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

3. 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.

4. 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.

5. 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

6. 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 of the Act)

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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.

15. 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.

16. 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

17. 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

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

20. 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

21. 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

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

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

24. 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

26. 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

28. 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

29. 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

30. 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

31. 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

32. 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?

34. Did you know that there are over …
So together we can support you with your lifelong learning and the purpose of this presentation is to outline some of the ways in which we can do this….

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