Transcript Title of Meeting (ARIAL 34 BOLD)

The Care Act 2014 – implications for providers
KICA conference – 11th February 2015
Hugh Constant
#SCIECareAct
What we’ll cover
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Overview of the Care Act 2014
• What it means for local authorities
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What it means for providers
Care Act 2014
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The most significant piece of social care legislation
since the establishment of the welfare state
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Builds on recent reviews and reforms
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Consolidates good practice
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Replaces numerous previous laws to provide a
coherent approach to adult social care in England
When is it happening?
Royal Assent
14 May 2014
Care Act care and
support reform
provisions
1 April 2015
Care Account and
Care Cap
1 April 2016
What it seeks to achieve
The Care Act aims to ensure that the care and support system:
• is clearer and fairer– more consistent and transparent
• promotes individual’s wellbeing – physical, mental and emotional
for all individuals
• enables people to prevent, reduce or delay needs for care and
support
• puts individuals in control of their lives so they can pursue
opportunities and realise their potential
Who is affected by the changes?
• Local authorities
• NHS
• Housing
• Local people
• Adults with care
and support needs
• Carers, young
carers and parent
carers
New duties
New
rights/support
Where can the changes be found?
Different sections of the
Act are designed to work
together
Overlap with children and
families, including
transitions
Primary legislation – the Care Act 2014
Legal duties and powers
Secondary legislation – the
regulations
More detail on critical requirements
Statutory guidance
Guidance on how to meet the legal
obligations in the Act
Implementation support
Best practice guidance, toolkits, etc.
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What is happening?
• Increased focus on individual wellbeing and prevention
• Wider focus on the whole population
• Better access to information and advice and assessments for all
• Embed and extend personalisation
• New model of paying for care - care account, care cap, PB and DP
• New national eligibility threshold
• Duty to integrate, cooperate and work in partnership between
partners and local authorities
• New safeguarding adults duties
Wellbeing
Duty to promote individual wellbeing - adults, carers, population
There is no hierarchy and all aspects of wellbeing or outcomes
should be considered of equal importance
The wellbeing principle applies to all adults
Wellbeing principle
Work,
education,
training &
recreation
Social
and
economic
wellbeing
Suitability
of living
arrangements
Individual
contribution
to society
Personal
control
Personal
dignity
Wellbeing
Domestic,
family &
personal
relationships
Physical,
mental &
emotional
health
Protection
from
abuse &
neglect
Key points
Different people
different
priorities
Different times
different priorities
All areas
are related
General duties to all residents
Prevent, delay and reduce needs
Information and advice
Integration, cooperation and partnership
General duties to residents with
certain needs
Safeguarding
Assessment
Duties to individuals who meet
certain criteria
Independent advocacy
Carers
General duties to people receiving
care and support
Continuity of care
Eligibility
General duties to people receiving
care and support
Charging
Deferred payments
What might this mean for local authorities?
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New duties and responsibilities
Changes to local systems and processes
More assessments and support plans
Responsibilities towards all local people
Training and development of the workforce
Costs of reforms
Preparation for reforms needed
What might this mean for local authorities?
What does this mean for care organisations?
 Offering services with regard to the wellbeing principle
 Greater local authority focus on promoting diversity and quality in
the market and market intelligence about self-funders needed
 Greater local authority involvement in services focused on
prevention and delay
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Market oversight and provider failure arrangements
Charging changes
Ordinary residence changes
Statutory safeguarding arrangements
Market shaping
 Principles which should underpin market shaping and commissioning
 Focus on outcomes and wellbeing
 Promoting quality, including workforce development and
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remuneration, and appropriately resourced care and support
 Supporting sustainability
 Ensuring choice
 Co-production with partners
A duty on local authorities to facilitate diverse, sustainable, high quality
services in their area to provide people with meaningful choice
regardless of who pays for care – it covers the whole market
Market position statement
 Suggested, not mandatory
 It, market shaping, and the JSNA should involve consulting with:
 people needing care and support, and representative organisations
 individuals and groups who are less frequently heard
 carers and representative organisations
 health professionals, social care managers and social workers
 independent advocates
 support organisations that help people consider care choices
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(including financial options)
provider organisations (including housing providers and registered
social landlords)
wider citizens and communities
All in this together?
Market Oversight
 April 2015: the financial health of the most difficult to replace care and
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support providers will become subject to monitoring by CQC
These providers have a duty to provide information to CQC
CQC have a duty to assess sustainability and inform local authorities
when they consider a provider is likely to be unable to continue
An early warning of likely failure so a local authority can prepare to step
in if needed
Domiciliary Care
 Applies to only the largest and difficult to replace providers – i.e.
