Care Act 2014 – Staff Briefings

Care Act 2014 – Staff Briefings

Key themes of today Overview and main principles of the Act
Information and advice Assessment and eligibility Care and support planning Financial assessments and payment processes Deferred payments Personal budgets and direct payments Transitions 2

Objectives By the end of the session you should be able to;
Describe the main themes of the Care Act 2014 Define the eligibility criteria Identify the key principles of financial assessment and eligibility Review the changes around care and support planning Understand the changes to the deferred payments scheme Define how Personal Budgets will work Understand the role you will play to deliver the Care Act changes Ownership of Council resources

Introduction The Care Act received Royal Assent on 14 May 2014
The Act is in three parts: Care and support Care standards Health Part 1 of the Act consolidates and modernises the framework of care and support law: New duties for local authorities New rights for service users and carers The majority of changes and consolidation of law takes place from April 2015 in phase one of the implementation. Phase two is concerned with the major reforms to the way that social care is funded, including the care cap and the care account, which will not come into operation until April 2016 Parts 2 and 3 of the Act deal with: recommendations from the Francis report (Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry), quality failure in health care providers, setting up a new performance rating system for health and care providers establishing Health Education England and the Health Research Authority.

Overview of timescales
Date Milestone May 2014 Received Royal Assent Jun 2014 Publication of draft guidance and regulations (Part 1) Oct 2014 Publication of final guidance and regulations (Part 1) Feb 2014 Publication of draft guidance and regulations (Part 2) Feb 2015 National communications campaign – phase 1 Apr 2015 Part 1 Care Act implemented – Care & support reforms Jul 2015 National communications campaign – phase 2 Oct 2015 Publication of final guidance and regulations (Part 2) Early assessments for self-funders Apr 2016 Part 2 Care Act implemented – Funding reforms

The Care Act 2014 replaces many previous laws
… … … … … National Assistance Act 1948 NHS and Community Care Act 1990 Carers (Recognition and Services) Act 1995 Chronically Sick and Disabled Person Act 1970 Community Care (Direct Payments) Act 1996 The Act is both a reforming piece of legislation (it changes the law) and a consolidating piece of legislation (it repeals many previous laws relating to care and support and replaces them with this Act). It builds on the coalition government’s ‘Vision for Adult Social Care’ document and ‘Caring for Our Future’ White Paper. Some of the changes in the Act are not completely new as they were previously best practice, but were not a statutory requirement for local authorities. This means that the impact of the Act will be different in different local areas, depending on how local areas had previously implemented best practice guidance May have legal challenge on new Act. E.g. challenge over installing a phone under chronically sick and disabled person act

What is the Act trying to achieve?
That care and support: is clearer and fairer promotes people’s wellbeing enables people to prevent and delay the need for care and support, and carers to maintain their caring role puts people in control of their lives so they can pursue opportunities to realise their potential The Act aims to makes care and support clearer and fairer, for example it: outlines a single national eligibility threshold for care and support requires local authorities to provide all local people with information and advice, related to care and support, to help them understand their rights and responsibilities, and plan for their future needs includes protections so that people do not go without care if their provider fails, regardless of who pays for their care Central to the Act is the concept of wellbeing. First and foremost local authorities now have a duty to consider the wellbeing of the individual needing care or support. The underpinning principle of the Act is to ensure that people’s wellbeing, and the outcomes which matter to them, are at the heart of every decision that is made. Rebalance the focus of social care on postponing the need for care rather than only intervening at crisis point. The aim is that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents needs or postpones deterioration wherever possible. Recognises carers’ vital input and aims to help them maintain their caring role, if they are willing and able to do so Embeds people’s rights to choice, personalised care and support plans, and personal budgets in legislation. A key aim of the Act is to embed and extend personalisation in social care. Person-centred care and support planning puts people at the heart of their care and offers them the opportunity to take control and ownership of the process and outcomes of their plan. Everybody will have a personal budget as part of their plan that identifies the cost of their care and support and the amount that the local authority will make available regardless of their care setting

An integrated Act Different sections of the Act are designed to work together Local authority wide Overlap with Children and Families, including transitions Partnerships and integration Leadership The Act is designed to be considered in its entirety and different sections should not be implemented in isolation. For example, one way of preventing or delaying the need for care and support is a good information and advice service that is accessible to all people in the local area. To be successfully implemented some elements of the Act need the cooperation of the whole local authority. It is important that wider parts of the local authority, such as public health and housing, are engaged. Part 3 of the Children and Families Act 2014 focuses on Special Educational Needs and Disability and introduces a system of support which extends from birth to 25. The Care Act deals with adult social care for anyone over the age of 18 and for young people moving into adult social care. This means there may be a group of young people aged who could be entitled to support though both pieces of legislation. The two Acts also have the same emphasis on outcomes, personalisation, and the integration of services. It is therefore essential that the planning and implementation of both of these Acts is joined up at a local level. For example, changes to transitions will need children’s services and adult’s services to work together to implement best practice. Need to act in partnership with other organisations to implement the Act successfully. Local authorities are required to carry out their functions with the aim of integrating services with those provided by the NHS and others such as housing, welfare and employment services. The importance of well-informed leadership - by the local authority as well as social care organisations from all sectors, health and other local authority partners – will be central to the successful implementation of the Act.

The framework of the Act and its statutory guidance
Assessment and eligibility Charging and financial assessment Care and support planning Cap & threshold Personal budgets and direct payments Review Key processes Prevention Information, advice and advocacy Diversity of provision and market oversight Integration, partnerships and transitions Safeguarding Carers General responsibilities and key duties Wellbeing Underpinning principle The Act places the wellbeing of the individual at its core by having wellbeing as the underpinning principle of the Act An enhanced focus on prevention New duties to act in partnership with others and with a focus on integration with health Improved transitions for young people Extended responsibilities for information and advice services The provision of an independent advocate if a person would otherwise be unable to participate in or understand the care and support system Better oversight of the care provider market to ensure it is diverse and sustainable, offering choice to service users Changes to safeguarding arrangements. E.g. establish Safeguarding Adults Boards There are also significant changes to the key processes that support someone to access the care and support system such as assessment and eligibility care and support planning charging and financial assessment There are a few other provisions (not shown on this diagram) that complete the legal framework: changes to ordinary residence – establishing where a person lives and how that affects the responsibilities of local authorities cross border placements – the ability to make care home placements in different UK countries the extension of the Human Rights Act to cover people receiving care and support from a regulated provider that is arranged by their council, whether in a residential setting or at home, however, this provision will not apply to people arranging or paying directly for their own care clarification of local authority responsibilities in relation to people in prison with needs a requirement to hold registers of blind and partially sighted people delegation of functions - a legal right for councils to contract out mainstream social work functions related to assessment, resource allocation and care planning if they so choose

The wellbeing principle
Wellbeing broadly defined: 9 areas in particular Local authorities should also have regard to other key principles when carrying out their activities, such as beginning with the assumption that the individual is best-placed to judge their wellbeing “The general duty of a local authority, … in the case of an individual, is to promote that individual’s wellbeing”. Creates a new statutory principle to embed individual wellbeing as the driving force behind care and support. Applies to local authorities not providers, but local authorities may make wellbeing a contractual obligation for providers. The Act defines wellbeing as made up of nine aspects. Sub section 3 then sets out a series of things the local authority must also have regard to when carrying out their functions, such as: individual is best-placed to judge their wellbeing respecting an individual’s views, wishes, feelings and beliefs decisions are made having regard to all the individual’s circumstances the need to protect people from abuse and neglect. Is not just to those who are eligible for care and support but should also apply to anyone who comes into contact with the care system Requires assessments to be holistic; less about deficit models of care, and more about enabling people to build on their strengths. Talking about individual rather than a collective sense of wellbeing. However, section 1.13 of the guidance does says that the principle should also be considered by the local authority when it undertakes broader strategic functions and cites planning as an example Three main ways within the Act and guidance: wellbeing underpinning discussions that might take place as part of the assessment etc. principles which can be used as a test against which individual decisions might be judged i.e. does changing this person’s care arrangements impact on their wellbeing? set of principles which judge the impact of broader, strategic decisions of the LA. However, the absence of a perception of wellbeing on the part of an individual does not automatically mean that they are entitled to care and support or that wellbeing is the only consideration that is used to judge who may have eligible needs for care and support.

Wellbeing Definition of wellbeing
Wellbeing is a broad concept, and the statutory guidance defines it as relating to the following nine areas in particular: personal dignity (including treatment of the individual with respect) physical and mental health and emotional wellbeing protection from abuse and neglect control by the individual over day-to-day life (including over care and support provided and the way it is provided) participation in work, education, training or recreation social and economic wellbeing domestic, family and personal relationships suitability of living accommodation the individual’s contribution to society We wont necessarily be involved in these. We may just signpost people to achieve these These are basic entitlements

New responsibilities of local authorities towards all local people
Arranging services or taking other steps to prevent, reduce or delay peoples’ needs for care and support Provision of information and advice, including independent financial advice Promoting diversity and quality in the market of care providers so that there are services/supports for people to choose from Local authorities’ universal obligations towards all local people A local authority is under a general duty to prevent, delay or reduce the need for care and support of all local people in its area. Local authorities will need to: facilitate a market that delivers appropriate supply to meet those needs identify people who may have needs that are not already being met identify carers who may have needs that are not being met. The Act identifies three main strands of prevention – preventing, delaying and reducing the needs for care and support. Local authorities must provide an information and advice service to help all local people understand the care and support system, access services and plan for the future, including enabling people to access independent financial advice to help steer them through the complexities of care funding. Information and advice must be accessible to all, so it cannot be simply online, and must be "proportionate" to an individual's needs New requirement on local authorities - promote a sustainable, diverse and vibrant market for care and support that delivers high quality services for all local people Genuine choice of service type available to people, not only a selection of providers offering similar services. Principal tool for achieving the market shaping duty is commissioning and contracting practices. The guidance recommends local authorities publish a Market Position Statement to help them understand, facilitate and engage with the local care market and demonstrate that they are meeting this duty.

New duties – integration and market oversight
A statutory requirement to collaborate and cooperate with other public authorities, including duty to promote integration with NHS and other services Duty for local authorities to step in to ensure that no one is left without the care they need if their service closes because of business failure CQC oversight of financial health of providers most difficult to replace were they to fail and to provide assistance to local authorities if providers do fail Duties on local authorities to promote integration and to cooperate generally and specifically in relation to individuals. The general requirement applies to all the local authorities’ care and support functions. There is a reciprocal ‘integration’ duty on health partners. There is a learning module about integration, cooperation and partnerships for more detail on this area. Managing provider failure. The aim is to ensure continuity of care, not to prop up failing providers. There is an updated duty for a local authority to temporarily meet needs when a care provider suffers a business failure and the services cease. It clarifies the local authority duty to step in to ensure that no one is left without the care they need. New market shaping duties mean they should understand the sustainability and capacity of their whole local market i.e. including those elements that they do not directly procure or commission. This should place them in a strong position for developing contingency plans for provider business failure and ensuring continuity of care in the event that a provider does suffer a business failure and the services cease. A new market oversight regime and a role for the Care Quality Commission (CQC) in relation to financial oversight of certain “difficult to replace” care providers. It aims to give Government early warning if one of these providers is likely to fail. The collapse of Southern Cross in 2011 demonstrated the potential effect of a large provider failing financially and there is now a requirement for CQC to assess financial sustainability of these providers and inform local authorities when failure is imminent, to support local planning.

