Transcript Care Act Briefing - 27 June 2014

Care Act 2014
Briefing event
27 June 2014
House Keeping
We don’t expect a fire alarm test today – if alarm sounds
exit through front doors if safe to do so and assemble in
the Sunken Gardens
Toilets – into the corridor, turn right and toilets are on the
right
Time for questions has been built into the agenda
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Care Act 2014
Welcome and Introduction
Councillor Peter Connor
Councillor Margaret Morris
Introduction
The Act has been promoted by the Government as: ‘the most
significant reform of care and support in more than 60 years’.
We believe we are well placed to implement the requirements but
still face significant challenges.
We want to ensure staff throughout the council and our Partners
across Salford are aware of the implications.
Today’s event is the start of that process.
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Care Act 2014
Overview of the Care Act
Sue Lightup
Introduction
The Act has been promoted by the Government as: ‘the most significant
reform of care and support in more than 60 years’.
It is in part a response to the Dilnot Commission on the Funding of Care
and Support, some of whose recommendations have been implemented
in full in the Act, others of which have implemented in part and others of
which have not been implemented.
It also responds to a report following a three-year review by the Law
Commission of adult social care law, published in May 2011.
Part of the Act is also intended to address some of the issues arising from
failures at Mid-Staffordshire Hospital.
The Care Bill received Royal Assent on 14 May and has now been
passed into law as the Care Act 2014 (the Act).
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Summary
The Act introduces major reforms to the:
• legal framework for adult social care,
• funding system,
and
• duties of local authorities and rights of those in need of social care.
The potential impact on local authorities’ finances and on their working
practices is enormous.
The main provisions of the Act:
the Act is divided into four parts.
• Part 1 reforms the adult social care system.
• Part 2 relates to care standards, providing the Government’s
legislative response to the Francis Inquiry into the failings at
Mid-Staffordshire hospital.
• Part 3 establishes new non-departmental bodies.
• Part 4 contains technical matters.
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Timing of implementation
• The provisions of the Act as they relate to the legal framework for
adult social care will come into force in April 2015.
The funding provisions will come into force in April 2016.
• consultation on draft regulations and guidance (for April 2015
elements)
6 June 2014, with a 10 week consultation period;
• formal publication of regulations and guidance (for April 2015)
October 2014;
• Care Act provisions in force from April 2015 (excluding funding reform);
• All Care Act provisions in force from April 2016 (including funding
reform).
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Summary of main provisions
Part 1 reforms the adult social care system:
• Sets out the general responsibilities of local authorities, describing
their broader care and support role towards the local community,
emphasising a preventive approach and giving them duties to consider
physical, mental and emotional wellbeing and to provide information to
those needing care;
Well-being is a principal underpinning the entire framework - it is a
broad concept, and it is described as relating to the following areas in
particular:
- personal dignity (including treatment
of the individual with respect);
- protection from abuse and neglect;
control by the individual over
day-to-day life (including over care
and support provided and the way
it is provided);
- physical and mental health and
emotional wellbeing;
- participation in work, education,
training or recreation;
- social and economic wellbeing;
- domestic, family and personal ;
relationships;
- suitability of living accommodation;
- the individual’s contribution to
society.
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Summary of main provisions (continued)
• Maps out the process of assessments, charging, establishing
entitlements, care planning and the provision of care and support;
• Makes provision for national eligibility criteria against which all local
authorities will be required to assess individuals’ entitlements to care;
• Enshrines the right of carers to receive support from their local council
and introduces a duty to meet carers’ eligible needs for support;
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Summary of main provisions (continued)
• Introduces a cap on care costs which anyone over state pension age
will be liable to pay. The Dilnot Commission’s original suggestion was
for a cap of £25,000 to £50,000 in 2010-11 prices. The Government
intends to set the cap at £72,000 in 2016/17 prices (equivalent to
£60,000 in 2010/11 prices) – the maximum amount that any individual
would have to pay for their care costs.
