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2.11 Transition (Preparing for Adulthood) to Adult Care and Support

CARE ACT 2014

It places a duty on the local authority to assess a child, young carer or child’s carer before they turn 18, in order to help them plan if likely to have needs once they (or the child they care for) turn 18 and if it will be of significant benefit.

RELEVANT CHAPTERS

Assessment

Integration, Cooperation and Partnerships

Care and Support Planning

Personal Budgets

RELEVANT INFORMATION

Chapter 16, Transition to Adult Care and Support, Care and Support Statutory Guidance (Department of Health, 2016)

Transition from Children’s to Adults’ Services for Young People using Health or Social Care Services (NICE, 2016)

See also Transition to Adult Care and Support Case Studies, Resources

May 2018: Section 16, Eligibility has been updated as the cap on care costs, introduced by the Care Act 2014 and planned for 2020, will no longer be implemented.

1. Introduction

Transition or preparing for adulthood is the term used to describe the process which is in place to support young people and their families move from services they have received as a child into those that they need when they become an adult.

Effective person centred transition planning is essential to help young people and their families prepare for adulthood. Transition to adult care and support comes at a time when a lot of change can take place in a young person’s life. It can also mean changes to the care and support they receive from education, health and care services, or involvement with new agencies such as those who provide support for housing, employment or further education and training.

The years in which a young person is approaching adulthood should be full of opportunity. Some of the issues that matter for young people approaching adulthood, and their families, may include (but are not limited to):

  • paid employment;
  • good health;
  • completing exams or moving to further education;
  • independent living (choice and control over one’s life and good housing options);
  • social inclusion (friends, relationships and community).

The wellbeing of each young person or carer must be taken into account so that assessment and planning is based around the individual needs, wishes, and outcomes which matter to that person (see Promoting Wellbeing).

Historically, there has sometimes been a lack of effective planning for people using children’s services who are approaching adulthood. Looked after children, young people with disabilities, and carers are often among the groups of people with the lowest life chances. Early conversations provide an opportunity for young people and their families to reflect on their strengths, needs and desired outcomes, and to plan ahead for how they will achieve their goals.

Professionals from different agencies, families, friends and the wider community should work together in a coordinated manner around each young person or carer to help raise their aspirations and achieve the outcomes that matter to them.

The purpose of carrying out transition assessments is to provide young people and their families with information so that they know what to expect in the future and can prepare for adulthood.

Transition assessments can develop solutions which do not necessarily involve the provision of services, and which may aid planning that helps to prevent, reduce or delay the development of needs for care or support.

The local authority’s own commissioning and procurement practices should take account of wider market shaping duties and therefore transition assessments should focus outcomes and wellbeing (see Market Shaping and Commissioning of Adult Care and Support). Transition assessments will also allow local authorities to better understand the needs of people in their population, and to plan resources and commission services for young people and carers accordingly.

2. Definitions

The Care Act 2014 contains provisions to help preparation for adulthood for three  particular groups of people – children, young carers and child’s carers.

See list of definitions below.

  • Child: in the context of this chapter, a child is most probably a young person in their teenage years preparing for their adult life. This chapter therefore uses the term ‘young person’ for people under 18 with care and support needs who are approaching transition, rather than the legal term ‘child’ contained in the Care Act itself.
  • Young person: see above.
  • Adult carer: an adult carer of a young person preparing for adulthood, this is equivalent to the term ‘child’s carer’ in the Care Act itself.
  • Young carer: a young carer under 18 preparing for adulthood themselves.
  • Young person or carer: this is the general term in the chapter for all three groups – young people, adult carers and young carers. Where something does not apply to all three groups, the specific groups to whom it does apply are specified using the terms above.
  • Transition assessment: each group has their own specific transition assessment; a child’s needs assessment, a young carer’s assessment, and a child’s carer’s assessment. The term used in this chapter for all three is ‘transition assessment’.
  • Likely need: the duty to conduct a transition assessment applies when someone is likely to have needs for care and support (or support as a carer) under the Care Act when they or the person they care for transitions to the adult system.
  • Significant benefit: a transition assessment must be conducted for all those who have likely needs (see above), however the timing of this assessment will depend on when it is of significant benefit to the young person or carer. This will generally be at the point when their needs for care and support as an adult can be predicted reasonably confidently, but will also depend on a range of other factors discussed in the section below ‘When a transition assessment must be carried out’.

