1. The Care Act: Reforming Care & Support Staff Conference 10 November 2014 Cathy Kerr, Director, Adult and Community Services

2. WHAT I WILL TALK ABOUT:  Care and support context  What the Care Act is  The timescales  Key points at national level  Challenges for the Council  Thames agreement and the Care Act  Local vision

3. Three-quarters of people aged 65 will need care and support in their later years Older people are the core user of acute hospital care - 60% of admissions, 65% of bed days and 70% of emergency readmissions. 72% of recipients of social care services are older people, accounting for 56% of expenditure on adult social care. CARE AND SUPPORT: DEMANDS ON THE SYSTEM 3

4. Supported …and around 6 million people caring for a friend or family member. …around 400,000 people in residential care, 56% of whom are state- supported …around 1.1 million people receiving care at home, 80% of whom are state- supported …1.5 million people employed in the care and support workforce Care and support affects a large number of people In England there are… NATIONAL CONTEXT – DEMANDS ON THE SYSTEM 4

5. WHAT IS THE CARE ACT? (1) “Reforms mark a generational shift in our system of care, a shift from a system that is essentially paternalistic, reactive and prescribed to one that is preventative, personalised and proactive in its care approach. A system that focuses on people's strengths, that seeks to secure personal wellbeing replacing one that focuses on deficits and meeting need.” Jon Rouse Director General for Social Care, Dept. of Health, May 2014

6. WHAT IS THE CARE ACT (2)?  Biggest change in Adult Social Care legislation for 60 years  Reforms the law and funding regime relating to care and support for adults and carers  New legal framework - brings legislation together into one modern law  Encompasses the whole population not just those with eligible social care needs  Integration with health runs throughout the Act  Some duties are not new and we have already progressed these (Personal budgets, Direct Payments)

7. THE CARE ACT REPLACES MANY PREVIOUS LAWS 7 1948 1960… 1970… 1980... 1990… 2000… 2010… National Assistance Act 1948 NHS and Community Care Act 1990 Carers (Recognition and Services) Act 1995 Chronically Sick and Disabled Person Act 1970 Community Care (Direct Payments) Act 1996

8. AN INTEGRATED ACT 8  Different sections of the Act are designed to work together  Local authority wide  Overlap with Children and Families, including transitions  Partnerships and integration  Leadership

9. SUMMARY OF THE CARE ACT DUTIES Key requirementsTiming Duties on prevention and wellbeingFrom April 2015 Duties on information & advice (inc paying for care) Duty on market shaping Assessments (including carers’ assessments) National minimum threshold for eligibility Personal budgets and care and support plans Safeguarding Universal deferred payment agreements Extended means testFrom April 2016 Care accounts Capped charging system

10. NATIONAL PICTURE  97% of Councils say that they are very or fairly confident that they will be able to deliver the Care Act Reforms from April 2015  Potential support needs particularly around costs, IT, workforce, information and advice, carers and market shaping  Other pressures on councils (e.g. funding shortfalls, Better Care Fund) compounded with uncertainty on key guidance and information has delayed or otherwise impacted upon preparations in a number of areas

11. CHALLENGES FOR THE COUNCIL AreaRisks Self fundersMany self funders within the borough. With “Care Cap” more self funders will become responsibility of Council. EligibilityNew framework may mean more residents eligible for services bringing more people into the care system. Finance & Resources Increased demand for services but cannot accurately predict additional demand or resultant financial impact WorkforceWorkforce already under pressure with problems recruiting social workers and paid carers. Financial assessment New ‘means test’; more residents eligible for Council funding CarersOver 15,000 carers in the borough, currently only a small proportion with Council services.

12. THAMES AGREEMENT & CARE ACT  Monthly meeting between Programme Managers (Richmond and Kingston)  Joint events to share knowledge  Areas of joint interest :  Commissioning new services (e.g. advocacy)  Information and advice  Common resource directory

13. OUR CARE ACT VISION Consistent with our local plans and strategies  Empowered people and strong communities work together to maintain independence and wellbeing  Individuals not institutions take control of their care.  Information about care and support, including financial information, is available for all local people, regardless of whether or not they fund their own care or whether they are receiving health or social care.  Care and support is delivered in partnership between the NHS and social care with wider support from voluntary and private sectors and housing.  The variety of people’s needs is matched by diverse service provision, with a broad market of high quality service providers.  We can draw on a workforce across health and social care who can provide care and support with skill, compassion and innovation, and who are given the freedom and support to do so.  Carers are valued and supported and are given the same respect as those they support.

14. FINALLY….  This is new, significant and unknown; we are establishing our understanding  It is resource intensive – people and money  The Council will have to make decisions on new issues – we will at some point stop doing some things we do and start doing new things  Requires significant culture change  Health services are an integral part of this  Lots of challenges – but all consistent with our agreed ‘direction of travel’