1. Care Act 2014 : briefing on funding & contract opportunities

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

3. 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.

4. 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 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.

5. 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.

6. Market diversification
Local authorities should facilitate the personalisation (including small, local, specialised and personal assistant services that are highly tailored) 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 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

7. 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

8. 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 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.
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,

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

10. 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” 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 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)

11. 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.

12. 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.

13. 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

14. 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.

15. Independent advocacy
The same advocate can provide support as an advocate under the Care Act and under the Mental Capacity Act 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 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 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.

16. 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:

17. 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
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