Young people who already have care needs when they turn 18 will
now receive free adult care and support when they reach that age;
• Makes provision for local authorities to enter into ‘deferred payment
agreements’ intended to enable people to meet their care costs without
having to sell their homes during their lifetime;
• Provides a new legal entitlement to a personal care budget for eligible
individuals;
• Outlines the responsibilities of local authorities and other partners in
relation to safeguarding adults, including a new requirement to
establish Safeguarding Adults Boards in every area;
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Summary of main provisions (continued)
• Provides for those in need of care to be able to move between local
authorities without interruption to their care (this is known as
‘portability’ of care) and clarifies how, if a care provider goes out of
business, individuals will be protected;
• supports the transition for young people between children’s and adult
care by giving local authorities powers to assess the needs and
entitlements of children, young carers and parent carers.
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A broad council-based approach with partners
participation:
Our Customer Journey
Early Intervention
Targeted Intervention
Longer Term
Intervention
• Information & Advice
• Initial Contact Assessment
• Preventative Services
• Reablement ● Intermediate Care
• Telecare/Telehealth/Equipment
• Further Assessment
• Self Directed Support
• Help at Home
• Residential/Nursing Care
Review
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Partners participation in:
•
Wellbeing
Well-being principal underpins the entire framework with well-being expanded
to include dignity/accommodation.
Requirement for collaboration, cooperation and integration with other public
authorities and the NHS, including Housing) with list of relevant partners
extended to cover registered housing providers and registered social
landlords.
•
Prevention
Sets out the general responsibilities of local authorities, describing their
broader care and support role towards the local community, emphasising a
preventive approach and giving them duties to consider physical, mental and
emotional wellbeing and to provide information to those needing care
•
Information and advice
Universal obligations for all people; prevention, information service, sign
posting, quality and choice.
Information should be available to enable people to make an informed decision
re: identified needs and to enable better self support when relevant
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Partners participation in:
• Market Shaping and Commissioning
New duty for LA to facilitate a vibrant. diverse and sustainable market
for high quality care and support for the benefit of the whole local
population
• Safeguarding
New duty for LA to carry out enquiries (or cause others to) where it
suspects an adult is at risk of abuse or neglect.
New ability for Safeguarding Adults Board ‘s to require information
sharing from other partners.
• Transition for children/young people
Supports the transition for young people between children’s and adult
care by giving local authorities powers to assess the needs and
entitlements of children, young carers and parent carers.
• Housing
DoH intend to issue fresh guidance to include emphasis on importance
of adequacy of housing provision being a vital component of safe and
timely hospital discharge.
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Consultation on Care Act guidance
What are the draft regulations and guidance?
• The Care Act contains the core legal duties and powers relating to
adult social care. And it also contains regulation making powers allowing Government to make secondary legislation (regulations) that
provide more detail.
• Statutory guidance is intended to provide local authorities (LA’s) with
the information they need about how they should meet the legal
obligations placed on them by the Act and the regulations.
• LA’s are required to act under the guidance, which means that they
must follow it, unless they can demonstrate legally sound reasons for
not doing so.
• The guidance will be used by LA’s to plan care and support at a local
authority level, as well as by practitioners themselves.
It will also be used by people using care and support, their families,
the voluntary sector and providers of care and support to help them
understand the new system, and by courts in deciding whether a local
authority has acted within the law.
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Consultation on Care Act guidance (continued)
• The draft regulations and guidance published (on 6 June 2014)
relate to the care and support reforms and provisions in the Act
which will come into effect in April 2015.
• The guidance describes how the care and support system should
operate in 2015/16.
And LA’s and other stakeholders have until the 15 August 2014 to
comment on the guidance.
• The final guidance is scheduled to be published in October 2014.
• Regulations and updated guidance to support implementation of the
additional reforms which come into effect in April 2016 (e.g. the cap
on care costs), will be subject to a separate consultation, to be
published later this year.
• You can play your part – each workstream sponsor will be coordinating
responses in their area, provide them with the name of someone to
contact or feed back to them your views
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Project structure
• We have established a Project Steering Group with 6 work streams
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Questions?
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Care Act 2014
Advice and Information
David Herne
[email protected]
Requirements from the Act
• A new duty to:
Establish and maintain a service for providing
…information and advice relating to care and support
for adults and carers
• Goes beyond basic care and support services to
broader holistic view
• Is a place leading role – i.e. lead the system
• Focus on individualised information
• Steer people towards relevant financial support/advice
• Requirement for independent advocacy
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Requirements from the Act
• Emphasis on a “service” for providing the information
• A broad audience, in care, seeking care, planning for
care etc etc
• Accessibility – eg Manner of provision, additional
requirements, independent advocacy
• Targeted to people at key “trigger” points on the
pathway
• Proportionate - type, extent and timing relevant to
individual needs
• Finances – understanding charging, ways to pay, money
mgt, Independent financial advice
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Gap analysis
• Starting point is promising
• Lots of aspects of the requirement in place but….
