The Care Act January 2015 Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Today’s session  Overview of the reforms  Information and Advice  Independent Financial Advice  Advocacy  Key Issues for Norfolk  Key Questions Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Overview of the Care Act From April 2015 care and support in England is changing for the better: More consistency across the country Putting people more in control of the care & support they receive More help for people providing unpaid care More financial help for those who need it Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

New duties / key changes Assessment & eligibility Charging & financial assessment Care & support planning Deferred payments PBs & direct payments Review Underpinning processes Prevention, information & advice Independent advocacy Integration, partnerships & transitions Market oversight Safeguarding Prisons Key duties & responsibilities Wellbeing Statutory duty to promote Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

From April 2015 Responsibility of local authorities to promote wellbeing and work collaboratively to prevent, reduce and delay the need for care and support (Clauses 1-7) National minimum threshold for eligibility (Clause 13) Needs assessments and carers assessments (Clause 9-12): focus on first contact and likely to mean a lot more assessments carried out by the local authority Personal Budgets, direct payments and care and support plans (Clauses 24-33): new Independent Personal Budgets for anyone with eligible care needs Independent advocates (clauses 67-68) to support people to be involved in assessment and care planning and safeguarding processes, where the person would be unable to be involved otherwise Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

From April 2015 Duty for councils to join up with health and housing where this delivers better care and promotes wellbeing Duty on councils to ensure there is a wide range of care and support services available that enable local people to choose the care and support services they want (market shaping) Transition for children to adult care (Clauses 58-66): co-operation, planning ahead and smooth transition; assessment of young carers Prisons, approved premises and bail accommodations: the local authority will be responsible for assessing and meeting the care and support needs of the offenders residing there, regardless of which area the individual came from or where they be released to (new) Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

From April 2015 New charging framework (Clause 14): power to charge- more detail in regulations Deferred payments agreements (Clauses 34-36) option to defer the sale of the home during the person’s lifetime- regardless of whether or not the local authority pays for their care: ‘may’ rather than ‘must’ until regulations confirmed New duty to provide information, advice and information to service users and carers who do not meet the eligibility threshold (Clause 4) Safeguarding framework for adults (Clauses 42-47): requires local authorities to ensure enquiries are made into allegations of abuse or neglect, and to establish a safeguarding adults board (SAB) in their area Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

From April 2016 Extended means test – increase in capital thresholds /extension to the means test Introduction of a cap on costs of meeting eligible needs for care and support (to be set at £72,000 for those of state pension age and above when it is introduced) including independent personal budgets and care accounts Care accounts Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Changes to assessment, eligibility and financial assessment process Deferred payment agreement Person appears to have needs Assessment Are their needs eligible? YES NO (written explanation) Financial assessment Advice and information Appearance of needs, strengths-based New eligibility threshold Written explanation & advice Universal scheme Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

An adult meets the eligibility criteria: Their needs are caused by physical or mental impairment or illness As a result of the adults needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being Wellbeing: Personal dignity Physical, mental & emotional health Protection from abuse & neglect Control over day to day life Participation in work, education, training and recreation Social and economic wellbeing Domestic, family and personal relationships Suitability of living accommodation An individuals contribution to society The specified outcomes are: Managing and maintaining nutrition Maintaining personal hygiene Managing toilet needs Being appropriately clothed Being able to make use of the home safely Maintaining a habitable home environment 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 New national eligibility threshold Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG Carers Assessment A carer’s assessment must explore: the carer’s needs for support AND sustainability of caring role It must also consider impact on the carer’s activities beyond their caring responsibilities, including the carer’s: desire and ability to work ability to partake in education, training or recreational activities opportunities to have time to themselves

Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG National Carers Eligibility Framework After completion of the assessment process, the local authority will determine whether the carer has eligible needs Carers can be eligible for support in their own right The Act introduces a national carers’ eligibility threshold: whether the carer’s needs are due to providing necessary care for an adult whether those needs puts the carer’s health at risk or means that they are unable to achieve specified outcomes; and as a consequence there is, or is likely to be, a significant impact on their wellbeing

Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Section 4 of the Care Act:  “ A local authority 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.” This does not mean that the local authority should provide all the elements itself. Instead, it should “understand, co-ordinate and make use of” the resources available across the community. Key principle: Information and advice helps to promote people’s wellbeing by increasing their ability to exercise choice and control and is a vital component of preventing or delaying people’s need for care and support. Therefore it is a key component running throughout most of the reforms introduced in the Care Act Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Information must be provided on:  How the system operates in the authority’s area and how to access care and support  How to complain or make a formal appeal to the authority  When independent advocacy will be provided  Choice of types of support and providers  How to access independent financial advice relevant to meeting needs for care and support  How to raise concerns about the safety or well-being of an adult who has care and support needs  Paying for Care and Support including charging arrangements But because of the duty to promote well-being in the Care Act, the subject matters covered must go much further than a narrow definition of care and support …………. Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice …and should also include: available housing and housing-related support options for those with care and support needs effective treatment and support for health conditions, including Continuing Health Care arrangements availability and quality of health services availability of services that may help people remain independent for longer such as home improvement agencies, handyman or maintenance services availability of befriending services and other services to prevent social isolation availability of intermediate care entitlements such as aids and adaptations children’s social care services and transition Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice and… eligibility and applying for disability benefits and other types of benefits availability of employment support for disabled adults children’s social care services and transition availability of carers’ services and benefits sources of independent information, advice and advocacy the Court of Protection, power of attorney and becoming a Deputy raise awareness of the need to plan for future care costs practical help with planning to meet future or current care costs accessible ways and support to help people understand the different types of abuse and its prevention. Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Who are the audiences for the information and advice?  A very broad group, including people who may need care and support now or in the future. (Local authorities should be mindful of the different circumstances that might trigger someone to need information and advice).  This includes carers; local authorities must recognise and respond to their specific requirements.  It also includes people not eligible for formal support – i.e. “self-funders”. (Local authorities must have regard to identifying these people and helping them to understand the financial costs of their care). Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Carers: Local authorities must recognise and respond to the specific requirements that carers have for both general and personal information and advice. A carer’s need for information and advice may be separate and distinct from information and advice for the person they are caring for: breaks from caring; the health and wellbeing of carers themselves; caring and advice on wider family relationships; carers’ financial and legal issues; caring and employment; caring and education; and, a carer’s need for advocacy. Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Key Trigger Points contact with other local authority services bereavement hospital entry and/or discharge diagnosis of health conditions – such as dementia, stroke or an acquired impairment Consideration or review of Continuing Healthcare arrangements take-up of power of attorney applications to Court of Protection application for, or review of, disability benefits such as Attendance Allowance and Personal Independence Payments, and for Carers Allowance access to work interviews contact with local support groups, charities, or user-led organisations including carers’ groups and disabled person’s organisations contact with or use of private care and support services, including homes care change or loss of housing contact with the criminal justice system admission to or release from prison ‘Guidance Guarantee’ in the Pensions Act 2014 retirement Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Independent Financial Advice Financial information and advice is fundamental to enabling people to make well-informed choices about how to pay for their care and is integral to a person’s consideration of how best to meet care and support needs – immediately or in the future Authorities should provide some of this directly where it is relevant to care and support but where it is not relevant they must ensure that people are helped to understand how to access independent financial advice This should include both generic free and fee-based advice as well as service providing regulated forms of financial advice Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Independent Financial Advice Local authorities should be able to describe the benefits of independent financial information and advice and why it would be beneficial to the person based on what is known of their circumstances Local authorities are not required or encouraged to make a direct referral to one independent financial adviser but should actively help and direct a person to a choice of advisers regulated by the Financial Conduct Authority with the appropriate qualifications and accreditation. This should be done on a transparent basis The same principle around accessibility, quality and proportionality apply to independent financial advice as they do to general information and advice Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Accessibility and Quality Wide accessibility can only be achieved by working with other information and advice providers (statutory and voluntary). The council should consider the persons or places where people might first seek help, and play a role in joining up information and advice organisations locally so they can work collaboratively. Information should be available in a variety of formats and using a variety of channels, e.g: - Face-to-face - Telephone/ s - Mass communication (e.g. leaflets, posters) - Free media and social media - Websites - Peer to peer contacts - Community settings - Advice and advocacy services Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Accessibility and Quality Information should be of high quality – i.e. clear, comprehensive, accurate, easily understood, up- to-date and consistent Information should be proportionate to a person’s needs – ranging from “quick read” to in-depth advice The council should consider how to make use of national as well as local sources In some instances the advice may need to be provided by an impartial source Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Information and Advice Developing and reviewing a plan or strategy Councils should have a plan for information and advice. These should be aligned with other strategies including joint strategies Plans should be based on analysis of population needs The plans should have regard to certain principles – e.g: involving people who use services and carers, interested organisations and service providers adopting a co-production approach; mapping to understand the current range of provision; co-ordination with other statutory bodies including CCGs, Health and Wellbeing Boards, Healthwatch and neighbouring local authorities; assessing the impact. Councils should review and publish information about the effectiveness of their information and advice services, including customer satisfaction. Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Independent Advocacy Sections 67 and 68 of the Care Act Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions When does the advocacy duty apply? The advocacy duty will apply from the point of first contact with the local authority and at any subsequent stage of the assessment, planning, care review, safeguarding enquiry or safeguarding adult review. If it appears to the authority that a person has care and support needs, then a judgement must be made as to whether that person has substantial difficulty in being involved. If they do, is there an appropriate individual to support them? An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one or more of the following processes described in the Care Act: Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

