1. The Care Act 2014 – implications for providers KICA conference – 11 th February 2015 Hugh Constant #SCIECareAct

2. What we’ll cover Overview of the Care Act 2014 What it means for local authorities What it means for providers

3. Care Act 2014 The most significant piece of social care legislation since the establishment of the welfare state Builds on recent reviews and reforms Consolidates good practice Replaces numerous previous laws to provide a coherent approach to adult social care in England

4. When is it happening? Care Act care and support reform provisions 1 April 2015 Royal Assent 14 May 2014 Care Account and Care Cap 1 April 2016

5. What it seeks to achieve The Care Act aims to ensure that the care and support system: is clearer and fairer– more consistent and transparent promotes individual’s wellbeing – physical, mental and emotional for all individuals enables people to prevent, reduce or delay needs for care and support puts individuals in control of their lives so they can pursue opportunities and realise their potential

6. Who is affected by the changes? Local authorities NHS Housing New duties Local people Adults with care and support needs Carers, young carers and parent carers New rights/support

7. Where can the changes be found? 7 Primary legislation – the Care Act 2014 Legal duties and powers Secondary legislation – the regulations More detail on critical requirements Statutory guidance Guidance on how to meet the legal obligations in the Act Implementation support Best practice guidance, toolkits, etc. Different sections of the Act are designed to work together Overlap with children and families, including transitions

8. What is happening? Increased focus on individual wellbeing and prevention Wider focus on the whole population Better access to information and advice and assessments for all Embed and extend personalisation New model of paying for care - care account, care cap, PB and DP New national eligibility threshold Duty to integrate, cooperate and work in partnership between partners and local authorities New safeguarding adults duties

9. Wellbeing Duty to promote individual wellbeing - adults, carers, population There is no hierarchy and all aspects of wellbeing or outcomes should be considered of equal importance The wellbeing principle applies to all adults

10. WellbeingWellbeing Individual contribution to society Social and economic wellbeing Work, education, training & recreation Personal dignity Personal control Domestic, family & personal relationships Protection from abuse & neglect Suitability of living arrangements Physical, mental & emotional health Wellbeing principle

11. Key points Different people different priorities Different times different priorities All areas are related

12. Prevent, delay and reduce needsInformation and adviceIntegration, cooperation and partnership General duties to all residents

13. SafeguardingAssessment General duties to residents with certain needs

14. Independent advocacy Carers Duties to individuals who meet certain criteria

15. Continuity of careEligibility General duties to people receiving care and support

16. ChargingDeferred payments General duties to people receiving care and support

17. What might this mean for local authorities? New duties and responsibilities Changes to local systems and processes More assessments and support plans Responsibilities towards all local people Training and development of the workforce Costs of reforms Preparation for reforms needed

18. What might this mean for local authorities?

19. What does this mean for care organisations?  Offering services with regard to the wellbeing principle  Greater local authority focus on promoting diversity and quality in the market and market intelligence about self-funders needed  Greater local authority involvement in services focused on prevention and delay  Market oversight and provider failure arrangements  Charging changes  Ordinary residence changes  Statutory safeguarding arrangements

20. Market shaping  Principles which should underpin market shaping and commissioning  Focus on outcomes and wellbeing  Promoting quality, including workforce development and remuneration, and appropriately resourced care and support  Supporting sustainability  Ensuring choice  Co-production with partners  A duty on local authorities to facilitate diverse, sustainable, high quality services in their area to provide people with meaningful choice regardless of who pays for care – it covers the whole market

21. Market position statement  Suggested, not mandatory  It, market shaping, and the JSNA should involve consulting with:  people needing care and support, and representative organisations  individuals and groups who are less frequently heard  carers and representative organisations  health professionals, social care managers and social workers  independent advocates  support organisations that help people consider care choices (including financial options)  provider organisations (including housing providers and registered social landlords)  wider citizens and communities

22. All in this together?

23. Market Oversight  April 2015: the financial health of the most difficult to replace care and support providers will become subject to monitoring by CQC  These providers have a duty to provide information to CQC  CQC have a duty to assess sustainability and inform local authorities when they consider a provider is likely to be unable to continue  An early warning of likely failure so a local authority can prepare to step in if needed

24. Domiciliary Care  Applies to only the largest and difficult to replace providers – i.e.  Domiciliary providers who deliver:  30,000 hours or more care in a week, or  care to 2,000 or more people in a week, or  care to 800 or more people in a week and they each receive more than 30 hours in that week 24

25. Residential Care  Residential care providers with:  bed capacity of 2,000 beds or more, or  bed capacity of between 1,000 and 2,000 beds and  either they have beds in more than 16 LAs  or the capacity in each of three or more LAs exceeds 10% of the bed capacity of those LAs

26. Financial sustainability of other providers  The vast majority of small and medium providers  LAs must ensure continuity of care in respect of business failure of all providers  Need to have  contingency plans  an understanding of current trading conditions  a sense of the sustainability of their pool of providers  Strengthens the need for contingency planning on all parties

