the white paper - caring for our future: reforming care and support draft care and support bill...
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The White Paper - Caring for our future: reforming care and support
Draft Care and Support Bill
Progress report on funding reform
The reform timeframe
Social Care Vision
_______Nov 2010
Law Commission
Report__________
May 2011
Dilnot Commission
Report___________
July 2011
Caring for our future -
engagement_________Sept - Dec
2011
• Care and Support White Paper• Progress report on funding• Draft Care and Support Bill
__________July 2012
Engagement and pre-
legislative scrutiny on
draft Bill
Legislation
Engagement on funding
reform
Spending Review
• Many people need some extra care and support during their adult years to lead an active and independent life. Three-quarters of people aged 65 will need care and support in their later years…
• And even if we don’t need care ourselves, we will all know someone – a family member or friend – who needs care and support. 5 million people in England currently care for a friend or relative.
Care and support affects everyone
3
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
19 per cent of men and 34 per cent of women will need residential care
Who needs care?At age 65, what are your chances of needing different types of care within your lifetime?
Source: Personal Social Services Research Unit
Caring for our future – getting reform right
During the Caring for our future engagement in autumn 2011, we listened to the views of people who use or who work in care and support across England.
Co-led by the Government and the care and support sector, the engagement brought together the recommendations from the Law Commission and the Commission on Funding of Care and Support, alongside other key areas for change.
Over 300 engagementevents took
place
More than 640separate responses
were submitted
Over 14,400 people visited our website
Over the period of the engagement:
During the Caring for our future engagement, people told us that care and support had the potential to transform people’s lives – but that there were many problems that need to be addressed.
They said:
•Too often the system only reacts to a crisis
•Society is not making the most of the skills and talents in communities
•People do not have access to good information and advice
•Access to care varies across the country and is confusing
•Carers have no clear entitlements to support
•Not all care is good. The quality of care is variable and inconsistent
•People often feel ‘bounced around’ and have to fight the system to have the joined-up care and support they need
•Our growing and ageing population is only going to increase the pressures on the current system.
What people told us
We will change care and support in two fundamental ways:
The Care and Support White Paper – our vision
1. The focus of care and support will be to promote people’s independence, connections and wellbeing by enabling them to prevent and postpone the need for
care and support.
2. We will transform people’s experience of care and support, putting them in control and ensuring that services respond to what they want.
Shifting the focus – from crisis to wellbeing
Need for intensive care and support
Living well
Low-level needs
Crisis
Need for intensive care and support
Living well
Low-level needs
Crisis
People will be given better information and advice to plan ahead to prevent care needs, and will be better connected to those around them.
More support within communities, better housing options and improved support for carers will help people maintain their independence and avoid a crisis.
Re-ablement services and crisis response will help people regain their independence at home after a crisis.
The current system does not offer enough support until people reach a crisis point
The new system will promote wellbeing and independence at all stages to reduce risk of people reaching a crisis point, and so improve their lives
Choice, control and quality
People can choose between a range of high quality options, or create their own
People develop their own care and support plan
People have clear information to make good choices about care
People are in control of their own budget
People’s views are heard and help improve services
In the new, person-centred system...
i
?
Not enough people have control of their care and support plan or budget
People do not have access to good, clear information about other options
People do not have enough choice about services
In the current system…
To help people stay active, independent and connected in their communities we will:
•Stimulate the development of schemes that help people share their time, talents and skills with others in their community.
•Develop, in a number of trailblazer areas, new ways of investing in services that help people to stay independent for longer, such as Social Impact Bonds
•Establish a new care and support housing fund, worth £200 million over 5 years to support the development of specialised housing for older and disabled people
•Involve communities in decisions around health and care services, through local Healthwatch and health and wellbeing boards.
