1. 1 Reforming care and support: The Care Act 2014 27 March 2015

2. 2 National Assistance Act 1948: established the welfare state and abolished the Poor Laws 19481960…1970… Chronically Sick and Disabled Persons Act 1970: reforms to key entitlements to community services A brief history of care and support NHS and Community Care Act 1990: first major set of reforms, including first right to assessments and start of commissioner/ provider split. 1980…1990…2000…2010… Carers (Recognition and Services) Act 1995: the first Act to recognise carers Community Care (Direct Payments) Act 1996: new powers to make direct payments Carers and Disabled Children Act 2000: extending direct payments to carers Health and Social Care Act 2001: updates on direct payments Social care law and policy has evolved over more than 65 years, incorporating around 30 Acts of Parliament, but reform has usually been piecemeal. The Care Act: reforming care and support Putting People First: the concordat which enshrined the personalisation agenda and started the focus on personal budgets

3. 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. 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… Context for change: demands on the system The Care Act: reforming care and support

4. 4 Councils are facing significant and increasing demand and financial pressure. Adult social care spending has fallen by c8.5% in real terms from 2011/12 to end of 2013/14 (2013/14 prices) Since 2011/12 central revenue support for councils has reduced by c10% each year (c39% by end of 2014/15). This is equivalent to a reduction in spending power of c4-5%. Impact varies locally – some councils have seen spending power reduce by c7% each year. Many councils have still given relative protection to ASC compared to some other services. Overall councils have reduced spending on ASC by c8.5% in real terms over three years to end 2013/14, consistent with 3% national efficiency assumption. User numbers have also reduced significantly over the SR period, particularly for +65s: – 19% fewer over-65s receiving community care – 2% fewer over-65s receiving residential/nursing care Reported outcomes and satisfaction have remained stable, but data limited to people receiving care. Overall councils have done very well in delivering savings whilst maintaining outcomes and satisfaction levels. However, picture varies locally and councils have relied on significant support from the NHS. Context for change: financial pressures The Care Act: reforming care and support

5. 5 The number of providers operating in the residential care market has remained relatively stable over time. The total market value was estimated to be £15.2 billion. The market remains very plural. Most providers are small and only have 2/3 care homes, with the 10 largest providers retaining 24 % of total market share. Top 10 providers by market share, UK September 2012 OrganisationRankHomesBeds Group Market Share* %Cumulative % Four Seasons Health Care Ltd. 145223,5666.20% Bupa Care Homes229821,4865.60%11.80% HC-One Ltd324112,9623.40%15.20% Barchester Healthcare Ltd 418912,1653.20%18.40% Care UK5905,6181.50%19.90% Orchard Care Homes 6763,9661.00%20.90% European Care Group 7713,6661.00%21.90% Minster Care Group8743,6231.00%22.80% Runwood Homes Ltd 9483,2460.90%23.70% The care and support provider market (1) Residential Care The Care Act: reforming care and support

6. 6 Approximately 8,600 home care providers are operating in the UK. The total value of the homecare market was estimated to be £6.3 billion in 2011/12, with the 10 largest providers retaining 17.3% of total market share Major providers of independent sector supplied home care, UK 2011-12 Home care providers by turnoverEstimated Annual Turnover (£ million)Market share Saga Group (Allied Healthcare + Nestor)3004.8% Carewatch1392.2% Mears Group plc1121.8% Care UK Ltd1111.8% City & County Healthcare1071.7% Housing 21951.5% Enara Group Ltd931.5% Lifeways Community Care Ltd681.1% Sevacare UK Ltd570.9% Marie Curie (specialist home nursing)370.6% TOP TEN1,08217.3% Remainder5,16782.7% Estimated total market size 20116,249100% The care and support provider market (2) Home Care The Care Act: reforming care and support

7. 7 The care and support workforce The adult care and support market supports a workforce of 1.5m people – more than for the NHS. The vast majority are in the private sector, and many are low-paid. The Care Act: reforming care and support

8. 8 Care and Support Reform

9. 9 Promote people’s wellbeing Enable people to prevent and postpone the need for care and support Put people in control of their lives so they can pursue opportunities to realise their potential The care and support White Paper was published in July 2012 and set out the Government’s vision for the future system. If adult care and support in England is going to respond to challenges it must help people to stay well and independent: The Care Act 2014 underpins and implements this vision. Caring for our Future The Care Act: reforming care and support

