Transcript Document

Reforming care and support:
The Care Act 2014
27 March 2015
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A brief history of care and support
Social care law and policy has evolved over more than 65 years, incorporating around 30
Acts of Parliament, but reform has usually been piecemeal.
National
Assistance Act
1948: established
the welfare state
and abolished the
Poor Laws
1948
NHS and Community Care
Act 1990: first major set
of reforms, including first
right to assessments and
start of commissioner/
provider split.
1960…
1970…
Chronically Sick and
Disabled Persons Act
1970: reforms to key
entitlements to
community services
Community Care
(Direct Payments)
Act 1996: new
powers to make
direct payments
1980…
1990…
2000…
Carers (Recognition
and Services) Act
1995: the first Act
to recognise carers
Carers and Disabled Children
Act 2000: extending direct
payments to carers
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The Care Act: reforming care and support
Health and Social
Care Act 2001:
updates on direct
payments
2010…
Putting People First: the
concordat which
enshrined the
personalisation agenda
and started the focus on
personal budgets
Context for change: demands on the system
Care and support affects a large number of people
In England there are…
Supported
Supported
…around 400,000
people in residential
care, 56% of whom
are state-supported
…around 1.1 million
people receiving
care at home, 80%
of whom are statesupported
…1.5 million
people employed
in the care and
support workforce
…and around 6 million
people caring for a
friend or family
member.
Three-quarters of people aged 65 will need care and support in their later years
19 per cent of men and
34 per cent of women
will need residential
care
48 per cent of men and
51 per cent of women
will need domiciliary
care only
33 per cent of men and
15 per cent of women
will never need formal
care
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The Care Act: reforming care and support
Older people are the core user of acute
hospital care - 60% of admissions, 65%
of bed days and 70% of emergency
readmissions.
72% of recipients of social care services
are older people, accounting for 56% of
expenditure on adult social care.
Context for change: financial pressures
Councils are facing significant and increasing demand and financial pressure.
Adult social care spending has fallen by c8.5%
in real terms from 2011/12 to end of 2013/14
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(2013/14 prices)
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•
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Since 2011/12 central revenue support for councils has
reduced by c10% each year (c39% by end of 2014/15).
This is equivalent to a reduction in spending power of
c4-5%.
Impact varies locally – some councils have seen
spending power reduce by c7% each year.
Many councils have still given relative protection to ASC
compared to some other services.
Overall councils have reduced spending on ASC by
c8.5% in real terms over three years to end 2013/14,
consistent with 3% national efficiency assumption.
User numbers have also reduced significantly over the
SR period, particularly for +65s:
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–
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19% fewer over-65s receiving community care
2% fewer over-65s receiving residential/nursing care
Reported outcomes and satisfaction have remained
stable, but data limited to people receiving care.
Overall councils have done very well in delivering savings whilst maintaining outcomes and
satisfaction levels. However, picture varies locally and councils have relied on significant support from
the NHS.
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The Care Act: reforming care and support
The care and support provider market (1)
Residential Care
Number of non-local authority residential providers, UK
16,000
The number of
providers operating in
the residential care
market has remained
relatively stable over
time.
14,000
12,000
9,011
10,000
7,548
8,000
6,000
7,340
7,224
7,101
6,948
6,882
6,781
8,860
Residential
Nursing
4,000
2,000
5,742
4,720
4,721
4,725
4,815
4,863
4,951
5,089
2000
2006
2007
2008
2009
2010
2011
2012
2,349
0
1987
Top 10 providers by market share, UK September 2012
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Organisation
Four Seasons Health
Care Ltd.