• Support national care provider organisations to develop ‘open care homes’ that build links with their local community
1. “I am supported to maintain my independence for as long as possible”
To help people understand and be confident about their options, we will :
•Establish a new national information website across health, care and support
•Support local authorities to develop better online information and advice services
•Introduce a national minimum eligibility threshold for care and support
•Make it easier for people to move across the country, by ensuring that no-one’s care and support is interrupted
•Extend the right to an assessment to all carers, and introduce a clear entitlement to support to meet their eligible needs.
2. “I understand how care and support works, and what my entitlements and responsibilities are”
To ensure that people are confident that their care and support will be of a high standard, we will :
•Give people access to clear and comparative information about the quality of care providers and the options they offer
•Legislate to ensure that local authorities, the NHS and the police work together at a local level to prevent abuse
•Rule out crude ‘contracting by the minute’ that can undermine dignity and choice for those who use care and support
•Consult on further steps to ensure service continuity for people using care and support should a provider goes out of business
3. “I am happy with the quality of my care and support”
To ensure that people are confident that the care workforce will be sensitive and compassionate to their needs, we will :
•Place dignity and respect at the heart of new recommended minimum training standards and a code of conduct for those working in care.
•Offer personal assistants (PAs), and their employers, greater support and training to improve recruitment, retention and the quality of the care and support they deliver.
•Train more care workers to deliver high quality care, including an ambition to double the number of care apprenticeships to 100,000 by 2017.
•Appoint a Chief Social Worker by the end of 2012 to provide a leadership role for the social work profession.
4. “I know that the person giving me care and support will treat me with dignity and respect”
To ensure that care and support focuses on meeting people’s individual needs and helping them to achieve their aspirations we will:
•Legislate to give people an entitlement to a personal budget as part of their care and support plan, and strengthen our ambitions on direct payments
•Increase the availability of independent advice and support to help people with eligible needs to plan and make choices about their care and support
•Develop, in a small number of areas, the introduction of direct payments for people who have chosen to live in residential care, in order to test the costs and benefits
•Invest a further £100 million in 2013/14 and £200 million in 2014/15 through joint funding between the NHS and social care to support better integrated health and care services
5. “I am in control of my care and support”
People need care and support for many different reasons and at different times in their lives. This White Paper is for all adults in England, of every age, gender, ethnicity, religion and sexuality.
The reformed system needs take account of the views and needs of:
•People from all backgrounds, and with all types of care and support need
•Equalities groups
•Families, including carers
•Care workers, and other people working in care and support
Who the White Paper is for
The Progress Report on funding reform
• The Progress Report sets out that the Government agrees that the principles of the Dilnot Commission recommendations – financial protection through capped costs and an extended means-test – would be the right basis for any new funding model.
• Whilst our intention is to base a new funding model on the recommendations if a way to pay for this can be found, we are not in a position to make a commitment now.
• A final view will be taken at the next Spending Review.
• We will engage with stakeholders on design issues in the interim. These include:
othe level of a cap;
othe level of the means test threshold;
oexploring voluntary, as well as universal, options.
15
The Progress Report on funding reform
The Government is committing to introducing many of the Commission’s other recommendations:
•We have already allocated an additional £7.2 billion to adult care and support over this Spending Review period.
•We are committing to introduce Universal Deferred Payments from April 2015 – a loan to cover the costs of residential care. This will ensure no one will be forced to sell their home in their lifetime to pay for care.
•We are introducing a national minimum eligibility threshold from April 2015.
•We will improve information and advice about the care and support system, and set up an expert working group – involving local authorities and the financial services industry – to support further developments.
16
Next Steps
White Paper Implementation
• The next stage will continue to rely on collaboration and leadership at all levels to deliver this ambitious programme of reform.
• We will launch a new Care and Support Transformation Group, which will act as an important forum for challenge and peer support.
• We will also create a Care and Support Implementation Board, to take ownership of the implementation plan and assurance on delivery of specific milestones.
Progress report on funding reform
• We will engage with stakeholders on the design issues for a capped cost system. A final decision will be taken at the Spending Review.
• We will introduce universal deferred payments in 2015.