10. 10 FromTo “Paternal” The State makes decisions on care and the services people receive. “Personal” Support is built around the needs and outcomes of the person, to fit with their life. “Repair” Focusing only on response after a crisis, when needs are greater and options fewer. “Prevention” Acting earlier to prevent or reduce needs, to help people stay well for longer. “Fragmentation” Isolated services focused internally, with little consistency and people lost between the gaps of organisations. “Integration” Joined-up services working as partners across local communities, and benefitting the whole population. “Exclusive” The focus is on services and institutions, and people are passive recipients of care. “Inclusive” Working with people and communities to develop shared solutions. Our reforms to care and support are intended to achieve four key shifts in the way the system works for people and they experience it: The future care and support system (1) The Care Act: reforming care and support

11. 11 The future system will focus on people by: ensuring that promoting people’s well-being will be at the heart of every decision. putting carers on the same footing as those they care for. creating a new focus on preventing and delaying needs, rather than only intervening at crisis point, and building on the strengths of the local community. embedding rights to choice, personalised care plans and personal budgets, and ensuring a range of high quality services are available locally. The future system will make care and support clearer and fairer by: extending the financial support provided to people who need it most protecting everyone from catastrophic care costs, by introducing a cap on the care costs that they will incur in their lifetime. ensuring that people are not forced to sell their homes in their lifetime to pay for residential care. providing for a national minimum threshold for eligibility to care and support. supporting people with information and advice to understand their rights and responsibilities, access care when they need it, and plan for their future needs. giving new guarantees to ensure continuity of care when people move between areas, or when they reach adulthood. To achieve these key shifts, the reform programme is built around these principles: The future care and support system (2) The Care Act: reforming care and support

12. 12 Staying independent – preventing and planning for care and support Assessing needs Paying for care Meeting eligible needs People should be supported to live independently for as long as they wish, with a focus on delaying and reducing needs, and building different types of support in the community. Local authorities will make available universal support, including information, advice and preventive services. Any adult with any needs for care and support, including carers, has a right to an assessment of their needs and the outcomes they want to achieve. If the local authority charges for a type of support, an adult will have a financial assessment to determine what financial support they may receive. The local authority will involve the adult in a care and support plan to decide how to meet their eligible needs. The local authority may also meet other needs that are not eligible. People who do not have eligible needs will receive information and advice on how to access support locally, and how to prevent or reduce their needs. People who have eligible needs but who choose to arrange their own care and support will receive information and advice on meeting their needs and preventing future needs, and (from April 2016) an independent personal budget. National minimum eligibility threshold The Care Act: reforming care and support Care and support journey in the new system

13. 13 Online services for information and advice Online information is recommended as the primary way for the public and information providers to access information about care and support Critical to meeting many of the duties under the Care Act. Aim is to ensure that citizens remain independent for longer Require an information and advice strategy ensure that accessible, accurate and good quality, to support choice for citizens across a variety of channels and with and through a variety of partners Benefits include early prevention, asset based approach and more informed decision making with overall lower cost and better choice of care Birmingham City Council working in partnership with Turning Point to understand better how to connect people and services in a timely and effective way. Aim of the service is to improve the health and wellbeing of the population by improving access to the existing care and support services in the area and enabling citizens to use community tools to help them access services. Cornerstone of this service is to empower citizens to self direct their care by supporting and enabling the use of the My Care In Birmingham website to identify needs and locate services to support those needs. Targeted at all adults in these client groups and their carers, with a particular focus on people not currently engaged with any services Example of practice The Care Act: reforming care and support

14. 14 Market shaping and commissioning Duty on local authorities to promote a sustainable, diverse and vibrant market for care and support that delivers high quality services for all local people. – Focusing on outcomes and promoting wellbeing – Promoting choice to drive quality – Supporting sustainability – Working with partners and people who use care/carers – Approaches to market intelligence and facilitation – Importance of workforce development and pay – Securing quality and outcomes through contracting The Care Act: reforming care and support

15. 15 Effective commissioning driving better outcomes Central role in driving up quality, enabling people to direct own care, facilitate integrated service delivery & make most effective use of available resources Best delivered in collaboration with others such as NHS & housing partners Commissioning for prevention of those with care and support needs and the wellbeing of all For many will require changes to commissioning and procurement practice Wiltshire ‘Help to Live at Home’ service replaced traditional community care services for older people with an integrated system of care and support. Assessments are person centred and focus on outcomes that leave customers better able to live well with less care. Results are outcomes that improve or preserve independence. Financial penalties applied when customers’ outcomes are not achieved and rewards care providers when customers recover faster than planned The Care Act: reforming care and support

