The Care Act 2014 – implications for providersKICA conference – 11th February 2015

Hugh Constant

#SCIECareAct

What we’ll cover

• Overview of the Care Act 2014

• What it means for local authorities

• What it means for providers

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

When is it happening?

Care Act care and support reform

provisions1 April 2015

Royal Assent 14 May 2014

Care Account and Care Cap

1 April 2016

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

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

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Where can the changes be found?

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

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

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

WellbeingIndividual 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

Key points

Different people different priorities

Different times different priorities

All areas are related

Prevent, delay and reduce needs

Information and advice

Integration, cooperation and partnership

General duties to all residents

Safeguarding

Assessment

General duties to residents with certain needs

Independent advocacy

Carers

Duties to individuals who meet certain criteria

Continuity of care

Eligibility

General duties to people receiving care and support

Charging

Deferred payments

General duties to people receiving care and support

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

What might this mean for local authorities?

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

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

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

All in this together?

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

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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

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

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

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

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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

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.

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

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

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

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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

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

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

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

Safeguarding for providers

Poor care – a matter of practice and regulation, not safeguarding

Duty to share information

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

More from SCIE

• SCIE learning events

• Safeguarding

• Assessment and eligibility

• Commissioning

• In-house training and consultancy

• SCIE resources www.scie.org.uk/care-act-2014

• Register for SCIE e-bulletin at www.scie.org.uk

• Email CareAct@scie.org.uk

• Prevention Library http://www.scie.org.uk/prevention-library

• Social Care Online http://www.scie-socialcareonline.org.uk/

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

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

www.scie.org.uk