Draft Care and Support Bill
The draft Care and Support Bill:Why reform is needed
19
The current law for adult social care:
• Is incoherent – the law has been added to piece by piece, without any attempt to reform or consolidate. There are no common objectives.
• Is complex and difficult to navigate – there are around 30 related Acts of Parliament. It is almost impossible for people who need care, carers and even those who manage the system to understand.
• Is outdated – the base statute is still the 1948 National Assistance Act, written for a time when the assumption was that institutional care was best.
• Is disempowering – most of the law focuses on disabilities rather than needs or outcomes, and services over which the person has little control.
• Is inconsistent and unfair – the law is full of anomalies, where people are treated differently without any clear reason.
The draft Care and Support Bill
20
This the most fundamental reform of social care law in over 60 years.
• We will create a single, modern legal framework for adult care and support.
• The new statute will be clearer, fairer, and built around the needs and goals of the people. The well-being principle and focus on individuals’ needs and outcomes creates a defining purpose for care and support.
• It will empower people to take control over their care and support and to understand their entitlements.
• It will provide clarity on the role of local authorities and support best practice through new regulations and guidance – reducing the time spent navigating the law.
• For the first time, the law will put carers on the same footing as the people they care for.
Key provisions
21
A new statutory principle which embeds individual well-being as the driving force underpinning the provision of care and support.
Population-level duties on local authorities to provide information and advice, prevention services, and shape the market for care and support services. These are supported by duties to promote cooperation and integration to improve the way public authorities work together.
Following the individual journey through the care and support system, clarifying rights and entitlements. Including putting eligibility framework in law (13), and new rights: to request local authority support (17), for carers to have needs met (19), and to plans and personal budgets (23).
New provisions on portability, to ensure care needs are met when a person moves areas.
The first statutory framework for adult safeguarding, setting out the key responsibilities of local authorities and their partners, and creating Safeguarding Adults Boards in every area.
New provisions to support better transition from children’s services for young people, young carers and parent carers, including protections to ensure no gap in services over transition (43).
Other legislative issues, including powers to recover debts (45-46), re-enacting delayed discharges provisions (47), and a new power for LAs to delegate functions a third party (51).
Clause No.
1
2-7
9-30
31-33
34-38
39-44
45-53
The draft Care and Support Bill:Consultation and pre-legislative scrutiny
We have published the draft Bill for consultation and pre-legislative scrutiny:
• Public consultation runs until 19 October for written responses – but engagement will be ongoing after that.
• We want to work with you to build on the Caring for our future engagement, and ensure stakeholder leadership through the consultation and beyond.
• Pre-legislative scrutiny will start in the autumn. This is the process where a Committee of MPs and/or Peers discuss the draft Bill and make recommendations for its improvement prior to formal introduction.
– The Committee are likely to ask for written submissions from interested parties in the autumn.– There will be public evidence sessions which stakeholders will be invited to over the autumn/winter.– The Committee publishes a report at the end of the scrutiny period, in early 2013.
Well-being principle
Needs assessmentCarer’s assessment
Determination of ‘eligible’ needs
Financial assessment
Adult refuses assessment and does not lack capacity and is not at risk of
abuse or neglect
Record of assessment and information/advice on meeting/preventing needs
Does the person have ‘eligible’ needs’?
Might the person’s needs be met by a type of care and support which is not charged for?
Does person have financial resources at/below the financial limit?
Does the person meet the ordinary residence requirement?
Duty to meet eligible needs:Entitlement to care and support
Has the person requested that the LA meet their eligible needs?
Personal budget
Care and support plan
Appearance of needs for care and support
Direct payment
Review
How will the person’s needs to be met?
Any changes to needs or
circumstances?
Provision of care and support
Are needs being met over time?
Gen
eral
resp
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rom
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and
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YES NO
YES NO
YES NO
YES NO
YES NO
Will the local authority use its power to meet the person’s needs?
