN) initiative which has changed the responsibility for, and funding of, some learning disability services.

Some clients living in care homes may additionally receive community-based services (e.g. attendance at day centres). For SALT purposes these clients should be counted as in residential or nursing care. If a group of people live together independently with a shared tenancy agreement then any services they receive should be classified as community-based. If not, check whether they should be counted as a ‘fully cash’ client Direct Payment only Direct payments are defined as monetary payments made by local CASSRs directly to adult clients aged 18 and over in lieu of social service provisions, who have been assessed as needing certain services.

A person who chooses to take their entire personal budget or receives all their services through a direct payment would be recorded in this category Or a ‘part cash’ client Part Direct Payment A person who chooses not to take their entire personal budget / care package as a direct payment but does receive some cash as a direct payment, would be counted here Or if their personal budget is managed entirely through council commissioned services CASSR managed Personal Budget Clients in receipt of a personal budget should be recorded here if none of their personal budget allocation is being taken as a direct payment.

In order to be counted as a personal budget client other criteria apply – see the definition of ‘personal budget’, above. This category includes flexible provision made to clients which does not meet the definition of a ‘direct payment’ above (e.g. vouchers or other forms of credit).

Or if they receive council commissioned services which aren’t under a Personal Budget CASSR Commissioned support only Finally, a client with a package of services provided by the CASSR but not under a personal budget, with no cash payments or payment schemes, should be counted in this category. As described above, those clients receiving services like equipment or adaptations are excluded from the LTS measures. As discussed in the FAQs of STS001, for mental health professional support may qualify as ‘long term support (eligible services)’. This would likely be for clients receiving ongoing mental health support which is part of a support / care plan following a community care assessment.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 53 Primary Support Reason There should be only ONE Primary Support Reason included per individual within this table. In other words, individual clients should appear in only one of the rows in the table. Calculation of age in SALT measure LTS001a 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 This measure is not used directly for any ASCOF measure.

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: In all tables, the total of rows = the total number of clients in that row (there can be no double counting of support setting / delivery mechanism).

Between Measures Rule 2: Client totals - the total number of clients counted in Table 1a of LTS001a should exceed the totals counted in each of Table 1a and 2a of LTS001b. Similarly, the total clients counted in Table 1b should exceed the totals counted in each of Table 1b and 2b of LTS001b. Rule 3: Client totals - the total number of clients counted in Table 1a of LTS001a should exceed the total counted in Table 1a of LTS001c. Similarly, the total of Table 1b of LTS001a should exceed the total counted in Table 1b of LTS001c.

Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document.

Frequently Asked Questions for LTS001a 1) Could you please explain where Day Care would be recorded in the SALT return? SALT differs from the RAP return in many respects and it is important to note that it is not a straight ‘count’ of clients and / or care types. Day care may appear within several SALT tables, both as a long term service and as a sequel to requests for support or short term care to maximise independence. For clients to be included within the long term support tables the following criteria must apply:  The support “is provided or commissioned by social services or an NHS health partner under Section 75 Agreements and must be part of a care / support plan following a Community Care Assessment.” (See ‘Who to include / exclude?’ section for measure LTS001a).

 The support “encompasses services provided with the 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…”.(see ‘General Description’ section for measure LTS001a).

54 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. If these criteria are matched then day care should be reported according to the guidance on the hierarchy specified in the ‘Support Setting / Delivery Mechanism’ section of LTS001a. Day care may also be put in place after a period of short term care to maximise independence.

In this case it may be reported within the STS002a/b tables as sequel ‘Long Term Support (any setting)’. Sequels to short term care to maximise independence are reported as according to the hierarchy detailed in the ‘Where More than One Sequel Applies’ section of STS002a. Finally day care may be put in place as a result of a request for support from a new client. In this instance it would appear in STS001 as a sequel to the request for support. Within table STS001 care is reported according to the hierarchy detailed in the ‘Hierarchy of Sequels’ section of STS001. 2) Is Occupational Therapy and Mental Health work included in SALT?

Yes, if it includes a social care component. In the same way that such activity would be included STS001 in relation to sequels to requests for support (see STS001 FAQ 21) SALT measures LTS001a/b/c should also include this work as long as the other criteria for inclusion in the LTS tables are met. If you have joint health and social services teams (operating a partnership under Section 75 Agreements) then work completed by mental health teams should be included, providing this includes a social care element and the work could lead to social care services. 3) How should we treat supported accommodation services in SALT? Are these to be handled the same way as RAP whereby they should not be included if delivered as part of housing services?

Supported accommodation should be treated in the same way as RAP - if the supported housing service is provided by the housing department or other agencies, it should be excluded from SALT. 4) What happens if a client who starts the year with a fully cash personal budget then begins to receive some additional council commissioned care in what becomes a mixed personal budget? How do we capture this in the LTS measures? The 'hierarchy' applies to all LTS measures but the above scenario will be captured differently in each LTS measure depending on the circumstances.

In LTS001a the client would be reported within the column headed ‘Direct Payment Only’ as this was the highest category in the hierarchy to apply during the year.

If the personal budget you describe is still in place on 31st March, then in LTS001b the client would appear in the column 'Part Direct Payment' because at the end of the year, this is the highest category which applies to their personal budget of mixed cash and commissioned services. Similarly, if support had been in place continuously for more than 12 months, the same 'Part Direct Payment' category would apply for LTS001c.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 55 LTS001b Of the clients in LTS001a, the number of people accessing long term support at the year-end (31st March) by Primary Support Reason, Reported Health Conditions, Age Band, Support from Carer, Gender, Ethnicity, Support Setting and Mechanism of Service Delivery. Period 31/03/2015 General description and business case This is a snapshot measure of supported clients at the year-end where the support is ‘long term’. Long Term support encompasses services provided with the intention of maintaining quality of life for an individual on an ongoing basis, and which have been allocated on the basis of eligibility criteria / policies (i.e.

an assessment of need has taken place) and are subject to regular review. Breakdowns by Primary Support Reason and age band allow for analysis of these specific groups. Two reported health conditions are collected to allow study of areas of policy interest (autism and Asperger’s). In future years it is possible that other health conditions will be added.

Support from Carer status gives some idea of the impact of informal carers in the cohort. Mechanisms of service delivery will allow investigation of the differing ways that personal budgets are being delivered while Support Setting gives information on the balance of residential and community based services. The information is important for aligning costs with activity, to establish the balance between short term interventions (covered in the ‘STS’ short term measures) and long term services and to help identify the cohort for whom personalised services could be delivered.

Who to include / exclude? For clients to be included in LTS001b the following criteria must apply:  The support is provided or commissioned by social services or an NHS health partner under Section 75 Agreements and must be part of a care / support plan following a Community Care Assessment This return is confined to adults aged 18 and over who were ‘on the books’ to receive long term support on the last day of the period, 31st March.

On the books A client is deemed to have been 'on the books' for LTS001b if there was an allocation of services for that client on 31st March of the reporting year, provided on the basis of eligibility criteria / policies (i.e. an assessment of need had taken place) and subject to regular review. A person who previously received services which had ceased by March 31st would not be considered to be 'on the books' and should not be recorded here.

