The Care Act 2014: The Occupational Therapists role in delivery Julia Skelton Director of Professional Operations College of Occupational Therapists

Implementing the reforms Primary legislation – the Care Act 2014 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.

Care Act 2014: Key Duties Information and Advice Promote Wellbeing Prevent needs for Care and Support Facilitate a diverse market of care and support provision Carry out an assessment of both individuals and carers A national minimum eligibility threshold.

Definition of Wellbeing Wellbeing is a broad concept and is described as relating to the following areas: Personal dignity Physical and mental health and emotional wellbeing Protection from abuse and neglect; Control by the individual over day to day life(including how care and support is provided) Participation in work, education, training or recreation Social and economic wellbeing Domestic, family and personal Suitability of living accommodation The individuals contribution to society All should be considered of equal importance

General duties Duty to Promote well-being 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. Shift from duty to provide particular services to a duty (and power) to meet needs (sections 18-20 of the Act)

Well-being Opportunities Occupation is central to mental health & well-being – (opportunities to think more broadly about how an individuals’ wishes and what might be impacting on their well-being) and how this might feature in a care plan) Well-being can help consider a less restrictive approach that might have longer-term benefits for the individual Challenges Individuals wishes (Care Act 2014) v assessing necessary and appropriate (Housing Grants Construction & Regeneration Act 1996) Financing agreed outcomes

New Definition of Disability The Equality Act 2010: if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities

Must and Should Must:- is an obligation; it must be done and if not then one is open to legal challenge therefore a clear breach Should:- is not an obligation however if you don’t do it you are open to question. You will  need to have  a good explanation  as to why you did not do what was required. Ignore a ‘should’ at your peril  

Assessment Requirements Consider a persons needs, their goals and what they wish to achieve Does an individual wish to carry out a self-assessment Assessment appropriate and proportionate Involve carer, family and relevant others Does the individual need help to participate in the assessment

Assessment cont. Assessors must have appropriate training and be competent Specialist assessment for those who are deaf blind Assessment must also consider Prevention, a persons own skills and abilities and support from wider community

Assessment cont. Opportunities Occupational Therapists are trained and competent to undertake assessments under the Care Act 2014 Challenges Proportionate v holistic

Appropriate Appropriateness requires the local authority to ensure the assessment process is adapted to the person’s circumstances, needs (communication needs, level of complexity, etc.) and preferences. In order to ensure that the assessment is appropriate, it must be person-centred, collaborative and involve a transparent and understandable process. The assessment process is intended to be flexible, and can be adapted to ensure that the individual or their carer is involved as much as they wish to be and as is practicable. All appropriate assessments are collaborative and should allow the adult with care and support needs or their carer to be able to: understand the assessment process understand the implications of the process for their condition and situation understand their own needs, outcomes and impact on their wellbeing start to identify options available to them understand the basis on which decision are reached.

Proportionate Proportionality means that the assessment is only as intrusive as it needs to be, to establish an accurate picture of the needs of the individual or their carer, regardless of whatever method of assessment is used – i.e. supported self-assessment, face-to-face assessment or other. This will involve: both hearing and understanding the initial presenting problem not taking this at ‘face value’ ensuring any underlying needs are also explored and understood. Needs may well differ in their breadth and depth, meaning: additional exploration of underlying needs may be required an individual or their carer may have needs which require more consideration only within some aspects of their lives individuals with a clear understanding of those needs and/or the care and support system may require less intensive assessment than someone who has recently developed needs and has less clarity about their needs and the care and support system.

Prevention, Reducing & Delaying Needs Prevention and Information can be provided prior to eligibility Equipment free Small minor adaptations £1,000 Reablement  6 weeks – what if 2 or 3 weeks more is required? Rehabilitation Communication equipment Public health & preventative activities Targeted interventions

Opportunities Occupational therapists are the profession to lead prevention approaches in social care. We have the skills and knowledge DFGs can still be assessed and outside eligibility test RRO greater flexibility. Are you a DFG Champion? New ideas and approaches - being heard

Provision via a personal budget Challenges Provision via a personal budget Adaptations and local agreements

Care and Support Planning Opportunities: Occupational Therapists can do care & support plans Occupational Therapists can and are acting as Best Interest Assessors Ensuring the balance is right in terms of managing caseloads Numbers of current self-funders of care requiring an assessment Personal Budgets – availability now enshrined in Law

Eligibility Research on eligibility under FACS and the new eligibility criteria – has been completed to inform Eligibility and affordability Test is: An Adult is ‘unable‘ to achieve 2 or more of the outcomes set out in the regulations

Other Aspects in Care Bill Continuity of Care Integration, co-operation and partnerships Market Oversight Safeguarding Finance, personal budgets, direct payments

New Opportunities Working with employment and welfare services Transitions to Adult Care and Support Prisons, approved premises and bail accommodation

Opportunities OTs have the skills to assess disabled young people and their needs and wishes as they approach 18 and thinking of career and longer term care and support needs OTs understand vocational rehabilitation and help individuals remain in or return to work OTs in many areas across England are now working in Prisons. COT has developed a network and already had some great articles in OTnews

Carers Requirements The wellbeing principle applies equally to adults with care & support needs & their carers Carers rights are enshrined in the Care Act; e.g. the right to an assessment LA has a duty to prevent carers developing needs for support. Children should not undertake inappropriate caring roles that may impact on their development

Key Challenges Incorporating the principles of wellbeing Prevention Assessments Links with Housing Transitions, Return to work, Prisons Integration Funding: CQC –State of Health and Social Care in England spoke about the sustainability of social care and being at the tipping point

Acts to be repealed or disapplied 13 in total National Assistance Act 1948 Chronically Sick and Disabled Persons Act 1970 Health and Social Care Act 2001 National Health Service Act 2006

Key Housing Facts There are more homes in private rented sector than social housing sector Owner occupation is falling but rising in the over 55s Rural area dwellers are made up of 90% older people Homelessness is increasing but 4,000 bed spaces have been lost

Reflections and thoughts Health, Social Care and Housing Housing is part of Public Health Incorporating Wellbeing into practice Promoting Equipment as preventative Recognising what equipment should be supplied under Health and Safety Regs Promoting the Occupational Therapists role within the Care Act Using the funding for DFGs - promoting greater flexibility Regulatory Reform Order Occupational Therapists; Improving Lives Saving Money

Call to Action Raise the profile of occupational therapists in social care and housing What would be the top three areas that you would wish to promote the role of occupational therapists within social care Engagement Exercise and the need for service examples Articles – more visibility Find out about new initiatives is this something you could implement locally?

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