New duties – advocacy, safeguarding and transitions
A duty to arrange independent advocacy if a person would otherwise be unable to participate in or understand the care and support system New statutory framework for protecting adults from neglect and abuse. Duty on local authorities to investigate suspected abuse or neglect, past or present, experienced by adults still living and deceased Duty to assess young people and their carers in advance of transition from children’s to adult services, where likely to need care and support as an adult Duty to arrange independent advocacy if the authority considers an individual would experience ‘substantial difficulty’ in participating. The duty does not arise if the local authority is satisfied that there is some other person who is an appropriate representative (provided that person is not engaged in providing care for the individual in a professional capacity or being paid to do so). Statutory footing some of the government’s expectations regarding safeguarding co-ordination. It includes the duty for the local authority to carry out enquiries where it suspects an adult is at risk of abuse or neglect past or present and to provide any services specified in a subsequent protection plan regardless of their eligibility status. Requirement for all areas to establish a Safeguarding Adults Board (SAB) with core partners to coordinate activity to protect adults from abuse and neglect. Young people under-18 who have complex health needs or life-limiting or life-threatening conditions may need to move from receiving ‘children’s’ services to ‘adult’s’ social care services. This move, known as transition. The Act introduces new duties on local authorities to carry out a transition assessment if they are likely to have needs for care and support after turning 18, and when there is significant benefit to the young person or carer in doing so. The assessment should be carried out at a time when it is of “significant benefit” to a young person’s preparation for adulthood. The purpose is to determine what adult social care a young person might be eligible for so they can make informed choices about their future.

Changes to assessment, eligibility and financial assessment processes
Person appears to have needs Assessment Are their needs eligible? YES NO (written explanation) Summary of the assessment, eligibility and financial assessment processes that a local authority must ensure are in place. Must undertake an assessment for anyone who appears to have any needs for care and support. Assessment starts from when local authorities start to collect information about the person. The assessment must focus on needs and the outcomes the person wants to achieve, consider the person’s strengths and capabilities and what preventative community based services may help the person improve their wellbeing – this could include provision that is universally available or be from the person’s wider network. After assessment, the LA will determine whether the individual has eligible needs against a new national eligibility threshold. If person’s unmet needs are not eligible, the local authority must provide a written explanation of the reasons why it is not going to meet their needs. The local authority must also provide personalised information and advice in writing on how to meet the needs they do have, and how the person can prevent or delay future needs. If the person’s unmet needs are eligible, the person wants support and the type of service(s) being considered is chargeable, then the local authority must carry out a financial assessment. The financial assessment will determine how much the person, and how much the local authority, will pay. The Act provides a new single legal framework for charging for care and support, which means that as of 1 April 2015 the guidance provided by CRAG and Fairer Charging will cease to apply. During the financial assessment, if relevant, the local authority must inform the person of their right to a deferred payment agreement (DPA). Duty to operate a deferred payment scheme and to offer deferred payments to people meeting the acceptance criteria for the scheme (they also have fairly broad discretion to offer it to other people). Deferred payment agreement Advice and information Care and support planning Financial assessment

What might this mean for people needing care and support?
April 2015 Better access to information and advice, preventative services, and assessment of need An entitlement to care and support, plans and reviews Personal budgets on a statutory footing for the first time Universal deferred payments scheme A common system across the country: Continuity of care Fair Access to Care Services (FACS) replaced by a national eligibility threshold April 2016 A cap on care expenditure comes into effect from April 2016 (£72,000 for non working age adults) Increase asset threshold to £118,000 (when include value of the property) Wider focus on the whole population that may need care rather than just those who have eligible needs and/or are state funded. The Act sets out an entitlement to care and support based on eligible unmet needs after assessment, where the person normally lives (ordinary residence) and, where relevant, the outcome of a financial assessment. New model of paying for care, putting in place – from April a cap on the care expenditure which an individual is liable for (see slide 17 for more details). In line with the Act’s aim of being clearer and fairer about care and support it seeks to impose a common system across the country. This is enacted via continuity of care and national eligibility criteria. Prescribes the way local authorities transfer responsibility for care and support if somebody moves from one local authority area to another so that their care is not interrupted. Continuity of care means making sure that there is no gap. This also applies to the needs of any carer moving with the person. The continuity duty continues until the second authority has carried out its own assessment and put in place all necessary care and support on the basis of that assessment. The national eligibility threshold replaces Fair Access to Care (FACS) .

What does this mean for carers?
The Care Act strengthens the rights and recognition of carers: Improved access to information and advocacy should make it easier for carers to access support and plan for their future needs The emphasis on prevention will mean that carers should receive support early on and before reaching crisis point Adults and carers have the same rights to an assessment on the appearance of needs A local authority must meet eligible needs of carers and prepare a support plan A carer should be kept informed of the care and support plan of the person they care for Duty to identify and refer young carers Children and Families Act 2014 Young carers service – being decommissioned from action for children. New arrangements being explored for the short term, from April 2015 and for the longer term i.e. fit with early help hubs. Most of the duties and principles within the Act apply to carers as well as to the person in receipt of care. It strengthens the rights and recognition of carers, including, for the first time, giving carers a clear entitlement to support, the duty to provide independent advocacy etc. The emphasis on prevention will mean that carers should receive support early on and before reaching crisis point. The previous requirement to provide ‘substantial’ and ‘regular’ care will be removed, and it removes the requirement to ask for an assessment. Assessments will need to consider what else (apart from the provision of support) would help to meet the outcomes that a carer wants. A new legal entitlement to support for carers. If a carer is ordinarily resident or present in the local authority’s area and their needs meet the eligibility criteria. If a carer is deemed to have eligible needs, the local authority should prepare a “support plan”. The support plan must help the carer decide how their needs should be met and which (if any) would be met by direct payment i.e. direct payments can be provided to carers. Ability of local authorities to charge carers for support – except for respite care - but authorities must have regard to the impact of doing so. Extends the rights of carers of adults, but note that corresponding duties have been included in the Children and Families Act 2014, which includes new duties for the assessment of young carers and parent carers of children under 18.

What this means for Trafford
New duties and responsibilities Changes to local systems and processes More assessments and support plans Responsibilities towards all local people Better understanding of self funders Continued understanding of care market Training and development of the workforce Costs of reforms On-going preparation for reforms There are many new statutory duties for local authorities, albeit that some of them are not completely new as they were previously best practice. The implications for local authorities will depend on their previous practices. Many of the reforms will most likely require changes to the financial, admin and IT systems e.g. to establish and monitor care accounts, to support increased number of deferred payment agreements, or to enable supported self-assessments, self-funder assessments. Duties have been widened to, in some instances, include all people in the local area with care and support needs not just those who are state funded. Requirement to promote a sustainable, diverse and vibrant market for care and support that delivers high quality services for all local people i.e. including self-funders. Local authorities will need to have a better understanding of self funders and the care market and ensure their Market Position Statements take into account the whole market. Require an increase in workforce capacity and/or new roles and ways of working. Significant financial impact on councils. The Department of Health (DH), Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) are working to analyse these costs and develop additional funding formulae for local authorities to implement the new duties. Take steps in 2015/16 to prepare for funding reform: understanding likely demand, awareness-raising, capacity-building, and early assessments.

Summary A significant piece of legislation that modernises the framework of care and support law, bringing in: New duties for local authorities New rights for service users and carers It aims to make care and support clearer and fairer and to put people’s wellbeing at the centre of decisions, and embed and extend personalisation Local authorities have new responsibilities towards all local people, including self funders There are significant changes to the way that people will access the care and support system

Sources of Information and advice
This is an overview of information and advice. It is intended for anyone who would like to know more about section 4 of the Care Act. Sources of Information and advice

What is information and advice?
Self-help information Websites, leaflets, NHS Choices etc No interaction Assisted information Telephone helplines, directories, libraries, one stop shops, CAB, charities, information centres, GPs, frontline staff etc Limited to moderate interaction Advice Telephone lines, information centres, one stop shops, CAB, support groups, carers centres, CIL, social workers, GPs, outreach staff/workers etc Moderate to high interaction Specialist advice and advocacy Independent financial advisers, legal help on complex matters in specific areas of law, independent advocates High interaction Information and advice is fundamental to enabling people to take control of, and make well-informed choices about, their care and support and how they fund it. So there is a clear link between good information and advice and the underpinning wellbeing principle of the Act. It is also a vital component of preventing or delaying people’s need for care and support. However, it can be difficult to unpick information, advice and advocacy services, since for many users of care and support, these three types of service provision overlap and are inter-related. In order to access the right services and/or information, people may require support from each of these types of services, and they do not always follow a linear progression (such as the person moving from a position of requiring information to advice and then advocacy). Helpful therefore to think of it as a spectrum of information and advice ‘activity’ with overlaps between the groupings. Four types of activity are identified in this spectrum self-help information assisted information Advice specialist advice and advocacy – Examples of common delivery mechanisms for these activities and their likely associated level of interaction between the person needing information and advice and those providing it. Note CAB = Citizen’s Advice Bureau, CIL = Centre for Independent Living.

A duty on local authorities
Section 4 of the Care Act places a duty on local authorities to ensure the availability of information and advice services for all people in its area, regardless of whether or not they have eligible care needs Local authorities do not have to provide all elements of this service Section 4 (1) of the Act says that local authorities must “establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers.” Importantly, the duty relates to the whole population of the local authority area, not just those with care and support needs or in some other way known to the system. The information and advice service should be more than many authorities have typically provided, and must be more than just basic information. Local authorities must ensure that the areas covered by their information and advice service go much further than a narrow definition of care and support and should therefore include care and support related aspects of health, housing, benefits, and employment. Whilst local authorities must establish and maintain a service, they do not have to provide all elements of this service. In many cases a local authority may not be best placed to provide advice, but they are expected to: Understand, coordinate and make effective use of all the high quality information and advice resources that are available. Think about how they are reaching out and joining up with other providers of information and advice to ensure the coherence of the overall ‘offer’. Signpost or refer people to relevant independent and impartial sources of information and advice.