YES NO
Clauses 1-7:General responsibilities
Set out the general responsibilities of local authorities towards all people:
• The well-being principle underpins the entire legal framework. It sets a defining purpose for care and support, and influences the way all functions are carried out in relation to individuals.
• Universal obligations towards all local people: – information and advice to help people understand care and support system, access
services and plan for the future– services or other steps to prevent, reduce or delay needs for care and support– promoting the market of providers so that there are high quality services to meet people’s
choices
• Requirement to work collaboratively and cooperate with other public authorities, including duty to promote integration with NHS and other services.
Clauses 8-16:Assessments
Start the person’s journey through the care and support system:
• Describe how needs can be met, to give an illustration for the clauses which follow.
• Single duties for assessment of people who may use services and carers. Focus of assessment on needs and outcomes – not other factors.
• Placing the eligibility framework in law for the first time, to be clear what needs are “eligible” for State support.
• Clarifying powers for charging for certain types of care and support, and local authority duties in relation to financial assessments – so that is carried out transparently and consistently.
• Updated powers to offer deferred payment agreements, where the person does not pay charges upfront – the Progress Report on Funding committed to this offer for all people in care homes.
Clauses 17-22:Core entitlements
Clarify who is entitled to have their care and support needs met by the local authority:
• Sets out the core entitlement for people who use services – based on eligible needs, ordinary residence, and where relevant the outcome of the financial assessment.
• Includes a new right to request the local authority’s support for self-funders with eligible needs.
• The first right to support for carers – on the equivalent basis to the people they care for, and with clarity around how meeting those needs may include care directly for the person cared for.
• Broad powers for the local authority to meet needs in all other circumstances.
• Exceptions and prohibitions where the local authority may not meet needs – forming the boundary with the NHS (e.g. for Continuing Healthcare), housing and other public services.
Clauses 22-30:Care and support planning
Describe what must happen after assessments to decide how needs should be met:
• Entitlement to a care and support plan, and requirement that local authority must help person decide how to meet their needs.
• Duties to provide outcome of assessment and information and advice on meeting and preventing needs to people who are not otherwise entitled to support.
• Right to a personal budget as part of the care and support plan.
• Entitlement to a choice of accommodation when someone is placed in a care home, with clear rules on ability to make top-up payments for more expensive locations.
• Right to request a direct payment to meet some or all of needs in the care and support plan – including rules for people lacking mental capacity, and payments to another individual.
Clauses 31-33:Portability
Enabling movement of people between areas without the fear of losing care:
• New duty to ensure continuity of care when moving between areas.– Sending local authority must share the care and support plan and other information
relating to the person and their carer.– Receiving local authority must provide information before the move, assess the person’s
needs, and then arrange to meet their needs on the day of arrival based on the previous care and support plan.
• Clarifying ordinary residence for people placed in accommodation in another area, so that people cannot be left between areas with responsibility uncertain.
• Updating powers for the Secretary of State to resolve disputes between local authorities.
Clauses 34-38:Safeguarding
The first statutory framework for protecting adults from abuse and neglect:
• New duty for local authority to carry out enquiries where it suspects an adult is at risk of abuse or neglect.
• Requirement for all areas to establish a Safeguarding Adults Board to bring together LA, NHS and police to coordinate activity to protect adults from abuse and neglect.
• SABs to carry out safeguarding adults reviews into cases where someone dies or there is concern about how authorities acted, to ensure lessons are learned.
• Removes the existing power for local authorities to remove people from their homes – but see the separate consultation on whether a new power is needed to ensure local authorities are able to protect people effectively.
Clauses 39-44:Transition from children’s services
New provisions to support better transition to adult care and support at the age of 18:
• New powers for local authorities to assess young people and young carers under the adult statute in advance of their 18th birthday, to prepare for transition.
• A new duty to assess the adult carers of children, to identify any support needs that could be met by adult services, and prepare for transition of the child.
• A power to provide support to meet the needs of carers of children – so that support can be provided from adults’ services in addition to that received by the family through children’s services.