Bupa Care Homes
HC-One Ltd
Barchester
Healthcare Ltd
Care UK
Rank
Homes
Beds
Group Market
Share* %
Cumulative %
1
452
23,566
6.20%
6.20%
2
3
298
241
21,486
12,962
5.60%
3.40%
11.80%
15.20%
4
189
12,165
3.20%
18.40%
5
90
5,618
1.50%
19.90%
Orchard Care Homes
European Care
Group
Minster Care Group
6
76
3,966
1.00%
20.90%
7
71
3,666
1.00%
21.90%
8
74
3,623
1.00%
22.80%
Runwood Homes Ltd
9
48
3,246
0.90%
23.70%
The Care Act: reforming care and support
The total market value was
estimated to be £15.2 billion.
The market remains very plural.
Most providers are small and
only have 2/3 care homes, with
the 10 largest providers
retaining 24 % of total market
share.
The care and support provider market (2)
Home Care
Approximately 8,600 home care providers are operating in the UK.
The total value of the homecare market was estimated to be £6.3 billion in 2011/12, with the
10 largest providers retaining 17.3% of total market share
Major providers of independent sector supplied home care , UK 2011-12
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Home care providers by turnover
Estimated Annual Turnover (£ million)
Market share
Saga Group (Allied Healthcare + Nestor)
300
4.8%
Carewatch
139
2.2%
Mears Group plc
112
1.8%
Care UK Ltd
111
1.8%
City & County Healthcare
107
1.7%
Housing 21
95
1.5%
Enara Group Ltd
93
1.5%
Lifeways Community Care Ltd
68
1.1%
Sevacare UK Ltd
57
0.9%
Marie Curie (specialist home nursing)
37
0.6%
TOP TEN
1,082
17.3%
Remainder
5,167
82.7%
Estimated total market size 2011
6,249
100%
The Care Act: reforming care and support
The care and support workforce
The adult care and support market supports a workforce of 1.5m people – more than for the NHS. The
vast majority are in the private sector, and many are low-paid.
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The Care Act: reforming care and support
Care and Support Reform
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Caring for our Future
The care and support White Paper was published in
July 2012 and set out the Government’s vision for the
future system.
If adult care and support in England is going to respond
to challenges it must help people to stay well and
independent:
• Promote people’s wellbeing
• Enable people to prevent and postpone the need
for care and support
• Put people in control of their lives so they can
pursue opportunities to realise their potential
The Care Act 2014 underpins and implements this
vision.
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The Care Act: reforming care and support
The future care and support system (1)
Our reforms to care and support are intended to achieve four key shifts in the way the system works
for people and they experience it:
From
To
“Paternal”
“Personal”
The State makes decisions on care and the
services people receive.
Support is built around the needs and outcomes of
the person, to fit with their life.
“Repair”
“Prevention”
Focusing only on response after a crisis, when
needs are greater and options fewer.
Acting earlier to prevent or reduce needs, to help
people stay well for longer.
“Fragmentation”
“Integration”
Isolated services focused internally, with little
consistency and people lost between the gaps of
organisations.
Joined-up services working as partners across local
communities, and benefitting the whole
population.
“Exclusive”
“Inclusive”
The focus is on services and institutions, and
people are passive recipients of care.
Working with people and communities to develop
shared solutions.
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The Care Act: reforming care and support
The future care and support system (2)
To achieve these key shifts, the reform programme is built around these principles:
The future system will focus on people by:
• ensuring that promoting people’s well-being will be at the heart of every decision.
• putting carers on the same footing as those they care for.
• creating a new focus on preventing and delaying needs, rather than only intervening at crisis
point, and building on the strengths of the local community.
• embedding rights to choice, personalised care plans and personal budgets, and ensuring a range
of high quality services are available locally.
The future system will make care and support clearer and fairer by:
• extending the financial support provided to people who need it most
• protecting everyone from catastrophic care costs, by introducing a cap on the care costs that
they will incur in their lifetime.
• ensuring that people are not forced to sell their homes in their lifetime to pay for residential
care.
• providing for a national minimum threshold for eligibility to care and support.
• supporting people with information and advice to understand their rights and responsibilities,
access care when they need it, and plan for their future needs.
• giving new guarantees to ensure continuity of care when people move between areas, or when
they reach adulthood.