What needs to be provided?
Information about how the local care and support system works How people can access care and support services What types of care and support are available Financial information and advice, including how to access independent financial advice How to raise concerns about the safety or wellbeing of someone who has care and support needs Help people to understand how care and support services work locally, the care and funding options available, and how people can access care and support services. The Act states that information and advice must be provided on these areas in particular: How the system works. An outline of what the ‘process’ may entail and the judgements that may need to be made, including specific information on what the assessment process and eligibility process is, how to complain or make a formal appeal to the authority, what they involve and when independent advocacy should be provided. How people can access support i.e. where/who and how to make contact, including information on how and where to request an assessment of needs, a review or to complain or appeal against a decision. The types and range of care and support services available to local people and which local providers offer certain types of services, including universal and wider services that support wellbeing. Where possible this should include the likely costs to the person of the care and support services available to them. Financial information and advice must include charging arrangements and how a person might plan for their future care. Local authorities must also identify those who may benefit from independent financial advice or information as early as possible, and help them to access it. How people can raise concerns about the safety or wellbeing of someone who has care and support needs and what will happen when such concerns are raised. Where it is reasonable, information and advice should also cover care and support services that, whilst physically provided outside the authority's area, are usually available to its local population.

Accessibility and proportionality
Information should be accessible to all who would benefit from it: A range of delivery mechanisms Staff aware of accessibility issues and appropriately trained Materials are adapted as necessary e.g. easy read versions The type, extent and timing of information and advice provided should be appropriate to the needs of the person: The right level needs to be provided at the right time More complex issues may require more intensive and more personalised information and advice Local authorities must ensure that information and advice is accessible and open to all who would benefit from it. Putting this into practice would mean for instance: advice and information content should, where possible, be provided in the manner preferred by the person and will therefore often need to be available in a number of different formats – not just leaflets and websites! websites meet accessibility standards printed materials clear and in plain English easy read versions other reasonable adjustments for groups with special needs such as people with sensory impairments, physical or learning disabilities or mental health problems; and people who do not have English as a first language. Help from an independent person to access or avail themselves of information and advice. The guidance says that “information and advice [should be] proportionate to the needs of those for whom it is provided”. In other words, the type, extent and timing of information and advice provided should be appropriate to the needs of the person. More complex issues may require more intensive and more personalised information and advice, helping people to understand the choices available to them, while general enquiries may require a less intensive approach. It is also important that the right level of information and advice is provided at the right time, recognising that a person’s need for information or advice may vary depending on the circumstance. For example, providing a person with too much information, more than they can take in, perhaps at a time of crisis, can be counter-productive.

Information & Advice at Trafford
Information and advice services reviewed in 2013 to ensure effectiveness On-going work to consolidate existing advice offer across CFW Council information and advice Access Trafford Screening & Signposting MyWay, Trafford Service Directory websites Welfare Advice Team Community advice services Citizens Advice Trafford Housing Options Healthwatch Trafford Carers Centre MyChoice eMarketplace Other voluntary sector organisations Developing signposting for indep financial advice Expanding advocacy provision

Assessment and eligibility
Care Act 2014 Assessment and eligibility

Outline of content Appropriate and proportionate assessment
Preventing needs Taking a holistic, strengths-based approach Supporting a person’s involvement Roles, responsibilities and expertise National eligibility framework Next steps and informing individuals Summary

Assessment Assessment is both a key process AND a critical intervention in ensuring the person independence is maintained or further developed An assessment should identify: Clearly define and evidence care and support needs what outcomes the individual is looking to achieve to maintain or improve their wellbeing how care and support might help in achieving those outcomes Draw on personal, community and family assets to promote independence Local authorities must assess anyone who appears to have any level of needs for care and support. This is regardless of the person’s financial situation. Assessment is not a gateway to services but an intervention it it’s own right. It is a crucial way to help a person understand their needs and how they can be met. For the assessor they must establish the full extent of the needs, including those currently met by a carer. This so called ‘carer blind’ aspect of assessment is new. It aims to ensure that the entirety of a person’s needs are identified. (See SCIE resources) Local Authority must take an assessment for anyone who appears to have any level of needs for care and support. Regardless of financial position. Assessment is not a gateway to services but an intervention its own right. So helping the person understand their own needs and how they can achieve outcomes. It must be a carer blind assessment – new requirement to ensure the entireity of the needs are identified. This is about what people need not what they want

Refusal of assessment The local authority is not required to carry out assessment where a person with possible care and support needs or a carer: feels that they do not need care may not want local authority support This can be overridden where they: lack capacity to take that decision and an assessment would be in their best interests are experiencing, or at risk of experiencing, any abuse or neglect

Appropriate and proportionate assessment
People should receive an assessment that is appropriate and proportionate – as extensive as required to meet a person’s needs. The process can be flexible and include e.g. telephone (screening & signposting), on-line (being developed at Trafford), face to face and combined assessments (utilising carer assessments where appropriate) To be appropriate assessments should meet the person’s communication needs Appropriate assessments can include the use of reablement, or aids and adaptations to ensure greater understanding of need Proportionate assessment exercise – one each Facilitator’s hints and tips Proportionate assessment may represent a cultural change for assessors used to applying more comprehensive approaches to a wide range of situations, and if relevant this dimension could be explored further with learners. This could include a discussion of what processes or behaviours can be put in place, or encouraged, so that all assessments fulfil the statutory duties, regardless of format? For example, judging the impact of a person’s needs on their wellbeing, or making a decision on the person’s capacity to make decisions. (See additional notes on proportionate assessment) It is also important to stress that this should be a person-centred process. Is the assessment proportionate to the severity of need and complexity of the situation.

Integrated assessments
All of the agencies involved should work closely together to prevent a person having to undergo a number of assessments at different times To achieve this local authorities should: ensure healthcare professionals’ views and expertise are taken into account work with healthcare professionals to ensure people’s health and care services are aligned and set out in a single care and support plan In cases of abuse, the local authority should lead the assessment and ensure that all agencies follow the local multi-agency procedures to ensure coordination of information and possible evidence It will be important to emphasise, early on in this session that assessment should not be seen as a gateway to eligibility and services. This may run counter to approaches that local assessors have been used to over several years. It may be appropriate therefore to explore with learners how their current or previous approach to assessment differs (or not) from the aims for assessment outlined in the statutory guidance. The guidance suggests a different way of approaching a task that some may have undertaken in a particular way for a long period of time. The guidance sees assessment as an opportunity for prevention, to delay or prevent people from having eligible needs and to explore strengths-based approaches – as will be explored in next few sections. It is important not to lose sight of the need to make this process person-centred and to involve the person as fully as possible. It is also important to stress the centrality of outcomes: outcomes may best be thought of in this context as the impacts that the person would like to achieve on their quality of life. The move to integrated health and social care teams at Trafford will support this.

Fluctuating needs In establishing the on-going level of need local authorities: must consider the person’s care and support history over a suitable period of time to take account of potential fluctuation of needs may also take into account at this point what fluctuations in need can be reasonably expected based on experience of others with a similar condition Particularly where people lack capacity This considers the action required to identify those needs which may not be apparent at the time of the assessment but which may have been in the past and may arise again in the future. The point at which the local authority assesses the individual’s needs may not be a true reflection of their condition over time. Their fluctuating needs need to be built into the care plan – assuming they are eligible for support. EG flexible services

Supported self-assessment – check eligibility
The local authority must offer the individual the choice of a supported self-assessment if they are able and willing. The person should be asked to complete the same assessment questionnaire that the authority uses in their needs or carer’s assessments The individual must have capacity to fully assess and reflect their own needs The local authority must assure itself that the person’s supported self-assessment is an accurate and complete reflection of their needs because there may be a difference of opinion Regardless of the format a needs assessment takes, the final decision on eligibility is with the local authority Guidance says that a supported self assessment is an assessment carried out jointly with the adult or carer and the LA. It places the individual in control of the process. It should be offered to the individual if they are willing and able to undertake it – they complete the form themselves. In Trafford we are finalising the online assessment tool – this would need to be followed up by professional assessment. Using the initial assessment form (currently screening part b) if requested

Preventing needs Assessment is a key element of any prevention strategy The assessment must consider whether the person concerned would benefit from the available preventative services, facilities or resources The guidance refers to three levels of preventative activity: primary prevention, which involves promoting wellbeing secondary prevention, which involves early intervention tertiary prevention, which involves maximising independence Guidance for panel developed in June – encouraged to look at preventative services e.g. medication review, telecare etc.

A strengths-based approach
The local authority must also consider what - other than the provision of care and support - might help the person in meeting the outcomes they want to achieve: a strengths-based approach This strengths-based approach recognises personal, family and community resources or ‘assets’ that individuals can make use of Trafford Reshaping Social Care Offer – developing local directory of alternative solutions Trafford Panel briefing in June 2014 Further training in March 2015 A holistic approach, considering the person’s strengths and support from the family and community. It is about reducing dependency and promoting independence.

Whole family approach Takes a holistic view of a person’s needs
Considers the impact of needs on family and wider networks In particular any children providing care: The impact of the person’s needs on the young carer’s wellbeing, welfare, education and development Whether their caring responsibilities are appropriate Sees the family and wider network as a source of support, where they are willing and able The key point is that the LA MUST identify whether or how the needs for care and support impacts on family members or others in their support network.

Supporting a person’s involvement
Might this person have difficulty in being involved? Can they be better supported to enable their involvement? [Reasonable adjustments under the Equality Act 2010]  Provide support and make adjustments Yes Yes Do they still have ‘substantial difficulty’ in being involved? Is there an ‘appropriate individual’ – a carer, friend or relative – that can facilitate their involvement?  Agree ‘appropriate individual’ Yes Yes The act calls for people to be heavily involved in their own assessment and decisions made about them. The level of involvement will of course vary but the principle of involvement remains a central theme to any assessment. Above slides shows 2 ways in which a person could be supported if it was thought they might have difficulty being involved. There will be Training on indep advocates – Martin White to attend managers meeting and develop guidance on this. The decision to involve a formal indep advocate will rests with the line manager. SCA/ SW to make recommendation  Duty to arrange for independent advocate No

Roles, responsibilities and expertise
registered social workers occupational therapists rehabilitation officers social care assessors expert assessors S LA must ensure a trained expert is involved in the assessment of adults who are deafblind. View on use of other experts depends on circumstances and how complex the assessment is – case by case basis. The Act also strengthens the guidance in relation to assessors having specialised training to assess an adult with autism.

National eligibility framework
After completion of the assessment process, the local authority will determine whether the individual has eligible needs The Act introduces a national eligibility threshold: whether the person has needs due to a physical or mental impairment or illness whether those needs mean that they are unable to achieve two or more specified outcomes as a consequence there is, or is likely to be, a significant impact on their wellbeing Local authorities can also decide to meet needs that are not deemed to be eligible if they chose to do so The test of need is not absolute. Las can also decide to meet needs that do not meet the criteria if felt necessary. HANDOUT Need to stress the need for evidence

Interpreting the eligibility criteria
The specified outcomes are: Managing and maintaining nutrition Maintaining personal hygiene Managing toilet needs Being appropriately clothed Being able to make use of the home safely Maintaining a habitable home environment Developing and maintaining family or other personal relationships Accessing and engaging in work, training, education or volunteering Making use of necessary facilities or services in the local community including public transport and recreational facilities or services Carrying out any caring responsibilities the adult has for a child An adult meets the eligibility criteria if: Their needs are caused by physical or mental impairment or illness As a result of the adult’s needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being All 3 conditions must be met for someone to become eligible. Unable to achieve – can include being unable to achieve without assistance, or could achieve but in doing so causes pain, distress or anxiety, or can do so but then endangers the health and safety of self or others, or can achieve the outcome but takes significantly longer than would normally be expected. NB – eligibility must be determined without consideration of what needs are being met by any carer at that time.