3. When a Transition Assessment must be Carried Out

Transition assessments should take place at the right time for the young person or carer and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like after the young person in question turns 18. There is no set age when young people reach this point; every young person and their family are different, and as such, transition assessments should take place when it is most appropriate for them.

The local authority must carry out a transition assessment of anyone in the three groups when there is significant benefit to the young person or carer in doing so, and if they are likely to have needs for care or support after turning 18. The provisions in the Care Act relating to transition to adult care and support are not only for those who are already receiving children’s services, but for anyone who is likely to have needs for adult care and support after turning 18.

If a young person or carer is ‘likely to have needs’ this means they may have any need for care and support as an adult. These needs may not be just those needs deemed eligible under the adult statute. It is highly likely that young people and carers who are in receipt of children’s services would be ‘likely to have needs’ in this context, and local authorities should therefore carry out a transition assessment for those who are receiving children’s services as they approach adulthood, so that they have information about what to expect when they become an adult.

4. Significant Benefit

When considering if it is of ‘significant benefit’ to assess, the local authority should consider the circumstances of the young person or carer, and whether it is an appropriate time for the young person or carer to undertake an assessment which helps them to prepare for adulthood.

The consideration of ‘significant benefit’ is not related to the level of a young person or carer’s needs, but rather to the timing of the transition assessment.

When considering whether it is of significant benefit to assess, a local authority should consider factors which may contribute to establishing the right time to assess (including but not limited to the following):

  • the stage they have reached at school and any upcoming exams;
  • whether the young person or carer wishes to enter further / higher education or training;
  • whether the young person or carer wishes to get a job when they become a young adult;
  • whether the young person is planning to move out of their parental home into their own accommodation;
  • whether the young person will have care leaver status when they become 18;
  • whether the carer of a young person wishes to remain in or return to employment when the young person leaves full time education;
  • the time it may take to carry out an assessment;
  • the time it may take to plan and put in place the adult care and support;
  • any relevant family circumstances;
  • any planned medical treatment/

For young people with special educational needs (SEN) who have an education, health and care (EHC) plan under the Children and Families Act 2014, preparation for adulthood must begin from year 9 – see Special Educational needs & Disability (SEND) Code of Practice ‘Preparing for Adulthood’. The transition assessment should be undertaken as part of one of the annual statutory reviews of the EHC plan, and should inform a plan for the transition from children’s to adult care and support.

Equally for those without EHC plans, early conversations with local authorities about preparation for adulthood are beneficial – when these conversations begin to take place will depend on individual circumstances.

For care leavers, local authorities should consider using the statutory Pathway Planning process as the opportunity to carry out a transition assessment where appropriate.

Local authorities should not carry out the transition assessment at inappropriate times in a young person’s life, such as when they are sitting their exams and it would cause disruption. The SEND Code of Practice similarly states that local authorities must minimise disruption to the child and their family – for example by combining multiple appointments where possible. Local authorities should seek to agree the best time for assessments and planning with the young person or carer, and where appropriate, their family and any other relevant partners.

In more complex cases, it can take some time not only to carry out the assessment itself but to plan and put in place care and support. Social workers will often be the most appropriate lead professionals for complex cases. Transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.

When transition assessments take place too late and care and support is arranged in a hurry, it can result in care and support which does not best meet the young person or carer’s needs – and sometimes at greater financial cost to the local authority than if it had been planned properly in advance.

Where it is judged by the local authority that the young person or carer is likely to have needs for care and support after turning 18, but that it is not yet of significant benefit to carry out a transition assessment, the local authority should consider indicating (when providing its written reasons for refusing the assessment) when it believes the assessment will be of significant benefit. In these circumstances, the onus is on the local authority to contact the young person or carer to agree the timing of the transition assessment, rather than leaving the young person or carer in uncertainty or having to make repeated requests for an assessment. (See also Transitions Case Studies.)

