Transcript CARE ACT 2014 - Warrington Voluntary Action

Introducing the Care Act 2014
Steve Peddie, Operational Director, Social Care,
Introducing the Care Act
Objectives
• To introduce the key elements of the Care Act and describe
the national and regional context
• To identify how implementation is being undertaken in
Warrington, outline work-stream, activity and explore
progress to date
• To understand the workforce impact and implications
• To help Elected Members to navigate the post-Care Act world
and appreciate risks and opportunities
Care Act 2014
•
Designed to combine the current laws
related to adult social care into one
Act.
•
Create a legal framework that is clear
and easy to navigate.
•
Modernise the law not only to meet
eligible need, but to focus on putting
the person in control of their life and to
achieve the outcomes they have
identified are important to them.
•
Address areas of unfairness.
Timescale
• The majority of changes contained within the Act are due to take place
in April 2015 with the reform of the funding arrangements to take
effect in April 2016/2017
• Final regulations and guidance were published
October 2014
The Guiding Principles of the Act
•
That the care and support:
• Is clearer and fairer
• Promotes people’s wellbeing
• Enables people to prevent and delay the need
for care and support, and carers to maintain their
caring role
• Puts people in control of their lives so they can
pursue opportunities to realise their potential
• Dignity in care
• Continuity of care
Key Areas of Change
Eligibility
• A national eligibility criteria has been
introduced
• Carers will have equity with the cared for in
respect of assessment and support
• A new duty to undertake assessments on
people serving a custodial sentence
• A new duty to work in partnership with
Children’s Services when the presence of a
young carer has been identified
Eligibility
The national eligibility criteria set a minimum threshold for adult care and
support needs & carer support needs which we must meet.
The threshold is based on identifying how a person’s needs affect their ability
to achieve outcomes, and how this impacts on their wellbeing.
We must consider whether:
• The adult’s needs arise from or are related to a physical or mental
impairment or illness
• As a result of the adult’s needs the adult is unable to achieve two or more
of the specified outcomes (which are described in the guidance below)
• As a result of their caring role a carer is unable to achieve one of the
outcomes below
• As a consequence of being unable to achieve these outcomes there is, or
there is likely to be, a significant impact on the adult’s or carers wellbeing
When assessing that an adult or carer is unable to achieve the outcomes set out in the
regulations we must consider if they can be achieved:
• Without assistance this includes prompting
• Is able to achieve outcome but doing so causes the adult significant pain, distress or anxiety
• doing so endangers or is likely to endanger the health or safety of the adult or of others
• Is able to achieve the outcome but takes significantly longer than would normally be
expected
The Outcomes
The Eligibility Regulations sets out a range of outcomes but they are not all exhaustive list:
a) managing and maintaining hygiene
b) maintaining personal hygiene
c)
managing toilet needs
d) being appropriately clothed
e) being safe in the house
f)
developing and maintaining relationships
g) engaging in work, training, volunteering
h) maintaining a home
i)
Making use of community facilities
j)
carrying out caring responsibilities for a child.
Eligibility and Wellbeing
• An adult is therefore eligible when they are unable to achieve 2 or more of
the outcomes above and a carer when they are unable to achieve one and as
a consequence there is a significant impact on their wellbeing.
• Significant impact on one area
• Cumulative impact of several areas
• Wellbeing is defined as:
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Personal dignity
Physical and mental health, emotional wellbeing
Protection from abuse and neglect
Control by the individual over day to day life
Participation in work, education, training, volunteering or recreation
Social and economic wellbeing
Domestic, family and personal relationships
Suitability of living accommodation
The individuals contribution to society
Assessment
•
Anyone eligible for an assessment must be supported to fully
participate in this process and that may include the support of an
independent advocate.
•
A legal duty to provide a care and support plan which has been
produced in partnership with the person, their carer and
advocate which will set out how their needs and outcomes will
be met and achieved. This could include non eligible need, what
the person can access in the community and their own personal
resilience.
•
If a person or carer is not deemed eligible for care and support at
the point of assessment they will need to be informed in detail
and in a format meaningful to them why the decision has been
made and given support and information about other prevention
services – these can be health services or free community
services.
Personal Budgets and Direct Payments
• People with an eligible need will have a legal right to be advised of the
amount of their personal budget. This is the amount of money that
Warrington Council has calculated it will cost to fund the necessary
support and care for that person.
• People will have a legal right to receive their personal budget as a direct
payment.
Safeguarding
• Replaces ‘No Secrets’
• We must make safeguarding personal – a risk managed approach
• The Act puts Safeguarding Adults Boards on a statutory footing. The
SAB must:
– include the local authority, the NHS and the police, who should meet regularly to
discuss and act upon local safeguarding issues
– develop shared plans for safeguarding, working with local people to decide how
best to protect adults in vulnerable situations
– publish a safeguarding plan and report to the public annually on its progress, so
that organisations can ensure sure they are working together in the best way
– arrange a Safeguarding Adults Review in some circumstances – for instance, if an
adult with care and support needs dies as a result of abuse or neglect and there is
concern about how one of the members of the SAB acted
• The local authority will arrange for an independent advocate to
represent and support a person who is the subject of a Safeguarding
Enquiry or a Safeguarding Adult Review
“The emphasis must be on sensible risk appraisal, not
striving to avoid all risk, whatever the price, but instead
seeking a proper balance and being willing to tolerate
manageable or acceptable risks as the price
appropriately to be paid in order to achieve some other
good – in particular to achieve the vital good of the
elderly or vulnerable person’s happiness.
