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Care Co-ordination is the process by which the care plan is brought into being, and supports the service user as they progress along the care pathway. It can have a therapeutic value of its own, enabling and empowering the service user through the direct provision of help and support, monitoring progress and continuing a dialogue with the service user to ensure they achieve the desired most effective outcome. The process will always be one of partnership with the service user.
CO-ORDINATION OF CARE
For Service Users of "Type 1 and 3" Services (see Section A4, page 13).
Where a service user's needs or risks are not of a complexity to require referral onwards to statutory agencies and comprehensive assessments, they will none the less have packages of care provided according to a Care Plan and co-ordinated by a Key Worker.
CRITERIA FOR CARE CO-ORDINATION
Where an individual passes through the Care Pathway to comprehensive assessment, it is almost certain that they will fall within the qualifying criteria for the Care Programme Approach and therefore be entitled to Care Co-ordination.
ROLE OF THE CARE CO-ORDINATOR
The Care Co-ordinator will be a named professional who will engage with the service user, and support them through the duration of their care plan. Central to the successful fulfilment of this is retaining service users in the service by supporting, motivating and helping solve problems.
The Care Co-ordinator will organise the care and services identified in the Care Plan across social care and other agencies.
The Care Co-ordinator will monitor the progress of the Care Plan by collating information from agencies and individuals who provide particular elements of a Care Plan. This will involve keeping the Care Plan under continuous review, holding regular routine review meetings, and arranging other review meetings where there are significant changes in the client's circumstances or other events.
The Care Co-ordinator should act as a communicator between the service user and those providing elements of the care plan to ensure the appropriate passage of relevant information on progress and developments. They should also draw together relevant information and convene case reviews where developments warrant it, and at regular intervals.
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