Care Act 2014 : briefing on funding & contract opportunities

An overview on: Market diversification Information and advice provision Provision of assessments Independent advocacy Challenges

Market diversification The Care Act places new duties on local authorities to facilitate and shape the market for adult care and support LAs to influence and drive the pace of change for their whole market, 4.2: Care Act Statutory guidance What Act means by “market shaping” “The Care Act places new duties on local authorities to facilitate and shape their market for adult care and support as a whole, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost-effective outcomes that promote the wellbeing of people who need care and support” 4.6. Market shaping means the local authority collaborating closely with other relevant partners, including people with care and support needs, carers and families, to facilitate the whole market in its area for care, support and related services. 4.7. The core activities of market shaping are to engage with stakeholders to develop understanding of supply and demand and articulate likely trends that reflect people’s evolving needs and aspirations, and based on evidence, to signal to the market the types of services needed now and in the future to meet them, encourage innovation, investment and continuous improvement.

Market diversification Local authorities should review the way they commission services 4.4 Care Act Statutory guidance Outcome focused that promote well-being & enabling people to stay independent 4.12 Care Act Statutory guidance Local authorities must facilitate markets that offer a diverse range of high-quality and appropriate services. 4.21 Care Act Statutory guidance Focusing on outcomes 4.4. Local authorities should review the way they commission services, as this is a prime way to achieve effective market shaping 4.12. Local authorities must ensure that the promotion of the wellbeing of individuals who need care and support, and the wellbeing of carers, and the outcomes they require, are central to all care and support functions in relation to individuals, emphasising the importance of enabling people to stay independent for as long as possible. 4.17. In encouraging outcomes-based services, consideration should be given to how services are paid for. Local authorities should consider incorporating elements of “payments by- outcomes” mechanisms 4.24. Local authorities should encourage a wide range of service provision to ensure that people have a choice of appropriate services; appropriateness is a fundamental part of quality.

Market diversification Local authorities must encourage a variety of different providers and different types of services 4.37: Care Act Statutory guidance Local authorities must encourage a range of different types of service providers.. Including user-led orgs 4.38: Care Act Statutory guidance Local authorities should encourage a genuine choice of service type, not only a selection of providers offering similar services 4.40: Care Act Statutory guidance 4.37. Local authorities must encourage a variety of different providers and different types of services. 4.38. Local authorities must encourage a range of different types of service provider organisations to ensure people have a genuine choice of different types of service. This will include independent private providers, third sector, voluntary and community based organisations, including user-led organisations, mutual and small businesses. This should recognise that the different underpinning philosophies, cultural sensitivity and style of service of these organisations may be more suited to some people with care and support needs. 4.40. Local authorities should encourage a genuine choice of service type, not only a selection of providers offering similar services, 4.43. When considering the sufficiency and diversity of service provision, local authorities should consider all types of service that are required to provide care and support for the local authority’s whole population, including, for example: •• information, brokerage, advocacy and advice services; •• direct payment support organisations.

Market diversification Local authorities should facilitate the personalisation (including small, local, specialised and personal assistant services that are highly tailored) 4.45. Care Act Statutory guidance Local authorities should help people who fund their own services or receive direct payments, to ‘micro-commission’ care and support services and/or to pool their budgets and should ensure a supporting infrastructure is available to help with these activities. 4.46. Care Act Statutory guidance 4.45. Local authorities should facilitate the personalisation of care and support services, encouraging services (including small, local, specialised and personal assistant services that are highly tailored), 4.46. Local authorities should help people who fund their own services or receive direct payments, to ‘micro-commission’ care and support services and/or to pool their budgets, and should ensure a supporting infrastructure is available to help with these activities. Notice should not must = DP entitlement much weaker now and can be denied of deemed too expensive

Market diversification Local authorities should facilitate local markets to encourage a sufficiency of preventative, enablement and support services 4.48: Care Act Statutory guidance Local authorities should encourage flexible services that support people to take part in work, education or training. 4.49: Care Act Statutory guidance 4.47. Local authorities must facilitate information and advice to support people’s choices for care and support. 4.48. Local authorities should facilitate local markets to encourage a sufficiency of preventative, enablement and support services, 4.49. Local authorities should encourage flexible services to be developed and made available that support people who need care and support, and carers who need support, to take part in work, education or training. Co-production with stakeholders

Market diversification Quality and value for money Value for money” means optimal use of resources to achieve intended outcomes, and must reference the quality of service delivered and the outcomes achieved for people’s wellbeing, and should not be solely based on achieving the lowest cost. 4.93 Care Act Statutory guidance Local authorities should ensure commissioned services that are adequately resourced and meet the wellbeing principle of the Act. 4.93…“Value for money” means optimal use of resources to achieve intended outcomes, and must reference the quality of service delivered and the outcomes achieved for people’s wellbeing, and should not be solely based on achieving the lowest cost. 4.100. Local authorities should ensure that where they arrange services, the assessed needs of a person with eligible care and support needs is translated into effective, appropriate commissioned services that are adequately resourced and meet the wellbeing principle of the Act. For example, short home-care visits of 15 minutes or less are not appropriate for people who need support with intimate care needs,