It is recognised that social services provide other preventative services to people in the community, for example through grants or service agreements. In the LTS measures, only those clients who have been assessed by the CASSR or by a legally delegated NHS health partner under section 75 Agreements and receive support specified in their care / support plan can be included in the long term (LTS) measures. Note that some forms of long term support that previously qualified for the RAP ‘P’ forms are no longer counted in the LTS measures. This includes provision of any equipment and adaptations.

The major changes are shown in the following table.

56 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Was counted in RAP ‘P’ forms SALT counts this in STS measures if provided as a sequel to requests for support Equipment and Adaptations (whether in P2s or P2f) Ongoing Low Level Support Professional Support Ongoing Low Level Support or short term support (other) depending on nature of provision. As discussed in the FAQs of STS001, for mental health professional support may qualify as ‘long term support (eligible services)’. This would likely be for clients receiving ongoing mental health support which is part of a support / care plan following a community care assessment.

Short term residential not respite Short Term Support (other) Carers who are themselves in receipt of services following assessment of eligibility (i.e. are seen as service users as well as carers supported to care) are included in this measure. Services for carers in their caring support role are captured in measure LTS003. CASSRs should therefore identify whether a service is for the client or for the carer. Where the service is for both the client and the carer, CASSRs need to make a judgement as to who benefits the most.

There should be no double counting - individuals should be counted only once, i.e.

the sum of rows and columns equals the number of clients in that row / column. This is unlike the old RAP return where multiple components of service could be recorded for a single client. Further detailed guidance is provided below. Full-cost and self-funding clients In a significant change from the RAP return, clients who pay the full costs of their care are included if they decide to work with the CASSR to plan their support, the CASSR commissions the care and then reviews it on an ongoing basis. Such ‘full-cost’ clients are still being supported by the council, and there is obviously an interest and mechanism (the annual review etc.) for determining whether good social care outcomes are being achieved.

Self-funded clients are still excluded from the collection (see below).

Full-cost client A full-cost client is one who pays the full direct costs of the services they receive but whose support is arranged by the CASSR which includes regular reviews, support planning etc. These clients should be INCLUDED in all the SALT measures. Self-funded client A self-funded client is one who pays the full direct cost of the services they receive and they decide not to take up any offer of support planning / care management (e.g. regular reviews) offered by the local authority. They should be excluded from the LTS measures (but may appear in the STS measures) because there is no way to reliably track their social care outcomes.

Other clients whose support bears no resource cost implications to the CASSR for its social care components (e.g. Supporting People, s256 and health funded clients) are excluded from the measure.

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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 57 Support Setting / Delivery Mechanism As for LTS001a, this should be worked out for each client from left to right as it appears in the proforma. In other words, the first support setting / category which applies should be chosen. The clients who appear in the Community columns should be receiving only community-based services.

There is a difference from measure LTS001a in that clients who have returned to the community from a former ‘permanent placement’ will be recorded as in a community setting if they are living in the community on 31st March. This also applies if a home is deregistered during the year and the client is living there on 31st March.

Temporary placements occurring at the year-end for a defined period (after which the client will return to the community - e.g. respite care to support a carer) should not be counted as residential / nursing as the client’s support is still based in the community. The table given in LTS001a has full explanations of each support setting / delivery mechanism. These are the same in all LTS001 measures but the important aspect for LTS001b is to consider the package as at 31st March. Personal Budget The definition of a ‘personal budget’ is the same as for LTS001a. Primary Support Reason As for measure LTS001a, there should be only ONE Primary Support Reason included per individual within this table.

In other words, individual clients should appear in only one of the rows in the table. Tables 2a and 2b Double Counting Unlike Tables 1a and 1b, double counting within columns can occur, if individuals have more than one Reported Health Condition.

Support Setting / Delivery Mechanism As for LTS001a. Reported Health Conditions Two Reported Health Conditions are mandatory for collection in 2014-15. These are the priority policy areas and have been agreed with a representative group of local authorities, ADASS and the Department of Health as suitable for collection. Only Reported Health Conditions relevant to the social care needs of the client need to be included. Further health conditions may become mandatory in 2015-16. Apart from the two mandatory conditions, the rest of the categories are included for voluntary collection. If a client is not believed to have any relevant health conditions, this can also be recorded on the proforma so that the proportion of clients for whom Reported Health Conditions data is available can be determined.

Please see the EQ-CL Framework guidance for more detail of these categories.

As many health conditions as are relevant can be reported for each client; unlike Primary Support Reason there is no requirement to choose the most important. Table 3 Support Setting / Delivery Mechanism As for LTS001a.

58 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Support from Carer As defined in the EQ-CL Framework, clients may have support provided by an unpaid carer. This includes support from family, friends and neighbours where the client has identified ‘there is someone who helps me.’ For this measure there is a need to distinguish between clients who have an identified carer from those who do not.

Carers should be identifiable from the client database used by the CASSR (i.e. there is the potential to report details about the carer(s) linked to clients). It is not necessary for the carer to be in receipt of support for their caring role and they will not necessarily have been assessed or reviewed for support during the year. One way to ensure all carers are identified may be to flag individuals as having a ‘Carer Role’. This will allow easy cross referencing of carers’ services and social care services for the same individual.

This return refers to carers of adults (where the cared for person is aged 18 or over as at 31st March) only. Carers under the age of 18 at 31st March where the cared-for person is over 18 should be included. The only distinction required for this measure is between clients who do not have an identified carer versus those who do. Carers may themselves be in receipt of long term care in their own right and are counted as clients for the purposes of this measure. They may themselves have their own carer (e.g. in the case of a husband and wife who care for each other). For this reason, councils should not rely on the Primary Support Reason – Social Support – Support to Carer as the means of identifying carers because it would miss clients who also act as carers.

Paid care workers funded by direct payments or provided as part of a commissioned service are excluded. Clients in residential and nursing care for the purposes of measure LTS001b should not have any carer recorded in Table 3, due to the fact that these are formal care settings featuring paid carers. Tables 4a and 4b Support Setting / Delivery Mechanism As for LTS001a. Ethnicity Ethnic categories are a modification of a subset of those used in the 2011 Census. It is recognised that some local authorities may break some ethnic categories down into greater detail in order to account for local issues, but they must be ‘rolled up’ and reported as presented here (see the EQ-CL Framework document for more detail on ethnic categorisation).

Gender Within SALT gender is defined as the gender the individual considers themselves to be. This is either male or female, and in the case of transgender, it should be recorded as the preference of the individual concerned. Calculation of age in SALT measure LTS001b 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.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 59 Relationships and Data Validation Relationship with ASCOF measures Data from this measure will be used for the denominator of the client measures in the revised ASCOF measure 1C (the proportion of people using social care who receive self-directed support and those receiving direct payments).

For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health. 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: In all tables, the total of rows = the total number of clients in that row (there can be no double counting of support setting / delivery mechanism).

Between Measures Rule 2: Client totals - the total number of clients counted in any table of LTS001b should not exceed the equivalent age totals counted in LTS001a but should be greater than the totals recorded in LTS001c (e.g. Table 1a of LTS001b should not add up to more clients than Table 1a of LTS001a but should exceed Table 1a of LTS001c). Rule 3: Tables 2a and 2b should have fewer clients than the other tables because only two mandatory Reported Health Conditions are being collected. The total of clients for Tables 1a+1b, 3, 4a+4b should be identical.

Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document.

For 2014-15 only two of the possible Health Conditions are mandatory for collection in tables 2a and 2b. For guidance and suggestions on how to collect information for this new category, please see the separate EQ-CL Framework document. Frequently asked questions for LTS001b 1) What happens if a client who starts the year with a fully cash personal budget then begins to receive some additional council commissioned care in what becomes a mixed personal budget? How do we capture this in the LTS measures? Please see FAQ 4 for LTS001a

60 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. LTS001c Of the clients in LTS001b, the number of people who have been accessing long term support for more than 12 months at the year-end (31st March). Broken down by Primary Support Reason, Age Band, Support Setting and Mechanism of Service Delivery. Period 31/03/2015 General description and business case This is a snapshot measure of supported clients at the year-end where the support is ‘long term’ and has been in place for at least 12 consecutive months.

This information is important because it identifies the cohort of clients for whom the council has invested (and may continue to invest) significant sums of money and who are potentially the most vulnerable, requiring regular reviews owing to their need for ongoing support.

When the information from LTS001c is combined with the review data collected in LTS002b, a clearer picture will emerge of the demands this group is placing on the CASSR and whether the level of demand is increasing (greater numbers, more intensive packages of care required) as well as the effectiveness of attempts to ‘re-enable’ this group through short term support packages (appearing in measure STS002b).

In all respects, the guidance for LTS001c is identical to the relevant sections of LTS001b above. Only a few of the breakdowns required of LTS001b are needed for LTS001c. The tables look identical to LTS001a but are a snapshot measure as per LTS001b. The only difference is that clients have had long term support in place for at least 12 consecutive months on 31st March. It is recognised that determining whether support arrangements have been in place for more than a year is not trivial. There may be interruptions to care (e.g. because clients are admitted to hospital for a short period) which do not constitute a termination of support.

Authorities may decide to use a ‘rule of thumb’ when working out whom to include in this measure. It would be helpful if details of how this was determined could be provided in the end section of the online SALT return. Future years may include guidance on how to count these clients but due to differing local circumstances it was decided best to leave this up to individual authorities to make reasonable local interpretations in the first year.

As mentioned in the guidance for LTS001a and b, some clients who would previously have been captured in the RAP return as ongoing clients in form P2s may not appear in the LTS001 measures (a, b or c). This is because some types of service such as equipment and adaptations (which previously may have fallen under the category of ‘equipment with an ongoing cost’) are now excluded from the definition of long term support. The table provided in the guidance for measure LTS001a applies here in the same way.

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. Support Setting / Delivery Mechanism See guidance for measure LTS001b. Personal Budget The definition of a ‘personal budget’ is the same as for LTS001a.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 61 Primary Support Reason As for measure LTS001a, there should be only ONE Primary Support Reason included per individual within this table. In other words, individual clients should appear in only one of the rows in the table. Calculation of age in SALT measure LTS001c 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 this measure is not utilised within ASCOF measures.

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: In all tables, the total of rows = the total number of clients in that row (there can be no double counting of support setting / delivery mechanism).

Between Measures Rule 2: Client totals - the total number of clients counted in any table of LTS001c should not exceed the equivalent age totals counted in either LTS001a or LTS001b (e.g. Table 1a of LTS001c should not add up to more clients than Table 1a of LTS001c or Table 1a of LTS001b). Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document. In the first year, finding out which clients have 12 or more months of consecutive service may rely on data inputted before SALT was implemented. As part of the transition to the new collections during 2013-14, councils are encouraged to make every effort to ensure that clients who were in receipt of long term support on 01/04/14 are clearly identified, so that those still in receipt of such support on 31/03/15 can be determined.

There may be some effects on the quality of data submitted if such clients cannot be clearly identified. Councils should record any difficulties, and the details of any ‘rules of thumb’ used in calculating whether a client had more than 12 consecutive months of service in the end section of the online SALT return. Variances between local authorities will be examined by the HSCIC as part of the year-end validation procedures. Frequently Asked Questions for LTS001c 1) If a client transfers from long term support in the community to long term support residential, should this person be counted as having continuous support for the purposes of measure LTS001c?

Irrespective of the change in setting the authority will have been providing continuous support to the client, which fits with the definition within SALT for inclusion in measure LTS001c if the support is for longer than 12 months.

62 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 2) What happens if a client who starts the year with a fully cash personal budget then begins to receive some additional council commissioned care in what becomes a mixed personal budget? How do we capture this in the LTS measures? Please see FAQ 4 for LTS001a

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 63 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 01/04/2014 – 31/03/2015 (all tables) General description and business case 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 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 ceased) are sometimes made outside of a formal review. Such changes are not captured by the measure. The data is also not intended to provide any sort of indication of what proportion of clients have been reviewed during the year.

Unplanned Reviews 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’. 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 outcome of that review (e.g. 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 short term support to maximise independence (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 Planned reviews that result in a care home admission (Table 2) are also captured in order to support ASCOF indicator 2A. The significant events leading to care home admission can also be analysed.

64 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Who to include / exclude? 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 (1 st April to 31 st 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 place ‘permanently’ 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 existing 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 ceased before the start of the year should not be included in LTS001a and will not appear here. There will be some clients recorded in measure LTS001a as 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 they will be captured in next year’s SALT data if they remain in receipt of long term support.

Carers who themselves received long term support for social care needs (i.e. they are being treated as service users) are included in this measure (this is in line with measure LTS001a). 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. Because clients can have more than one review during the year, a total number of clients should also be calculated and entered at the bottom of the table, within the cell labelled ‘Total clients in table’. This is required for all the review tables in SALT.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 65 Significant Events The table 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 accident / incident’ category should be used. Hospital Episode (Planned) Even when a hospital admission or treatment was known about in advance, the result of medical treatment may be unexpected and result in a request for a review to the CASSR.

Hospital Episode (Unplanned) If an unexpected admission to hospital or treatment in hospital is required, this may result in the care needs of a client changing when they are due to return home.

Issues related to carer 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 CASSR is required to review the client to cover the gap in support. Change of residence This may include clients who move within the community (for example from their own home to extra care housing) and moves to / from residential and nursing care. Some examples; if a care home deregisters, these new circumstances may prompt a re-assessment of client care needs. Alternatively, if a client has moved into residential or nursing care this change may trigger an unexpected, unplanned review.

The CASSR may have no knowledge of the client prior to the move, and may be requested to provide care management support on a temporary or ongoing basis even if the client meets the costs of the care (the client would appear in measure LTS001a as a ‘full coster’).

It is important to note that this category as the cause of a review. Essentially, if a change in residence triggers the review, then choose this option. Safeguarding Concern Although measures LTS002a and b are not concerned with details of the safeguarding process (safeguarding referrals are captured in the SAR collection and not SALT), a safeguarding alert may trigger an unplanned review of the client’s social care needs. Fall This is often a significant event for older and frail clients, although it may be even the risk of a fall that triggers the review.

Bereavement Bereavement may result in increased care needs for clients and although this may occur in addition to other causes, it should be chosen if it appears to be the most important factor.