 Domiciliary providers who deliver:
 30,000 hours or more care in a week, or
 care to 2,000 or more people in a week, or
 care to 800 or more people in a week and they each receive
more than 30 hours in that week
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Residential Care
 Residential care providers with:
 bed capacity of 2,000 beds or more, or
 bed capacity of between 1,000 and 2,000 beds and
 either they have beds in more than 16 LAs
 or the capacity in each of three or more LAs
exceeds 10% of the bed capacity of those LAs
Financial sustainability of other
providers
 The vast majority of small and medium providers
 LAs must ensure continuity of care in respect of business failure of all
providers
 Need to have
 contingency plans
 an understanding of current trading conditions
 a sense of the sustainability of their pool of providers
 Strengthens the need for contingency planning on all parties
Managing provider failure and
service interruptions
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Triggered whenever there is business failure leading to a
service interruption
However this is only triggered “when the service can no
longer be provided”
What matters: whether the needs of the people affected
appear to be urgent
The duty on a local authority to ensure needs are met is not
specific:
 providing information on alternative providers
 arranging care and support
Charging and financial assessment
– Care Act principles
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Affordable
Comprehensive
Clear and transparent
Promote wellbeing, social inclusion, and personalisation
Independence, choice and control
Be person-focused
Consistent
Encourage employment, education or training
Help people plan for the future costs of meeting their needs
Be sustainable for local authorities in the long-term
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Charging and Financial assessment
 This section replaces the Charging for Residential Accommodation
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Guidance(CRAG) and Fairer Charging Guidance
In 2015/16 sees little change from existing practice
The following do not change (save for annual uprating):
 DWP Benefits,
 Funded Nursing Care
 NHS Continuing Care
Upper capital limit remains at £23,250 for 2015/16
Rules on the use of ‘top-up fees’ are re-enforced to make clear that all
arrangements must be through the local authority. This means a
provider must not seek a ‘top-up fee’ directly with the person receiving
local authority funded care.
Charging changes for 2015/16
What does change from April 2015:
 Deferred payments: People do not have to sell their homes in their
lifetime to pay for residential care
 Must be offered by all local authorities
 Cannot charge a carer for services provided to the person they care
for, even if this is to meet the carer’s needs for support
Deferred payments
 All local authorities must offer deferred payment agreements when:
 A) The person’s eligible needs are to be met by residential care,
 B) The person has less than £23,250 in assets excluding the value
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of their home, and
 C) The home is owned outright and is not occupied by a spouse or
dependent relative
Local authorities may refuse a deferred payment if,
 They are unable to secure a charge on the property, or
 The property is uninsurable
First party top ups are allowed within deferred payments
Charging changes: 2016
What changes from 2016:
 Introduction of the cap on care costs
 Regulations now out for consultations
 £72,000 care costs
 Not included: up to £230 accommodation costs
 Extension to the point at which means tested support becomes
available. New limits will be:
 Upper capital limit of £118,000 in a care home, unless a
property disregard applies
 Upper capital limit of £27,000 in all other settings or if a property
disregard applies
 Lower capital limit of £17,000 in all settings
LA-arranged care for self-funders
 For care in a care home:
 “Self-funders” may ask their local authority to meet their needs
 This may be by achieved by a range of activity, for example through
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signposting or brokerage
Can be charged
The person cannot be charged more than the cost the local
authority is able to secure, plus an administration charge
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Ordinary residence
 Regulations set out three types of accommodation:
 Care home/nursing
 Supported living/extra care housing
 Shared lives schemes, where the principle of deeming applies
 For all of them, the relevant LA will be the placing LA, not the host LA, if
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the LA has arranged the care
Determining ordinary residence involves factors such as time, intention
and continuity, and involves questions of both fact and degree
The “deeming provision”: the adult is treated as remaining ordinarily
resident in the place the person has voluntarily adopted for settled
purposes, whether for a short or long duration
Implications, therefore, where the person lacks mental capacity
Safeguarding – LAs must:
promote the physical, mental and emotional wellbeing of
individuals
make or arrange for safeguarding enquiries
set up Safeguarding Adults Boards
arrange for independent advocacy when it is needed
cooperate with each of its relevant partners
Safeguarding – LAs must have regard to:
the importance of beginning with the assumption that the
individual is best-placed to judge their wellbeing
respecting an individual’s views, wishes, feelings and beliefs
decisions being made having regard to all the individual’s
circumstances
the need to protect people from abuse and neglect
Safeguarding for providers
Poor care – a matter of practice and
regulation, not safeguarding
Duty to share information
Summary – New Opportunities
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Services aimed at prevention
 different forms of intermediate care
 community engagement
 information and advice
Independent advocacy
Personal budgets and direct payments
New services as a result of integration
More demand for carer support
More from SCIE
• SCIE learning events
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Safeguarding
Assessment and eligibility
Commissioning
In-house training and consultancy
SCIE resources www.scie.org.uk/care-act-2014
Register for SCIE e-bulletin at www.scie.org.uk
Email [email protected]
Prevention Library http://www.scie.org.uk/prevention-library
Social Care Online http://www.scie-socialcareonline.org.uk/
National implementation support
Care and support
reform implementation
Resources developed by SCIE, Skills for Care, Care
Providers Alliance, The College of Social Work, etc.
www.local.gov.uk/care-support-reform
Register for care and support reform e-bulletin
[email protected]
Public awareness campaign: Care and Support and You
www.gov.uk/careandsupport
[email protected]
[email protected]
www.scie.org.uk