Introduction and overview Care Act 2014

What is this module about? Part 1 of the Care Act and its statutory guidance Who’s it for? Adult social care as well as wider elements of local authorities Health and other local authority partner organisations Social care provider and support organisations in all sectors Those involved in the governance of these organisations and people who work, care, support and volunteer in them Practitioners What might you learn? The basic framework of the Act and its key components The core principles behind the Act and what it is intended to deliver Some implications of the Act and key changes Short summary of Part 1. Understanding basic framework and what the Act intends to do.

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 Parts 2 & 3 are concerned with the recommendations of the Francis report Most changes will be affected by April 15, changes to charging will be implemented April 16. Not just the domain of Social Care but the whole of the LA and will impact on partners

Legislation, regulations and guidance Primary legislation – the Care Act 2014 Legal duties and powers Secondary legislation – the regulations More detail on critical requirements Statutory guidance Guidance on how to meet the legal obligations in the Act Implementation support Best practice guidance, toolkits and other products that help support implementation Whilst this briefing hopes to give an overview of the Act to have a greater understanding you need to read the Act / guidance / and regulations SCIE have developed several tools to support the implementation, including Assessment and Eligibility map, Commissioning Advocacy, and safeguarding briefing notes. Act states some things MUST be done by the LA and something's SHOULD Must, however written, means Must, no choice what so ever. Should, whilst there is no specific legal duty about such recommendations DH wants LAs to do this. Therefore the expectation is the LA will do this or have a good reason why they haven’t.

The framework of the Act and its statutory guidance Underpinning principle Wellbeing General responsibilities and key duties Prevention Integration, partnerships and transitions Information, advice and advocacy Diversity of provision and market oversight Safeguarding Key processes Assessment and eligibility Charging and financial assessment Care and support planning Personal budgets and direct payments Review Main reforms set out in diagram above. Enhanced focus on prevention. New duties to work in partnership with others with a focus on integration with health. Extended responsibilities for I&A not just via web portals Independent Advocates for people who have significant difficulty in participating in process ( outside of MCA) Provider failure and having to meet needs. Ie, Southern cross Safeguarding on a Statutory footing, rather than section 7 guidance. LA must make enquiries if concern that someone is at risk of abuse or neglect.. “ make enquires, or cause others to do so, if it believes an adult is experiencing, or at risk of abuse or neglect” Cannot devolve duty to ensure enquiry is carried out. Partners Must cooperate with each other. For CL make reference AGAIN to independent advocates. DV and organisational abuse included in categories. Assessment not been seen in isolation but as an intervention in its own right. National threshold Cap on charging, care account Person taking control and resp9onsibility Can delegate, not SA. Ordinary residence cross boarder placements and the extension of HR protection ( self funders)

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 [Facilitators Note: This slide has animation. Each click brings in a different point for discussion] Clearer and fairer Care and support needs for people in prison Introduces the national Eligibility threshold Emphasis on Information and advice and the rights and responsibilities of the individual as well as the LA. Wellbeing Legal duty. Prevent and delay Public health, healthy lifestyles Support from the Larger community Improve accessibility Rehab and re -enablement Adaptations

The Care Act 2014 replaces many previous laws 1948 1960… 1970… 1980... 1990… 2000… 2010… 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 Whilst there are new things the Act brings in, it also places previous good practice onto a statutory footing. Meaning that we don’t just do it because we think its right we have to do it because it is the LAW

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 [Facilitators Note: This slide has animation. The first bullet point appears on the first click and then the next click brings in the second bullet point and so on]

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 [Facilitators Note: This slide has animation. The first bullet point appears on the first click and then the next click brings in the second bullet point and so on]

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 [Facilitators Note: This slide has animation. The first bullet point appears on the first click and then the next click brings in the second bullet point and so on]

Changes to assessment, eligibility and financial assessment processes Person appears to have needs Assessment Are their needs eligible? YES NO (written explanation) [Facilitators Note: This slide has animation. The first box appears on the first click and then the next click brings in the second box, the next click the third box, and so on] Assessment starts at first contact, gathering information. May be self assessment ( but checked and agreed by LA, may be telephone assessment) proportionate. Person should be given as much information about the process as is possible. Assessment is for anyone who appears to have any level of need Eligibility: their needs are caused by physical or mental impairment or illness. Their needs stop them achieving 2 ( 1 for carers) or more specified outcomes As a consequence there is or likely to be a significant impact on their wellbeing. Needs will be eligible or not. If eligible they will then be met or not. Deferred payment agreement Advice and information Financial assessment

Changes to care and support planning processes Las have a duty to meet Eligible unmet needs Must describe the person’s needs How they will be met their PB that identifies cost of care. Self funders will need to have their cost of care recorded for cap IPB is designed to reflect what it would cost the LA to meet the person’s needs. Consultation details of this Dec 14.