Change in Client Condition In some cases the reason may simply be that the client’s health has deteriorated, without any specific event occurring. The increase in support needs then prompts contact with the CASSR resulting in an unplanned review. Other Accident / Incident Where none of the above categories apply, this category will capture all other triggers of an unplanned review. Details of what events forced use of this category should be given in the end sheet of the online SALT return. Sequel to Review 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 proforma from left to right (or the table below from top to bottom).

Rather like in the STS measures, there is

66 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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 may change following the initial decision, e.g. clients may die following a decision to place in residential care 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 the correct category to capture here.

There is no expectation that CASSRs will go back and ‘correct’ sequels recorded that later changed or did not occur, although every effort should be made to faithfully capture the sequels as far as they were known following completion of the review.

The table below gives more detail on each category and is ordered in the same way as the proforma when reading the table from top to bottom. Change in Setting Move to nursing care Choose this if a community based client is now moving to registered nursing care. If the client is already in residential care, then record this as level of long term support increased rather than as a change in setting. This is so that national ASCOF measure 2A does not over count new admissions. Move to residential care As above but for registered homes that do not offer nursing care.

Move to community Where a client is reviewed in a residential 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 (also see note below) Support provided that is intended to be time limited, with the intention of maximising the independence of the individual and reducing / eliminating need for ongoing support by the CASSR.

No Change in Setting Level of long term support increased Although this measure does not capture the degree of increase in care support, it should be possible for CASSRs to record the direction of changes to packages. If a client is already in residential care and moves to nursing care then record this as level of long term support increased rather than as a change in setting. No change in long term support Despite a change in client circumstances, the review does not result in changes to long term support being made. Level of long term support decreased In some cases, unplanned reviews may reveal that not all the support being provided was actually needed and reductions are made.

ALL long term support temporarily suspended Changes in client circumstances may result in a suspension of care, such as when the review prompts an emergency hospital admission. ALL long term support ended This may apply either if a client dies immediately following review, or if the change in circumstances results in the client being supported through other means (e.g. by family, by private provision). This 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.

Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. 67 Short Term Support to Maximise Independence 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, either this year or next year, in measure STS002b where the outcomes of short term support are 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.

For that reason, if short term support is due to take place in a residential home, do not record the sequel as a ‘change in setting’ but simply as ‘short term support to maximise independence’.

Table 2 This table is needed to provide a full account of reviews 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 unscheduled 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.

Calculation of age in SALT measure LTS002a 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 all tables in this measure (along with STS001, STS002a and STS002b) will be used to capture the number of new admissions to residential and nursing care, for ASCOF measure 2A. For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health.

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 None. Between measures Rule 1:The total number of sequels in each of Tables 1a and 1b must be greater than or equal to the number of sequels captured in each of Tables 1a and 1b from Measure LTS002b, as additional clients are included in measure LTS002a (being based on LTS001a rather than LTS001c).

68 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 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. In order to get as good a data collection as possible councils are encouraged to develop systems that will allow them to identify sequels to reviews that may have taken place in the previous year, but whose sequel is only known from April 2014.

This will mean review events and their sequels need to be captured on the client database prior to April 2014. It is suggested that reviews be captured for SALT purposes from about February 2014 onwards so that any sequels which aren’t known until April can be included. In councils where the complete set of data is not available, explanations of any missing data should be made in the end section of the online return.

Frequently Asked Questions for LTS002a 1) Are we right in thinking that some reviews will not be captured and reported on with the new SALT return – in particular those completed for service users in services less than 12 months who have a planned review (i.e. planned 6 week reviews)? You are right to identify that a number of reviews will not be collected in SALT, in contrast to those collected in RAP. LTS002a is restricted to only unplanned reviews and those planned reviews resulting in a move to residential / nursing care. This does not prevent or discourage local authorities from recording 6- week or other planned reviews for local business management or other purposes.

The data in SALT is, however, intended to support priority areas in national policy and local benchmarking purposes. 2) How should I record the emergency short term provision of additional services for existing clients? These events would be followed up by an unscheduled review to determine the ongoing support needs.

SALT captures changes in care provision following review events. SALT would not capture changes to care provision in advance of a review, with the exception of sequels to ST-MAX provision in STS002b. 3) If a client with long term support falls down the stairs and is admitted to hospital, what would the Significant Event reason be - unplanned hospital discharge or fall? The significant event 'Hospital Episode (unplanned)' should be chosen, because it is the immediate event preceding review. Although the fall led to the admission to hospital, the pre-discharge review being carried out by social care is concerned with ensuring adequate support following the hospital treatment, which will depend how successful that treatment has been in reducing the client's on-going needs.

If the fall had not required hospital admission and the review was being carried out as a direct response, then 'fall' would be the appropriate significant event. 4) How should we treat '12-week disregard' clients in this measure? Please refer to FAQ 25 for SALT measure STS001.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 69 5) Following review of a long term client in LTS001 the social worker arranges a residential care placement and this is recorded on our system however following financial assessment the client decides to pay privately for their placement. Which of the following sequels should apply - All long term support ended or Change in setting – Move to residential care? This client has become a self-funder, and therefore both the support setting and mechanism of service delivery will no longer be captured in any measure of the SALT return, because the local authority no longer provides, commissions or reviews that support.

The change has taken place as part of the sequence of events used to determine the appropriate sequel to your review, so the correct sequel to use is 'All long term support ended'. Care should be taken in relation to clients who are placed in residential or nursing care subject to a 12 week disregard who after this period become self funders, these should be reported as per FAQ 25 for SALT measure STS001.

70 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. LTS002b Those clients receiving long term support for more than 12 months at the year-end (LTS001c), for whom an unplanned or planned review of care needs took place during the year and the sequel to that review Period: 01/04/2014 – 31/03/2015 (all tables) General description and business case Review activity is seen to be of renewed importance in delivering the personalisation agenda. ‘Sequel to review’ is a proxy for outcomes for those people who have a long term support need. By making a distinction between planned and unplanned reviews it will be possible for local authorities to better understand the consequences of events both within and outside its control.

For example, a high proportion of planned reviews relative to unplanned reviews may represent proactive risk management of those clients in long term support, although it may also suggest that ‘screening’ of contacts from existing clients is too robust. There may be other reasons and the data provides the starting point for further investigation. The data should assist with business planning / resource allocation.

This measure focuses on those clients who have been in receipt of long term support for more than 12 months. It will also allow benchmarking and analysis by sequel - e.g. some councils may report very few changes to support provision after review, which may prompt a check of the quality of reviews being carried out. Who to include / exclude? The rationale for this measure is similar to that of LTS002a except that it only looks at clients who have been receiving long term support for more than a year. Both planned and unplanned reviews are captured.

For clients to be included in LTS002b, the following criteria must apply:  The return is for adults aged 18 and over only who have been counted in LTS001c  Only clients with reviews of long term support needs should be included – ‘reablement reviews’ or other reviews or checks of preventative low-level services such as equipment, should be excluded  Each 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 (1 st April to 31 st March) even though service provision or other arrangements might not yet have been set up.