The role of an independent advocate under the Care Act Advocates should represent the individual, always with regard to their wellbeing and interests, including helping a person to: Understand the process Communicate their wishes, views and feelings Make decisions and challenge those made by the authority Challenge a decision made by the local authority Understand their rights Support and represent them in the safeguarding process Look at records and to talk to those who can help Consult both the records and the family and others if the person does not have capacity Applies to adults, carers and children in transition Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

An ‘appropriate individual’ to facilitate the person’s involvement Considerations Who is appropriate to support and represent the person? Is a family member or friend an appropriate individual? Must Be able to facilitate the individual’s active involvement with the process The person who is supported must agree to the suggested ‘appropriate individual’ Must NOT Be someone who is already providing care or treatment professionally or paid Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Providing an independent advocate where there is an appropriate person There are times when an independent advocate should be provided even where the person has family or others involved. These are: when it is suspected that the family member or other person is abusing the adult when a placement is being considered in NHS-funded provision and the local authority believes that it would be in the best interests of the individual to arrange an independent advocate where there is a disagreement between the local authority and the person who would facilitate the individual’s involvement, and they both agree that an independent advocate would be beneficial to the individual Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Who can act as an independent advocate under the Care Act? Independent advocates must have: a suitable level of experience appropriate training competency in the task integrity and good character the ability to work independently of the authority arrangements for regular supervision Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Interface with the Mental Capacity Act There are similarities with the MCA, but the duty to provide independent advocacy under the Care Act is broader and applies to a wider set of circumstances e.g. it provides support both to people who have capacity but who have substantial difficulty in being involved and to those who lack capacity The local authority must meet its duties in relation to working with an Independent Mental Capacity Advocate and those in relation to an independent advocate under the Care Act The same advocate can provide support as an independent advocate under the Care Act and under the Mental Capacity Act, if trained and qualified to do both There are many advantages of having one independent advocate, or one organisation, providing both services Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Key issues for Norfolk Very important for Norfolk because of demographics Puts various aspects of social care on statutory footing e.g. national eligibility threshold; ‘wellbeing’ defined Good news re priorities including: carers, wellbeing, personalisation, safeguarding Challenges: financial clauses, focus upon information, more assessments, need to know about more people, new systems to set up e.g. care accounts Risks: whole system needs to be adequately resourced for changes in funding of adult social care Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

What this means for Norfolk County Council Pressure on staff resources e.g. more people asking for a social care assessment, requirement to give advice and support to more people Huge potential cost impact to the local authority (spend on care packages as more people eligible for support, capital limits, deferred payments (debt) More administration to provide each person with a care account, keep track of what people are spending (an annual account, monitor and provide information when a person is reaching their care Tight timeline to deliver implementation in April 2015 and April 2016 Digital Norfolk Ambition changes will be happening at the same time as the implementation of the Care Act The need to achieve budget savings at the same time as the additional resources needed for implementation Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Key Questions Immediate thoughts and observations? How do the Care Act requirements align with the requirements of our specifications and contracts? Are there any obvious gaps between what is in place now and what needs to be in place to meet the requirements of the Care Act What support do you need from NCC to best prepare for implementation in April 2015? Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG

Other sources of information Statutory guidance for implementation from Department of Health (includes easy read version) implementation Resources from SCIE   short video by SCIE which provides a good overview: Think Local Act Personal Norwich CCG South Norfolk CCG North Norfolk CCG West Norfolk CCG Gt Yarmouth & Waveney CCG