East of England Implications of the Care Bill for Market Shaping Activity March 2014

A quick reminder IPC has been leading on the DCMQC programme over the last fifteen months for DH, working in partnership with ADASS and the CPA. IPC has also just completed for CQC a report on market stability as a precursor to the regulator taking on their new role with regard to market oversight. We have also been involved in giving expert advice to government on the Care Bill as it has developed. Today - A focus on the care bill and the impact it might have on the care market. 2

Key Clauses of the Care Bill Clause 1 of the Bill creates a new statutory principle designed to embed individual well-being as the driving force behind care and support. Clause 2 outlines the local authority’s role in preventing, reducing or delaying the need for care and support. Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or housing. 3

Key Clauses of the Care Bill Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or housing. Clause 4 of the Bill aims to clarify and modernise existing duties on local authorities by setting out the broad, high-level requirements for local authority information and advice services. Clause 5 creates a new duty requiring local authorities to promote the diversity and quality of local services, so that there is a range of high quality providers. 4

Key Clauses of the Care Bill Clauses 9-13 deal with assessment for care and replaces the current system of individual local authorities setting the threshold for eligibility. Under its provisions, central regulations will specify what levels of need (or combination of needs) will be eligible for public support. Clauses 14 to 17 lay out the new financial arrangements for paying for care. Clauses deals with LAs response to provider failure and gives CQC responsibilities relating to the finances of the largest social care providers – The Market oversight regime. 5

Caveats Need to be careful in how you read the wording. ‘Must do’ and ‘must have regard to’ do not mean the same thing. Some of what looks like new money is not and some provisions do not have funding attached to them. Most of the duties within the Act apply to carers as well as to the person in receipt of care. 6

Markets

General LA duties towards the market The LA must promote the efficient and effective operation of a market for meeting care and support needs. Make information available. Current and likely future demand and supply to meet that. Help people take part in work, training and education. Ensure the market is sustainable. Foster continuous improvement in services. Foster the workforce. The LA must have regard to ensuring sufficient services are available for meeting the needs for care and support for adults and their carers. 8

Market oversight Designed, post Southern Cross, to act as an early warning and intervention system for large, geographically significant or specialist care providers who may be in difficulties. Where there is a risk to financial sustainability CQC can require a provider to prepare a plan to mitigate that risk and conduct an independent review. If the provider cannot continue in business, the LA must be notified and continuity plans implemented. 9

Provider failure Proposes a temporary duty on LAs where a provider fails, that the LA must need the needs of adults who would have received care and support from that provider. To do so regardless of whether the person is their resident or whether the authority carried out the needs assessment or whether the person passes eligibility criteria. Authority may charge for carrying out this duty (other than the supply of information). 10

Information and advice

The LA must provide an information and advice service relating to care and support for adults and support for carers. The Act provides a list of what kinds of information and advice the LA should provide. This should be for all regardless of whether people are eligible for state funded care. In particular the LA should identify people who can benefit from financial advice. Also includes making safeguarding advice available and advice about the care market. 12

Prevention and well-being

Well-being A general overarching duty to promote well-being. Applies to those in receipt of services and carers. Generally, but not exclusively defines what well- being might be, eg, personal dignity, physical and mental health and emotional well-being, protection from abuse and neglect…. …and things the LA should have regard to, eg, the importance of beginning with the assumption that the individual is best-placed to judge the individual’s well-being and taking into account an individual’s views, wishes, feelings and beliefs; 14

Prevention Divides into Preventing or developing a need for care and support. Delaying a need for care and support. Applies to the person in receipt of care and carers. The LA must have regard to using existing services in their area. The importance of being proactive in terms of identifying needs. 15

Prevention Also ties in to the duty to integrate with NHS services where the local authority considers that integration of services would: Promote the wellbeing of adults with care and support needs (including carers), Contribute to the prevention or delay of developing care needs, Improve the quality of care in the local authority’s area. 16

Funding and finance

Changes to care funding Provision of an assessment for care needs and information / advice should be available whether the person is eligible or not. Should cover whether that person has needs and whether they are eligible needs. All people should then be given a copy of their assessment. Also a duty to assess carers. The government can set up the eligibility framework in regulations. The regulations will set out how a local authority must go about determining whether an adult’s needs meet the eligibility criteria. 18

Changes to care funding When a person has care and support needs but does not qualify for financial support from the local authority, they are still able to request that the local authority arrange the care and support that they require on their behalf. The local authority is not under a duty to meet any of the adult's eligible needs which are being met at that time by a carer. 19

General considerations Is any change to the care market automatically de- stablising? Is market oversight shutting the stable door after the fiscal horse has bolted? Should there be tighter regulation on who can provide care? Should LAs commissioning activities be equally as subject to inspection as are care providers? 20

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