There should be one sequel for each review counted Detailed Guidance for Data Tables Tables 1a and 1b Unplanned reviews were discussed in measure LTS002a and the definition here is the same. All unplanned reviews and their sequels captured in this measure are therefore also recorded in LTS002a - this measure is a subset of the client captured in LTS002a. This means no new analysis needs to take place for these tables as the clients with more than 12 months of continuous long term support have already been identified in LTS001c. The data can therefore be ‘reused’. Because clients can have more than one review during the year, a total number of clients should also be calculated and entered at the bottom of the table, within the cell labelled ‘Total clients in table’.

This is required for all the review tables in SALT.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 71 Table 2 Planned Reviews Planned reviews are those that happen routinely, usually at regular intervals, as distinct from unplanned reviews that are triggered by significant events. The CASSR should be able to distinguish between planned and unplanned reviews from their client database, and report only planned reviews here. Because there are no significant events for planned reviews, both age groups (18-64 and 65+) are captured in the same table. The sequels and additional sequels are identical to those outlined in measure LTS002a (please see the guidance for that measure for details).

Table 3 Table 3 requires a check on which clients have received both planned and unplanned reviews during the year. Combined with the clients counted in Tables 1a/b and Table 2, an analysis can be made of what proportion of clients with more than 12 months of long term support have been reviewed during the year, which might be useful for service performance management purposes. Calculation of age in SALT measure LTS002b 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 this measure is not utilised within ASCOF measures.

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 None.

Between measures Rule 1: The total number of clients counted in Tables 1a, 1b and 2 minus Table 3 should not exceed the total number of clients counted in measure LTS001c. 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. In order to get as good a data collection as possible councils are encouraged to develop systems that will allow them to identify sequels to reviews that may have taken place in the previous year, but whose sequel is only known from April 2014.

This will mean review events and their sequels need to be captured on the client database prior to April 2014. It is suggested that reviews be captured for SALT purposes from about February 2014 onwards so that any sequels which aren’t known until April can be included. In councils where the complete set of data is not available, explanations of any missing data should be made in the end section of the online return.

72 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. LTS003 Carer support provided during the year, broken down by the age of the carer, Primary Support Reason of the client (cared-for) and the type of support provided. Period 01/04/2014 – 31/03/2015 (all tables) General description and business case Carers make a vital contribution to promoting the wellbeing and independence of the people they care for and supporting carers effectively helps them to have a life of their own alongside caring. Carers also prevent clients from requiring more intensive social care support, which would place additional pressure on local authority budgets.

Carers may themselves have social care needs that impact on their caring role.

The information collected here will give a view of the support being provided for carers nationally and when benchmarked the data will allow differences between local authorities to be examined. Local authorities will be able to combine this data with results from the Carers Survey to allow an examination of how different carer circumstances and modes of support influence outcomes for those carers. The idea is that best practice can emerge and be shared, resulting in wider improvements. This measure includes support for both new carers and those already known to the council and / or in receipt of ongoing support, even if they are not reviewed during the year.

Who to include / exclude?

The intention is to count the numbers of carers supported, which in some cases involves support delivered to the cared for person (e.g. respite) rather than the carer. Carers who are assessed or reviewed but receiving no substantial support will in most cases receive some form of information & advice or be signposted to another organisation. Carers should also be recorded where they do not receive any identifiable support following an assessment or review. The measure also includes carers who may not have the Primary Support Reason of ‘Social Support – Support for Carer’. For example, a husband who cares for his wife also receives support for his own social care needs.

The CASSR decides that the support received for social care needs is the primary support reason, and records this as such. Although his PSR is not ‘Social Support – Support for Carer’, he continues to receive support as a carer, and he should be included in this measure. One way to ensure all carers are identified may be to flag individuals as having a ‘Carer Role’. This will allow easy cross referencing of carers’ services and social care services for the same individual. LTS003 does distinguish whether support for carers is provided through an ‘assessment’ or ‘review' although this is not a requirement for the provision of services.

Local authorities will have different systems in place for determining the needs of carers and allocating support. For example, ‘universal services’, given without any formal assessment of need, are included in this measure. Nevertheless, it is expected that substantial support to carers (e.g. a personal budget or respite provision) would follow either a review of existing support arrangements or a new assessment for those contacting the council for the first time. Although local arrangements for assessment of carer needs differ, all should include direct contact with the carer. Matters relating to adult safeguarding procedures are NOT dealt with here (please see the Safeguarding Adults Return (SAR) collection Guidance for details of how these are collected).

Whether someone is included in the LTS003 measure as a carer has no bearing on whether they might also appear in one of the SALT measures as a client (STS or LTS measures). See the section on 'Carers who are also service users' below for more detail on this. LTS003 encompasses short term interventions (e.g. one-off cash payments) as well as longer term services (e.g. ongoing ‘rolling respite’). It is included in the Long Term Support section of SALT because the support to the cared-for person is likely to be an ongoing commitment, requiring ongoing consideration by the CASSR.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 73 For responses to be included in LTS003 the following criteria must apply:  The provision of support has to occur within the year (1 st April – 31 st March) so assessments / reviews which have occurred prior to year-end but with services due to begin in the following year are excluded. Conversely, support provided this year as a result of assessments / reviews last year is included.  Carers without a linked client (i.e. where details of the cared for person are not recorded on the CASSR database) should be included.

 Carers under the age of 18 where the cared-for person is over 18 at the time of request / review should be included. Determining whether support is for the client or carer People requesting support with their own social care needs (i.e. potential service users) may also be acting as carers – but such requests are NOT part of this measure. CASSRs therefore need to identify whether a particular request is for social care needs or carer support needs. Support for carers may be recorded on the client’s social care record rather than that of the carer. For SALT, the service can be recorded on either.

However, CASSRs should only include requests for support here that are related to providing support to the carer in their caring role, although this may result in actual service provision to the cared-for person. The test of whether support is for a carer should be based on whether the support is only needed because the carer has a role in supporting the client. e.g. if the client receives a ‘sitting service’, to give the carer some free time, that support is entirely due to the carer’s need for a break, and would not otherwise be provided to the client.

Councils will therefore need to ensure that carer’s services (as defined by SALT) are identifiable on their client databases, regardless of whose record they are recorded against.

If multiple instances of support (e.g. at different times of the year) are made in relation to the same carer, the carer is only counted once. There is a hierarchy similar to that used in other STS and LTS measures whereby the most significant type of support provided is counted, when reading the table from left to right. Provision of carer services which are delivered to the cared-for person are recorded in addition to any support provided directly to the carer (the guidance for Table 1 below provides more details).

Carers who are also service users Some carers also have social care needs themselves and are in receipt of long or short term support. Measure LTS003 includes carers who have received carer support and also received long or short term support as a client in their own right. Their inclusion as a carer in LTS003 has no bearing on their new client status for any other SALT measure. There should be no double counting of carer and client services across tables in the SALT return – carers who are also service users may appear in LTS003 as well as LTS001a (possibly LTS001b and c also) and/or STS002a or b in the same year, but this must relate to different packages of support provided for different purposes -e.g.

respite care delivered to a client to give the carer a break is primarily for the benefit of the carer and is therefore counted in LTS003 but not LTS001 or LTS002. Any short term support to maximise independence (ST-Max) given to the person as a client must be for a different purpose than any support given to them as a carer.