Interpreting the eligibility criteria
An adult meets the eligibility criteria if: Their needs are caused by physical or mental impairment or illness As a result of the adults needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being An adult is to be regarded as being unable to achieve an outcomes if the adult: is unable to achieve it without assistance; is able to achieve it without assistance but: doing so causes them significant pain, distress or anxiety; doing so endangers or is likely to endanger health or safety; takes significantly longer than would normally be expected.

Eligibility threshold
The specified outcomes are: Managing and maintaining nutrition Maintaining personal hygiene Managing toilet needs Being appropriately clothed Being able to make use of the home safely Maintaining a habitable home environment Developing and maintaining family or other personal relationships Accessing and engaging in work, training, education or volunteering Making use of necessary facilities or services in the local community including public transport and recreational facilities or services Carrying out any caring responsibilities the adult has for a child An adult meets the eligibility criteria: Their needs are caused by physical or mental impairment or illness As a result of the adults needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being An adult is to be regarded as being unable to achieve an outcome if the adult: is unable to achieve it without assistance; is able to achieve it without assistance but doing so causes the adult significant pain, distress or anxiety; is able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the adult, or of others; or is able to achieve it without assistance but takes significantly longer than would normally be expected. So…consider that whether as a consequence of the person being unable to achieve 2 or more of the specified outcomes there is likely to be a significant impact on the person’s wellbeing. In particular those 9 areas of wellbeing

Wellbeing Definition of wellbeing
Wellbeing is a broad concept, and the statutory guidance defines it as relating to the following nine areas in particular: personal dignity (including treatment of the individual with respect) physical and mental health and emotional wellbeing protection from abuse and neglect control by the individual over day-to-day life (including over care and support provided and the way it is provided) participation in work, education, training or recreation social and economic wellbeing domestic, family and personal relationships suitability of living accommodation the individual’s contribution to society We wont necessarily be involved in these. We may just signpost people to achieve these. These are basic entitlements.

National carers eligibility framework
After completion of the assessment process, the local authority will determine whether the carer has eligible needs Carers can be eligible for support in their own right The Act introduces a national carers’ eligibility threshold: whether the carer’s needs are due to providing necessary care for an adult whether those needs puts the carer’s health at risk or means that they are unable to achieve specified outcomes; and as a consequence there is, or is likely to be, a significant impact on their wellbeing Local authorities can also decide to meet carers’ needs that are not deemed to be eligible if they chose to do so

Interpreting the carers’ eligibility criteria
The specified outcomes are: Carrying out any caring responsibilities the carer has for a child Providing care to other persons for whom the carer provides care Maintaining a habitable home environment Managing and maintaining nutrition Developing and maintaining family or other personal relationships Engaging in work, training, education or volunteering Making use of necessary facilities or services in the local community including recreational facilities or services Engaging in recreational activities A carer meets the eligibility criteria if: Their needs are caused by providing necessary care for an adult. As a result: their health is at risk or they are unable to achieve specified outcomes As a consequence there is or is likely to be a significant impact on the carer’s well-being The test of eligibility of a given need is not absolute. Careful consideration needs to be given to recording decisions.

Record-keeping and informing individuals
Informing the individual of their eligibility determination The local authority must: produce a written record of whether any of the individual’s needs meet the eligibility criteria, and the reasons for why they do and why they do not Informing individuals who are not eligible Where the individual does not have eligible needs, the local authority must also provide: information and advice on what support might be available in the wider community; or what preventative measures might be taken to prevent or delay the condition progressing ? There has to clear transparency on how and why decisions have been made. The person must receive a copy of the assessment. Where there are no eligible needs the LA must provide info and advice on support in the wider community. Signposting for instance. Standard letter template for those not with eligible needs and those with eligible needs will be available.

Next steps Assessment What are the needs and outcomes the person wants to achieve? Eligibility determination Are the person’s needs eligible? Met needs What needs can be/are being met through non-service provision? (via personal, family and community resources) Unmet needs Are included in the personal budget Do eligibility exercises Nb – NOTION OF FLUCUATING NEEDS – consider how they will change, consider flexible services, establish if current assessment gives true picture of needs overall. Process is: Assessment begins at first contact and assessment identifies needs and the outcomes they want to achieve. Eligibility determination happens after the assessment has concluded. Where there are some eligible needs the care and support planning process starts. So LA checks if the person wants any or all of their care provided by the LA, whether they meet the ordinary residence requirement and consider how the LA can meet the needs. It is only the person’s remaining UNMET needs that will be met by the provision of services that are included in the personal budget.

Summary Assessment based on appearance of need for care and support:
Consider the person’s needs and the outcomes they want to achieve Be appropriate and proportionate Maximise the person strengths (personal, family and community resources and telecare) Involve the person needing care in the assessment, and consider if they would have substantial difficulty being involved Throughout the process, also consider if the person lacks capacity or is at risk of abuse National eligibility threshold, for people needing carer and carers, based on outcomes and wellbeing

Care and support planning

Outline of content Introduction Production of the plan
Planning for people who are at risk of harm Planning for people who lack capacity Combining plans Sign off and assurance Summary

Care & Support Plans Defined
Care Plan (SW/ SCA) How needs identified in the assessment will be met to achieve outcomes and improve wellbeing Support Plan (provider) Details of how needs are met on a day to day basis 51

Personalisation in social care and health
The Care Act 2014 Our Health, Our Care, Our Say Putting People First Direct payments Community Care Reforms Griffiths Report Some of the background legislation and practice reforms which feed into Care Act.

Person centred care and support planning
Person centred planning Person not services Emphasis on assets and capabilities First person Person has control

The Care Act and person-centred planning
Care and support planning should put people in control of their care The person must be actively involved and influential throughout the planning process Independent advocates must be instructed early in the planning process for those who have substantial difficulty and have no other means of accessing appropriate support to facilitate their involvement

Person-centred care and support planning

Production of the plan Involving the person Key elements Context
Further considerations Direct payments Constraints

Involving the person The local authority must take all reasonable steps to involve the person, their carer and relevant others The local authority must instruct an independent advocate if there is no one else that can facilitate involvement

Key elements of the care plan
Final plan must include Assessed and eligible Needs and assets Co produced outcomes How needs will be met/ reduced Own financial contribution Direct payments Personal budget When developing the plan, there are certain elements that must always be incorporated in the final plan: the needs identified by the assessment the outcomes the individual is looking to achieve to maintain or improve their wellbeing the person’s own capabilities, assets and strengths and the potential for improving their skills, as well as the role of any support from family, friends or others that could help them to achieve what they wish for from day-to-day life whether, and to what extent, the needs meet the eligibility criteria the needs that the authority is going to meet, and how it intends to do so for a person needing care, for which of the desired outcomes care and support could be relevant for a carer, the outcomes the carer wishes to achieve, and their wishes around providing care, work, education and recreation where support could be relevant the personal budget, direct payments and the amount which the person must pay towards the cost of meeting the needs information and advice on what can be done to reduce the needs in question, and to prevent or delay the development of needs in the future where needs are being met via a direct payment, the needs to be met via the direct payment and the amount and frequency of the payments. It is important that these aspects are not viewed as a fixed list. People can influence additional aspects to plans that are important to them i.e. outcomes not necessarily linked to needs the local authority has a duty to meet, etc. These requirements should not encourage a lengthy process where this is not necessary, or fixed decisions that cannot be changed easily if the person wishes to make adjustments. The maximum flexibility should be incorporated to allow adjustment and creativity.

Context Take a holistic approach Record needs being met by carer
Consider a combined plan to meet both the person’s and carer’s needs Consider universal services and community-based and/or unpaid support

Further considerations for the plan
Be proportionate but compliant with rules Take account of fluctuating needs Make sense to the person Must be agreed with the person or their representative

Direct payments The local authority must inform the person which, if any, of their needs could be met by a direct payment The person should be provided with appropriate information and advice concerning the usage of direct payments and how they differ from traditional services People should be empowered to make informed decisions about how to best meet their needs Already offered and in place at Trafford A note on direct payments and the care plan

Constraints There should be no constraint on how assessed, eligible, unmet needs are met as long as this is reasonable The local authority has to satisfy itself that the decision is an appropriate and legal way to meet needs Limited list of prescribed providers must be avoided

The person prepares the plan jointly with the local authority
Person’s Best Interests Secured Information Appropriate people

Planning for people who are at risk of harm
The person will have been subject to and/or remain at risk of abuse or neglect They will have been subject to a local authority section 42 enquiry into their situation and will have an agreed safeguarding plan The plan must actively involve the person in agreeing what outcomes they want and how they will be achieved While aiming to meet the person’s outcomes the plan must also balance risk appropriately by using the least restrictive options The plan will be subject to review under the local multi-agency safeguarding procedures

Planning for people who lack capacity
The Mental Capacity Act 2005 (MCA) requires local authorities to assume that people have capacity and can make decisions for themselves, unless otherwise established A person must be given all practicable help to make specific decisions before being assessed as lacking capacity Where an individual has been assessed as lacking capacity, the local authority must commence care planning under the ‘best interests principle’ within the meaning of the MCA The duty to involve the person remains throughout the process

Minimising and authorising deprivation of liberty for people who lack capacity
The Mental Capacity Act 2005 (MCA) provides legal protection for acts of restraint only if the act is: necessary to prevent harm to the person a proportionate response to the likelihood of the person suffering harm and the seriousness of that harm, and in the person’s best interests If the degree and intensity of restrictions and restraints are so significant that they amount to a deprivation of liberty, this must be authorised under the Deprivation of Liberty Safeguards (DOLS) under the MCA A reminder of the MCA

Combining plans Consider if multiple plans exist
Obtain consent from all parties Establish a lead organisation

Sign-off and assurance
Sufficient time has been taken to ensure the plan is appropriate to meet identified needs Should There is consensus on the factors in the plan Addresses how the needs in question will be met Occur when Includes the final personal budget Final agreement is recorded

Sign-off and assurance
In the event that the local authority decides that it cannot sign-off a plan, or where a plan cannot be agreed, it should state: the reasons for this the steps which must be taken to ensure that the plan is signed-off The local authority must give a copy of the final plan to: the person for whom the plan is intended any other person they request to receive a copy any other person the individual requests to share it with their independent advocate if they have one

Summary The person must be actively involved throughout the planning process An independent advocate must be instructed at an early stage if a person has substantial difficulty in engaging in the process The plan must describe what needs the person has, and which needs the local authority is to meet The plan must include: the personal budget and direct payments The local authority must inform the person which, if any, of their needs may be met by a direct payment The local authority must give a copy of the final plan to the person and others requested by the person in an accessible format The local authority has a duty to keep the person’s plan under review

Review/ reassessment The aim of review is to ensure all people with a care and support plan, or support plan have the opportunity to reflect on: what’s working what’s not working what might need to change The review process should be: person-centred outcomes focused accessible proportionate to the needs to be met The process must involve the person needing care and the carer where feasible, and an independent advocate where relevant Reviewing intended outcomes detailed in the plan is the means by which the local authority complies with its ongoing responsibility towards people with care and support needs. Review ensures that plans are kept up to date and relevant to the person’s needs and aspirations, will provide confidence in the system, and mitigate the risk of people entering a crisis situation. Like care planning, the review process should be person-centred, outcome focused, accessible and proportionate, and must involve the person and carer where feasible. Where the person has substantial difficulty in being actively involved with the review, and where there are no family or friends to help them being engaged, an independent advocate must be involved. Consideration should be given to authorising others to conduct a review – this could include the person themselves or carer, a third party (such as a provider) or another professional, with the local authority adopting an assurance and sign-off approach.