Market diversification Local authorities are under a duty to consider added social value when letting contracts through the Public Services (Social Value) Act 2012 4.104. Care Act Statutory guidance 4.104. Local authorities are under a duty to consider added social value when letting contracts through the Public Services (Social Value) Act 2012

Information and advice provision Local authorities must: “establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers”. 3.11 Care Act statutory guidance The local authority has an active and critical role in the provision of information and advice Staff providing information and advice should be aware of accessibility issues and be appropriately trained. 3.20 Care Act statutory guidance 3.3 To fulfil its duty under section 4 of the Act, a local authority is likely to need to go further than providing information and advice directly (though direct provision will be important)

Information and advice provision Wide range of themes that info & advice must cover Case by case consideration of the info needs of people Ensure range of info and advice cross sector and cross borough Consider need for impartial independent advice The service should also address, prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required. In fulfilling this duty, local authorities should consider the people they are communicating with on a case by case basis, and seek to actively encourage them towards the types of information and/or advice that may be particularly relevant to them. 3.22. There are some circumstances where it is particularly important for information and advice to be impartially provided.

Accessibility of information and advice LA’s should ensure that products and materials (in all formats) are as accessible as possible for all potential users. Reasonable adjustments could include the provision of information in accessible formats or with communication support. Information and advice is proportionate to the needs of those for whom it is provided. 3.27. The local authority should ensure that products and materials (in all formats) are as accessible as possible for all potential users. 3.28. As required under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in accessible formats or with communication support. 3.34. Local authorities should help ensure that information and advice is proportionate to the needs of those for whom it is provided.

Assessments Very low threshold for duty to assess = more assessments Section 6 of Care Act statutory guidance 3 new duties to assess in transition Section 16 of Care Act statutory guidance Can be carried out by a range of professionals 6.84: Care Act statutory guidance Local authorities can delegate the majority of their care and support functions including assessment 6.99: Care Act statutory guidance Assessment of children Assessment of children’s carers Assessments of young carers 6.9. The purpose of an assessment is to identify the person’s needs and how these impact on their wellbeing 6.84. Assessments can be carried out by a range of professionals including registered social workers, occupational therapists and rehabilitation officers. 6.99. Local authorities can delegate the majority of their care and support functions, including assessment

Independent advocacy Eligibility: local authorities must seek to ascertain whether an individual is able to be involved in their assessment and must consider whether the individual has substantial difficulty in doing so in 4 areas. 1. understanding the information provided; 2. retaining the information; 3. using or weighing up the information as part of the process of being involved; 4. communicating the person’s views, wishes or feelings. Where a person has substantial difficulty in any of these four areas, then they need assistance = relative or independent advocate (last resort) 6.33. At the point of first contact, request or referral (including self-referral), local authorities must seek to ascertain whether an individual is able to be involved in their assessment and local authorities must therefore consider whether the individual has substantial difficulty in doing so. Local authorities must consider whether the adult would experience substantial difficulty in any of these four areas: understanding the information provided; retaining the information; using or weighing up the information as part of the process of being involved; and communicating the person’s views, wishes or feelings. Where a person has substantial difficulty in any of these four areas, then they need assistance. 6.34. If a person does have substantial difficulty, the local authority must find someone appropriate and independent to support and represent the person, for the purpose of facilitating their involvement. It also applies to children who are approaching the transition to adult care and support, when a child’s needs assessment is carried out, and when a young carer’s assessment is undertaken.

Independent advocacy The same advocate can provide support as an advocate under the Care Act and under the Mental Capacity Act. 7.9. Care Act statutory guidance Advocates must have a suitable level of appropriate experience & work towards the National Qualification in Independent Advocacy (level 3) within a year of being appointed 7.43. Care Act statutory guidance 7.9. Many of the people who qualify for advocacy under the Care Act will also qualify for advocacy under the Mental Capacity Act 2005. The same advocate can provide support as an advocate under the Care Act and under the Mental Capacity Act. This is to enable the person to receive seamless advocacy and not to have to repeat their story to different advocates. Under whichever legislation the advocate providing support is acting, they should meet the appropriate requirements for an advocate under that legislation. 7.59. All local authorities must ensure that there is sufficient provision of independent advocacy to meet their obligations under the Care Act.

Some opportunities…. Diversity & quality of provision (choice & type) Stronger requirement for holistic provision that promotes wellbeing in widest sense Stronger requirements for range info & advice provision Increased provision of independent advocacy To summarise:

Some Challenges… No money ! = more for less in contracts / will diversity of provision really happen ie DP / cheaper alternatives.. Will VFM emphasis on quality mean anything? Resist independent advocacy duty where possible. Payment by outcomes ? Qualification / quality mark requirements Lots more should’s than musts Same contract / contract value but more work 11.26. However, a request for needs to be met via a direct payment does not mean that there is no limit on the amount attributed to the personal budget. There may be cases where it is more appropriate to meet needs via directly-provided care and support, rather than by making a direct payment. For example, this may be where there is no local market for a particular kind of care and support that the person wishes to use the direct payment for, except for services provided by the local authority. It may also be the case where the costs of an alternate provider arranged via a direct payment would be more than the local authority would be able to arrange the same support for, whilst achieving the same outcomes for the individual. 4.17. In encouraging outcomes-based services, consideration should be given to how services are paid for. Local authorities should consider incorporating elements of “payments by- outcomes” mechanisms