5. Requests for Transition Assessment

A young person or carer, or someone acting on their behalf, has the right to request a transition assessment. The local authority must consider such requests and whether the likely need and significant benefit conditions apply – and if so it must undertake a transition assessment.

6. Refusal of Transition Assessment

If the local authority thinks these conditions do not apply and refuses an assessment on that basis, it must provide its reasons for this in writing in a timely manner, and it must provide information and advice on what can be done to prevent or delay the development of needs for support.

Where someone is refused (or they themselves refuse) a transition assessment, but at a later time makes a request for an assessment, the local authority must again consider whether the likely need and significant benefit conditions apply, and carry out an assessment if so.

7. Identifying Young People and Young Carers who are not already receiving Children’s Services

Most young people who receive transition assessments will be children in need under the Children Act 1989 and will already be known to local authorities.

However, local authorities should consider how they can identify young people who are not receiving children’s services who are likely to have care and support needs as an adult. Key examples include:

  • young people with degenerative conditions;
  • young people (for example with autism) whose needs have been largely met by their educational institution, but who once they leave, will require their needs to be met in some other way;
  • young people detained in the youth justice system who will move to the adult custodial estate;
  • young carers whose parents have needs below the local authority’s eligibility threshold but may nevertheless require advice or support to fulfil their potential, for example a child with deaf parents who is undertaking communication support;
  • young people and young carers receiving Children and Adolescent Mental Health Services (CAMHS) may also require care and support as adults even if they did not receive children’s services from the local authority.

Even if they are not eligible for services, a transition assessment with good information and advice about support in the community can be particularly helpful for these groups as they are less likely to be aware of this.

When young people who have not been in contact with children’s services present to the local authority as a young adult, they often do so with a high level of need for care and support. Local authorities should consider how to work with education and health services to identify these groups as early as possible so they can plan and prevent the development of care and support needs (see Integration, Cooperation and Partnerships and Special Educational needs & Disability (SEND) Code of Practice ‘Preparing for Adulthood’).

8. Adult Carers and Young Carers

Preparation for adulthood will involve assessing how the needs of young people change as they approach adulthood and also how carers’, young carers’ and other family members’ needs might change over time.

The local authority must assess the needs of an adult carer where there is a likely need for support after the child turns 18 and it is of significant benefit to the carer to do so. For instance, some carers of disabled children are able to remain in employment with minimal support while the child has been in school. However, once the young person leaves education, it may be the case that the carer’s needs for support increase, and additional support and planning is required from the local authority to allow the carer to stay in employment.

The SEND Code of Practice sets out the importance of full time programmes for young people aged 16 and over. For instance, some sixth forms or colleges offer five day placements which allow parents to remain in employment full time. However, for young people who do not have this opportunity, for example if their college offers only three  day placements, transition assessments should consider if there is other provision and support for the young person such as volunteering, community participation or training which not only allows the carer to remain in full time employment, but also fulfils the young person’s wishes or equips them to live more independently as an adult (see Market Shaping and Commissioning of Adult Care and Support and SEND Code of Practice – chapter 8 on preparation for adulthood).

The local authority must also assess the needs of young carers as they approach adulthood. For instance, many young carers feel that they cannot go to university or enter employment because of their caring responsibilities. Transition assessments and planning must consider how to support young carers to prepare for adulthood and how to raise and fulfil their aspirations.

The local authority must consider the impact on other members of the family (or other people the authority may feel appropriate) of the person receiving care and support. This will require the authority to identify anyone who may be part of the person’s wider network of care and support. For example, caring responsibilities could have an impact on siblings’ school work, or their aspirations to go to university. Young carers’ assessments should include an indication of how any care and support plan for the person/s they care for would change as a result of the young carer’s change in circumstances. For example, if a young carer has an opportunity to go to university away from home, the local authority should indicate how it would meet the eligible needs of any family members that were previously being met by the young carer.

9. Features of a Transition Assessment

The transition assessment should support the young person and their family to plan for the future, by providing them with information about what they can expect. All transition assessments must include an assessment of:

  • current needs for care and support and how these impact on wellbeing;
  • whether the child or carer is likely to have needs for care and support after the child in question becomes 18;
  • if so, what those needs are likely to be, and which are likely to be eligible needs;
  • the outcomes the young person or carer wishes to achieve in day to day life and how care and support (and other matters) can contribute to achieving them.