A person with eligible care and support needs has a care and support plan and carers have a support plan. The plan describes what needs the person has, and which needs the local authority will meet. Everybody has a personal budget as part of the care and support plan/support plan that identifies the cost of their care and support and the amount that the local authority will make available. They may have a direct payment for some or all of the personal budget. The local authority is under an ongoing duty to keep the person’s plan under review, to ensure that the needs continue to be met: they will review the plan periodically, involving the person and agreeing any necessary changes. The review will help to identify if the person’s needs have changed and can lead to a reassessment and a revision of the plan, including the personal budget, if changes are required. When a small change to a plan is required it may not be appropriate for the person to go through a full review and revision of the plan. Where the local authority is satisfied that a revision is necessary, it must work through the assessment and care planning processes to the extent that it thinks appropriate.

Keeping plans under review
Changes to circumstances What’s working What’s not working Any required changes Outcomes achieved New outcomes Personal budgets Changes to support networks Is person satisfied with plan Keeping plans under review is an essential element of the planning process. Without a system of regular reviews, plans could become quickly out of date meaning that people are not obtaining the care and support required to meet their needs. Plans may also identify outcomes that the person wants to achieve which are progressive or time limited, so a periodic review is vital to ensure that the plan remains relevant to their goals and aspirations. Local authorities should establish systems that allow the proportionate monitoring of both care and support plans and support plans to ensure that needs are continuing to be met. This system should also include cooperation with other health and care professionals. The process should cover these broad elements: have the person’s circumstances and/or care and support or support needs changed? what is working in the plan, what is not working, and what might need to change? have the outcomes identified in the plan been achieved or not? does the person have new outcomes they want to meet? could improvements be made to achieve better outcomes? should direct payments be considered? is the personal budget still sufficiency to meet the person care and support needs Is the person at risk of abuse or neglect Are there any changes in the person’s informal and community support networks which might impact negatively or positively on the plan? is the person, carer, independent advocate satisfied with the plan?

Routes to reviewing/ reassessing
Planned review Date set with the individual during the planning process Unplanned review Resulting from a change in needs or circumstances Requested review Person, carer, advocate or interested party makes a request There are several different routes to reviewing a care and support or support plan including: a planned review (the date for which was set and recorded with the individual during care and support or support planning, or through general monitoring) The first planned review should be an initial ‘light-touch’ review of the planning arrangements 6-8 weeks after sign-off of the personal budget and plan and be combined with an initial review of direct payment arrangements and other plans. an unplanned review which results from a change in needs or circumstance that the local authority becomes aware of, e.g. a fall or hospital admission a requested review where the person or their carer, family member, advocate or other interested party makes a request that a review is conducted. Local authorities should provide information to people at the planning stage about to request for a review, the process and timescales. The process should be accessible and include multiple routes to make a request The local authority must consider a request for a review judge the merits of conducting it. The review must involve the person, carer and an independent advocate where relevant A review should be performed unless the authority is reasonably satisfied that the plan remains sufficient and the request is frivolous, inaccurate or is a complaint Where a decision is made not to conduct a review following a request, the local authority should set out the reasons for not accepting the request in a format accessible to the person, along with details of how to pursue the matter if the person remains unsatisfied.

Revision of the plan The development of a revised plan must involve the person, their representative or independent advocate Where a revision is necessary, the local authority must where appropriate carry out a re-assessment, using process involved in the original assessment and care planning processes, revising the plan and personal budget accordingly The re-assessment process should not start from the beginning, but pick up from what is already known about the person and should be proportionate Where a decision has been made following a review that a revision of their plan is necessary, the local authority should inform the person, or a person acting on their behalf of the decision and what this will involve. The development of the revised plan must be made with the involvement of the adult/carer, their representative or independent advocate The revision should wherever possible follow the process used in the assessment and care planning stages – and if appropriate the local authority must carry out an assessment and financial assessment, and then revise the plan and personal budget accordingly. This process may be referred to as a ‘re-assessment’ and it cannot occur without the local authority first conducting a review and then deciding that a revision of a plan is necessary. Where the plan was produced with the assistance of an independent advocate, then consideration should be given to whether an independent advocate is also required for the revision of the plan - ideally the same person. Likewise, where a specialist assessor has been used previously. Particular attention should be taken if the revisions to the plan proposes increased restraints or restrictions on a person who has not got the capacity to agree them. This may become a deprivation of liberty, which requires appropriate safeguards to be in place.

Timeliness and regularity of reviews
In the absence of any request for a review, or any indication that circumstances may have changed, the local authority should conduct a periodic review of plan no later than every 12 months The review should be performed as quickly as is reasonably practicable It should not contain any surprises and must not be used to arbitrarily reduce a care and support package Any reduction to a personal budget should be the result of a change in need or circumstance Periodic reviews and reviews in general must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstance. As with care and support planning, it is expected that in most cases the revision of the plan should be completed in a timely manner proportionate to the needs to be met. Where there is an urgent need to intervene, local authorities should consider implementing interim packages to urgently meet needs while the plan is revised. However, local authorities should work with the person to avoid such circumstances wherever possible by ensuring that any potential emergency needs are identified as part of the care and support planning stage and planned for accordingly. 3. Trafford review – 6 monthly in community and 12 monthly in care home

Personal budgets

Outline of content Introduction Elements of the personal budget
Calculating the personal budget Agreeing the final budget Use of a personal budget Use of a carer’s personal budget Appeals/disputes Summary

Introduction The Care Act places personal budgets into law for the first time, making them the norm for people with care and support needs. It is vital that people: are clear how their budget was calculated have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs Personal budgets enable the person to: exercise greater choice take control over how their care and support needs are met Personal budgets (PBs) are a key part of the government’s aspirations for a person-centred care and support system. Why? PBs have been part of government policy for a while and the Care Act guidance states that “independent research shows that where implemented well, personal budgets can improve outcomes and deliver better value for money.” The key point is that the allocation of a clear upfront indicative (or ‘ball-park’) allocation at the start of the planning process will help people to develop the plan and make appropriate choices over how their needs are met. It is vital that the process used to establish the personal budget is transparent and the method used robust so that people have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs. The personal budget enables the person (and their advocate if they have one) to exercise greater choice and take control over how their care and support needs are met. What does exercising greater choice and achieving more control mean? Knowing, before care and support planning begins, roughly how much money is available to meet needs and having clear information about the proportion the local authority will pay, and what amount (if any) they will pay Being able to choose from a range of options for how the money is managed, e.g. taking a direct payment, or the local authority managing the budget Having a choice over who is involved in preparing the care and support plan for how the personal budget will be spent, including from family or friends Having greater choice and control over the way the personal budget is used to purchase care and support, and from whom.

Third party Local authority The diagram appears when the slide opens, the first click brings in the ‘Local authority’ box and the second click brings in the ‘third party’ box to enable you to explain ISFs (Individual service funds) Diagram illustrates the main elements of the care and support planning process. If the local authority has a duty to meet a person’s needs it must help the person decide how their needs are to be met, through the preparation of a care and support plan. The plan must describe what needs the person has, and which needs the local authority is to meet. Everybody whose needs are met by the local authority will have a personal budget as part of the care and support plan/support plan that identifies the cost of their care and support and the amount that the local authority will make available. An indicative amount should be agreed with the person at the start of care and support planning, with the final amount of the personal budget confirmed through this process. At all times the wishes of the person must be considered and respected. The person can choose for the personal budget to remain with the local authority to arrange care and support on their behalf, or be placed with a third-party provider, often called an individual service fund (ISF). Note that where an ISF type arrangement is not available locally, the local authority should explore arrangements to develop this offer. Can take some or all of the budget as a direct payment, i.e. people can choose how much control they wish to take over the arrangement of their care or support. Duty to keep the person’s plan and personal budget under review, to ensure that their needs continue to be met.

Elements of the personal budget
The personal budget must always be an amount sufficient to meet the person’s care and support needs The overall cost must be broken down into: the amount the person must pay (following the financial assessment) the remainder of the budget that the authority will pay Must always be an amount sufficient to meet the person's care and support needs and must include the cost to the local authority of meeting the person’s needs which the local authority is under a duty to meet, or has exercised its power to do so. It is vital that the process used to establish the personal budget is transparent and the method used robust, so that people have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs. The personal budget may be an integrated one which sets out other amounts of public money that the person is receiving, such as money provided through a personal health budget or benefits. Integrated health and care, and integration of other aspects of public support are the long-term vision of the Government. This will provide the individual with a seamless experience, and can help to remove unnecessary bureaucracy and duplication that may exist where a person’s needs are met through money from multiple funding streams. Local authorities should take a lead in driving the integration of support services for their population, e.g. this may involve agreeing with partner organisations, a lead organisation that agrees to oversee monitoring and assurance of all budgets the person is receiving, while still allowing each body to fulfil their statutory obligations.

Other costs that may be presented or excluded
Local authority brokerage fee Presented Any additional payment or a “top-up” Costs for intermediate care or reablement must be excluded Excluded The brokerage fee that a local authority may charge when putting in place the necessary arrangements to meet eligible needs of a person whose financial resources are above the financial limit, but who has requested the local authority meet their needs, is not part of the personal budget, since it does not relate directly to meeting needs, but it may be presented alongside the budget to help the person understand the total charges to be paid. An additional payment or a “top-up” a person makes in order to be able to secure the care and support of their choice (where this costs more than the local authority would normally pay for such a type of care) does not form part of the personal budget. Provision of intermediate care and reablement to meet eligible needs, must be excluded from the personal budget. Reablement is one of four categories (crisis response, home-based intermediate care, bed-based intermediate care and reablement); historically the other three have been provided by health staff. There is a tendency for the terms “reablement”, “rehabilitation” and “intermediate care” to be used interchangeably, the Guidance clarifies the differences. “Intermediate care” is a structured programme of care provided for a limited period of time, to assist a person to maintain or regain the ability to live independently at home. “Reablement” is a particular type of intermediate care, which has a stronger focus on helping the person to regain skills and capabilities to reduce their needs, in particular through the use of therapy and training. It is defined as services to help people live independently, provided in the person’s own home, by a team of mainly social care professionals.

