the care bill: reforming care and support the care act reforming care & support gerald hunt,...

The Care Bill: reforming care and support

The Care Act

Reforming Care & Support

Gerald Hunt, Assistant Director

North Somerset Council

9 July 2014


The Act is built around people, it:

• ensures that people’s well-being, and the outcomes which matter to them, will be at the heart of every decision that is made;

• puts carers on the same footing as those they care for;

• creates a new focus on preventing and delaying needs for care and support, rather than only intervening at crisis point;

• puts personal budgets on a legislative footing for the first time, which people will be able to receive as direct payments if they wish.

What does the Care Act do?


The Act makes care and support clearer and fairer, it:

• reforms the funding system for care and support, by introducing a cap on the care costs that people will incur in their lifetime.

• will ensure that people do not have to sell their homes in their lifetime to pay for residential care, by providing for a new universal deferred payments scheme;

• provides for a single national threshold for eligibility to care and support;

• gives new guarantees to ensure continuity of care when people move between areas, to remove the fear that people will be left without the care they need;

• includes new protections to ensure that no one goes without care if their providers fails, regardless of who pays for their care;

• has new provisions to ensure that young adults are not left without care and support during their transition to the adult care and support system.

What does the Care Act do?

Financial elements of social care reform

• Increase in the upper threshold from £23,250 to £118k with property, £27,000 without property

• Increase in the lower threshold from £14,250 to £17,500

• A lifetime cap on individual contribution of £72k towards care costs

• Individual contribution towards general living expenses of £12,000 per annum

• All the above from April 2016

• Deferred Payment scheme from April 2015

Clarity or Complexity: the £72,000 contribution ‘Cap’

Weekly Cost

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Excess above Local

Authority Rate

£200

Local Authority Rate less

Living Costs

£270

Living Costs

£230 TOTAL £700

Key Self-funded for life

Contribution limit, i.e. Dilnot Cap to £72K

State Funding support

• Assumes £700 per week cost of care

• Assumes £500 per week local authority rate

The tariff effect post Dilnot

Lower level of means test from £14250 to £17,500 post 2017

Upper level of means test today @ £23,250.00

Post 2016 extension of means test threshold to £118k

The tariff at £1 per £250 of assets above the new lower threshold limit starts at circa £400 per week if the tariff remains as it is today.

Funding Reform - Continuing Work Focus - 65 and Over•As the arrangements for Working Age

people have yet to be decided the focus of the modelling work is on those 65 and over.

•To improve the robustness of the results:

•The Surrey Model and the Surrey Model results are first being reviewed by an independent expert at the LSE.

•Then the model and a selection of results will be reviewed by the joint ADASS / DoH / LGA group.

Funding Reform - Continuing Work Focus - 65 and Over• We would still suggest that where possible – even though it is

cumbersome to use - that as many LA’s as possible attempt to make use of the Surrey Model to add to the 20 councils results.

• All the LA’s in the South West are making use of the Surrey Model – where three Councils who have made extensive use of the model are supporting others across the region with more limited resources.

• In the East Midlands a number of councils are using the The Lincolnshire model (a simpler model) – with some also cross referencing the results using the Surrey Model.

• Once we have results from a larger group of councils across England – we can then develop a very simple tool to take these National results to apply at a local level using local data.

• If you are not able to make use of the Surrey Model at this stage then we suggest that you take a look at the Lincolnshire Model. With any model or tool you will need to collect local data.

Care Reform DoH Impact Assessment

9


Implementing the reforms: governance

•The reforms will involve significant changes to how local authorities operate currently.

•Wide ranging engagement with local government and other key stakeholders to shape and guide reforms.

•DH, LGA and ADASS has established a joint programme office to support implementation and understand LA readiness and risks to delivery.

•Range of implementation tools being co-produced covering IT, workforce training, commissioning standards, and financial modelling.


Implementing the reforms

Primary legislation – the Care Bill

The legal duties and powers

Secondary legislation – the regulations

More detail on critical requirements, often related to processes. The scope of regulations will depend on the powers specified in the Bill.

Statutory guidance

Guidance on how to meet legal obligations in the Bill. Will set out at a high-level the expectations of local authorities when exercising their functions. These are not mandated requirements, but the LA must have “cogent” reasons that it can legally justify if it wants to take another course.

Practice guidance/implementation support

Best practice guidance, toolkits and other products which help support implementation. These do not have any legal status, so may be used by LAs, or not. They will vary from one area to another, and should be agreed/co-produced with stakeholders to ensure buy-in.