• A new duty to ensure continuity of care around transition – so that if a young person is receiving a children’s service on their 18th birthday, but adult care and support is not ready to meet their needs, they must continue to receive the children’s service.
Clauses 45-53:Other provisions
A series of other provisions to complete the legal framework:
• Restating existing powers for local authorities to recover debts – for instance where someone has failed to pay any charges due for their care and support.
• Re-enacting the provisions which focus the local authority and NHS on hospital discharges and reducing delays.
• A few small amendments to the provisions for people receiving after-care for certain mental disorders under the Mental Health Act.
• A requirement for local authorities to hold registers of blind and partially sighted people.
• A power to issue statutory guidance to help local authorities carry out their functions in the new statute.
• A new power for local authorities to delegate some of their functions to a third party – although they would still be legally responsible for ensuring duties are fulfilled.
Key milestones
Now - April 2013Now - April 2013 Publication of White Paper & draft Bill (July 2012)
Consultation on draft Bill (to mid October 2012)
Pre-legislative scrutiny (autumn-early 2013)
Government response to PLS (Feb-March 2013)
Consultation on safeguarding intervention powers (July-October 2012)
Consultation on market oversight; and launch of support scheme for market shaping (Autumn 2012)
April 2013 onApril 2013 on Care and Support Bill introduced to Parliament (from May 2013)
Consult on draft regulations and statutory guidance (over 13/14 and 14/15)
Implementation of new legislation (April 2015 onwards)
Next steps:Commenting on the draft Bill
For more information and to get involved in the consultation:
• Use the online portal to see and comment on each clause individually: http://careandsupportbill.dh.gov.uk
• See more information, factsheets and opportunities for discussion on the Caring for our Future website: http://caringforourfuture.dh.gov.uk
• Email us at [email protected] by 19 October.
• Follow us on Twitter: @caresupportbill
• Please help us arrange meetings with your networks and stakeholders to discuss the draft Bill more widely.
A voluntary sector view of the White Paper
Caroline HawkingsSenior Public Policy Advisor
Key questions
Does the White Paper set out the framework for a high quality social care system which:
•works for the most vulnerable people?
•will continue to be relevant for future generations of disabled and other people?
Context of White Paper
Harsh realities for disabled people•Cuts to council-funded social care •Councils are reducing budgets for adult social care by £891m. (=30% of council planned reductions) •80% of councils substantial threshold in 12/13 compared to 78% in 11/12. (Adass Budget Survey 2012). •Less income due to changes from DLA to Personal Independence Payments & Universal Credit. •Employment – only 50% of disabled people in work compared to 80% of non-disabled people
Positive progress
• Ethos - promoting well-being & independence & asset-based approach
• National eligibility threshold• Carers – clearer entitlement on the same basis as
service users• Housing £200m capital fund• Expansion of direct payments• Portability of assessments
Roles of Voluntary Sector organisations
• Harnessing the skills resources & networks of local communities
• Expansion of volunteering & time-banking
• Models of working eg. direct payments in residential care & Social Impact Bonds
• Evidence, Evidence, Evidence
Advocacy – the missing link?
• Better informed consumers critical to White Paper’s vision
• ‘Information and advice alone is useless without the support to understand and take action on it.’
Voiceability
• Advocacy is key to: information, support plans, personal budgets, Healthwatch
• Danger of over-reliance on the web• Need for advice independent of relatives/PAs• Include advocacy specifically in draft Bill• Test approaches
Questions on Quality
• New Provider Quality Profiles – cost issues, how to validate & interpret data?
• Ratings or no ratings?
• Aspirational NICE Quality Standards relation to CQC mandatory requirements?
• Confused consumers? CQC, Skills for Care, SCIE, NICE, TLAP, Healthwatch
Workforce
‘Good care is about people and personal relationships, not organisations and processes. Good care and support services are underpinned by an ongoing
human connection between staff, people with care and support needs, and their families.’
Bringing Clarity to Quality in Care & Support
What’s missing?
