Community Care
Community care in Northern Ireland. The Department of Health, Social Services, and Public Safety is responsible for health and personal social services. The legislation consists of Acts of Parliament, the Assembly, statutory instruments together with regulations and directions by government ministers and department. Guidance is published for public authorities in relation to the implementation of practices and policy. Guidance may be legally binding notwithstanding that it is not published as legislation.
The Health and Personal Social Services (NI) Order 1972 as amended (1991), the Health and Personal Social Services (NI) Order 1994, and the Health and Social Care Reform Act (NI) Act 2009 are the central legislation governing health and social care.
The Department has a duty to make arrangements insofar as it considers necessary for the prevention of illness and the care and aftercare of persons suffering from illness. It is a duty to make wise guidance and assistance available to the extent it considers necessary and to make such arrangements and provide a secure provision of facilities as it considers suitable and adequate to discharge its duties. It has the power to recover charges as it considers appropriate in respect of assistance and facilities provided.
The 2009 Act restructured health and social care. It sets out an overriding duty on the Department in relation to the health and social care system, in similar terms to the above. It details specific areas where a statutory duty is placed on the Department. The Department has a duty to provide an integrated health and social care system designed to improve physical and mental health as well as the social well-being of persons in Northern Ireland. It must develop policies to reduce health inequalities in the population.
The Department has general power to provide and secure the provision of health and social care as it considers appropriate to the discharge of its duty. It is the duty of each HSCT to exercise its functions to improve health and social well-being and reduce health inequality between those for whom it provides health and social care.
The Chronically Sick and Disabled Persons (NI) Act 1978 sets out duties for persons who are chronically sick or have a disability. There is an obligation between service providers to share information and make arrangements, as are necessary for the provision of social welfare services to meet the needs of any person who comes within the definition of chronically sick and disabled. This covers persons who are blind, deaf, or dumb, or are substantially handicapped by illness, injury, or congenital deformity and whose handicap is of a permanent or lasting nature or are suffering from a mental disorder within the meaning of the Mental Health Order.
The range of services that may be provided includes: practical assistance in the home; provision of assistance by way of radio, television, library, recreational services; provision of lectures, games, outings, and recreational facilities; travel arrangements for the purposes of participating in services; assisting in arrangements for the carrying out of works of adaptation to the home; facilitating holidays; provision of meals; provision of assistance in obtaining telephone.
The Act creates a duty in relation to assessments of the chronically sick and disabled persons. An assessment must be carried out when requested by either the person with a disability or a carer.
The mental health legislation places a general duty on the Regional Health and Social Care Board and the Regional Agency for Public Health and Social Well-being to promote mental health; secure prevention of mental disorders and promote the treatment, welfare, and care of persons suffering from mental disorders.
Children (NI) Order 1995 creates rights and duties in relation to children, which may require community care services. Social services are under a duty to promote and safeguard the interests of children in need. In furtherance of their duty, they are empowered to provide a wide range of services. Trust has significant powers to provide services to children. This may include assistance in kind or in cash. Families may be able to access services under the Children’s Order where the trust has failed to exercise its discretion to provide services under more general legislation.
The Carers and Direct Payment Act (NI) 2002 provides a duty to assess the needs of child carers and carers of a child with a disability when requested to consider what services are to be provided where appropriate; to provide information to child carers and carers of a child with a disability regarding their right to an assessment of needs and providing a direct payments scheme.
The direct payment scheme is available to disabled persons who are subject to the Chronically Sick and Disabled Persons Act, aged 16 years and over; parents of disabled persons; those assessed as needing services under the health and personal social services legislation; disabled parents’ carers, 16 and 17-year-old carers assessed for services.
The legislation changes the previous arrangements for direct payments under the children’s legislation. The statutory right to an assessment must be carried out when requested. Trust must consider whether or not it should provide services on completion of the assessment.
Trust has powers to make direct payments to carers for services for their own assessed needs. Where they carry out an assessment and the carer whose needs have been assessed asks for a carer’s assessment, the trust may take into account the results of the carer’s assessment when deciding what services are to be available to the person who is being cared for.
Trust must take such steps as are reasonably practicable to ensure that information is available to carers on their right to an assessment. Direct payments may only be made to persons whose carers involved have the legal capacity to consent.
Health and social care services were restructured in 2009 under the Health and Social Care Reform Act (NI) Act 2009. The Health and Social Service Councils, Central Services Agency, Health and Social Services Boards, and the Mental Health Commissions were dissolved. Health and Social Care Trusts are now known as Health and Social Care Trusts.
The functions of the Health and Social Services Boards are transferred to the Regional Health and Social Care Board and the Regional Agency for Public Health and Social Well-being.
There are five Health and Social Care Trusts in Northern Ireland: Belfast, Northern, Southern, South Eastern, and Western.
The trusts manage staff and services at hospitals and other establishments that were previously managed by the Board. The statutory functions of the Boards have mostly been delegated to the trusts.
Trust has powers and duties. Some duties are mandatory, some are qualified. They have powers that may be discretionary. Discretionary powers are subject to principles of legitimate expectation and may be subject to judicial review.
Legislation orders and circulars place duties on trust in relation to providing services for persons in their area. Persons will have different requirements. Trusts will generally make a range of services available to persons in need of community care, including domiciliary care services; home help services; respite care; day centre provision; aids and adaptations; community health services; residential and nursing care; hospital discharge arrangements; meals on wheels services; assessment of care needs.
A person with special needs that means they cannot cope in one way or another with their care is entitled to community care services. This may arise because of illness or disability, mental or physical, or from dependency that has developed over time in institutional care.
Approximately 185,000 persons in Northern Ireland are classed as carers. The 2002 legislation provides for carer’s rights. A carer is someone who provides or intends to provide a substantial amount of care on a regular basis.
Carers, child carers, and carers of a child with a disability have the right to an assessment when requested. Once the carer’s assessment has been carried out, the authority must consider what services can be provided for the person cared for or the carer. It may charge for services.
The legislation empowers trustees to make direct payments to carers for services to meet their assessed needs. The authorities are to take such steps as are reasonably practicable to make information available to carers regarding their rights to an assessment.