Transition assessments for young carers or adult carers must also specifically consider whether the carer:

  • is able to care now and after the child in question turns 18;
  • is willing to care now and will continue to after 18;
  • works, or wishes to do so;
  • is or wishes to participate in education, training or recreation.

The same requirements and principles apply for carrying out transition assessments as for other needs assessments under the adult statute (see Assessment).

For example, assessments must include an assessment of the outcomes, views and wishes that matter to the child or carer in question, and an assessment of their strengths and capabilities.

The young person or carer in question must be involved in the assessment for it to be person centred and reflect their views and wishes. The assessment must also involve anyone else who the young person or carer wants to involve in the assessment. For example, many young people will want their parents involved in their process.

Transition assessments should be carried out in a reasonable timescale. Local authorities should inform the young person or carer of an indicative timescale over which the assessment will be conducted and keep them informed.

While like all assessments  the transition assessment must identify all a person’s needs for care and support, they should be proportionate to that person’s needs. For someone with a low level of need, an assessment might be light touch, but in many cases, more thorough examination will be required to establish a person’s needs fully.

Transition assessments should consider the immediate short term outcomes that a child or carer wants to achieve as well as the medium and longer term aspirations for their life. Progress towards achieving outcomes should be monitored.

EHC plans must be person centred, and must focus on preparation for adulthood from Year 9. Therefore, for young people with EHC plans, transition assessments should build on the plans which will already contain information about the person, their aspirations and progress towards achieving their desired outcomes.

Similarly, for young people and carers who do not have an EHC plan, but who already have other plans under children’s legislation, the transition assessment should build on existing information.

10. Capacity

See also Mental Capacity.

In all cases, the young person or carer in question must agree to the assessment where they have mental capacity and are competent to agree. Where a young person or carer lacks mental capacity or is not competent to agree, the local authority must be satisfied that an assessment is in their best interests. Everyone has the right to refuse a transition assessment, however the local authority must undertake an assessment regardless if it suspects that a child is experiencing or at risk of abuse or neglect.

The right of young people to make decisions is subject to their capacity to do so as set out in the Mental Capacity Act 2005. The underlying principle of the Act is to ensure that those who lack capacity are supported to make as many decisions for themselves as possible, and that any decision made or action taken on their behalf, is done so in their best interests. This is a necessity if the transition assessment is to be person centred.

For young people below the age of 16, local authorities will need to establish a young person’s competence using the test of ‘Gillick competence’ (whether they are able to understand a proposed treatment or procedure). Where the young person is not competent, a person with parental responsibility will need to be involved in their transition assessment, – or an independent advocate provided if there is no one appropriate to act on their behalf (either with or without parental responsibility).

11. Independent Advocacy

The Care Act places a duty on local authorities to provide an independent advocate to facilitate the involvement in the transition assessment where the person in question would experience substantial difficulty in understanding the necessary information or in communicating their views, wishes and feelings – and if there is nobody else appropriate to act on their behalf (see Independent Advocacy). This duty applies for all young people or carers who meet the criteria, regardless of whether they lack mental capacity as defined under the Mental Capacity Act 2005.

12. Combined Assessments

The local authority may combine a transition assessment with any other assessment it is carrying out, or it may carry out assessments jointly with, or on behalf of, another organisation. All such cases must meet the consent condition around mental capacity or the competence condition set out above. For example, transition assessments should be combined with existing EHC assessments unless there are specific circumstances to prevent it.

The power to join up assessments also applies, so for example if an adult is caring for a 17 year old in transition and a 12 year old, the local authority could combine:

  • the child’s needs assessment of the 17 year old under the Care Act;
  • any assessment of the 17 year old’s needs under section 17 of the Children Act;
  • any assessment of the 12 year old’s needs under section 17 of the Children Act;
  • the child’s carer’s assessment of the adult under the Care Act;
  • the parent carer assessment of the adult under the Children and Families Act.

13. Information and Advice

Information and advice must be accessible and proportionate to whoever needs it and must consider individual circumstances. For example when providing information and advice to young people and young carers, it is often more effective if information is given face to face from a trusted source, such as the young person’s care coordinator.