Calculating the personal budget
Transparency Sufficiency Timeliness There are many variations of systems used to arrive at personal budget amounts, ranging from complex algorithmic-based resource allocation systems (RAS), to more ‘ready-reckoner’ or non-points based approaches. The following specific elements are key. A mechanism for understanding needs and/or outcomes A mechanism for scoring/weighting these needs and/or outcomes A mechanism for translating these scoring/weightings into an indicative upfront resource allocation A mechanism for arriving at a final resource allocation (or personal budget). Complex RAS models of allocation may not work for all client groups It is important that these factors are taken into account, and that a ‘one size fits all’ approach is not taken. Most important principles in setting the PB are: Transparency: Authorities should make their allocation processes publicly available or provide this on a bespoke basis for each person. This will ensure that people fully understand how the personal budget has been calculated, both in any indicative amount given and the final PB allocation. Timeliness: It is crucial when calculating the personal budget to arrive at an upfront allocation which can be used to inform the start of the care and support planning process. After refinement during the planning process, this indicative amount is then adjusted to be the amount that is sufficient to meet the needs. This forms the PB recorded in the care plan Sufficiency: The PB must be sufficient to meet the person’s needs which the local authority is required to meet and must also take into account the reasonable preferences to meet needs as detailed in the care and support plan, or support plan. This should prevent disputes from arising, but it must also be possible for the person, carer or advocate to challenge the local authority on the sufficiency of the final amount.

Sufficiency of the personal budget and implications for direct payment
The personal budget must: always be sufficient reflect the cost to the local authority of meeting the person’s needs be open to challenge Direct payments are not intended to be less than is required to purchase care and support on the local market The Act sets out that the PB must be an amount that reflects the cost to the local authority. In establishing the ‘cost to the local authority’, consideration should be given to the cost of the service at an appropriate quality, through local provision to ensure that the personal budget reflects local market conditions. There may be concern that the ‘cost to the local authority’ results in the direct payment being a lesser amount than is required to purchase care and support on the local market due to local authority bulk purchasing and block contract arrangements. However, a request for needs to be met via a direct payment does not mean that there is no limit on the amount attributed to the personal budget and there may be cases where it is more appropriate to meet needs via directly provided care and support, for example: Where there is no local market for a particular kind of care and support Where the costs of an alternate provider arranged via a direct payment would be substantially more than the local authority would be able to arrange, whilst achieving the same outcomes for the individual. In cases such as these, the care plan should be reviewed to ensure that it is accurate and that the personal budget allocation is correct. The authority should work with the person, their carer and independent advocate to agree on how best to meet their care and support needs. It may be that the person can take a mixture of direct payment and local authority arranged care and support, or the local authority can work with the person to discuss alternate uses for the personal budget. The focus on wellbeing requires personal budget allocation to focus on funding outcomes. Currently there is insufficient consideration given to: Harnessing community capital and resources Use of assistive technologies Sharing resources across services by placing them directly in the community

Agreeing the final budget
The final budget should be agreed at the end of the planning process Sign off should take place if the plan is within the indicative budget (or justifiably above it) the proposed use of the money is: appropriate legal meets the needs identified in assessment The personal budget should be finalised at the end of the care and support planning process – to ensure that there is scope for it to increase or decrease. Some local authorities are devolving responsibility for finalising budgets anticipated to come out at a fairly low level to frontline staff and/or social work team managers so as to avoid unnecessary delays and minimise the use of panels. Generally, the agreement of the final budget and support plan should not involve scrutiny of specific elements of the plan on the basis of their cost alone. Consideration should be given to the cost of meeting needs as part of a wider evaluation of other aspects, such as value for money and anticipated outcomes. Due regard should be taken to the use of approval panels in both the timeliness and bureaucracy of the planning and signing-off process. In some cases, panels may be an appropriate governance mechanism to sign-off large or unique personal budget allocations and/or plans. Where used, panels should be appropriately skilled and trained, and local authorities should refrain from creating or using panels that seek to amend planning decisions, micro-manage the planning process or are in place purely for financial reasons.

Use of a personal budget
Maximum possible range of options Local authority managed PB Third party managed PB (ISF) Direct payments Mixed package The person should have the maximum possible range of options for managing the personal budget, including how it is spent and how it is used. Evidence from the POET survey suggests that people using council-managed personal budgets are currently not achieving the same level of outcomes as those using direct payments, and in too many cases do not even know they have been allocated a personal budget or, if they do, do not know the amount that has been allocated. The survey also noted the importance of ensuring that help is available to the person to plan their budgets. For all social care groups, councils making the personal budget process easier was robustly associated with better outcomes for personal budget holders, and similarly for carers. Local authorities should not inadvertently limit options and choices. There are three main ways in which a personal budget can be deployed: managed account held by the local authority (Traff = comm services) managed account held by a third party (often called an individual service fund or ISF) (Limited at Trafford) direct payment. (Traff = Personal Budget Team/ Personalised Support Team) In addition a person may choose a ‘mixed package’ that includes elements of some or all three of the approaches above Local authorities must the decision is recorded in the plan and the person is given as much flexibility. The mixed package approach can be a useful option for people who are moving to direct payments for the first time. This allows a phased introduction of the direct payment, giving the person time to adapt to the direct payment arrangements.

Appeals/disputes The local authority must make its own arrangements for dealing with complaints in accordance with the 2009 regulations The local authority should take all reasonable steps to limit appeals or disputes regarding the personal budget allocation. Reducing appeals and disputes will include thorough effective care and support planning, and transparency in the personal budget allocation process. Additionally, many disputes may be avoided by informing people of the timescales that are likely to be involved in different stages of the process. Keeping people informed how their case is progressing may help limit the number of disputes. As at July 2014, complaints provision for care and support is set out in Local Authority Social Services and NHS Complaints Regulations The Act will introduce new rights to appeal certain decisions in 2016 (consultation on this due end 2014).

Current Position At Trafford
Personal Budgets At Trafford the RAS, which gives a personal budget allocation is used RAS currently is being revised – Reshaping Social Care Offer This will now refer to the total amount needed to meet someone's care and support needs that are not being met Direct Payments Currently have approx. 680 (across CFW) on direct payment Renaming personal budget team to fit with national terminology

Summary The Act places personal budgets into law for the first time, making them the norm for people with care and support needs Personal budgets are designed to enable people to exercise greater choice and take control over how their care and support needs are met The personal budget must: always be sufficient to meet the person’s care and support needs include the cost to the local authority and the amount the person must pay exclude the provision of intermediate care and reablement The carers personal budget must enable the continuation of the carer role and must have regard to the wellbeing principle of the act The local authority is under an ongoing duty to keep the person’s plan and personal budget under review

Charging and financial assessment

Outline of content Introduction Conducting the financial assessment
What charges can be made? Choice of accommodation and top-up fees Charging to support carers Recovery of debts Summary

Introduction – Already in place at Trafford
Local authorities may charge a person needing care or a carer, but certain types of care and support must be arranged free of charge If a local authority has chosen to charge a person for a service it is arranging it must undertake a financial assessment of one level or another The detail of how to charge is different depending on whether someone is receiving care in a care home, their own home, or another setting The rules for charging are split into those for: A care home; and All other settings Local authorities should develop and maintain a policy on charging in settings other than care homes (see later slide) The act provides a single legal framework for charging for care and support for the first time. A LA has the discretion to choose whether or not to charge for services to meet both eligible and non-eligible needs. Where it decides to charge it must follow the regulations – next slide.

Charging and financial assessment principles from the statutory guidance
Ensure that people are not charged more than it is reasonably practicable for them to pay Reduce variation in the way people are assessed and charged Be clear and transparent Promote wellbeing, social inclusion, and support the vision of personalisation, independence, choice and control Support carers Be person-focused Apply the charging rules consistently Encourage and enable those who wish to stay in or take up employment, education or training Be sustainable for local authorities in the long-term Facilitator’s hints and tips The Care Act and the regulations underneath it broadly recreate the current framework for charging. It may be useful to check with learners, early on in the session, their understanding of the framework and key changes, to enable you to focus on the elements most closely aligned with their job role. The key changes are: The operation of the 12 week disregard. This continues to apply when a person first enters a care home but will now also apply when a person suddenly loses another property disregard such as when a qualifying relative who has been living in the property suddenly dies or goes into a care home themselves. Local authorities also have discretion to apply the 12 week property disregard in other circumstances that lead to a sudden change in finances. Debt recovery. The Care Act introduces a new legal framework for the recovery of debts. It revokes S22 of HASSASSA 1983 and replaces it with the provisions under S69 of the Act. Further details slide 15. Pensions flexibilities. As a result of the introduction of flexibilities to defined contribution pensions the rules around notional income from pension products have been refined. This means that when applying notional income it must be to the maximum income that would be available under an annuity. The charging framework in the guidance lists principles that a LA’s approach to charging for care and support should take into account the following: The principle is that people should only be required to pay what they can afford. Notion that care and support should be comprehensive to reduce the variation in how people are assessed and charged. Be clear and transparent so people know what they will be charged

Where Care Act charges must not be made – Already in place at Trafford
Intermediate care including reablement (for up to six weeks) Aids, and minor adaptations of less than £1,000 Care and support provided to people with CJD After care/support provided under Mental Health Act 1983 s117 NHS services Any services which an authority is under a duty to provide through other legislation

Financial assessment – Already in place at Trafford
In a financial assessment, both capital and income must be assessed, which will be either disregarded, partially disregarded or included Some capital and income must be disregarded and local authorities have discretion to disregard assets in some other circumstances The value of a person’s main or only home must be disregarded where they are receiving care in a setting that is not a care home or where a qualifying relative occupies the property as their main or only home To help encourage people to remain in or take up employment earnings from current employment must be disregarded Notional capital and income can be taken into account La must take a financial assessment if they have chosen to charge a person for a service it is arranging. The income and the capital of the person only NOT a couple’s assessment. When assessing income only the income of the person. Income net of tax or NI. In a financial assessment income and capital will be either disregarded, partly disregarded or included in the assessment. 2 disregards as an example; Property must be disregarded in certain circumstances such as where a person is receiving care in a setting that is not a care home, as their home is the only roof over their head so to speak. Use discretion in other circumstances. Not yet clear. Could be where the property is the sole home of someone who has given up own home to care for a person who is now in a care home. Earnings from current employment must be disregarded but not benefits and income from savings etc. Notional capital – where someone deemed to have capital or income even if they haven’t applied for it – eg, an unclaimed occupational pension.

