Housing, Wellbeing & the Care Act Integrated approaches to prevention Liz Greer North East ADASS Care Act Programme Manager liz.greer@northeastcouncils.gov.uk 07557 759770

Overview-the Care Act Modernising legislation replacing patchwork of law developed since 1948 Reforms the way care and support is provided (April 15) Financial reforms postponed until 2020 Wellbeing & personalised care at the heart of the reforms Aims to make care and support clearer and fairer for all New national eligibility threshold New duties on Councils & their partners New entitlements for people who use services & their carers

Demands on the system …and around 6 million people caring for a friend or family member. …around 400,000 people in residential care, 56% of whom are state-supported …around 1.1 million people receiving care at home, 80% of whom are state-supported Three-quarters of people aged 65 will need care and support in their later years Compared with today, we expect 600,000 more older people to have potential care needs in the next 20 years. The number of people with dementia will double to 1.4 million by 2030 The number of people with three or more long term conditions is set to increase from 1.9 million in 2008 to 2.9 million in 2018. The number of adults with learning disabilities who require some form of support will increase between 3.2% and 7.9% per year until 2026. Older people are the main users of acute hospital care - 60% of admissions, 65% of bed days and 70% of emergency readmissions. 72% of recipients of social care services are older people, accounting for 56% of expenditure on adult social care.

Cuts in Council spending Adult social care spending has fallen by @8.5% in real terms from 2011/12 to end of 2013/14

New ‘universal’ duties on Councils Promote wellbeing Prevent, reduce or delay development of care needs Provide information and advice about care and support Shape and commission care markets to meet current and future need Limit impacts of provider failure or service interruption These duties apply to all people in the local population, irrespective of current or future needs for care and support

Prevention Services, resources & facilities which prevent the development of care and support needs could include: universal access to good quality information support to create safer neighbourhoods Promotion of healthy and active lifestyles via eg exercise classes Reducing loneliness or isolation through befriending schemes or community activities Encouraging early discussions with families about potential care arrangements or suitable accommodation should a family member become ill or disabled

Reduction Services, resources & facilities to reduce the development of care and support needs eg targeted interventions aimed at those with an increased risk of developing needs (eg stroke;falls) Fall prevention programmes Adaptations to housing eg to improve accessibility Equipment loans Telecare services Handyperson services Early identification of carers & support to help them care effectively and look after their own health and wellbeing.

Delay Minimising the effect of a disability or deterioration for people with complex needs and promoting independence through : rehabilitation/reablement services equipment services and adaptations Carer support eg respite care, peer support ,adaptations, IT and assistive technology, access to advice and information about carer benefits and financial advice

And the winners are..? Substantially lower threshold for assessment and care and support- lower even than service users Can get help even if the cared-for person is not eligible Usually no charge or financial assessment for care and support Rights to personal budgets & direct payments …and around 6 million people caring for a friend or family member.

Information and advice Councils must set up and maintain an information and advice service distinct from the duty to meet eligible needs Councils (working with partners) must provide targeted information and advice at key ‘trigger points’ in people’s lives Early identification of people who will benefit from financial advice or information including how care and support can be funded Must be offered in a variety of media, formats, languages & face to face Independent advocacy must be offered where people will experience substantial difficulty in understanding, retaining or using information (where there is no-one else to fulfil this role) People can readily access regulated and unregulated financial advice at different points in their care journey

Trigger points Bereavement Hospital entry and/or discharge Diagnosis of health condition Consideration or review of Continuing Healthcare arrangements Take-up of power of attorney or applications to Court of Protection Application/review of disability benefits Access to work interviews Contact with/use of private care services, including home care Change/loss of housing Contact with the criminal justice system/release from prison Retirement

New duty on Councils-cooperation & integration Councils must cooperate with named public bodies including Housing, Public Health, Benefits, Employment & Training Agencies, Probation Services, NHS England, CCGs, NHS and Foundation provider Trusts Duty to co-operate is reciprocal ie named partners must also cooperate with Councils Duty to co-operate is extended where possible to other partners eg private housing providers Integration between care and support provision, health and health related services (including housing) must be promoted

Integration, cooperation and partnerships “Councils should consider how they can work with partners to identify unmet needs and coordinate shared approaches to preventing or reducing such needs...including housing providers ...who can provide local insight into changing or emerging needs” “Councils must ensure the integration of care and support provision...with health and health-related services, which include housing. This responsibility includes a focus on integrating with partners to prevent, reduce or delay needs for care and support.”

Approaches to integration  Examples of integration include:  Sharing population data to better understand/profile local needs Joint commissioning of services to deliver better outcomes in a local area Integrated approaches to provision of advice and information which may reduce, delay or prevent the development of care needs Integrating assessments to cover health, care and housing needs integrated provision of care and support services  

Discussion