Care Act 2014 – State of Readiness ADASS President David Pearson

Purpose of the Care Act Session What does the review by the Major Projects Authority tell us about our work so far and the risks? What does the stocktake of Local Authorities tell us? Feedback from regions What are the areas of greatest risk and how are we tackling them? Detailed work on tables to assist with some of the high profile areas

Overview Care Act received Royal Assent on 14 th May 2014 Very high degree of collaboration with amendments in the final stages of the bill and in drafting regulations and statutory guidance Widespread support for principles of health and wellbeing, personalisation, and co-commissioning / co-production The Act is a platform for the next few decades albeit in tough times Regulations and statutory guidance will shape the experience of the Act

Major Projects Authority Project Assurance Review Independence of DH and the Programme Board Aim to identify the key threats to delivery of the Programme and help improve delivery confidence Scope both 16/16 and 16/17 implementation covering: ~Policy, Business Context Programme delivery ~The Summary case for change ~Management of intended outcomes, and Stakeholder engagement ~Approach to managing Risks and Issues ~Readiness for the next stage Over 40 cross programme interviews over 5 days

MPA: Findings Delivery Confidence Assessment 15/16Amber“Strong commitment and support across system but inherent challenge and risk“ 16/17Amber/Red“Greater complexity & funding uncertainty” Areas that are working well ‘A very strong tripartite relationship and joint programme office’ that should be protected Disparate policy initiatives pulled together in a single programme and coherent direction Consistent understanding of vision, objectives and main issues Energy within the programme

MPA: Findings Areas of concern “a major issue is funding” sufficiency and allocation mechanism ~ could threaten the strong collaborative approach to delivery Residual risks around workforce and informatics that are greater for the 16/17 deliverables The Programme would benefit from greater programme management rigour but not at expense of relationships 11 recommendations to strengthen the programme

Local Authority Stocktake (LAS) Implementation Stocktake Developed and run by the PMO with sector input 100% response rate Focus on 9 proxy responses as an overall readiness indicator ~More detail in full report, including regional analysis Traffic lights indicate where councils should be /progress at this stage Surveyed before regulations and guidance consultation began Report does not make recommendations

LA Stocktake: Findings Programme Management & Governance Q1 – Council has plan/programme to deliver the Care Act reforms Confidence Q2 – How confident that the Care Act can be delivered Councils with 3 or more ‘red’ proxy indicators 17% have self-assessed as having slightly slower progress Yes: CompleteNo: UnderwayNo: Not StartedDon’t Know Very confidentFairly confident Not very confident Not at all confident

LA Stocktake: Findings Local preparedness On the whole a fair to good level of preparedness based on self-assessment with almost all having a plan in place Good level of awareness with local systems leaders Reasonably good progress in identifying people and carers who may have care and support needs Significant concerns around the costs of the reforms Workforce, informatics and communications are areas of concern

Major Projects Authority & Local Authority Stocktake Areas of Concern Both assurance exercises broadly highlighted the same 4 areas of concern: ~Informatics ~Workforce ~Communications ~Affordability

“Wicked issues” from the East Midlands Region Self funders – Do we know enough about them and how to influence their behaviour? Information and advice – Some of what we are going to have to provide will be very specialist e.g. BSL, Easy Read, prisoners. Would national products be a good idea? Carers – Do we really know what demand to expect? Prevention – We need to prepare care managers to be able to provide a lot more information than they have done to date Financial impact – a lot of new responsibilities creep in almost under the radar, has the Impact Assessment really captured the costs of these? Workforce - “right sizing” the workforce when it is hard to precisely quantify the impact of the changes. Continuing Health Care and the Care Act Disabled Facilities Grants in two-tier council systems

“Wicked issues” from the Eastern Region Unknown costs of implementing the reforms Additional carers’ assessments and personal budgets Readiness of ICT systems Workforce Communication strategy/plan/materials Public expectations

“Wicked issues” from the North East Region The higher rates of deprivation and unemployment in the region in combination with low home ownership means a large percentage of people accessing social care would fall beneath the proposed £17,000 means tested threshold lower limit. This means that LAs would still be required to meet the vast majority of the full costs of care. The proposed ‘substantial’ eligibility criteria is more ‘generous’ than current offer from some LAs in the region meaning a possible significant increase in numbers. The region already currently has the highest rates for people accessing ASC per 100,000 population. Identifying the numbers of potential self funders and carers who may be approaching local authorities for assessment. As a result of low property prices many people in the North East would still lose the full value of their property even with the £72k care cap. The lower care costs in the region would also mean many people would not benefit from the £72k cap. Significant additional responsibilities – market management, advice and assistance to those not eligible – without appropriate levels of funding at a time when social care is already under considerable pressure

“wicked issues” from the North West Region (1) In the NW a Task & Finish Group is scoping and preparing. Over 40 members have volunteered to participate (not all attend every meeting). Two sessions have identified that we want to: Share information and analysis undertaken individually or in groups Highlight good practice Encourage collaboration and lead roles to reduce duplication Communicate the ‘must-do’s’ Make recommendations about the improvement play deployment of resources including the NW grant allocation Liaise and feed back information with LGA and DH named individuals Method for identifying self-funders. Local authorities can be broadly aware of self-funders in residential care, but less clear for those in non-residential care. Clarity on how to identify unknown demand without additional resource and within a reducing budget. Method for identifying the local costs of implementation in 15/16. There are concerns that the allocation for the new duties will be underestimated.

The daily living cost if still set at £12k per year will have an impact locally – given that the NW have lower residential fee rates. We understand that there will be a new funding formula – and only the care element of the residential fee rate will be covered. Establish additional demand from carers – given a good NW network to help scope. Method identifying the numbers of deferred payment agreements that will be required and how existing arrangements (workforce, IT and finance systems) can meet these. Providing programme management guidance/resources. Request for a clear breakdown of activity at the national – regional – sub-regional tiers with local ‘must do’s’ to avoid duplication. Sharing information and good practice – to potentially manage demand IT support systems – understanding what is required and the software companies’ responses Prisons. We have a number of large prisons in the NW and the impact is not yet clear. “wicked issues” from the North West Region (2)

Governance and programme management - in place for counties, much less developed in UAs, need for additional resource Number of self funders estimated or advanced progress by counties. UAs report moderate/early progress – some not yet started Less progress with estimating carers’ assessments Cost modelling underway – half of UAs just started /not done any work Engagement with key groups about the Care Act has hardly started Workforce reviews have started - no development plans in place Greatest risk - total implementation cost and funding, as well as additional demand for assessment “Wicked issues” from the South East Region

Summary Assessment is positive about tripartite arrangement. MPA and LA Stocktake consistent on areas of risk and no surprise to programme board. Regulations and Statutory guidance need full participation to improve. 16/17 paying for care costs still subject to discussions about the gap in assessment of costs with PSSRU support. Further work needed on carers and workforce to assure progress and reduce risk.

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