• Fragmented and couldn’t be described as a coherent
service…… yet
• Need a clear offer for access to IFA
• Better information on independent advocacy
• Some parts of the offer in development eg W2W portal
and MECC
• Need to assess whether all formats and languages
currently covered
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Partner considerations
• Local Authorities must
– co-operate with each of relevant partners
– Promote integration between care and support
provision
– This can include integration of information and advice
• Strategic planning must start with JSNA /JHWS
• JHWS planning should include emphasis on alignment
and integration of services
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You can help with
• Support for working up the Independent Financial
Advisor offer
• Information on independent advocacy
• Care and support package through Way2Wellbeing
portal
• Re-launch of Making Every Contact Count – do the right
thing
• Identification of languages in common use
• Anything else you can suggest!!!
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Care Act 2014
Market Shaping and Commissioning
Jennifer McGovern
[email protected]
Market Shaping and Commissioning
•
The Act introduces new duties on local authorities to
facilitate a vibrant, diverse and sustainable market
for high quality care and support in their area, for the
benefit of their whole local population (regardless of
how the services are funded).
•
The local authority’s own commissioning and
procurement practices should take account of these
wider ‘market shaping’ duties.
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Principles of Market Shaping and Commissioning
• A focus on outcomes and wellbeing;
• Promoting quality services, including through workforce
development and remuneration and ensuring
appropriately resourced care and support
• Supporting sustainability, and ensuring choice;
• Designing strategies that meet local needs;
• Engaging with providers and local communities;
• Understanding and facilitating the development of the
market; and,
• Securing supply in the market and assuring its quality
through contracting.
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Salford’s Starting Position
Further ‘Act’ Requirements
• Commissioning Strategies
- Effective engagement with the
providers
• Market Position Statement
- Refresh Market Position Statement
• Engagement
- Workforce Strategy
• Personalisation Framework
- Annual assessment ‘Self funders’
• Developing Quality Assurance
Framework
- Housing Related Support
Commissioning Plan
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Partner considerations
• Local Authorities must
– co-operate with each of relevant partners
– Promote integration between care and support
provision
– This can include integration of commissioning and
workforce planning
• Strategic planning must start with JSNA /JHWS
• JHWS planning should include emphasis on alignment
and integration of services
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You can help with
• Partners to work collaboratively with provider
engagement
• Partners to work collaboratively with public
engagement
• Joined up workforce strategy
• Partners supporting the care pathway from
acute settings to ordinary living (including
housing solutions)
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Care Act 2014
Operational Practice
Dave Clemmett
[email protected]
Care Bill Requirements..What Stays the Same and What
Changes
•
•
•
•
•
•
Preventing Needs for Care and Support
Eligibility Framework in Law
New Approach to asset Based proportionate Assessments
Carers ...extra responsibilities
Self Funders...extra responsibilities
Transition from Childhood and tie in with Children and
Families Act.
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Who pays for care
• How is this paid for by people?
- What services are paid for
- Will need to keep Care Accounts for people
and what they have spent
- Offer deferred payments
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Promoting
Health
&
Wellbeing
Personal
Safety
&
Responsibility
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Other areas of increased responsibilities
•
•
•
•
•
•
•
•
Continuing Healthcare
Prison Population
Hospital Discharge
Terminal Illness
Review of Care/Support Plans
Duty to Cooperate
Promotion Integration
Complaints... robust challenge to City Council Decisions
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Current Advocacy Services in Salford
•
•
•
•
•
•
•
•
Age UK
Dementia Support Service
CAB
Carers Centre
Healthwatch – Voice of People
Salford Disability Forum
Salford Being Heard
Mental Health CAB
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Analysis of Impact to date
• Capacity Planning 15% increase activity.