27. Managing provider failure and service interruptions  Triggered whenever there is business failure leading to a service interruption  However this is only triggered “when the service can no longer be provided”  What matters: whether the needs of the people affected appear to be urgent  The duty on a local authority to ensure needs are met is not specific:  providing information on alternative providers  arranging care and support

28. Charging and financial assessment – Care Act principles  Affordable  Comprehensive  Clear and transparent  Promote wellbeing, social inclusion, and personalisation  Independence, choice and control  Be person-focused  Consistent  Encourage employment, education or training  Help people plan for the future costs of meeting their needs  Be sustainable for local authorities in the long-term 28

29. Charging and Financial assessment  This section replaces the Charging for Residential Accommodation Guidance(CRAG) and Fairer Charging Guidance  In 2015/16 sees little change from existing practice  The following do not change (save for annual uprating):  DWP Benefits,  Funded Nursing Care  NHS Continuing Care  Upper capital limit remains at £23,250 for 2015/16  Rules on the use of ‘top-up fees’ are re-enforced to make clear that all arrangements must be through the local authority. This means a provider must not seek a ‘top-up fee’ directly with the person receiving local authority funded care.

30. Charging changes for 2015/16 What does change from April 2015:  Deferred payments: People do not have to sell their homes in their lifetime to pay for residential care  Must be offered by all local authorities  Cannot charge a carer for services provided to the person they care for, even if this is to meet the carer’s needs for support

31. Deferred payments  All local authorities must offer deferred payment agreements when:  A) The person’s eligible needs are to be met by residential care,  B) The person has less than £23,250 in assets excluding the value of their home, and  C) The home is owned outright and is not occupied by a spouse or dependent relative  Local authorities may refuse a deferred payment if,  They are unable to secure a charge on the property, or  The property is uninsurable  First party top ups are allowed within deferred payments

32. Charging changes: 2016 What changes from 2016:  Introduction of the cap on care costs  Regulations now out for consultations  £72,000 care costs  Not included: up to £230 accommodation costs  Extension to the point at which means tested support becomes available. New limits will be:  Upper capital limit of £118,000 in a care home, unless a property disregard applies  Upper capital limit of £27,000 in all other settings or if a property disregard applies  Lower capital limit of £17,000 in all settings

33. LA-arranged care for self-funders  For care in a care home:  “Self-funders” may ask their local authority to meet their needs  This may be by achieved by a range of activity, for example through signposting or brokerage  Can be charged  The person cannot be charged more than the cost the local authority is able to secure, plus an administration charge 33

34. Ordinary residence  Regulations set out three types of accommodation:  Care home/nursing  Supported living/extra care housing  Shared lives schemes, where the principle of deeming applies  For all of them, the relevant LA will be the placing LA, not the host LA, if the LA has arranged the care  Determining ordinary residence involves factors such as time, intention and continuity, and involves questions of both fact and degree  The “deeming provision”: the adult is treated as remaining ordinarily resident in the place the person has voluntarily adopted for settled purposes, whether for a short or long duration  Implications, therefore, where the person lacks mental capacity

35. Safeguarding – LAs must: promote the physical, mental and emotional wellbeing of individuals make or arrange for safeguarding enquiries set up Safeguarding Adults Boards arrange for independent advocacy when it is needed cooperate with each of its relevant partners

36. Safeguarding – LAs must have regard to: the importance of beginning with the assumption that the individual is best-placed to judge their wellbeing respecting an individual’s views, wishes, feelings and beliefs decisions being made having regard to all the individual’s circumstances the need to protect people from abuse and neglect

37. Safeguarding for providers Poor care – a matter of practice and regulation, not safeguarding Duty to share information Poor care – a matter of practice and regulation, not safeguarding Duty to share information

38. Summary – New Opportunities  Services aimed at prevention  different forms of intermediate care  community engagement  information and advice  Independent advocacy  Personal budgets and direct payments  New services as a result of integration  More demand for carer support

39. More from SCIE SCIE learning events Safeguarding Assessment and eligibility Commissioning In-house training and consultancy SCIE resources www.scie.org.uk/care-act-2014www.scie.org.uk/care-act-2014 Register for SCIE e-bulletin at www.scie.org.ukwww.scie.org.uk Email CareAct@scie.org.ukCareAct@scie.org.uk Prevention Library http://www.scie.org.uk/prevention-libraryhttp://www.scie.org.uk/prevention-library Social Care Online http://www.scie-socialcareonline.org.uk/http://www.scie-socialcareonline.org.uk/

40. National implementation support Resources developed by SCIE, Skills for Care, Care Providers Alliance, The College of Social Work, etc. www.local.gov.uk/care-support-reform Register for care and support reform e-bulletin CareBillReform@local.gov.uk Public awareness campaign: Care and Support and You www.gov.uk/careandsupport Care and support reform implementation

41. careact@scie.org.uk hugh.constant@scie.org.uk www.scie.org.uk