What might this mean to you? In small groups discuss what these changes may mean for the organisation you work in / represent.

What might this mean for people needing care and support? Better access to information and advice, preventative services, and assessment of need An entitlement to care and support A cap on care expenditure which an individual is liable for comes into effect from April 2016 A common system across the country: Continuity of care Fair Access to Care Services (FACS) replaced by a national eligibility threshold Continuity of care, if P moves from one LA to another no disruption to care, The continuity duty applies until the new LA has carried out its own assessment and put in place all necessary care and support based on that assessment.

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 Children and Families Act 2014 [Facilitators Note: This slide has animation. The first bullet point appears when the slide opens and then the next click brings in the secondary bullet points that explain it further, and the next click shows the last bullet point about the Children and Families Act] New duties for assessment of young carers and parent carers of children under 18.

What might this mean for local authority partners and care organisations? NHS, housing and children’s services share the duty to integrate Partners and providers will find: They may need to respond to the wellbeing principle Greater local authority focus on promoting diversity and quality in the market and market intelligence about self-funders needed Greater local authority involvement in services focused on prevention and delay National, not local, eligibility criteria New, statutory safeguarding arrangements [Facilitators Note: This slide has animation]

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 well-being, taking into account their views, wishes, feeling, beliefs “The general duty of a local authority, … in the case of an individual, is to promote that individual’s wellbeing”. [Facilitators Note: This slide has animation. The quote appears on opening the slide and then the first click brings in two bullet points] Wellbeing principle applies to LA not providers but LA may well make it a contractual arrangements. Not just about eligible needs but as a set of values by which we carry out our duties. Not the only consideration in judging eligibility

Exercise  Thinking about wellbeing in general, what does this mean to you? Suggestions: Does the person have access to all parts of their home, if not does this impact on them? People walking into someone’s house without knocking or announcing themselves , Blind!

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. The concept of wellbeing is multifaceted, whilst it must be considered through the assessment process it is also used as the final criteria in deciding eligibility.

National Eligibility criteria the needs arise from or are related to a physical or mental impairment or illness as a result of those needs the adult is unable to achieve two ( any for carer) or more of the specified outcomes: a. managing and maintaining nutrition b. maintaining personal hygiene c. managing toilet needs d. being appropriately clothed e. being able to make use of the home safely f. maintaining a habitable home environment g. developing and maintaining family or other personal relationships h. accessing and engaging in work, training, education or volunteering i. making use of necessary facilities or services in the local community, including public transport and recreational facilities or services j. carrying out any caring responsibilities the adult has for a child

National Eligibility Criteria cont.: As a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult’s wellbeing. All three criteria must be met to be eligible.

Statement from the Council Education, Health and Social Care will meet eligible needs as per the Care and Support Statutory Guidance (issued under the Care Act 2014). Where appropriate, and with permission from the person, a combined/ integrated assessment will be completed with any other relevant agency e.g. Health.

How will people experience the new system in 2016/17? If you have care and support needs, you could be supported by… Assessment of the care and support you need, and eligibility for state support Information and advice on local services and how much they cost Reablement, rehabilitation and other free services 1 Support from family, networks community… How much you might pay for your care and support depends on your financial situation You have a financial assessment to see what you have to pay 2 Every year the local authority Reviews your care needs and financial situation Keeps a record, from April 2016, called a care account, of how much eligible care you have needed in total 4 Costs are capped There is a cap on expenditure on eligible care from April 2016 3 [Facilitators Note: This slide has animation. The first box appears on the first click and then the next click brings in the second box, the next click the third box, and the fourth click the fourth box] Everyone is entitled to the provisions outlined in box 1 Box 2 financial thresholds change 2016 The cap covers eligible CARE costs only, so accomodation costs in residential care are not included ( “hotel” costs)

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

What might this mean for your practice? In small groups discuss what you’ve heard and identify changes that you will think you will need to make to your practice.