16. 16 Investing in carer’s support Carers within the local community are partners in care. They make significant contribution to maintain the health and wellbeing of the person they care for The Care Act gives LAs a responsibility to assess a carer’s needs for support The LA will assess whether the carer has needs and what they may be. It will consider the impact of caring It will also consider the things that a carer wants to achieve in their own day-to-day life. The person with care needs does not to have eligible needs themselves If both the carer and the person they care for agree, a combined assessment of both their needs can be undertaken. Integrated assessments can also be undertaken Based on a sample from one Council of which there were 24 with identified carer’s (63%) meeting an element of the care needs across substantial and critical. Of those, there were 18 where the identified carer was allocated a budget for carer’s services The Care Act: reforming care and support

17. 17 Focusing on preventing or delaying needs and maintaining independence Assessment and eligibility framework key element of any prevention strategies authorities put in place First contact with the authority, triggers the requirement to assess May identify needs that could be reduced, or delayed by providing specific preventive services, or information and advice on other universal services available locally Could lead to a pause in the assessment process to allow such interventions to take place and for any benefit to the adult to be determined Calderdale Council and the NHS have developed a new integrated front-end service called Gateway to Care. First point of contact between customers and adult social care to help the customer find a solution to their presenting problem, focusing on prevention, early intervention and safeguarding. The service can divert people away from formal care to a community-based solution or offer a direct ’preventative’ intervention which is usually in the form of short-term help to build independence and resilience. Example of practice The Care Act: reforming care and support

18. 18 Appropriate and proportionate assessments From their very first contact with the local authority, an adult with an appearance of need for care and support or a carer should be given as much information as possible about the assessment process Getting the initial response right can save time and costs later. Some local authorities have found that putting in place a single access point for all new requests and people currently receiving care can speed up and simplify the process for people approaching the authority; and can also free up time for professional staff to focus on more complex cases. May decide to use an assessment tool to help collect information about the adult or carer. Social care contact centre in South Tyneside diverts 75 per cent of social care enquiries to solutions developed by the voluntary sector or in the local community. Developed a screening tool for the contact centre which assists staff to make their assessments in a consistent and constructive way. Council ensures that every person has a follow-up contact six weeks after the initial contact to check on the outcome of the intervention. Example of practice The Care Act: reforming care and support

19. 19 What the Care Act means for Mental Health

20. 20 s117 After Care and the Care Act Under the Care Act every mental health patient and carer has a right to a needs assessment and a care and support or support plan (though qualifying patients may then get services under section 117) There is nothing in the Care Act that excludes mentally ill people from any of its provisions which is good news for those who have not been detained under a section that qualifies them for section 117 No one has to accept section 117 services, a few people who qualify see them as discriminatory and may prefer to opt for services provided under the Care Act The Care Act: reforming care and support

21. 21 How the MHA, MCA and Care Act fit together All Acts want to: Enable people to have a say in their own care Support people with information, advice and advocacy to understand their rights and responsibilities Ensure that people’s well-being, and the outcomes which matter to them, will be at the heart of every decision that is made A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success. The Care Act: reforming care and support

22. 22 What the Care Act 2014 means for social workers and AMHPs Shift away from top-down model of care to focus on wellbeing, prevention and early intervention Role of social workers in specialist mental health services needs to go beyond statutory role Integrated mental health services and other employers must recognise and support social work’s wider role The Care Act: reforming care and support

23. 23 Implementing the reforms

24. 24 Approach to implementation The reforms will involve significant changes to how local authorities operate currently, and our approach is therefore based on the principle of co-production with local government, and those who use care and support. Wide-ranging engagement with local government and other key stakeholders to shape and guide reforms. We have established or adapted a series of working groups to co-develop regulations and guidance, and support implementation in each of the work-streams of the overall programme. DH, LGA and ADASS has established a joint programme management office to support implementation and understand LA readiness and risks to delivery. Now added provider sector support to the office. Range of implementation support tools being co-produced covering practice guidance, IT, workforce training, commissioning standards, and financial modelling. The Care Act: reforming care and support

25. 25 Questions and comments? Views and enquiries CareBillReform@local.gov.uk CareBillReform@local.gov.uk Further information http://www.local.gov.uk/care-support-reform The Care Act: reforming care and support