‘Light-touch’ financial assessments – Trafford is expanding this role
A local authority may choose a ‘light touch financial assessment’ for instance where: The person has significant financial resources, and does not wish to undergo a full financial assessment for personal reasons There is a small or nominal charge for a particular service, and carrying out a financial assessment would be disproportionate An individual is in receipt of certain benefits e.g. Jobseekers Allowance The authority must be sure the person is able to pay any charges due A person must be informed that they have the right to request a full financial assessment should they so wish, and so, in effect, agree to a light touch assessment At Trafford conducting more desk based assessments and risk based approach at e.g. checking DWP information prior to assessments Trafford are considering introducing a credit check for third party top up payers Trafford has revised the debt management policy to support collection of the contributions

Information and advice
Accessible information and advice, including: (Shared on MyWay and leaflets available at Trafford – all being refreshed) Independent financial information and advice Operation of top-ups Deferred payment agreements (DPA) Complaints The person must be given a written record of the financial assessment which includes: (Already in place at Trafford) Explanation of how it has been carried out What the charge will be How often it will be made The reason for any fluctuation in charges

If the person lacks capacity – Already in place at Trafford
At the time of the assessment of care and support needs, the local authority must establish whether the person has capacity If the person lacks capacity, the local authority must find out if the person has someone with legal powers to act on their behalf, as the appropriate person will need to be involved If there is no such person, then an approach to the Court of Protection is required – at Trafford the court can appoint the local authority Many of you will already carry out mental capacity assessments

Capital limits A person with more in capital than the upper capital limit is responsible for arranging and funding their own care and support Upper capital limit Lower capital limit Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital Below the upper capital limit, a person is entitled to access means-tested local authority support Property and savings generally. In assessing what a person can afford to contribute a LA must apply the upper and lower capitil limits, after disregards have been taken into account. The upper capital limit for 2015/16 is £23250 and the lower limit is £14250 – may change in April 2016. In theory the treatment of capital is striahtforward – if they have more than £23250 they will be deemed to be able to afford the full cost of their care. If below £14250 they will not need to contribute from their capital, but possibly from their income. If between the 2 they will make a contribution known as ‘tariff income’ from their capital in addition to contributing from their income. In practice is more complicated – see Annex B of statutory guidance for more info.

Deprivation of assets – Already in place at Trafford
Deprivation of assets refers to where a person has intentionally deprived themselves of or decreased their overall assets in order to reduce the amount they are charged towards their care If a person deliberately tries to avoid care and support costs through deprivation of assets, the local authority may charge the person as if they still possessed the asset Deliberate deprivation may occur when someone knows they have a care and support need and that they would be charged and reduces their assets in order to avoid those charges HANDOUT AND EXERCISE IF TIME Hanyu Deng????? At Trafford you will have heard panel asking when assets were disposed of – this is why

What charges can be made?
The rules for charging are split into those for a care home and all other settings Charges should be reasonable and not leave people with less than a specified amount of income Where a person has capital between the upper and lower limit, they may be charged a ‘tariff income’ of £1 per week for every £250 in capital between the two amounts A local authority must not charge more than the cost that it incurs in meeting the assessed needs of the person A local authority cannot charge an administration fee for arranging care and support Give handout on charging here. ADE example. Nora and Agi Exercise Las do have discretion about charging – they may choose to disregard additional sources of income, set maximum charges etc. LA therefore need to develop and maintain a policy on how they wish to apply this discretion.

Choice of accommodation and top-up fees
The local authority must provide for the person’s preferred choice of accommodation, subject to certain conditions (within council agreed value) This choice applies between providers of the same type The local authority must offer at least one option that is affordable within a person’s personal budget, and should offer more than one A person can choose a more expensive setting, through a ‘top-up’ from a third party (or the resident in some circumstances) The local authority must ensure that the person paying the ‘top-up’ is willing and able to meet the additional cost, and enters into a written agreement with the local authority, agreeing to meet that cost Choice of accommodation Example supported living or residential care etc. There must be genuine choice and must ensure at least one option is available and affordable within a person’s budget. However someone can choose more expensive settings or alternative settings where they can have a 3rd pay the top up. If the care is being funded by a deferred payment agreement then the cost of any top ups is added to the amount owed. Check with Chris – can the resident pay towards their top-up??

Charging to support carers
Carers play a vital role in the care and support system Local authorities are not required to charge a carer for support, but they may do so If the local authority chooses to charge for it, replacement care should be charged to the adult needing care and not the carer seeking a respite break Local authorities should ensure that any charges do not negatively impact on a carer’s ability to look after their own health and wellbeing and to care effectively and safely Charging of carers must be in accordance with the non-residential charging rules A local authority should carry out a financial assessment to ensure that charges are affordable, but it is likely that a light-touch financial assessment will be appropriate Trafford does not currently charge carers

Recovery of debts The existing powers under S22 of HASSASSA 1983 will no longer apply from 1 April 2015 From then on local authorities must use the provisions under S69 of the Care Act: Must offer a DPA whenever possible Trafford will start recovering debt under debt recovery policy where DPA’s are not agreed Ultimately an authority has powers to recover money through the county court Principles of the approach to debt recovery: Court action should be the last resort The local authority should act reasonably Affordable repayments Debts and repayments discussed with the person New policy being agreed with members and new board established Slide and then exercise – what charges can be made. Agi and Nora and Fred. Give hand-out. At Trafford a new policy is being agreed – workers will be required to complete a risk assessment form prior to recovery decision being made on a case by case basis

Summary The local authority may charge people for care and support services, and for arranging them, but some services must be free of charge The local authority must carry out a financial assessment of both capital and income if it is going to charge for services A ‘light touch’ financial assessment may be appropriate There should be choice of accommodation for individuals whose needs are best met outside their own home Top-up fees can be charged if a person chooses a more expensive residential care option Debts may continue to be recovered under the new legal framework, but from 1 April 2015 HASSASSA 1983 will no longer apply

Deferred payment agreements

Outline of content Introduction Eligibility for a deferred payment
Information and advice How much can be deferred? Making the agreement Interest rates and charges Termination of the agreement Summary [Note not to be confused with ‘Payment Deferred’ which is a crime novel by C S Forester, published in 1926, on which a film and play were based]

Introduction – Already in place at Trafford
The Act places a duty on all local authorities to operate a deferred payment scheme and to offer deferred payments to people meeting the acceptance criteria for the scheme By taking out a deferred payment agreement (DPA), a person can ‘defer’ or delay paying the costs of their care home until a later date A deferral can last until death, however people may choose to use a deferred payment agreement as a ‘bridging loan’ to give them time and flexibility to sell their home when they choose to do so Payment is deferred and not ‘written off’. This must be stressed to the individual This scheme available throughout England from April 2015 and local authorities will be required to offer DPAs to people who meet certain national criteria governing eligibility for the scheme. Confirm with Chris – length of deferred payments we currently offer.

Paying for care and support
A person could meet the costs of their care and support from a combination of any of four primary sources: Income, including pension Savings or other assets A financial product A Deferred Payment Agreement Advantages of DPA for an individual? Disadvantages?

Who is eligible for a deferred payment agreement
Who is eligible for a deferred payment agreement? – Tightens eligibility criteria at Trafford A deferred payment agreement (DPA) must be offered to anybody who has ‘adequate security’ and: Whose needs are to be met by the provision of residential care Who has less than the upper capital limit in assets excluding the value of their home Whose home is not occupied by a spouse or dependent relative However, some discretion may be exercised – local authorities may offer DPAs to others who don’t meet the criteria, including people in supported living accommodation Permission may be refused in certain circumstances e.g. where there is insufficient security Example Lucille develops a need for residential care. She lives alone and is the sole owner of her home. Her home is valued at £100,000, and she has £15,000 in savings. Lucille meets the 3 criteria governing eligibility for a deferred payment: she has been assessed as having eligible needs which the local authority decides should be met through residential care. She has less than the upper capital limit of £23,250 in assets excluding the value of their home. Her home is not occupied by a spouse or dependent relative. 3 criteria governing eligibility. If a person has there the LA must offer a DPA. Need to check people haven't moved in to avoid payment

Adequate security – New for Trafford
A local authority must have adequate security in place when entering into a DPA They must accept a ‘first legal mortgage charge’ as adequate security and they have discretion to accept other security The security should be revalued periodically (Enough equity in the property for a user to self-fund for one year – still to be agreed). Handout – how much can be deferred.

Example Lucille develops a need for residential care. She lives alone and is the sole owner of her home. Her home is valued at £100,000, and she has £15,000 in savings. Lucille meets the 3 criteria governing eligibility for a deferred payment: she has been assessed as having eligible needs which the local authority decides should be met through residential care she has less than the upper capital limit of £23,250 in assets excluding the value of their home her home is not occupied by a spouse or dependent relative.

Exercising discretion
Local authorities can offer DPAs to people in residential care who do not meet the criteria. For example: If someone would like to use wealth tied up in their home to fund reasonable top-ups If someone has other accessible means to help them meet the cost of their care and support If a person is narrowly not eligible e.g. because they have slightly more than the asset threshold Local authorities may offer DPAs to people in extra care settings in some circumstances EXERCISES Agnes Smith and Rupi Majithia – are they eligible for a deferred payment agreement

Refusing a deferred payment agreement – Tightens criteria at Trafford
A local authority may refuse a request for a DPA in certain circumstances This is intended to provide local authorities with a reasonable safeguard against default or non-repayment of debt e.g. where: the local authority is unable to secure a first mortgage charge on the property someone wishes to defer a larger amount than they can sustainably afford a person’s property is uninsurable and they are unable to provide adequate security

Refusal to defer any more charges – Already do this Trafford
A local authority may refuse to defer any more charges for a person who has an active DPA for example: when a person’s total assets fall below the level of the means test and the person no longer needs to defer their care costs where a person no longer has relevant residential care (or where appropriate extra care) needs where a spouse or dependent relative has moved into the property after the agreement has been made where a relative who was living in the property at the time of the agreement subsequently becomes a dependent relative Local authorities must also cease deferring further amounts when a person has reached the ‘equity limit’ setting out the maximum that they are allowed to defer

Information and advice- Via MyWay and leaflets available at Trafford – all being refreshed
The local authority should tell people about the DPA scheme and how it works, if they feel someone might benefit from having a DPA The explanation should include: The criteria for obtaining a DPA and the requirements Interest and admin charges The types of security that the authority is prepared to accept Implications for income, benefit entitlements and charging Termination of the DPA and options for repayment What happens if the person doesn’t repay The overall advantages and disadvantages of DPA The suggestion that people may want to consider taking independent financial advice.