The Children and Families Act 2014 requires local authorities to publish a local offer, which includes provision of information and advice for children’s social care in their local area, including specific requirements for young people who are preparing for adulthood (see chapter 4 of SEND Code of Practice). The Care Act places a similar duty on local authorities to provide information and advice about adult care and support (see Information and Advice).

Given the similar requirements on both children and adult services to provide information and advice that is easily accessible, local authorities should consider jointly commissioning and delivering their information and advice services for both children’s and adult care and support as part of their requirement to work together to smooth the transition between children and adult services.

Transition assessments will often represent a very different context to that which the person is accustomed, so ensuring that people have general information and advice about adult care and support will sometimes be a prerequisite for giving more detailed information and advice. For example, the right to self-assessment applies as with other assessments under the Care Act (see Assessment), however there is the important caveat that for children, the local authority must ensure that a self-assessment is appropriate. This means for example ensuring that a young carer conducting a self-assessment is clear about the support available both to them and the person(s) they care for, avoiding a situation where the young carer assumes the default of continuing in the same caring role through ignorance of other options.

14. Information Sharing

When sharing information with a young carer about the person they care for a supported self-assessment during transition, the local authority must be satisfied that it is appropriate for the young carer to have the information. They must have regard to all circumstances in taking this decision, especially the age of the young carer, however each case will be different and there is no one age at which a young carer is necessarily old enough to receive information. The local authority must ensure that the adult consents to have their information shared in this way.

15. Cooperation between Professionals and Organisations

People with complex needs for care and support may have several professionals involved in their lives, and numerous assessments from multiple organisations. For children with special educational needs, the Children and Families Act 2014 brings these assessments together into a coordinated EHC plan (see SEND Code of Practice, Chapter 9).

Local authorities must cooperate with relevant partners, and this duty is reciprocal (see Integration, Cooperation and Partnerships). This includes an explicit requirement which states that children and adult services must cooperate for the purposes of transition to adult care and support. Often, staff working in children’s services will have built relationships and knowledge about the young person or carer in question over a number of years. As young people and carers prepare for adulthood, children’s services and adults’ services should work together to pass on this knowledge and build new relationships in advance of transition.

The local authority should have a clear understanding of their responsibilities, including funding arrangements, for young people and carers who are moving from children’s to adult services. Disputes between different departments within a local authority about who is responsible can be time consuming and can sometimes result in disruption to the young person or carer.

The local authority must also cooperate with relevant external agencies including local GP practices, housing providers and educational institutions. Again, this duty is reciprocal. This cooperation is crucial to help ensure that assessments and planning are person centred. Furthermore, local health services or schools are vital to identifying young people and carers who may not already be in contact with local authorities.

It can be frustrating for children and families who have to attend multiple appointments for assessments, and who have to give out the same information repeatedly. The SEND Code of Practice highlights the importance of the ‘tell us once’ approach to gathering information for assessments and this will be important in other contexts as well. The local authority should consult with the young person and their family to discuss what arrangements they would prefer for assessments and reviews.

All relevant partners should be involved in transition planning where they are involved in the person’s care and support.

Equally, the local authority should be involved in transition planning led by another organisation, for example a child and adolescent mental health service, where there are also likely to be needs for adult care and support.

Agencies should agree how to organise transition assessments so that all the relevant professionals are able to contribute. For example, this might involve arranging a multi-disciplinary team meeting with the young person or carer. However, it may not always be possible for all the professionals from different agencies to be present at appointments, but they should still be enabled to contribute. Transition assessments must be person centred, which means that contributions by different agencies should reflect the views of the person to whom the assessment relates.

15.1 Care coordination

Many people value having one designated person who coordinates assessments and transition planning across different agencies, and helps them to navigate through numerous systems and processes that can sometimes be complicated.

Often there is a natural lead professional involved in a young person’s care who fulfils this role and the local authority should consider formalising this by designating a named person to coordinate transition assessment and planning across different agencies, and may also wish to consider setting up specialist posts carry out this coordination function for people who are preparing for adulthood.

