1. Care Act 2014

2. Presented by Simon Cheverst of RadcliffesLeBrasseur May 2015

3. Background Legislative development Reflective of the changing philosophy Complete review and overhaul required

4. Community care legislation pre April 2015 National Assistance Act 1948 Health Services and Public Health Act 1968 Chronically Sick and Disabled Persons Act 1970 Section 117 of the Mental Health Act 1983 Disabled Persons (Consultation, Recognition and Services) Act 1986 NHS and Community Care Act 1990 Carers (Recognition and Services) Act 1995 Health and Social Care Act 2001 Section 254 and Schedule 20 of the NHS Act 2006 Not to mention the Guidance….

5. Review and Response Reviews are undertaken by the Dilnot Commission and the Law Commission followed up by consultation, White Papers, debate and draft bills Former legislation repealed and replaced with Care Act 2014. Staggered implementation: –General community care provisions come into effect on 1 April 2015. –Funding aspects of reform to come into effect 1 April 2016.

6. Arrangement of the Care Act 2014 General Responsibilities (s 1 – 7) Examples of how to meet need (s 8) Assessment of needs and eligibility (s 9 - 13) Duties and powers to provide for needs (s 18 - 23) Direct and deferred payments (s 31 – 36) Continuity of care and ordinary residence (s 37 – 41) Safeguarding (s 42 – 47) Market Shaping and transitions for young people (s 53 – 66) Advocacy (s 67 – 68) Duty of Candour (Part 2) Underpinned by statutory regulations and guidance.

7. General responsibilities of Local Authorities Section 1 – Promoting individual wellbeing. Outcome focused and underpinned by principles of wellbeing

8. Section 1 outcomes Personal dignity Physical and mental health, and emotional wellbeing Protection from abuse and neglect Control over day to day life Participation in work, education, training or recreation Social and economic wellbeing Domestic, family and personal relationships Suitability of living accommodation Individuals contribution to society

9. Wellbeing checklist Assumption that the person is the best judge of their wellbeing Persons views, wishes and feelings Importance of preventing or delaying needs All the persons circumstances Full participation in decision making Balance with wellbeing of carers Protection from abuse and neglect Minimum restrictions

10. General duties Preventing needs for care and support (s.2) Promote integration of health and social care (s.3) Information and advice (s.4) Promote diversity and equality in services (s.5)

11. Duty to cooperate General duty to cooperate with relevant partners (s.6) Specific duty to request cooperation with relevant partners (s.7)

12. Assessment Sections 9 to 12 provide that: The Local Authority are under a duty to assess where an adult appears to need care and support. That adult has a right to refuse an assessment, save where he or she lacks capacity and the assessment is in their best interest, or where there are safeguarding concerns. There is a duty to consult the adult, any carers and any other person named by the adult. Regulations provide the right to a supported self assessment and a specialist assessment. The assessment should be proportionate to the presenting issues.

13. Eligibility criteria Section 13 provides : A national eligibility framework. The governmental duty to set eligibility criteria in regulations. New national minimum thresholds set at substantial. In order to qualify the person must have 1) an impairment or illness; 2) be unable to achieve 2 of the listed outcomes which 3) has a significant impact on wellbeing.

14. Listed outcomes Nutritional needs Hygiene needs Toiletry needs Clothing needs Safety at home Maintain a habitable home environment Develop or maintain relationships Engage in work training, education or volunteering Accessing and making use of community services Looking after a child

15. Carers rights Sections 10 to 13 provide: A duty to assess any carer who appears to have need for support. Removal of the requirement that the support be provided on a regular/substantial basis. Removal of the requirement for the carer to request an assessment. A duty to provide a service if the need arises from 1) the caring activity, 2) a (one) listed circumstance applies and 3) this has a significant impact upon wellbeing.

16. Carers outcomes Care for a child Provide care to those other than the adult Maintain a habitable home Nutrition Maintain personal relationships Access the community Engage in recreational activity

17. Following assessment Sections 25 and 26 provide the right to a care and support plan, and also place a duty on the Local Authority to provide a personal budget. Section 29 places a duty upon the Local Authority to provide a care account. Section 30 places a duty upon the Local Authority to provide or arrange preferred accommodation. Sections 31 to 33 provide a right to direct payment.

18. Financial assessments and charging At present and until April 2016: Financial upper threshold of £23,250 (capital) and lower threshold of £14,250. Minimum income for non-residential care linked to income support regulations (ISR) + 25% + disability related expenses. LA’s have some discretion. Certain income and capital sums must be disregarded (personal injury payments, etc). Those above the threshold can ask the LA to arrange though an administration charge may be levied.

19. The Reforms April 2016 Cap on care costs: £72,000 for older people. Lower for people of a working age (figure to be determined though estimated at somewhere in the region of £40,000) Zero pounds for those 18 or younger at the point the need arose. Financial assessment for residential services (UL remains at the 23k level for non-residential services) £118,000 upper limit £17,000 lower limit Mandatory deferred payment scheme in operation.

20. Adult safeguarding Puts for the first time adult safeguarding on a statutory footing. Section 42 provides that the Local Authority must make enquiries it considers necessary (or cause enquiries to be made where it suspects: –An individual has care and support needs. –An individual may be subject to abuse or neglect. –Is unable to safeguard themselves.

21. Safeguarding Adult Boards (SAB) Section 43 and schedule 2 provides: A duty on the Local Authority to establish a SAB With primary objective to help and protect adults at risk of abuse or neglect. NHS and Police must nominate members with required skills and experience. Section provides statutory duty to provide information to an SAB. Statutory safeguarding adults reviews (section 44). SAB may do anything necessary or desirable in achieving the primary objective.

22. Additional reforms Extension of the Human Rights Act to services procured by the Local Authority. Right to portable assessments. Changes to Section 117 of the Mental Health Act. New appeals process. Rights to advocacy. Transitional assessments for young people. Care and support in prison. Duties in the case of business failure.

23. DISCUSSION…