Workforce tensions
• Ambition for a caring, skilled & valued workforce, but
• High turnover of staff & low rates of pay
• Recommended training standards & voluntary Compact & Skills Pledge
• High expectations of social workers
• Need for a coherent strategy
Concluding thoughts
• Good, but could do better• Need strategic leadership from central Government
eg. on quality • Necessity for advocacy• Practical & financial support for social care workforce
• Wait and see…
Contacts
www.scope.org.uk
www.vodg.org.uk
Connected and Confident CommunitiesSeptember 2012
Social Action for health and well-being: building co-operative communities
(October 2011)
“Our vision is of a society in which social action and reciprocity are the norm and where volunteering is encouraged, promoted and supported because it has the power to enhance quality, reduce inequality or improve outcomes in health, public health and social care.”
Caring for our future: reforming care and support
(July 2012)
“Help people stay active, connected and independent …”
“Active communities will reach out to those around them ..”
“Stimulate the development of time banks, time credits and other approaches that help people share their time, talents and skills with others in their community…”
“I am supported …”
• … transformed to focus on people’s skills and talents, helping them to develop and maintain connections to friends and family
• Communities will be encouraged and supported to reach
out to those at risk of isolation: – involve communities in decisions around health and care
services, through local Healthwatch and health and wellbeing boards;
– stimulate the development of time banks, time credits and other approaches that help people share their time, talents and skills with others in their community;
“… to maintain …”• local area coordination, connected care or asset-based community
development • approaches that promote support within communities are strengthened
and developed across the country• The voluntary and community sector is uniquely placed to reach socially
isolated people and connect them to befriending services and other networks of friendship and support.– local health and care commissioners to identify how the skills and
networks in a community can make an important contribution to the health and wellbeing of local people and build this into their JSNAs and JHWSs.
– Commissioners will also need to consider how they can further support and nurture these community networks and increase people’s awareness and understanding of how they can improve their own health and wellbeing.
– The Think Local, Act Personal partnership, supported by Public Health England, will establish a collaborative network to support and spread the adoption of community-based approaches.
“… my independence …”
• We expect local authorities (including parish councils), together with their local communities, to maximise the potential for spaces and buildings in a community to act as meeting places or centres for activity. Leisure centres, libraries, day centres and community centres should be open, inclusive and culturally sensitive venues. Promoting the innovative use of venues in our communities will help to reduce social isolation and increase connections.
“… as long as possible”• We will support the growth and development of time banking,
time credit and other approaches that help people to give their time and skills.
• The lessons from Project Carebank, being piloted in Windsor and Maidenhead and other projects will be shared nationally so that similar models can be adapted by local communities up and down the country.
• Working with CSV and other partners across our communities to lead a ‘call to care’. This will bring together the available evidence, and examples of innovative leadership and expertise, to build a strong and credible case for communities and commissioners to roll out timesharing approaches that will improve the health, care and wellbeing of our communities.
The role of social care in promoting equality and eliminating inequalities
Jabeer Butt
Race Equality Foundation
www.raceequalityfoundation.org.uk
Introduction
• Since 1978, significant improvement in the quality of social care experienced by some communities that experience discrimination and inequality
• However evidence suggests the persistence of inequality and discrimination, and as consequence poor social care experience and outcomes
• Therefore crucial to ensure social care reform agenda promotes equality
Promoting equality and eliminating inequality: exploring the evidence for black and minority ethnic older people
Promoting equality and eliminating inequality: exploring the evidence for black and minority ethnic older people
Promoting equality and eliminating inequality: exploring the evidence for black and minority ethnic older people
Promoting equality and eliminating inequality: exploring the evidence for black and minority ethnic older people
Promoting equality and eliminating inequality: exploring the evidence for black and minority ethnic older people
Conclusion
• If social care reform is to be effective it needs to reduce or ameliorate the risk factors
• At the same time for social care to be effective it needs to enhance or build on the protective factors