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The Care Act: reforming care and support
Care and support journey in the new system
People who have eligible
needs but who choose to
arrange their own care
and support will receive
information and advice on
meeting their needs and
preventing future needs,
and (from April 2016) an
independent personal
budget.
Staying independent –
preventing and planning
for care and support
People should be supported to live
independently for as long as they
wish, with a focus on delaying and
reducing needs, and building different
types of support in the community.
Local authorities will make available
universal support, including
information, advice and preventive
services.
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Assessing
needs
Any adult with any needs
for care and support,
including carers, has a
right to an assessment of
their needs and the
outcomes they want to
achieve.
The Care Act: reforming care and support
National minimum eligibility threshold
People who do not have eligible needs will receive
information and advice on how to access support
locally, and how to prevent or reduce their needs.
Paying for
care
If the local authority
charges for a type of
support, an adult will
have a financial
assessment to
determine what
financial support they
may receive.
Meeting
eligible
needs
The local authority will
involve the adult in a care
and support plan to decide
how to meet their eligible
needs. The local authority
may also meet other needs
that are not eligible.
Online services for information and advice
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Online information is recommended as
the primary way for the public and
information providers to access
information about care and support
Critical to meeting many of the duties
under the Care Act. Aim is to ensure
that citizens remain independent for
longer
Require an information and advice
strategy ensure that accessible,
accurate and good quality, to support
choice for citizens across a variety of
channels and with and through a
variety of partners
Benefits include early prevention,
asset based approach and more
informed decision making with overall
lower cost and better choice of care
The Care Act: reforming care and support
Example of practice
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Birmingham City Council working in partnership
with Turning Point to understand better how to
connect people and services in a timely and
effective way.
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Aim of the service is to improve the health and
wellbeing of the population by improving access
to the existing care and support services in the
area and enabling citizens to use community
tools to help them access services.
•
Cornerstone of this service is to empower
citizens to self direct their care by supporting
and enabling the use of the My Care In
Birmingham website to identify needs and
locate services to support those needs.
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Targeted at all adults in these client groups and
their carers, with a particular focus on people
not currently engaged with any services
Market shaping and commissioning
Duty on local authorities to promote a
sustainable, diverse and vibrant market
for care and support that delivers high
quality services for all local people.
– Focusing on outcomes and promoting
wellbeing
– Promoting choice to drive quality
– Supporting sustainability
– Working with partners and people
who use care/carers
– Approaches to market intelligence
and facilitation
– Importance of workforce
development and pay
– Securing quality and outcomes
through contracting
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The Care Act: reforming care and support
Effective commissioning driving better outcomes
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Central role in driving up quality,
enabling people to direct own care,
facilitate integrated service delivery &
make most effective use of available
resources
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Best delivered in collaboration with
others such as NHS & housing partners
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Commissioning for prevention of those
with care and support needs and the
wellbeing of all
•
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For many will require changes to
commissioning and procurement
practice
The Care Act: reforming care and support
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Wiltshire ‘Help to Live at Home’ service replaced
traditional community care services for older
people with an integrated system of care and
support.
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Assessments are person centred and focus on
outcomes that leave customers better able to live
well with less care.
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Results are outcomes that improve or preserve
independence. Financial penalties applied when
customers’ outcomes are not achieved and
rewards care providers when customers recover
faster than planned
Investing in carer’s support
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Carers within the local community are
partners in care. They make significant
contribution to maintain the health and
wellbeing of the person they care for
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The Care Act gives LAs a responsibility
to assess a carer’s needs for support
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The LA will assess whether the carer has
needs and what they may be. It will
consider the impact of caring
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It will also consider the things that a carer
wants to achieve in their own day-to-day
life. The person with care needs does
not to have eligible needs themselves
•
If both the carer and the person they care
for agree, a combined assessment of
both their needs can be undertaken.