Stakeholder engagement groups

Assessment & Eligibility

Information & Advice

Quality & Safety

Prevention Care MarketsPaying for CareCare Planning

& Personalisation

ADASS Housing Network

TLAP Info, Advice & Brokerage

working group

Paying for Care Task & Finish Group (with input from ADASS Resources

network)

DCMQC Project Board

Market Oversight & Provider Failure working group

Charging for Care

Cross-border placements Virtual reference group

Care planning & personalisation Working Group

Financial Services Steering Group

Care & Support Programme & Implementation Board

Law Reform

Delegation Virtual Advice Network

A&E Task & Finish Group (TG)

Financial Services CEO Group

Integration Implementation

Board

C&S in Prisons::Health & Justice

Partnership Board

Inter-departmental

Ministerial Group (IDMG)

NHS key Stakeholder

Groups

Joint Transformation Group Cabinet Office LGA Boards Cross-sector stakeholder groups

InformaticsPaying for the Reforms WorkforceCommunications

Outcomes & Information

Development Board

Adult Social Care Workforce Development Board

Mkt shaping & commissioning sub-group of TLAP’s National Market Forum

Info and Advice Core Advisory group

Safeguarding Adult Advisory Group (SAAG)

ICSGCare and Support Reform Comms Group

ITF Ministerial Board

Awareness-raising Working Group

Continuity of care Virtual Advice Network

X-Government carers’ strategy

Board

Prevention Task and Finish Group

Ordinary ResidenceVirtual reference

group

Advocacy Core Advisory Group

4x Stakeholder T&F Groups:

•Family and Community•Safeguarding Adults•Multi-agency•Practice

Cross-Governmental officers Group

Virtual reference groups:

•Advocacy•Info & Advice

Appeals & Complaints Virtual reference group

Working Age Adults working

group

Choice of accommodationVirtual reference

group

Standing Commission on

Carers

Transition working group

ADASSIMG

CSA Bill Group

Virtual reference group – Transitional

Provision

Virtual reference group – Sight Registers

Paying for Care Task & Finish Group (with input from ADASS Resources network)

Longer-term group (TBC)

LGA/ADASS Working group



1. General Responsibilities : New functions to ensure that people who live in their area:

Receive services that prevent their care needs from becoming more serious, or delay the impact of their needs by considering;

• What services, facilities and resources are already available in the area (e.g. voluntary and community groups) and;

• Identifying people in the local area who might have care and support needs, or are carer’s with needs, that are not being met;

Can get the information and advice they need to make good decisions about care and support – we must provide information on;

• What process local people need to use to get care and support that is available;

• Where local people can find independent financial advice about care and support and help them to access it and help to plan for the future costs of care;

• How people can raise concerns about the safety or well being of someone who has care and support needs.


2. Who is entitled to public care & support? : Legal duties or entitlements make clear what LA’s must do, what people can expect, so that everyone knows where they stand.

• People currently have different entitlements for different care and support, across a number of Acts, making the law confusing and complex.

• The Care Act creates a single, consistent route to establishing an entitlement to public care and support for all adults with needs for care and support.

• It also creates the first ever entitlement to support for carers, on a similar basis

• New legal duty for an adult’s “eligible needs” to be met by the LA, subject to their financial circumstances. Eligible needs are those that are determined after the assessment.

• The LA must help the person to make decisions about how they want their needs to be met, and prepare a care and support plan.


3. Assessing needs and determining eligibility : A move to outcome and needs based assessment putting views, needs and wishes the centre of the work

• Assessment to decide whether a person needs care and support and must be carried out by a trainer assessor;

• The assessment must be:

• Provided to all people who appear to need care & support regardless of finances or whether LA thinks their needs will be eligible;

• Of the adult’s needs and how they impact on wellbeing and outcomes;

• Carried out with involvement from the adult and where appropriate their carer or someone else they nominate, including Ind. advocate;

• Assessments must be appropriate and proportionate, and if the person agrees and has capacity may also be via self assessment (with LA involvement to support the process).

• Eligibility is set out in the draft regulations that set the national minimum threshold (substantial).


4. Personalising care & support : Maximum control over how needs are met . . .

• The Act sets out when the LA has a responsibility to meet someone’s care and support needs, how it can when it does not have to, and says what must happen next to help the person make decisions about how their needs should be met;

• Legal entitlement to a personal budget unless only receiving en/reablement services;

• Even if don’t meet eligibility, LA must advise people about what needs they have, how to meet them or prevent further needs developing;

• The person must be involved in developing their plan and LA will have to do everything it reasonably can to agree;

• Independent advocacy must be provided in planning & review processes where appropriate.