The only exception to this is where direct payments for the carer are added to the client’s personal budget (for efficiency). The cash personal budget would already be counted in LTS001 (a, b or c) for the client and would be counted again (as a carer direct payment) in LTS003. This example still meets the aim stated above that there should be no double-counting, as the money paid to the client for carer support is for different purposes (and should be separately identified in the support plan).

74 Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. Detailed Guidance for Data Tables Table 1 Age Group of Carer As noted above, young carers may be supporting an adult or older person and this table will capture the age group of the carer. It also includes carers aged over 85 in order to allow analysis of where a carer may themselves be quite frail (Table 3 captures carers who are in receipt of client services themselves). Support Direct to the Carer vs. Support Involving the Cared-for Person For each carer who has received support, use the table below, working from top to bottom, to determine which service to report. The measure is a count of people not a count of services, so there is a hierarchy of support to follow in a similar way to other SALT measures.

However, it is possible that the carer receives no services directly, but a service is given to the client instead (e.g. in order to give the carer a break). Service provision to the client (for the carer’s benefit) will be counted in addition to any support given to the carer directly. So where support is delivered to both the carer AND the cared-for person (for the carers’ benefit) the service to the carer would be captured in the main section of the table according to the hierarchy from left to right, with the additional support received by the cared-for person also being recorded in the column “Support Involving Cared For Person.

If a carer only has respite (or another service delivered to the client) it is important to include this in the ‘No Direct Support provided to carer’ column of the table, as well as in the ‘Respite or Other Forms of Carer Support delivered to the cared-for person’ column. Note however that additional funds added to the client’s personal budget for carer support and paid to the client should be counted in LTS003 in the ‘Direct payment only’ or ‘Part direct payment’ categories and NOT in the ‘Respite or Other Forms of Carer Support delivered to the cared-for person’. Although provided to the client, the money must be clearly identified up-front as being for carer support and be available to the carer to use in ways and at times of their choosing.

This will ensure that carers direct payments and personal budgets are fully captured, even though for simplicity councils may choose to add this money to a client’s existing allocation of funds.

Hierarchy of support given Direct Payment only This should be chosen where support is provided to the carer entirely through the provision of a cash payment or cash personal budget. As mentioned above, carer payments may be combined with a cash personal budget paid to the cared-for person. The carer must nevertheless have control of any funds intended for carer support. Part Direct Payment Similar to the above but where only some of the support comes through the provision of a cash payment or cash personal budget. This might be, for example, where a one-off payment is given to help the carer purchase some equipment and in addition, respite services are arranged by the council on an ongoing basis.

CASSR managed Personal Budget Where the local authority commissions support with a cost and this is done via a self-directed support route with an up-front allocation of funds, but where the carer chooses not receive any of that support in the form of a cash payment themselves. CASSR Commissioned Support only Where the CASSR commissions support with a cost and provides this outside of a personal budget (i.e. there is no self-directed support and allocation of funds and no choice for the carer in how to spend those funds).

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 75 Information, Advice and Other Universal Services / Signposting If no costed support is given following screening / assessment but some form of advice or information (in the form of leaflets, verbal discussion with the carer) or other provision is made. This includes where specific recommendations are made or appointments set up with other organisations (e.g. in the voluntary sector). No Direct Support Provided to Carer If there is no support required or available to offer direct to the carer then use this category.

Also include cases here where although nothing was delivered to the carer, the cared-for person received services for the benefit of the carer (such as respite care).

‘No Direct Support’ allows recognition of the fact that an assessment / review has taken place where those requests for support fell outside eligibility criteria for carer services. In addition, support to the client is reported as follows: Respite or Other Forms of Carer Support delivered to the cared-for person This category is a subset of the numbers captured in the main section of the table. If any support is delivered to the client for the benefit of the carer, it can be included here. If all carers support is delivered to the client, it is still necessary to record ‘No Direct Support Provided to Carer’ in the main section of the table, in order that an accurate count of carers is made.

The most common example is respite care which might involve the client being placed in a residential setting in order to give the carer a break from their caring responsibilities. Note that direct payments made to the client’s account for carer support are NOT included here - they should already have been counted in the direct payment categories, above. Table 2 Primary Support Reason The primary support reasons in Table 2 relate to the client’s social care need, not the carer’s need. For details of how to record Primary Support Reasons please see the EQ-CL Framework document. It is possible that two or more carers might support a single client.

Because Table 2 is about clients supported, you would still only record that single client in Table 2 under the relevant Primary Support Reason. If the carers received different types of support then include the most significant type of support received by those carers, using the same 'hierarchy' as Table 1 but applying it between carers as well as for each carer. e.g. if two carers were supporting one client, the first received local authority assistance in the form of a direct payment, the other received information & advice as well as local authority commissioned support, ONLY the direct payment support would be captured in Table 2.

As for Table 1, if all the support given to the carers goes direct to the client, also record this client in the 'Respite or Other Forms of Carer Support delivered to the cared-for person' column. Note that applying this 'hierarchy' between carers only applies to Table 2. Tables 1 and 3 account for the support provided to all carers, so Table 2 can focus specifically on clients supported. Many carers have a client linked to them on the social care database. Where there is a linked client, then the most recently recorded Primary Support Reason should be captured from the client record. If there is no linked client, then the category ‘no recorded cared-for person’ should be used.

Unlike the other tables, if there is more than one client supported by any carer, count all the cared- for clients, even if the Primary Support Reasons are the same or not known. This ‘double counting’ will mean that for Table 2, the total of all the cells will NOT add up to the equivalent totals for Tables 1 or 3, because carers may be supporting more than one cared-for person. The CASSR should include all cared-for people in this table, including those not formally in receipt of support as a client. There will also be some cared-for people who are not captured on the client database; these are captured in the ‘No PSR – cared for person not recorded or details not current’ row of the proforma.

Table 3

76 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Assessed separately, jointly or not assessed? To be counted in the ‘assessed separately’ or ‘assessed jointly’ rows, direct contact is required with the carer and this must involve an assessment of need that determines the support provision made. This may include written as well as verbal / face to face contact (e.g. forms sent through the post to conduct a self-assessment and returned to the CASSR).

If the carer is assessed or reviewed during the year, the cared-for person (if identified) may also have been involved in that assessment – this is termed a ‘joint assessment’.

The level of client involvement will vary, case by case and between councils. Nevertheless, if the cared-for person is known, linked to the carer on the client database and was involved in a significant way in the assessment / review of the carer, this should be included under the ‘assessed jointly’ row. If there was no significant client involvement (e.g. where the carer specifically requests a separate assessment) then it should be counted under the ‘assessed separately’ row. In all cases what is being referred to by ‘carer assessment’ is an assessment of the carers needs (not those of the client).

Sometimes support (e.g. ‘universal services’) will be offered that doesn’t require a full assessment of carer needs. These cases may go through a screening process (perhaps done by a contact centre) and support may be given without direct contact with the carer or without anything more than a short phone call. These should be counted in the ‘No review or assessment during the year’ row. Not all carers in receipt of support services will be reviewed during the year – however these should be counted (in the ‘No review or assessment during the year’ row) even though no review takes place. This is a change from the RAP return in that those services would previously have been excluded.