What good is it making someone safer if it merely
makes them miserable?”
Lord Justice Munby
Information and Advice
•
A shared duty to provide an information and advice service
that covers the needs of all the population, not just those
with eligible need.
•
The information and advice services must cover more than
just basic information about care and support. We need to
really promote some of the wonderful, free at the point of
access, grass roots services in the borough.
•
LAs must have regard to identifying people who may
benefit from independent financial advice.
• Produce a market position statement which will give people more choices in respect of
their care and support and will be a clear statement of intent in respect of how we
plan to commission and the standards we expect. It will also be an opportunity to alert
the market to emerging need.
• The service must also explain how the public can raise any safeguarding concerns or
make any complaints.
Advocacy
The Act aims to strengthen the voice of people who use
services, and their carers, over the process of assessing,
planning and safeguarding.
Local authorities will need to commission independent
advocacy services to support people who may require it.
Local authorities must arrange an independent advocate
to facilitate the involvement of a person in their
assessment, in the preparation of their care and support
plan and in the review of their care plan, if two
conditions are met:
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•
the person has substantial difficulty in being fully
involved in these processes
there is no one appropriate available to support and
represent the person’s wishes.
Integration with NHS and other partners
• The Act states that LAs must undertake all their functions and duties
under the Act with a view to integrating care and support provision with
health and housing, but it is equally emphatic about the requirement for
this to be reciprocated.
• It specifies a culture of mutual co-operation must be embedded in joint
working facilitated by formal joint working and governance arrangements
across our shared systems.
• Briefings for all partner agencies will be offered when
the guidance is clearer.
Other New Duties
• LAs must have a system in place to identify unmet need.
• We will have new responsibilities around transition, provider failure
and supporting people who move between areas.
• Funding of care (a lifetime cap) – for next year
What does this mean for Warrington?
• Stocktakes 1, 2 & 3 – Warrington has some strengths (e.g. Carers services)
more to do (e.g. information and advice) and a number of unknowns (e.g.
establishing predicted additional demand). Much like most Council areas
• A Care Act Board leads a number of work streams, as defined by the project
plan
• The funding reforms are complicated and
we need to ensure our residents
understand them. We have a range of
staff with the technical skills to understand
and communicate the legislation into
something meaningful for the public.
• Early signs indicate a larger cohort of people will be eligible for funding
from 2016
• The national eligibility criteria has been published
• We are currently reviewing our current assessment process and looking to
develop with partners a risk stratification process which will help us across
the system understand and articulate need
• Warrington’s performance in respect of carer assessments is very positive.
Mechanisms have also been developed to identify unknown carers
so the pressures in this area may not be
as great as some Councils anticipate.
Finance
Finance
Beyond 2015 and into 2016
• Consultation into phase 2 of the Care Act
implementation (post-Dilnot)
• The Care Cap
• What counts towards the cap?
• Daily living costs (proposed to be £230pw)
• Care accounts
Working age adults
The cap on care costs is based on the idea that people can plan and prepare for the
risk of having care and support needs in later life, if they have some certainty over the
cost they face.
For those born with, or who develop, a care and support need early in life, there is less
opportunity to do so in the same way.
The Commission recommended that there should be a different approach for people
of working age because for this group the risk is ‘uninsurable’.
Their view was that people turning 18 with an eligible care and support need should
have a zero cap for life, and that the level of the cap should be tiered by age groups up
to state pension age.
Though DH is actually proposing to introduce:
– a zero cap (ie no cost) for life for anyone who develops an eligible care and support need
before the age of 25
– a cap of £72,000 for everyone else, and to equalise the amount a working age person is left
with after charges with that of older people.
You can have your say right now on:
http://careact2016.dh.gov.uk
http://careact2016.dh.gov.uk/category/workingage/
Summary - where are we up to in Warrington?
‘Stocktake 3’
• Good engagement
• Good on preparing for
advocacy
• Strong on carers
• Good on preparing to take on
prisons
• Good on safeguarding –
compliant
• Workforce preparations going
well
• Preparations for the systems
(e.g. assessment) going well
• Integration with health
progressing well
• Still unsure of future levels of
demand – e.g. carers and selffunders
• Aware of pressures around the
need to do early assessment of
self-funders before April 2016
• More pace needed on
information and advice
• ICT systems a challenge –
including implementing a ‘care
account’
• More to do to shape the market
Summary Messages
• Safeguarding is about risk-management. The individual
in control
• Resilience message – an ‘asset based’ approach to
assessment
• Ambiguity in messages to the public about being able
to mitigate or ‘cap’ the costs of care
• Financial unknowns:
– Level of increased demand (new demand, unseen demand
from self-funders, FACS disappears – less certainty)
– The burden of people hitting the cap in the future
• Workforce changes – is the profile right for the future?
• Expect further integration with NHS partners