The Care Act 2014 Personalisation and the New Eligibility Regulations Making it work for people with multiple and complex needs Be the Change Frontline Network Event Newcastle 26th July 2017

Workshop Aim To explore the implications of the Care Act 2014 for people with multiple and complex needs What kind of support is covered? Who is eligible? How should commissioners, service managers and practitioners respond to these changes? Voices experience and progress to date in securing assessment and support under the Care Act

The Perfect Storm?

Old Community Care System Health All Health Care Adult Social Care Older people, disability etc. Social Care Supporting People Homeless people, unpopular groups Housing Related Support

End of SP ring-fence in 2009 Cartoon from Inside Housing By 2015 – SP funding cut by 67% nationally 90% increase in rough sleeping in London between 2010/11 -14/15 (after a steep decline in 2000’s) What should replace SP? Homeless people, unpopular groups

Grants & Block Contracts CARE ACT SUPPORTING PEOPLE PROGRAMME Housing Options Adult Social Care Personal Budget “Cash for Care” Grants & Block Contracts Service Provider Individual Individual Service Provider Housing Related Care and Support Including Housing Related Support Housing Related Support But NOT ‘Personal Care’

The Care Act, 2014 - What support does it cover? Adult social care conceptualised as having a much broader care and support function – not just about ‘personal care’ Under the Care Act, local authorities are to maintain the boundary between their ‘care and support function’ and their ‘housing function’ (e.g. to meet accommodation needs under the Housing Act, 1996) Care and support can encompass housing related support: “There is nothing to stop local authorities in the care and support role from providing more specific services such as housing adaptations… or enabling individuals to develop community connections in relation to housing needs” (p295)

Types of Personal Budget Direct Payment Individual Service Fund (ISF) Managed Personal Budget “The focus is not on what is purchased but on whether or not it is a good way of meeting desired outcomes….” (Glasby 2013)

New Eligibility Regulations* Good News for ‘Homeless People’? Removes reference to ‘eligible’ and ‘ineligible groups’ so that any adult with any level of need will have the right to as assessment “To make the law fair and consistent, we want to remove many anomalies which treat particular groups of people differently. We do not want people to be dealt with differently based on the type of service they need or where they need it” (DH, 2013 p1) *Replaces the FACS Criteria

The Eligibility Decision Process Needs: Physical or mental impairment (including drug and alcohol issues)? Outcomes: As a result of the impairment, the adult is unable to achieve 2 or more of the following: managing and maintaining nutrition maintaining personal hygiene managing toilet needs being appropriately clothed maintaining a habitable home environment being able to make use of the home safely developing and maintaining family or other personal relationships accessing and engaging in work, training, education or volunteering making use of necessary facilities or services in the local community including public transport and recreational facilities or services carrying out any caring responsibilities the adult has for a child Impact on Wellbeing: As a consequence there is likely to be a significant impact on the adult’s wellbeing As a consequence there is likely to be a significant impact on the adult’s wellbeing

Significant Impact on Wellbeing As compared to people who are not homeless, homeless people Attend A&E 6 times as often Get admitted 3.2 times as often and stay in hospital 3 times as long Have unscheduled care costs 8 times higher Homelessness is an independent risk factor for premature mortality. Average age of death of a long term homeless person is 47 years

Is the homelessness sector ready to contract with personal budget holders? In the homelessness and housing related support sector there is mistrust of ‘personal budgets’ so few homeless people are being referred ‘Personal budgets are ‘recognised as one of the many ways of delivering personalised services, but not the central one’ (SITRA, 2014 p15). In adult social care and support the goal is that everyone should be offered a personal budget: ‘Personal budgets need to be included in the law as they are important for making care and support personalised. If they are not in law it will be more difficult to offer them to everyone. While some local authorities are already making great progress in this area, legislation is needed to make it happen everywhere’ (DH 2013 p2) Concerns about handing over control and a lack of awareness about mechanisms such as ISFs  

Recommendations The Care Act is an opportunity to rebalance the provision of adult social care (to put an end to the ‘inverse care law’ and the misrepresentation of homelessness as a ‘lifestyle choice’) Need for collaborative working locally between providers and commissioners to raise awareness about the Care Act (especially the new eligibility regulations) and to ensure that they are being implemented fairly. Need for providers to receive training around the architecture of personal budgets (e.g ISFs) Need to monitor progress as regards the uptake of Personal Budgets (PBs) among ‘unpopular groups’

Improving the Uptake of PBs in Stoke-on-Trent

Making the Headlines! “Retirement village residents are scared for their safety due to 'alcoholic' tenants at the complex. The occupants of Willow Barns say people with substance misuse problems are causing anti-social behaviour issues and disturbing their neighbours”. Sentinel 4.7.17

Case Study - Janice Is Janice eligible for care and support under the Care Act 2014?  Explain your answer. What challenges would homelessness practitioners face when addressing this case and how would you resolve these? What issues would social workers face? What do you think are the reasons for Janice’s reluctance to accept support? How would you manage this? What would an ideal integrated health, social care and housing plan look like and do you think there is a difference between this ideal and the reality of current practice?