5. Charging and financial assessment : More consistent way of assessing what people can afford to pay towards their care and support

• The rules for charging date back to 1948 and as a result hard to follow and anomalies;

• Somethings stay the same – no charges for equipment, minor adaptations & reablement;

• Cap on care from April 2016;

• Emphasis on light touch assessment when a small charge for a particular service – less rules;

• Deferred payment agreements.


6. Reforming how people pay for care and support : The ‘care cap’

People will be responsible for:

• Any extra care costs (e.g. more expensive option);

• Support not covered by eligible care and support package (e.g. cleaners / gardeners);

• General living costs;

The LA will be responsible for:

• Any further costs of meeting eligible needs once a person reaches the cap;

• Financial help if they have less than c£17k in assets and not enough income to cover their care costs.


7. Protecting Adults from abuse or neglect : The Act for the first time sets out a clear legal framework for LA and other health & social care systems should protect adults at risk of abuse or neglect

• The Act requires LA’s to have SAB’s in their area, with boards having a clear basis in law for the first time by:

• Existing practice of engagement with LAs, Health community, CQC;

• LA’s and others to make enquiries when perceived at risk regardless of LA contracted provider or not;

• Safeguarding adult reviews for continuous improvement;

• Independent advocacy to represent and support a person who is subject to a safeguarding enquiry or review;

• Supply of information – sharing information related to abuse or neglect.

• Power of access – no new powers to enter a persons property which remain with the police.


8. The law for carers : Carers will be recognised in the law in the same way as those they care for with ‘legal rights for care and support’

• The Act gives a responsibility to assess a carer’s need for support. This replaces the existing law about ‘ a substantial amount of a regular basis’ to qualify for an assessment – more will qualify for an assessment, comparable to the people they care for;

• Carers are also assessed on eligibility;

• Carers should receive a personal budget;

• Young carers and caring for disabled children not dealt with by the Care Act;

• Unclear over two new legislative responsibilities where transitions stand.


9. Continuity of Care when moving between area

• Many disabled and older people don’t consider moving to another area because they cannot be sure that they will get equivalent levels of care and support in the new area.

• The Act outlines a process LA’s must follow when someone wants to move areas, and what must happen to ensure their needs are met when they arrive in the new area.

• Information sharing between the LA’s is crucial.

• The LA that the individual is moving to, must carry out their own assessment and ensure services are in place. If their assessment is different from the previous LA’s, then this must be put in writing.

• If the assessment or services are not in place then a “continuity duty” is triggered.


10. Market Oversight and Provider Failure : “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust”

• The Act introduces a regime to oversee the financial stability of the most hard-to-replace care providers, and to ensure people’s care is not interrupted if any of these providers fail.

• Southern Cross in 2011 highlighted the need for reform.

• The Act imposes clear legal responsibilities on LA’s where a care provider fails, this temporary duty applies no matter what type of care is being received regardless of whether a person pays for their care themselves.

• The temporary duty is applied until LA satisfied that the person’s needs are being met by the new provider.


10. Market Oversight and Provider Failure :• CQC will take on new responsibility for assessing

financial viability of certain ‘hard-to-replace’ care providers who because of their size, specialism or concentration would pose highest risk for individual LA’s;

• Draft regulations propose criteria on which providers it will oversee, with different criteria for residential and non residential care and support providers;

• CQC will request providers in financial difficulty to develop a sustainability plan and where needed, independent business review;

• CQC will oversee providers plans to remedy the situation and ensure any failure is well managed;

• CQC’s aim is not to stop providers failing at all costs or to bail out providers in difficulty.


11. Transition for children to adults : “Services at transition should be aimed at moving a person into work / adult like in such a way as to promote their independence and so reduce their long term needs”

• Transition planning largely unchanged and the draft guidance is very light on detail about adults of working age;

• Alongside the Care Act, the Children & Families Act creates a new ‘birth to 25 years’ Education, Health and Care plan (EHC) for children and young people with special educations needs, and offers families personal budgets;

• Where a person is over 18, the care part of the EHC plan will be provided for by adult care and support under the Care Act.

•Scale and complexity of the task facing local authorities and the demands on capacity.

•Need to continue to strengthen and prioritise engagement in key areas of policy, regulation and guidance.

•Great deal of the context for the Act clear, but key policy / guidance yet to be finalised – e.g. working age cap.

•Links to other key national programmes – Better Care Fund and Integration.

•IT – meeting the requirements of the Bill but also the future challenge of integration, shared records and customer access.

•Workforce – developing the skills, ensuring capacity.

Implementing the reforms: challenges ahead


the care bill: reforming care and support the care act reforming care & support gerald hunt,...

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