This coordinating role, sometimes referred to as a ‘key working’ or ‘care coordination’, can not only help to deliver person centred, integrated care, but can also help to reduce bureaucracy and duplication for local authorities, the NHS and other agencies. Care coordinators are also often able to build close relationships with young people and families and can act as a valuable provider of information and advice both to the families and to local authorities. Care leavers will have Personal Advisers to provide support, for example by providing advice or signposting the young person to services. The Personal Adviser will be a natural lead in many cases to coordinate a transition from children’s to adult care and support where relevant (see also Transitions Case Studies).

16. Eligibility

Having carried out a transition assessment, the local authority must give an indication of which needs are likely to be eligible needs (and which are not likely to be eligible) once the young person in question turns 18, to ensure that the young person or carer understands the care and support they are likely to receive and can plan accordingly.

There is a particularly important role for local authorities in ensuring that young people and carers understand their likely situation when they reach adulthood. The different systems for children’s and adult care and support mean that there will be circumstances in which needs that were being met by children’s services may not be eligible needs under the adult system.

Adult care and support is subject to means testing and charging (see Eligibility). Please note: The Government will no longer progress with a cap on care costs in 2020, delayed from 2016. A Green paper will be published in the summer of 2018 regarding new legislation for social care reform.

It is critical that families are able to understand what support they are likely to receive when the young person or carer is in the adult system, and that the transition period is planned and managed as far in advance as is practical and useful to the individual to ensure that there is not a sudden gap in meeting the young person’s or carer’s needs.

Where the transition assessment identifies needs that are likely to be eligible, local authorities should consider providing an indicative personal budget, so that young people, carers and their families are able to plan their care and support before entering the adult system (see SEN code of practice for further information about right to a personal budget for people with EHC plans, and Personal Budgets).

For any needs that are not eligible under the adult statute, local authorities must provide information and advice on how those needs can be met, and how they can be prevented from getting worse.

17. Transition Plans

The local authority and relevant partners should consider building on a transition assessment to create a person-centred transition plan that sets out the information in the assessment, along with a plan for the transition to adult care and support, including key milestones for achieving the young person or carer’s desired outcomes.

An advantage of a transition plan is that it is easier to update and refine without undertaking a new assessment – transition assessments and plans should be reviewed regularly to take account of changes both in circumstances and desired outcomes.

The priorities of young people and young carers will often change a lot during their adolescent years, and plans should be updated frequently enough to reflect this.

The local authority should also accept reasonable requests from young people and their families to review transition plans (see Review of Care and Support Plans).

In the case of an adult carer, if the local authority has identified needs through a transition assessment which could be met by adult services, it may meet these needs under the Care Act in advance of the child being cared for turning 18.

In deciding whether to do this the local authority must have regard to what support the adult carer is receiving under children’s legislation.

If the local authority decides to meet the adult carer’s needs through adult services, as for anyone else under the adult legislation, the adult carer must receive a support plan and a personal budget – as well as a financial assessment if they are subject to charges for the support they will receive (see Care and Support PlanningPersonal Budgets and Charging and Financial Assessment for Adult Care and Support).

A local authority may not meet adult carer’s needs for support under section the Care Act by providing care and support to the child cared for – this will always happen under children’s legislation.

18. Planning and Commissioning Age Appropriate Local Services and Resources

The Care Act requires local authorities to arrange preventative services, and to ensure a diverse range of quality providers of care and support in their local area. There are similar requirements in relation to the Local Offer in the Children and Families Act (see Market Shaping and Commissioning of Adult Care and Support).

Promoting a local market that offers a choice of high quality services will include taking into account the needs of young people and young carers transferring from children’s services after turning 18.

In order to prepare to live independently as adults, many young people leaving full time education will require different types of care and support to that which is typically provided to children or older people. For young adults with care and support needs or young adult carers, this might include things such as advice on housing options, support to help them live in their own home or employment training and internship opportunities..

Given the clear similarities in the statutory requirements under both Acts, local authorities should consider jointly planning and commissioning these services where there is potential to make better use of resources.

It can cause significant disruption to young people and their families if they would prefer to stay local but are forced to travel out of area due to lack of adequate local provision. This will also often result in high transport costs and high costs of out of area placements.