If a carer supports more than one client they should still be counted only once. If they have more than one carer assessment during the year, use the most recent assessment to determine whether they were assessed separately or jointly. Unlike the RAP return, this will not affect the recording of support provision. Counting the total number of carers By adding up all the cells in Table 1, under the heading ‘Support Direct to Carer’, the total number of carers directly provided with support can be calculated for each table. This total includes the ‘No direct support provided to carer’ column but NOT the ‘Respite or Other Forms of Carer Support delivered to the cared-for person’ column as these carers should already be recorded in the main section of the table.

Calculation of age in SALT measure LTS003 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 this measure will be utilised in the carers’ elements of ASCOF measure 1C. For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health. 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 carers captured in Tables 1 and 3 should be equal.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 77 Rule 2: the total number of carers captured in Tables 1 and 3 under the heading ‘Support involving cared-for person’ should be less than or equal to the total number of carers captured in Tables 1 and 3 under the section ‘Support Direct to Carer’. Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document. During 2013-14 councils will be preparing for the new collections and along with changes needed for EQ-CL an important aspect of this is setting up client databases so that carer support can be captured in the new ways required by the SALT measure.

Unlike some of the other SALT measures there is no requirement for referencing carer support provided in the previous year. Frequently Asked Questions for LTS003 1) As a local authority we commission third party organisations to provide support to carers. Carers can access these services directly. Should carers who do not contact the local authority but access carers support from these organisations directly be included in these tables?

LTS003 is not concerned whether carers have contacted the local authority directly or whether a third party (e.g. a voluntary sector organisation) is providing assessment of eligibility for services. Although local arrangements for assessment of carer needs differ, all should involve direct contact with the carer. If carers are not being assessed by or on behalf of the local authority, the services provided can only be captured under the ‘Information, Advice and Other Universal Services / Signposting’ category. Authorities will have a range of differing funding arrangements with third party organisations.

In some instances the organisation will be able to provide the relevant details of each carer (age, the person they care for etc.). These can be used to report the carer support in LTS003. In other instances the funding may be more general and the authority would have no expectation of the maintenance of carer by carer records. In such cases we would not expect that an authority would report these carers within LTS003.

If however the local authority commissions support (both by signposting and direct referrals) for carers who meet agreed assessment criteria and then pays for that support on a per-client basis, this activity could be part of LTS003 if the rest of the inclusion criteria are met. 2) We provide funding to a carers centre who produce a quarterly newsletter for carers. Could you let me know if the newsletter should be reported as provision of information and advice within LTS003? The answer of whether a carers’ newsletter would constitute ‘Information, Advice and Other Universal Services / Signposting’ depends on whether it can be considered as a 'service' or 'support' to the carer and whether any consideration of their needs was made.

In a change to the way Information and Advice was reported in RAP, SALT no longer requires support being 'tailored' to the needs of the individual - accepting that some standardised forms of advice / information can be useful. There is still a need to understand what the carer’s circumstances are, though the depth of any screening / assessment needs to be proportionate, depending on the scenario. Some cases would require just a 'screening' over the phone, without a full carer assessment. The SALT Guidance states that “LTS003 does distinguish whether support for carers is provided through an ‘assessment’ or ‘review' although this is not a requirement for the provision of services.

Local authorities will have different systems in place for determining the needs of carers and allocating support.” The following should assist in determining whether the newsletter would appear in SALT:

78 Copyright © 2014, Health and Social Care Information Centre. All rights reserved.  if the person receiving the newsletter has been confirmed to remain a carer, and had some form of (perhaps very brief) screening / assessment to confirm they do not have more serious caring needs but might find the newsletter informative, then this would count. The carer details (age, etc.) would of course need to be known.  if the person is sent a newsletter in response to a specific request for information, this would also count (providing details were logged of course).

 if the person did not ask for the newsletter and / or has not been in contact with the Council in their capacity as a carer and / or has not had their carer’s needs screened or assessed, then this would not count.

An example would be if a carers newsletter / leaflet was sent out on its own or with other publications as part of a general 'mailshot' (e.g. “Are You a Carer ? We can Help!"), perhaps to raise awareness etc. This is not in response to any identified need, so would not be relevant to SALT.

3) Could you provide some detail on how to report the primary support reason for following cared for individuals in SALT measure LTS003? (i) A cared for individual who received ST-MAX a year and a half ago but has not received any input since It is possible that any primary support reason captured in relation to the period of ST-MAX would no longer apply. It is unrealistic to expect that a review of PSR would be carried out for measure LTS003 therefore this client should be reported against PSR ‘No PSR – Cared for person not recorded or details not current’ (ii) A cared for individual who received long term services until six months ago when they declined further input Again the circumstances of the client may change and having declined further input we would not expect you to attempt to review their PSR specifically for LTS003.

Again this client should be reported against PSR ‘No PSR – Cared for person not recorded or details not current’ (iii) A cared for individual who appears within our records due to the provision of telecare but where there is no primary support reason captured This client exists in your client record system but you may not have captured any PSR due to different assessment processes for ongoing low level support. If this is the case they should be reported against primary support reason ‘No PSR – Cared for person not recorded or details not current’.

(iv) A cared for individual who appears within our records due to the provision of equipment and adaptations where a primary support reason was captured at first contact Some councils may have conducted an assessment prior to the provision of ongoing low level support that did result in the allocation of a primary support reason to the cared for individual. In this case a rule of thumb should be drawn up to identify whether to report these clients against the support reason captured at assessment. Factors for consideration in this regard could include how recent the assessment was (e.g. was it within the reporting year) and whether the primary support reason will be subject to review at any point.

Please confirm any such local rules in the end sheet of the return.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 79 LTS004 Accommodation and employment status of working age clients with a Learning Disability Period 01/04/2014 – 31/03/2015 (all tables) General description and business case The information which is collected through this return is used in answering parliamentary questions and ministerial briefings. The data is used to feed into the learning disabled outcome measures in ASCOF 1E and 1G. Note that the measure LTS004 in SALT is distinct from the ‘L’ measures in the old ASC-CAR return in two ways. It uses Primary Support Reason (from EQ-CL) rather than the primary client type to identify learning disability clients.

Secondly clients ‘known to the council’ are taken solely from SALT measure LTS001a.

Who to include / exclude? Include: Clients with a Primary Support Reason of ‘Learning Disability Support’ known to the CASSR (see definition below) and who:  Appear in SALT measure LTS001a  Are of working age (18-64)  Have their most recent Primary Support Reason in relation to long term support recorded as ‘Learning Disability Support’ Exclude:  Clients who are detained under the Mental Health Act. Detailed Guidance for Data Tables Table 1 Number of hours worked When recording people in Table 1, the total number of hours worked should be used. For example, if a person has two jobs, one of seven hours paid work per week and one of ten hours paid work per week, they are working for seventeen hours, and should be recorded as ‘Paid - 16 hours or more a week’.