Integrated assessments can also be
undertaken
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The Care Act: reforming care and support
Based on a sample from one Council of which there were 24
with identified carer’s (63%) meeting an element of the care
needs across substantial and critical. Of those, there were 18
where the identified carer was allocated a budget for carer’s
services
Focusing on preventing or delaying needs and
maintaining independence
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Assessment and eligibility framework Example of practice
key element of any prevention
• Calderdale Council and the NHS have
strategies authorities put in place
developed a new integrated front-end
First contact with the authority,
service called Gateway to Care. First
triggers the requirement to assess
point of contact between customers
and adult social care to help the
May identify needs that could be
reduced, or delayed by providing
customer find a solution to their
specific preventive services, or
presenting problem, focusing on
information and advice on other
prevention, early intervention and
universal services available locally
safeguarding. The service can divert
Could lead to a pause in the
people away from formal care to a
assessment process to allow such
community-based solution or offer a
interventions to take place and for any
direct ’preventative’ intervention which
benefit to the adult to be determined
is usually in the form of short-term help
to build independence and resilience.
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The Care Act: reforming care and support
Appropriate and proportionate assessments
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From their very first contact with the
local authority, an adult with an
appearance of need for care and
support or a carer should be given as
much information as possible about
the assessment process
Getting the initial response right can
save time and costs later.
Some local authorities have found that
putting in place a single access point
for all new requests and people
currently receiving care can speed up
and simplify the process for people
approaching the authority; and can
also free up time for professional staff
to focus on more complex cases.
May decide to use an assessment tool
to help collect information about the
adult or carer.
The Care Act: reforming care and support
Example of practice
•
Social care contact centre in South
Tyneside diverts 75 per cent of social
care enquiries to solutions developed
by the voluntary sector or in the local
community. Developed a screening
tool for the contact centre which
assists staff to make their assessments
in a consistent and constructive way.
Council ensures that every person has
a follow-up contact six weeks after the
initial contact to check on the outcome
of the intervention.
What the Care Act means for
Mental Health
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s117 After Care and the Care Act
• Under the Care Act every mental health patient and
carer has a right to a needs assessment and a care
and support or support plan (though qualifying patients
may then get services under section 117)
• There is nothing in the Care Act that excludes mentally
ill people from any of its provisions which is good news
for those who have not been detained under a section
that qualifies them for section 117
• No one has to accept section 117 services, a few
people who qualify see them as discriminatory and may
prefer to opt for services provided under the Care Act
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The Care Act: reforming care and support
How the MHA, MCA and Care Act fit together
All Acts want to:
• Enable people to have a say in their own care
• Support people with information, advice and advocacy
to understand their rights and responsibilities
• Ensure that people’s well-being, and the outcomes
which matter to them, will be at the heart of every
decision that is made
• A person is not to be treated as unable to make a
decision unless all practicable steps to help them to do
so have been taken without success.
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The Care Act: reforming care and support
What the Care Act 2014 means for social
workers and AMHPs
• Shift away from top-down model of care to focus on
wellbeing, prevention and early intervention
• Role of social workers in specialist mental health
services needs to go beyond statutory role
• Integrated mental health services and other employers
must recognise and support social work’s wider role
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The Care Act: reforming care and support
Implementing the reforms
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Approach to implementation
• The reforms will involve significant changes to how local authorities
operate currently, and our approach is therefore based on the principle
of co-production with local government, and those who use care and
support.
• Wide-ranging engagement with local government and other key
stakeholders to shape and guide reforms. We have established or
adapted a series of working groups to co-develop regulations and
guidance, and support implementation in each of the work-streams of
the overall programme.
• DH, LGA and ADASS has established a joint programme management
office to support implementation and understand LA readiness and risks
to delivery. Now added provider sector support to the office.
• Range of implementation support tools being co-produced covering
practice guidance, IT, workforce training, commissioning standards, and
financial modelling.
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The Care Act: reforming care and support
Questions and comments?
Views and enquiries
[email protected]
Further information
http://www.local.gov.uk/care-support-reform
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The Care Act: reforming care and support