19. Moving to Adult Care after the Young Person or Carer turns 18

There is no obligation on the local authority to move from children’s social care to adult care and support as soon as someone turns 18.

Very few moves will take place on the day of someone’s 18th birthday.

For the most part, the move to adult services begins at the end of a school term or another similar milestone, and in many cases should be a staged process over several months or years.

Prior to the move taking place, the local authority must decide whether to treat the transition assessment as a needs or carers assessment under the Care Act (see Assessment).

In making this decision the local authority must take into account when the transition assessment was carried out and whether the person’s circumstances have changed.

If the local authority will meet the young person’s or carer’s needs under the Care Act after they have turned 18 (based either on the existing transition assessment or a new needs assessment if necessary), the local authority must then undertake the care planning process as for other adults – including creating a care and support plan and producing a personal budget (see Care and Support Planning and Personal Budgets).

The local authority should ensure that this happens early enough that a package of care and support is in place at the time of transition.

20. Combining EHC Plans and Care and Support Plans after the age of 18

Where young people aged 18 or over continue to have EHC plans under the Children and Families Act 2014, and they make the move to adult care and support, the care and support aspects of the EHC plan will be provided under the Care Act. The statutory care and support plan must form the basis of the ‘care’ element of the EHC plan (see Care and Support Planning).

Under the Children and Families Act, EHC plans must clearly set out the care and support which is reasonably required by the learning difficulties and disabilities that result in the young person having SEN.

For people over 18 with a care and support plan, this will be those elements of their care and support which are directly related to their SEN.

EHC plans may also include other care and support that is in the care and support plan, but the elements that are directly related to SEN should always be clearly marked out separately as they will be of particular relevance to the rest of the EHC plan.

21. Continuity of Care after the age of 18

Young people and their carers have sometimes faced a gap in provision of care and support when they turn 18, and this can be distressing and disruptive to their lives.

The local authority must not allow a gap in care and support when young people and carers move from children’s to adult services.

If transition assessment and planning is carried out as it should be, there should not be any gap in provision of care and support.

However, if adult care and support is not in place on a young person’s 18th birthday, and they or their carer have been receiving services under children’s legislation, the local authority must continue providing services until the relevant steps have been taken, so that there is no gap in provision.

The ‘relevant steps’ are if the local authority:

  • concludes that the person does not have needs for adult care and support;
  • concludes that the person does have such needs and begins to meet some or all of them (the local authority will not always meet all of a person’s needs – certain needs are sometimes met by carers or other organisations);
  • concludes that the person does have such needs but decides they are not going to meet any of those needs, for instance, because their needs do not meet the eligibility criteria under the Care Act 2014 (see Eligibility).

In order to reach such a conclusion, the local authority must have conducted a transition assessment (that they will use as a needs or carers assessment under the adult statute).

Where a transition assessment was not conducted and should have been (or where the young person’s circumstances have changed), the local authority must carry out an adult needs or carer’s assessment (see Assessment).

In the case of care leavers, the Staying Put Guidance (HM Government, 2013) states that local authorities may choose to extend foster placements beyond the age of 18. All local authorities must have a Staying Put policy to ensure transition from care to independence and adulthood that is similar for care leavers to that which most young people experience, and is based on need and not on age alone.

For some people with complex SEN and care needs, local authorities and their partners may decide that children’s services are the best way to meet a person’s needs – even after they have turned 18. Both the Care Act 2014 and the Children and Families Act 2014 allow for this.

The Children and Families Act enables local authorities to continue children’s services beyond age 18 and up to 25 for young people with EHC plans if they need longer to complete or consolidate their education and training and achieve the outcomes set out in their plan.

Under the Care Act 2014, if, having carried out a transition assessment, it is agreed that the best decision for the young person is to continue to receive children’s services, the local authority may choose to do so.

Children and adults’ services must work together, and any decision to continue children’s services after the child turns 18 will require agreement between children and adult services.

Where a person over 18 is still receiving services under children’s legislation through their EHC plan and the EHC plan ceases, the transition assessment and planning process must be undertaken. Where this has not happened at the point of transition, the requirement under the Care Act to continue children’s services (as set out above) applies.

