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.

• 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

Timescale

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

EligibilityThe 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 hygieneb) maintaining personal hygienec) managing toilet needsd) being appropriately clothede) being safe in the housef) developing and maintaining relationshipsg) engaging in work, training, volunteeringh) maintaining a homei) Making use of community facilitiesj) 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:

– 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.

• 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.

Personal Budgets and Direct Payments

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.

AdvocacyThe 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:

• 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.

• 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

Other New Duties

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 adultsThe 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/working-age/

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 self-funders

• 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