Learning disabled clients known to the CASSR The definition of individuals ‘known to the council’ is restricted to those adults with a primary support reason of Learning Disability Support who appear in SALT measure LTS001a. Only those aged 18-64 with a primary support reason of Learning Disability Support should be included. Those clients who have a learning disability but this is not their primary support reason should be excluded. The working and accommodation status of each client included in the table should have been captured or confirmed during the reporting year. Do not default to a status captured in previous reporting years but instead utilise the category ‘Unknown’ to report these clients.

If there are reasons for a significant number of clients not having their status updated, please tell us about this in the end section of the SALT return.

80 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Working Age / Adults Those aged 18 to 64 years old inclusive. Employee A person who works for a company and has their National Insurance paid for directly from their wages and are earning at or above the National Minimum Wage. This also includes those who are working in supported employment (i.e. those who are receiving support and assistance from a specialist agency to maintain their job) who are earning at or above the National Minimum Wage. Self-employed People who work for themselves and generally pay their National Insurance themselves; this should also include those who are unpaid family workers (i.e.

those who do unpaid work for a business they own or for a business a relative owns). Self-employed people should have their hours included in the ‘paid work’ categories.

Unpaid voluntary work Work of a voluntary nature that is unpaid, including unpaid work experience, is no longer collected in SALT as a distinct category, so clients in this situation should be captured under one of the two ‘not in paid employment’ categories, described below. Not in Paid Employment (seeking work) This is a new category introduced into the Equalities and Classifications Framework (EQ-CL). The review or first assessment of a client with Learning Disabilities Support should allow determination of whether employment is being sought.

Not in Paid Employment (not actively seeking work / retired) This is a new category introduced into the Equalities and Classifications Framework (EQ-CL).

Service users who are aged 64 or under but have retired are classed as being of working age and should be included in LTS004. Older clients need not be considered. Unknown In some cases it may not be possible to determine what a client’s employment status is. Such clients, who will be considered not in employment for the purposes of the ASCOF indicator, should be recorded here.

Table 2 Settled accommodation Accommodation arrangements where the occupier has security of tenure / residence or is part of a household whose head holds such security of tenure / residence. Table 2a includes the accommodation types that represent settled accommodation for the purposes of this settled accommodation indicator. The settled accommodation status is determined upon the usual accommodation of the person in the medium to long term. Non-settled accommodation Accommodation arrangements that are precarious, or where the person has no or low security of tenure / residence in their usual accommodation and so may be required to leave at very short notice.

Table 2b lists the accommodation types that represent non-settled accommodation for the purposes of this settled accommodation indicator.

Unknown In some cases it may not be possible to determine what a client’s accommodation status is. Such clients, who will be considered as not in settled accommodation for the purposes of the ASCOF indicator, should be recorded here.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 81 Calculation of age in SALT measure LTS004 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 Table 1 is used for ASCOF indicator 1E (proportion of adults with learning disabilities in paid employment).

Data from Tables 2a and 2b are used for ASCOF indicator 1G (proportion of adults with learning disabilities who live in their own home or with their family).

For more details on the definition and calculation of this measure, see the ASCOF Handbook of Definitions published by the Department of Health. Data Validation Note the rule given below is 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 people recorded in Table 1 and Table 2 should be equal. Transitional Arrangements For guidance on capturing Primary Support Reason for existing clients please refer to the EQ-CL Framework document.

There are minor changes to the employment categories from those captured in ASC-CAR. Local records will need to be adapted in order to capture the new categories. In particular, the determination of whether a client is actively seeking work is new. Councils are advised to develop ways of collecting this new information as soon as possible so that capturing for SALT can begin in April 2014.

82 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Appendix 1: SALT Diagrams The SALT Technical Group has produced a number of diagrams which are intended to support the implementation of the new SALT measures.

They provide a diagrammatical representation of the measures and may prove useful as quick reference aids. Please note that the diagrams do not contain any new guidance. Figure 3: Summary of SALT collection.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 83 Figure 4: Measure STS001 Tables 1a & 1b. Figure 5: Measure STS001 Tables 2a & 2b.

84 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Figure 6: Measure STS002a Tables 1, 2a, 2b & 3. Figure 7: Measure STS002a Table 4

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 85 Figure 8: Measure STS002b Tables 1, 2a, 2b & 3. Figure 9: Measure STS002b Table 4.

86 Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. Figure 10: Measure LTS001a Tables 1a & 1b. Figure 11: Measure LTS001b Tables 1a, 1b, 2a, 2b, 3, 4a & 4b.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 87 Figure 12: Measure LTS001c Tables 1a & 1b. Figure 13: Measure LTS002a Tables 1a & 1b.

88 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Figure 14: Measure LTS002a Table 2. Figure 15: Measure LTS002b Tables1a & 1b.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 89 Figure 16: Measure LTS002b Table 2. Figure 17: Measure LTS002b Table 3.

90 Copyright © 2014, Health and Social Care Information Centre.

All rights reserved. Figure 18: Measure LTS003 Tables 1 & 2.

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 91 Figure 19: Measure LTS003 Table 3 Figure 20: Measure LTS004.

92 Copyright © 2014, Health and Social Care Information Centre. All rights reserved. Appendix 2: Identification of age banding in SALT measures The table below provides confirmation of how age banding should be identified for activity recorded in SALT measures. The column headed ‘Date for identification of age for allocation of age banding’ should be used in the following way: A request for support relating to a client born on the 30th March 1949 is to appear in SALT measure STS001.

In considering the allocation of the request to support to tables 1a or 1b the age of the client as at the 31st March of the reporting year should be considered. In this case the reporting year is 2013/14, so the clients age as at 31st March 2014 is 65 and the request for support would be included in table 1b.

SALT measure and description Date for identification of age for allocation of age banding Other age restrictions STS001 – Requests for support for new clients 31st March Client aged 18+ at time of request STS002a – Short term care to maximise independence sequels for new clients 31st March Client aged 18+ at time of sequel STS002b – Short term care to maximise independence sequels for existing clients 31st March Client aged 18+ at time of sequels STS003 – Snapshot short term care to maximise independence 31st March Client aged 18+ at time of care STS004 – Proportion of older people who were still at home 91 days after discharge from hospital into reablement / rehabilitation services Date of discharge Clients aged 65+ only LTS001a – The number of people accessing long term support during the year to 31st March 31st March Clients aged 18+ only LTS001b – Of the clients in LTS001a, the number of people accessing long term care at year end (31st March) 31st March Clients aged 18+ only LTS001c – Of the clients in LTS001b, the number of people who have been accessing long term support for more than 12 months at year end 31st March Clients aged 18+ only 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 31st March Clients aged 18+ only

Copyright © 2014, Health and Social Care Information Centre. All rights reserved. 93 SALT measure and description Date for identification of age for allocation of age banding Other age restrictions LTS002b – Those clients receiving long term support for more than 12 months for whom an unplanned or planned review of care needs took place during the year and the sequel to that review 31st March Clients aged 18+ only LTS003 – Carer support provided during the year, broken down by the age of the carer, Primary Support Reason of the client and the type of support provided 31st March Carers under 18 included, additional age bandings as per EQ-CL LTS004 – Accommodation and employment status of working age clients with a learning disability 31st March Age band 18-64 only In addition to the advice shown in the table above FAQ 10 in relation to STS001 should be consulted in relation to transition from Children’s to Adults provision.

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