Transcript Regional Perspectives on the Care Act 2014

Care Act 2014 – State of Readiness
ADASS President
David Pearson
Purpose of the Care Act Session
• What does the review by the Major Projects Authority
tell us about our work so far and the risks?
• What does the stocktake of Local Authorities tell us?
• Feedback from regions
• What are the areas of greatest risk and how are we
tackling them?
• Detailed work on tables to assist with some of the high
profile areas
Overview
• Care Act received Royal Assent on 14th May 2014
• Very high degree of collaboration with amendments in the
final stages of the bill and in drafting regulations and
statutory guidance
• Widespread support for principles of health and wellbeing,
personalisation, and co-commissioning / co-production
• The Act is a platform for the next few decades albeit in
tough times
• Regulations and statutory guidance will shape the
experience of the Act
Major Projects Authority
Project Assurance Review
• Independence of DH and the Programme Board
• Aim to identify the key threats to delivery of the Programme and help improve
delivery confidence
• Scope both 16/16 and 16/17 implementation covering:
~ Policy, Business Context Programme delivery
~ The Summary case for change
~ Management of intended outcomes, and Stakeholder engagement
~ Approach to managing Risks and Issues
~ Readiness for the next stage
• Over 40 cross programme interviews over 5 days
MPA: Findings
Delivery Confidence Assessment
• 15/16
Amber
•
16/17
Amber/Red
“Strong commitment and support across
system but inherent challenge and risk“
“Greater complexity & funding uncertainty”
Areas that are working well
• ‘A very strong tripartite relationship and joint programme office’ that should be
protected
• Disparate policy initiatives pulled together in a single programme and coherent
direction
• Consistent understanding of vision, objectives and main issues
• Energy within the programme
MPA: Findings
Areas of concern
• “a major issue is funding” sufficiency and allocation mechanism
~ could threaten the strong collaborative approach to delivery
• Residual risks around workforce and informatics that are greater
for the 16/17 deliverables
• The Programme would benefit from greater programme
management rigour but not at expense of relationships
• 11 recommendations to strengthen the programme
Local Authority Stocktake (LAS)
Implementation Stocktake
• Developed and run by the PMO with sector input
• 100% response rate
• Focus on 9 proxy responses as an overall readiness indicator
~ More detail in full report, including regional analysis
• Traffic lights indicate where councils should be /progress at this stage
• Surveyed before regulations and guidance consultation began
• Report does not make recommendations
LA Stocktake: Findings
Programme Management & Governance
Q1 – Council has plan/programme to deliver the Care Act reforms
Yes: Complete
No: Underway
No: Not Started
Don’t Know
36
63
1
0
Confidence
Q2 – How confident that the Care Act can be delivered
Very confident
Fairly
confident
Not very
confident
Not at all
confident
36
63
1
0
Councils with 3 or more ‘red’ proxy indicators
17% have self-assessed as having slightly slower progress
LA Stocktake: Findings
Local preparedness
• On the whole a fair to good level of preparedness based on
self-assessment with almost all having a plan in place
• Good level of awareness with local systems leaders
• Reasonably good progress in identifying people and carers
who may have care and support needs
• Significant concerns around the costs of the reforms
• Workforce, informatics and communications are areas of
concern
Major Projects Authority & Local
Authority Stocktake
Areas of Concern
• Both assurance exercises broadly highlighted the same
4 areas of concern:
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Informatics
Workforce
Communications
Affordability
“Wicked issues” from the East
Midlands Region
• Self funders – Do we know enough about them and how to influence
their behaviour?
• Information and advice – Some of what we are going to have to provide
will be very specialist e.g. BSL, Easy Read, prisoners. Would national
products be a good idea?
• Carers – Do we really know what demand to expect?
• Prevention – We need to prepare care managers to be able to provide a
lot more information than they have done to date
• Financial impact – a lot of new responsibilities creep in almost under the
radar, has the Impact Assessment really captured the costs of these?
• Workforce - “right sizing” the workforce when it is hard to precisely
quantify the impact of the changes.
• Continuing Health Care and the Care Act
• Disabled Facilities Grants in two-tier council systems
“Wicked issues” from the
Eastern Region
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Unknown costs of implementing the reforms
Additional carers’ assessments and personal budgets
Readiness of ICT systems
Workforce
Communication strategy/plan/materials
Public expectations
“Wicked issues” from the North East
Region
• The higher rates of deprivation and unemployment in the region in combination with low
home ownership means a large percentage of people accessing social care would fall
beneath the proposed £17,000 means tested threshold lower limit. This means that LAs
would still be required to meet the vast majority of the full costs of care.
• The proposed ‘substantial’ eligibility criteria is more ‘generous’ than current offer from some
LAs in the region meaning a possible significant increase in numbers. The region already
currently has the highest rates for people accessing ASC per 100,000 population.
• Identifying the numbers of potential self funders and carers who may be approaching local
authorities for assessment.
• As a result of low property prices many people in the North East would still lose the full value
of their property even with the £72k care cap. The lower care costs in the region would also
mean many people would not benefit from the £72k cap.
•Significant additional responsibilities – market management, advice and assistance to those
not eligible – without appropriate levels of funding at a time when social care is already under
considerable pressure
“wicked issues” from the North West
Region (1)
In the NW a Task & Finish Group is scoping and preparing. Over 40 members
have volunteered to participate (not all attend every meeting). Two
sessions have identified that we want to:
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Share information and analysis undertaken individually or in groups
Highlight good practice
Encourage collaboration and lead roles to reduce duplication
Communicate the ‘must-do’s’
Make recommendations about the improvement play deployment of
resources including the NW grant allocation
Liaise and feed back information with LGA and DH named individuals
Method for identifying self-funders. Local authorities can be broadly aware
of self-funders in residential care, but less clear for those in non-residential
care. Clarity on how to identify unknown demand without additional
resource and within a reducing budget.
Method for identifying the local costs of implementation in 15/16. There are
concerns that the allocation for the new duties will be underestimated.
“wicked issues” from the North West
Region (2)
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The daily living cost if still set at £12k per year will have an impact locally –
given that the NW have lower residential fee rates. We understand that there
will be a new funding formula – and only the care element of the residential fee
rate will be covered.
Establish additional demand from carers – given a good NW network to help
scope.
Method identifying the numbers of deferred payment agreements that will be
required and how existing arrangements (workforce, IT and finance systems)
can meet these.
Providing programme management guidance/resources. Request for a clear
breakdown of activity at the national – regional – sub-regional tiers with local
‘must do’s’ to avoid duplication.
Sharing information and good practice – to potentially manage demand
IT support systems – understanding what is required and the software
companies’ responses
Prisons. We have a number of large prisons in the NW and the impact is not yet
clear.
“Wicked issues” from
the South East Region
• Governance and programme management - in place for counties,
much less developed in UAs, need for additional resource
• Number of self funders estimated or advanced progress by counties.
UAs report moderate/early progress – some not yet started
• Less progress with estimating carers’ assessments
• Cost modelling underway – half of UAs just started /not done any
work
• Engagement with key groups about the Care Act has hardly started
• Workforce reviews have started - no development plans in place
• Greatest risk - total implementation cost and funding, as well as
additional demand for assessment
Summary
• Assessment is positive about tripartite arrangement.
• MPA and LA Stocktake consistent on areas of risk and
no surprise to programme board.
• Regulations and Statutory guidance need full
participation to improve .
• 16/17 paying for care costs still subject to discussions
about the gap in assessment of costs with PSSRU
support.
• Further work needed on carers and workforce to
assure progress and reduce risk.
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