Both the Children and Families Act 2014 and the Care Act 2014 also require young people and their parents to be fully involved making decisions about their care and support. This includes decisions about the most appropriate time to make the transition to adult services.

The EHC plan or any transition plan should set out how this will happen, who is involved and what support will be provided to make sure the transition is as seamless as possible.

22. Safeguarding after the age 18

Where someone is over 18 but still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with by the Adult Safeguarding Team (see also Adult Safeguarding).

Where appropriate, they should involve the local authority’s children’s safeguarding colleagues as well as any relevant partners (for example police or NHS) or other persons relevant to the case.

The same approach should apply for complaints or appeals, as well as where someone is moving to a different local authority area after receiving a transition assessment but before moving to adult care and support.

23. Ordinary Residence and Transition to Higher Education

Where a young person is intending to move to a higher or further education institution which is out of the area where they were receiving children’s services, they will usually remain ordinarily resident in the area where their parents live (or the local authority area which had responsibility for them as a child).

However, this is not always the case (see Ordinary Residence). It will be an important aspect of transition planning to confirm as early as possible where someone will be ordinarily resident as an adult (see also Transitions Case Studies).Where a young person or carer wishes to attend a higher or further education institution, the local authority should help them identify a suitable institution as part of transition planning (if they have not done so already).

Once an offer has been accepted, the local authority should ensure the relevant institution is made aware as soon as possible of the young person’s or carer’s needs and desired outcomes and discuss a plan for meeting them.

As set out in the SEN code of practice, an EHC plan will cease if someone progresses to further or higher education, but a care and support plan is likely to be required thereafter.

Wherever possible, this should be a conversation involving the young person or carer, anyone else they wish to involve, the local authority, and the institution – as well as the local authority where the institution is located where appropriate. All higher and further education institutions have clear duties and responsibilities under the Equality Act 2010 with regard to ensuring that disabled students do not face discrimination or less favourable treatment when applying to, and studying in these institutions. They are likely to have a learning support team or similar that can lead transition discussions on their behalf. These conversations should also ensure young people and carers are aware of their rights to the Disabled Students Allowance and student loans.

The objective is to ensure that there will be an appropriate package of care and support in place from the day the young person or carer starts at the institution. In many cases a young person or carer studying at university will have a dual location, for example coming home to stay with the parents during weekends or holidays. Where this is the case, local authorities must ensure their needs are met all year round.

24. Transition from Children’s to Adult NHS Continuing Health Care

CCGs should use the National Framework for NHS Continuing Healthcare and supporting guidance and tools (especially the Decision Support Tool) to determine what ongoing care services people aged 18 years or over should receive (see Continuing Healthcare – NHS).

The framework sets out that CCGs should ensure that adult NHS continuing healthcare is assessed at all transition planning meetings for all young people whose may be potential eligibility.

CCGs and LAs should have systems in place to ensure that appropriate referrals are made whenever either organisation is supporting a young person who, on reaching adulthood, may have a need for services from the other agency.

The framework sets out best practice for the timing of transition steps as follows:

  • children’s services should identify young people with likely needs for NHS Continuing Health Care and notify the relevant CCGs when such a young person turns 14;
  • there should be a formal referral for adult NHS CHC screening at 16;
  • there should be a decision in principle at 17 so that a package of care can be in place once the person turns 18 (or later if agreed more appropriate).

Where a young person has been receiving children’s continuing health care, it is likely that they will continue to be eligible for a package of adult NHS CHC when they reach the age of 18.

Where their needs have changed such that they are assessed as no longer requiring such a package, they should be advised of this and of their right to request an independent review and mediation

The CCG should continue to participate in the transition process, in order to ensure an appropriate transfer of responsibilities, including consideration of whether they should be commissioning, funding or providing services towards a joint package of care.

Where it will benefit a young person with an EHC plan, local authorities have the power to continue to provide children’s services past a young person’s 18th birthday for as long as is deemed necessary.

Where there is a change in CHC provision, this must be recorded in the young person’s EHC plan, where they have one, and the young person must be advised of their right to ask the local authority for mediation up to the age of 25 (see SEND Code of Practice).