1. The Care Act 2014 Barbara Booton
Feb 2014
England
The Care Act Barbara Booton

2. The Care Act Aims Policy context The legal framework Main provisions
The new care and support system
Further information and resources

3. What does it Aim to Achieve?
A single modern piece of law for adult care and support in England
Replaces and updates complex and outdated legislation that has remained unchanged since 1948
Introduces a care and support system that is aimed at being clearer, fairer and fit for the future
Focuses on people’s well-being, supporting them to live independently for as long as possible and in control of their care
The Care Bill has been developed to create a single modern piece of law for adult care and support in England. It will update complex and outdated legislation that has remained unchanged since 1948 including repealing the Chronically Sick and Disabled Persons Act 1970.
The government’s aim is that it will introduce a care and support system that is clearer, fairer and fit for the future. It focuses on people’s well-being, supporting them to live independently for as long as possible. Care and support will be centred on people’s needs, giving them better care and more control over the care they receive. It will also provide better support for carers.

4. Policy context
The Government’s White Paper Caring for our future: reforming care and support (July 2012), set out a long-term programme to reform care and support. At the centre of the White Paper is a vision for a modern system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives so that they can pursue opportunities, including education and employment, to realise their potential. The Care Bill is a crucial step in delivering that vision.
The existing law that underpins care and support is outdated and confusing. The Law Commission concluded after a three-year review that the current legal framework makes it difficult for people who need care and support, and carers, to know what they are entitled to, and for local authorities to understand their responsibilities.
Part 1 of the Care Bill takes forward the recommendations of the Law Commission’s report on adult social care. More than simply modernising the legislation, the Bill takes forward many significant policy reforms for care and support. In doing so, the Bill also responds to the recommendations of the Commission on the Funding of Care and Support.
The Bill will put into legislation the changes proposed by the Commission to reform the funding system for care and support. It introduces a cap on the care
costs which people will incur in their lifetime.
The Bill also reflects the recommendations of the Joint Committee that scrutinised the Draft Care and Support Bill and the comments received during the
consultation.

5. The legal framework
The new legal framework will have three layers, of which the Care Bill is just one part.
Skills for Care’s remit is not primarily to explain how the Act will work in detail. In fact much of this is only now being decided as the information currently available is the top of this pyramid. The details which will follow within the regulations and guidance which the DH and key partners are working on currently for all areas of the care bill.
The Bill itself – The Public Bill Committee concluded its work and reported on the 4 February The Bill is expected to have its report stage and third reading on a date to be announced. Previous stages of the Bill: the Bill completed its House of Lords stages on 29 October 2013 was presented to the House of Commons on 30 October The Bill had its second reading debate in the House of Commons on 16 December 2013.
Secondary legislation – the Bill provides for around sets of regulations. DH are working with stakeholders to develop the regulations which will underpin the new law
Statutory guidance – DH began developing new statutory guidance from late 2013 and intend to co-produce this with stakeholders networks to support development

6. Summary of the main provisions
Part 1: Care and support
Part 2: Care standards
Part 3: Health
Health Education England (HEE)
Health Research Authority (HRA)
The first part of the Care Bill is a critical step in reforming care and support and achieving the aspirations of the white paper, Caring for our Future. It also introduces a cap on the costs that people will have to pay for care in their lifetime, as recommended by the Commission on the Funding of Care and support. The Bill pulls together threads from over a dozen different Acts into a single, modern framework for care and support.
Care standards: part 2 of the Bill delivers a number of elements in the Government’s response to the findings of the Francis Inquiry, which identified failures across the health and care system. The government’s response is aimed at helping to ensure that people who use care and support are ‘the first and foremost consideration of the system and everyone who works in it’ and restore the NHS to its core values. The government has said that quality of care and people’s experience should be the basis on which providers of health and care are judged and that the Bill takes a step towards that. It will allow for Ofsted-style ratings for hospitals and care homes that will allow patients and the public to compare organisations or services in a fair and balanced way, so they can see which they prefer and where they want to go.
Part 3 of the Bill Part sees HEE established to provide national leadership for education and training. HEE has appointed and supported the development of Local Education and Training Boards (LETBs) which have taken on responsibility for the workforce planning and education and training functions of SHAs. It also establishes the Health Research Authority in the same way, strengthening its ability to protect patients’ interests in health and social care research whilst promoting research and streamlining the approvals process. Both of these bodies will be independent of the Department of Health, giving them the impartiality and stability they need to carry out their roles.

