1. Charging for adult social care: Update Katy Lindfield & Joe Matthews Social Care Charging & Charging Reform NAFAO Conference 23rd May 2018

2. Changes to the Charging Rules Green Paper Top-Ups - CMA Report
Why we’re here
DHSC – Leading the nation’s health and care

3. Changes to the Charging Rules

4. Changes to the Charging Rules:
Deferred Payment Agreements:
Intention was that both traditional and loan-type DPAs were mandatory
However, LAs were not obligated to offer DPAs unless they were meeting needs
Our changes mean that both are now mandatory as intended
Infected Blood:
Charitable Payments for infected blood have always been disregarded
Previously came from a number of organisations but have now been brought together under England Infected Blood Support Scheme.
Change happened automatically because of links to income support
DHSC – Leading the nation’s health and care

5. Changes to the Charging Rules:
Payments of capital from the Thalidomide Trust
Reflects changes made to the Income Support Regulations but didn’t automatically read through
Payments of capital from the Thalidomide Trust will be disregarded
Intended to stop Thalidomide Trust from keeping payments and enable Thalidomiders to make big purchases (like adapted cars)
Regulations intended to be laid 8th June and come into force beginning of July
No changes to treatment of income from Thalidomide Trust

6. Green Paper

7. Reform: Green Paper on Older People’s Care
“We need to do better on social care” – Secretary of State set out seven principles for reform in a March Speech:
quality and safety embedded in service provision
whole-person, integrated care with the NHS and social care systems operating as one
the highest possible control given to those receiving support
a valued workforce
better practical support for families and carers
a sustainable funding model for social care supported by a diverse, vibrant and stable market
greater security for all – for those born or developing a care need early in life and for those entering old age who do not know what their future care needs may be
A Green Paper by summer 2018 will build on the above principles – changes to what individuals pay for care could be in scope for achieving principle seven, “security for all”

8. Reform: continued
What individuals pay for care is only part of the wider work to reform services
Other issues under consideration based on our principles for reform:
How people can live independently for longer (reducing loneliness, supporting mobility)
Where care is received (e.g. home, care home or supported accommodation)
How services are experienced (particularly when provided by different sectors)
Quality and safety of care
Building a sustainable care and support system will require some big decisions.  But getting this right promises a better system that everyone can have confidence in, where people understand their responsibilities, can prepare for the future, and know that the care they receive will be to a high standard and help them maintain their independence and well-being.

9. Top-Ups

10. Top-Ups – CMA Findings and Recommendations
Competition and Markets Authority reviewed the social care market
Found that top-ups were being agreed without the knowledge of LAs in some areas
Top-ups between individuals and providers agreed on less favourable terms than LA contracts.
Recommended that:
LAs tell individuals that providers should not be contacting them or their families directly for top-ups
LAs should be clear of advantages of top-ups with LA involvement
LAs make a requirement that top-ups agreed under the same terms and conditions

11. We accepted recommendations in principle
Have come up with potential changes to guidance to :
Remove reference to separate contracts to avoid ambiguities
Clarify that, where the LA is meeting needs, top-ups are made as part of the contract for that individual’s care and so must be on same terms
Include recommendation that LAs notify individuals and their families that providers should not be approaching them for top-ups without the knowledge of the LA and they should not agree them without speaking to the LA first.

12. In Groups Take 15 minutes to discuss at your tables:
Do you allow separate top-up agreements between providers and individuals? How does this work?
Have you experience of providers directly approaching residents and their families for top-ups?
How prevalent is this? How do you respond?
What do you think of potential changes to guidance? Does it reflect current practice?
What impact would this have on you and/or the care home market in your area?

13. Feedback