Information and advice
The local authority should also: Consider potential issues around loss of capacity, and offer advice on options for deputyship, legal power of attorney and advocacy Advise people that they will need to consider how they plan to use, maintain and insure their property Keep people informed about the DPA as it continues and provide necessary information on termination

Interest rate and administration charge
The DPA scheme is intended to be run on a cost-neutral basis, with local authorities able to recoup: the costs they may incur in deferral of charges via an interest rate (national rate is lower then Trafford, will need to adjust local rate) administrative costs associated with DPAs – Already do this Local authorities will have the ability to charge interest on any amount deferred Local authorities should maintain a publicly-available list of administration charges that a person may be liable to pay – available on Trafford websites

Termination of the deferred payment agreement
Sale of property /security Voluntary repayment Death

Summary Local authorities have a duty to operate a deferred payment scheme and are required to offer DPAs when the person: has adequate security meets the acceptance criteria for the scheme, and will agree to the DPA terms and conditions Additionally, local authorities have a fairly broad discretion including: extending DPAs to extra care settings; agreeing top-ups; and of the security they will accept The amount that can be deferred is dependent on there being adequate security, and whether the amount deferred is sustainable Interest on deferred costs, and administrative costs can be charged, but the scheme should run on a cost neutral basis

Transition to adulthood
This overview forms part of the suite of learning materials that have been developed to support the implementation of part one of the Care Act These materials summarise and explain the ‘Care and Support Statutory Guidance’ (October 2014) and are designed to help those involved in care and support services to understand and implement the Act. This presentation is an overview of transition to adulthood. It is intended for anyone who would like to know more about chapter 16 of the statutory guidance. There is an accompanying open learning workbook as well as a full presentation on this topic area. Transition to adulthood

Why does transition to adulthood matter?
It’s a complex transition for anyone More children and young people with complex conditions in early childhood are now surviving into adulthood Getting it wrong can lead to poor outcomes Getting it right can set young people up for the rest of their lives Transition is an essential part of human life and experience. Young people (and their parents) use the term to refer to the process of change for young people as they progress from childhood to adulthood. It happens at different ages for all young people, including those with complex needs or disabilities. There is considerable evidence to point to the importance of the transition experience. Moving into adulthood is one of the most far reaching and complex transitions for anyone, but young people with disabilities face additional challenges including transfer from children’s to adult health and social services, particularly as more children with conditions formerly often lethal in early childhood are now surviving into adulthood. Transition is a time of risk. Poor transition is likely to be a key contributor to poor outcomes: harm can be done through poor transition. Research shows that we can set young people up for the rest of their lives and make a huge difference to their life chance outcomes if we do it well. Successful transition to adulthood for disabled young people has long been recognised in government policy publications and guidance. However, there are a number of problems in achieving a coordinated approach to transition. These often include: poor multi-agency working; absence of a holistic approach to understanding individual and family needs; lack of information for young people and parents; and insufficient attention to the concerns/priorities of the young person. Challenges here combine organisational and attitudinal issues. The key aim of the Care Act, in relation to transition, is for this to be a seamless process for young people and their families, and one which results in young people entering adulthood being better set up for life.

Children and Families Act 2014 and SEN reform
Key points, relevant to transitions, from the Children and Families Act 2014 are set out in the SEN Code of Practice. The DfE’s vision for special educational needs and disability (SEND) reforms are that they will implement a new approach which seeks to join up help across education, health and care, from 0 to 25. Help should be offered at the earliest possible point, with children and young people with SEND and their parents or carers fully involved in decisions about support and what they want to achieve. The Children and Families Act instills new rights to assessment and support for young carers and parent carers – similar to the requirements under the Care Act. New 0-25 Education, Health and Care Plans (EHC) replace the current system of Statements and Learning Difficulty Assessments. For young people with SEN who have an EHC plan, preparation for adulthood must begin from year 9. EHC plans must be person-centred, outcome focused and from aged14 + must focus on Preparing for Adulthood outcomes of : higher education and/or employment independent living – choice and control over lives and support with good housing options and support participating in society – friends, relationships and participating in and contributing to the local community being as healthy as possible (health and wellbeing) The national Preparing for Adulthood programme (PfA) was commissioned by the DfE to support the SEN reforms. PfA has developed five key ‘good practice’ messages about transition to adulthood, as shown on this diagram.

Care Act 2014: transition assessment
A local authority has a duty to carry out a transition assessment for a young person or carer, in order to help them plan, if they are likely to have needs once they (or the child they care for) turn 18 There are 3 groups of people who have a right to a transition assessment: Young people, under 18, with care and support needs who are approaching transition to adulthood Young carers, under 18, who are themselves preparing for adulthood Adult carers of a young person who is preparing for adulthood Local authorities must assess the needs of an adult carer where there is likely to be a need for support after the young person in question turns 18 A key provision of the Care Act is the duty to carry out a transition assessment for these 3 groups of people in order to help them plan if they are likely to have needs once they (or the child they care for) turn 18: Young people, under 18, with care and support needs who are approaching transition to adulthood Local authorities must assess the needs of young carers where there is a likely need for care and support after they are 18, and consider how to support young carers to prepare for adulthood and how to raise and fulfil their aspirations Adult carers of a young person who is preparing for adulthood. Local authorities must assess the needs of an adult carer where there is likely need for support after the young person they care for turns 18. Note that the power to join up assessments applies so, for example, if an adult is caring for a 17 year old in transition, the local authority could combine assessment of the 17 year old under both Acts and/or assessment of the adult carer under both Acts. Transition assessments for young carers or adult carers must specifically consider whether the carer: is able to care now and after the child in question turns 18; is willing to care now and will continue to after 18; works or wishes to do so; and wishes to participate in education, training or recreation. In addition, the Care Act gives local authorities powers to ensure continuity so that where a young person is receiving children's services those services will not stop abruptly when the person turns 18, but must continue until adult services have a plan in place.

Transition assessment: significant benefit
If a young person or young carer is likely to have needs when they turn 18, the local authority must assess them when it considers there is “significant benefit” to the individual in so doing The timing of this assessment will depend on when it is of significant benefit to the young person or carer Local authorities should consider how they can identify young people who will need an assessment but are not receiving children’s services Trafford transition models and protocols are being updated to reflect Care Act and Children and Families Act requirements Local authorities must carry out a transition assessment of anyone within the three groups where there are likely needs for care and support after turning 18 and when there is significant benefit to the young person and carer in doing so. ‘Significant benefit’ is not related to the level of a young person or carer’s needs, but rather to the timing of the transition assessment. This will be informed by one or a number of circumstances e.g. upcoming exams, wishes in terms of entering college or work, whether the young person is planning to move out of the family home, planned medical treatment and so on. Every young person and their family are different, and as such, transition assessments should take place when it is most appropriate for them. Young people who are ‘likely to have needs’ after they turn 18 are highly likely to include young people and carers who are in receipt of children’s services but not exclusively so. Identifying children not known to the local authority might include, for example, young people with degenerative conditions or with mental health problems who have not required children’s services but whose needs increase as they approach adulthood. The guidance also makes reference to: young people (for example with autism) whose needs have been largely met by their educational institution, but who once they leave, will require their needs to be met in some other way young people detained in the youth justice system who will move to the adult custodial estate young carers whose parents have needs below the local authority’s eligibility threshold but may nevertheless require advice or support to fulfil their potential, for example a child with deaf parents who is undertaking communication support.

Transition assessment: key requirements
The assessment process itself must : be person-centred throughout ensure that the wellbeing of each young person or carer is taken into account include any other person who the young person or carer wants to involve always be appropriate and proportionate to the complexity of the person’s needs The process must establish: current needs and how these impact on wellbeing whether the young person or carer is likely to have eligible needs the outcomes the young person or carer wishes to achieve The focus on this slide is on key ‘musts’ for the local authority (from the guidance). The guidance confirms that the same requirements and principles apply for carrying out transition assessments as for other needs assessments under the adult statute. The process itself must be person-centred. The young person or carer in question (or others they wish to be involved) must be involved in the assessment for it to be person centred and to reflect their views and wishes. The guidance recognises that individuals may need additional information and advice to engage in the assessment process in a meaningful way. So, for instance, a young carer conducting a supported self-assessment needs to be clear about the support available both to them and the person(s) they care for. More complex issues may require more intensive and more personalised information and advice, helping people to understand the choices available to them. The process itself must be appropriate and proportionate to the complexity of the person’s needs. All transition assessments must include consideration of the current needs for care and support and how these impact on wellbeing. They must establish whether the young person or carer is likely to have needs for care and support after the young person in question becomes 18 and, if so, what those needs are likely to be, and which are likely to be eligible needs. Transition assessments must also establish the outcomes the young person or carer wishes to achieve in day-to-day life and how care and support (and other matters) can contribute to achieving them.

Joint legislative framework
Together the Children and Families Act 2014 and the Care Act 2014 create a new comprehensive legislative framework for transition: Focus on personalised, outcome-based approaches New focus on carers across both Acts - families transition rather than just the young person Duties in both Acts are on the local authority: a variety of operating models joined up information and advice service The EHC plan requirement for preparation for adulthood to begin at 14 is a good default position for transition planning generally At Trafford from 16, more intensive dialogue between children's and adults A flexible framework where transition can be a personalised evolution from to reduce the "cliff-edge" transition at 18 At Trafford, formal transition from children's to adults and reassessment still takes place at 18 The emphasis of the Care Act reflects established best practice in relation to preparation for adulthood and joint working between local authorities' adult and children's services departments. The Care Act 2014 and Children and Families Act 2014 provide a single legislative framework for transition to adulthood, with a focus on personalised outcome-based approaches and carers as families transition rather than just the young person. People working across education, health and social care need to understand both Acts and how they work together. Local authorities can achieve more by implementing the two acts together. Note that the national Preparing for Adulthood programme has developed a factsheet that sets out the links between the two reforms. Duties in both Acts are on the local authority, not children’s or adult’s services, so various operating models around transitions are possible. Another example is the overlap of information and advice duties in both Acts. The Children and Families Act 2014 requires local authorities to publish a local offer, which includes provision of information and advice for children’s social care in their local area. The Care Act places a similar duty on local authorities to provide information and advice about adult care and support. Given the similar requirements, local authorities should consider jointly commissioning and/or delivering their information and advice services. The EHC plan requirement for preparation for adulthood to begin at 14 is a good default position for transition planning generally and highlights the importance of building towards adulthood over time and developing skills in independent living. The ability to continue children's services beyond 18, and join up various assessments across both Acts, means a more flexible framework where transition can be a personalised evolution from with no need for a "cliff-edge" transition at 18.

Tools & Resources Care Act factsheets Trafford Care Act Webpage Trafford Care Act Intranet Site – coming soon E-learning – coming soon SCIE website Skills for Care website development/Learning-and-development.aspx Reshaping Social Care Training – coming in March Management/ Team Briefings – Advocacy, carers – Coming in March 128

Care Act 2014 – Staff Briefings

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Care Act 2014 – Staff Briefings

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