7. Part 1 – Care and support Clause No. Topic 1-7
General responsibilities of local authorities
8-13
Meeting needs for care and support
14-17
Charging and assessing financial resources
18-23
Duties and powers to meet needs
24-33
Next steps after assessment
34-36
Deferred payment agreements
37-41
Moving between areas
42-47
Safeguarding adults from risk of abuse or neglect
48-57
Market failure and oversight
58-66
Transition for children to adult care and support
67-68
Independent advocacy support
69-79
Other provisions
Part 1 of the Bill covers a wide range of new provisions for adults needing care and support, and their carers. It emphasises a new approach to social care that promotes wellbeing and asset-based approaches. It strengthens carers' rights and introduces a new adult safeguarding framework. This section also contains powers to introduce a system of capped care costs and a universal deferred payment scheme.

8. Framework Underpinning Principle Wellbeing
Responsibilities & Key Duties
Prevention
Integration
Information, Advice & Advocacy
Diverse Care markets
Safeguarding
Key Processes
Assessment & Eligibility
Charging & Financial Assessment
Care & Support Planning

9. Part 2 – Care standards Clause No. Topic 80-84 Quality of services
85-87
Care Quality Commission
88-89
Independence of the Care Quality Commission 90
Performance ratings
91-93
False or misleading information 94
Regulated activities
Part Two of the Bill takes forward the measures within the Government's five-point plan in response to the Francis Report that require adjustments to the system through primary legislation. This package of measures includes requirements for the CQC to develop a system of performance reviews and assessments which will allow for comparison of organisations against a single version of performance. It also gives CQC powers to appoint a new Chief Inspector of Hospitals to instigate a new failure regime. The Bill will make it an offence for care providers to supply or publish certain types of false or
misleading information and introduce additional legal sanctions.

10. What does the Care Act do?
The Act is built around people.
It introduces:
ensures that people’s well-being, and the outcomes which matter to them, will be at the heart of every decision that is made;
puts carers on the same footing as those they care for;
creates a new focus on preventing and delaying needs for care and support, rather than only intervening at crisis point;
puts personal budgets on a legislative footing for the first time, which people will be able to receive as direct payments if they wish.

11. The Act makes care and support clearer and fairer, because it:
reforms the funding system for care and support, by introducing a cap on the care costs that people will incur in their lifetime.
will ensure that people do not have to sell their homes in their lifetime to pay for residential care, by providing for a new universal deferred payments scheme;
provides for a single national threshold for eligibility to care and support;
gives new guarantees to ensure continuity of care when people move between areas, to remove the fear that people will be left without the care they need;
includes new protections to ensure that no one goes without care if their providers fails, regardless of who pays for their care;
has new provisions to ensure that young adults are not left without care and support during their transition to the adult care and support system.