– Carers
– Self Funders
• Job roles/skill mix
• Capacity to Manage Change and keep show on the road
• Same time as Integrating with Health
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Care Act 2014
Safeguarding
Keith Darragh
[email protected]
Safeguarding
Safeguarding is everybody’s business
• Care Act requirements
– New duty for LA to carry out enquiries (or cause others to)
where it suspects an adult is at risk of abuse or neglect
– New emphasis on making safeguarding personal – range
of options besides safeguarding
– Continuing theme regarding appropriate advocacy
– Statutory Status for Adult Safeguarding Board (Health,
Police, Local Authority)
– Promotion of multi agency awareness, understanding and
training
– Specific training for elected members / Healthwatch
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Partnership working – key points
• Co-operation with investigation of suspected abuse
• Sharing of resources to make safeguarding outcomes
personal – joint workforce strategies
• Continued support to the Multi Agency Safeguarding
Board
• Contribution to the development of relevant and
inspiring training
• Preparation work to be undertaken by the Safeguarding
Board
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Care Act 2014
Deferred Payment Scheme
Keith Darragh
[email protected]
Paying For Care – Care Act Principles
• Currently
– People pay for care through a means tested system
– There are different rules for the amount a person pays
depending on whether they are supported to live in their
own homes or residential care
• Care Act 2014 - Principles
– Local Authorities can choose to charge (with certain
exceptions)
– People should only pay what they can afford (means test)
– Charges should be clear and transparent
– Apply charging rules equally to those with similiar needs
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Care Act Requirements
• Local Authorities must undertake a financial
assessment of what a person can afford to pay
• Different rules still apply - depending on whether a person
is supported to live in their own homes or residential
care
• Main difference is for residential care, Local Authorities
required to offer deferred payment agreements to
people who meet criteria for the scheme
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Deferred Payment Agreements - people not having to sell
their home in their lifetime
• The Act establishes a universal deferred payment scheme
• Applies – When somebody’s needs are such that they need to
live in a care home to meet their needs and allows people to
defer / delay having to pay the costs of their care and support
until a later date – Payment “deferred” not “written off”
• Eligibility – Local Authorities must offer deferred agreements to
– People who have local authority arranged care
– People who arrange and pay for their own care (self
funders)
• Impact for the council – making large loans to individuals over
long periods of time
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Partnership working – key points
• Charging is still a key part of the Adult Social Care
system
• Local Authority financial administration will increase
• Deferred Payments cost will be carried by Local
Authorities – interest charges will apply to the debt
• Can we collaborate to do this?
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Care Act 2014
Care Accounts
Keith Darragh
[email protected]
Care Act – Who Pays for Care
The Care Act introduces
• A financial “lifetime cap” on each individual’s contribution to
eligible care needs - £72,000, whether that care is arranged by
the Council or is paid for privately (self funders) – from April
2016
• Requirement for Adult Social Care to undertake assessments
for self funders to determine
– Are their care needs eligible for funding by the state ?
– The cost of care paid for by the individual – as would be paid
if the Council arranged for the care
• Local Authority to set up “care accounts” to track what people
pay to see when they reach the care cap of £72,000
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Care Act – Implications
• More assessment capacity required to assess self funders
• Increase in financial administration resources
• Development of systems to track care costs – over multiple years and
potentially with varying care costs eligible as needs rise
• And…
• The full costs have not yet been determined nationally
• The implementation date is after the General Election
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Questions?
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Care Act 2014
Overview of Major Risks
Sue Lightup
Major Risks (1)
• Unknown number of ‘self funders’ requiring additional
assessments for Care Accounts.
• Increased numbers of assessments for Carers.
• New responsibility for assessing and meeting some needs of
prisoners
• Raised expectations of support that won’t be met:
– Care Accounts
– Carers
• Potential increased demand for Deferred Payment Schemes.
• Potential increased pressure on Care Homes and Care
Providers to equalise rates between council commissioned
services and ‘self funders’.
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Major Risks (2)
• New responsibility towards ‘self funders’ in the event of a market
failure.
• Increased provision of information could stimulate an increased
demand for services.
• Providers may not engage with us as willingly or fully as
required.
• Implementing the provisions of the Act at the same time as we
are transforming how we are organised will increase the
challenges we face.
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Reflections
• In groups of 2 or 3 consider the implications for your
organisation / service of the Care Act
– Can you identify a strength we can build on?
– Can you identify a gap we can work on?
– What 1 thing can you do in your organisation to support the
implementation?
– Any other observations?
• Write your answers on a post-it
• Place on relevant flipchart
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