12. The new care and support system
You may need care and support if you have a condition such as dementia, or other problems that affect your quality of life or ability to carry out daily activities.
If you have a care and support need, you should contact your local authority, which can provide…
…an assessment of the care and support you need, what services are right for you and whether you are eligible for state support
…info & advice on the services available to help you stay well
…reablement, rehabilitation & other free services
…advice on local services and how much they cost
You will still be responsible for some care-related expenses…
Every year your local authority will review your care needs and your financial situation. From April 2016 they also keep a record of how much eligible care you have needed in total.
You pay what you can afford towards the cost of your care
but from April 2015 you will be able to defer the payment of residential care fees so that you don’t have to sell your home in your lifetime to pay for care.
Your local authority helps with costs you can’t afford
if you have less than £23k of wealth. From April 2016, if you have less than £118k you could receive some financial help with residential care costs.
If you are in residential care, you will pay a contribution towards your general living expenses, just like you would if you were living in your own home. This contribution is expected to be around £12k a year in 2016.
From April 2017 people’ experience of care a support will change;
The Bill provides for a person’s journey through the care and support system, mapping out the process of assessments, charging, establishing entitlements, care planning, and the provision of care and support. In particular:
Single Route: The Bill provides for a single route and a clear duty to meet an adult’s needs for care and support. This includes the ability for people with eligible needs to request that the local authority help them by brokering care and support on their behalf, regardless of their personal finances. This right also applies for carers.
Assessments: The Bill sets out the process of assessments, including requiring sufficient expertise is used in making assessments, for both those who need care and carers, ensuring that the focus is on an individual’s needs and outcomes.
Care and support planning: The Bill sets out what must happen after the conclusion of the assessments, whether or not the local authority is going to meet the person’s needs. This includes the process of care and support planning, including entitlements to personal budgets and ongoing reviews. This includes a requirement for local authorities to prepare an independent personal budget in certain circumstances, even if the authority was not going to be providing care
Financial Assessments: if the local authority is considering providing a service for which they require a charge, then they must carry out a financial assessment to determine how much the person can afford to pay towards the cost of care and support.
Charging: The Bill sets out the powers and rules of local authorities for charging for care and support services, so that people know what to expect.
The Bill proposes a single eligibility threshold for social care, which is intended to be broadly similar to the ‘substantial’ level of care need currently in use.
Capped costs: the Bill allows government to set the level of the cap on care cost contributions and establish personal “care accounts”
Deferred payments: The Bill provides for authorities to enter into agreements with individuals to defer payments payable to the local authority for chargeable services. Regulations may set out when authorities may or must allow someone to defer payment, what charges may be deferred, and any interest or administration fee that may be charged by the authority.
Boundaries of responsibilities between services: The Bill sets out those circumstances in which adult care and support may not meet needs, because the responsibility rests with another organisation. This is intended to set out the boundary between care and support and other services,
Continuity: The Bill ensures that when a person moves local authority area they do not face a gap in their care and support, by assigning to the new local authority responsibility for meeting needs from the day of arrival. The Bill also establishes where a person lives, who is responsible for meeting the person’s needs, a mechanism for resolving disputes and costs recovery.
You are responsible for the cost of any additional services that you choose to have beyond what the local authority would provide, such as having a second bedroom in a care home, or help with lower level care needs.
Care costs after April 2016 are capped at £72k, which is the limit on what you will have to spend on eligible care over your lifetime.
Once you have reached the cap your local authority will pay the reasonable costs to meet your eligible care needs for the rest of your life. If you receive financial support then you could spend less than this amount.

13. DH, LGA and ADASS joint programme office
The Bill has been a great exercise in coproduction, and DH have carried that into implementation by setting up a Programme Board, that has ADASS, and LGA, and providers, and third sector, and services users all represented. Underneath that there is a programme office that is entirely joint between DH, ADASS and LGA, co-located, and they’ve charged themselves collectively with undertaking delivery.
The ‘joint programme office’ has been set up to:
Facilitate engagement in national policy, regulations and statutory guidance
Identify key operational milestones, risks and interdependencies for local government
Provide assurance on implementation
Coproduce tools and other resources to support implementation

14. Care Act milestones Key requirements Timing
Duties on prevention and wellbeing
From April 2015
Duties on information and advice (including advice on 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 test
From April 2016
Care accounts
Capped charging system

15. Further information & resources
The Care Act:
2014/0168/14168.pdf
Explanatory notes:
19 factsheets and a glossary to accompany the Act:
Learning and development programme: