THE CARE ACT What’s in it for social workers Joe Godden With Thanks to Peter Feldon, BASW member

BASW want to know what your views and experiences are re the Act Will be discussion in a few minutes going to do a bit of an overview of the Act and identify key things identified for social workers

Background to the Care Act Consolidation Philosophy Funding – Dilnot etc. Integration agenda Filling some gaps e.g. Carers and Advocates

What are the most important changes? Asset based approach / personalisation Independent advocates National eligibility criteria Statutory requirement for prevention and advice Cap on care costs Carers rights Consolidation in one place

Care & Support Statutory Guidance Published in late October 2014 Over 200,000 words Overview from SCIE

What the Guidance says about the role of social workers providing advice to other staff debt recovery managing complexity safeguarding

Providing Social Work Advice Information and advice – staff undertaking this role should have “access to the support of registered social work advice” Person-centredness – “In ensuring that the (care and support planning) process is person-centred, the local authority should ensure that..there is sufficient local availability of …access to social work advice.”

Debt Recovery Positive resolution through use of social work skills Mediation Debt indicative of a wish to leave a care home or depression, mental ill-health or dementia

Managing Complexity Eligibility Prevention Safeguarding ‘Substantial difficulty’ in involvement ‘Sufficiency’ of the personal budget

Your views Q1 Do you support the principles of the Act? Talk to person on either side of you and discuss: – Something you are positive about, including positive examples of potential benefits of the Act – Something you are worried about re the implementation – Other issues you want to raise: Do you feel that you have adequate training? May 6th

Survey 176

How do you think implementation of the Act is going?

Cause of problems

Any problems in implementation

Comments ctd “Understanding that this is a fundamental change to the way social work is practiced to support a strengths based model of support, means reclaiming the heart of social work”. “None whatsoever. It has been a shambles. And I thought Council couldn't stoop much lower” “Assessment forms introduced with the new Act have been easier to use than expected and seem to focus well on client need”. “It has led to significant simplification of our processes and forms/plans”.

Budget pressures The cash invested in Adult Social Care will reduce by a further 1.9% in (equivalent to £266m). This is the third year of continuing cash reductions and the fifth year of real terms reductions in spending. Since 2010 spending on Social Care has fallen by 12% at a time when the population of those looking for support has increased by 14% requiring savings of 26% to be made, totalling £3.53bn over last 4 years. ADASSADASS The LGA has long warned that the health and social care system is chronically underfunded.

Additional funding £335 million for cost of implementation £135 under Better Care Fund (BCF) The Public Accounts Committee has criticised initial planning for the £5.3bn better care fund as 'deeply flawed'. NHS spending “was judged a higher priority than supporting adult care”. MPs say there are serious concerns with regard to the protection of adult social care and that it appears likely the fund will not support adult social services to the extent originally anticipated LGCLGC £4m for training

Post election British Association of Social Workers – Guy Shennan, chair: “We want to see a return to a commitment to social justice. Social workers have had to deal with the fallout of the austerity agenda. It’s time for government to play fair and stop punishing the poor for the economic failures of the rich”. Guardian Guardian

Post election Association of Directors of Adult Social Services – Ray James, president: “We urge the government to act to meet the significant growth in the volume and complexity of needs faced by generations that rightly expect to lead longer, more fulfilled lives. We want to see a system that is protected through adequate funding and a sustainable workforce Guardian

Conservative party manifesto “The manifesto is silent about the unprecedented challenges facing social care”. Kings Fund according to the Institute for Fiscal Studies the Tories will also need to find £30bn in real-terms cuts from ‘unprotected’ departments, including social care according to the Institute for Fiscal Studies Labour manifesto made reference but no funding

So what do we do social workers do re the Care Act Stay positive about the principles Get to know the Act – it is a requirement of your HCPC registration to be up to date re legislation – and it is your responsibility Partnership with users and carers – lets learn together and if necessary challenge together Think about outsourcing – debate is taking place Stronger together in BASW “The strong independent voice for social work and social workers”

National eligibility framework  After the assessment process, the LA will determine whether the individual has eligible needs  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 22

Eligibility Framework

24 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 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 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 M aking 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

25 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.

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. 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 26 Eligibility threshold

Case studies Florence Brown is 75 years old and lives alone in a house that she used to share with her husband (who died six months ago) and her two daughters. She suffers from COPD, is frail and has restricted mobility Florence Brown Adam is 47 years old and has a diagnosis of moderate/severe learning disability Adam Mishal is in her early 30’s and was diagnosed with multiple sclerosis four years ago. Mishal

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 28

Prevention Preventing or delaying the development of needs for care and support, and also reducing needs that already exist – can help people maintain independence for longer Information and advice to be given regardless of eligibility Assessments to consider whether the person “would benefit” from preventative and other services Should be evidence-based? Preventive services could result in a person no longer meeting eligibility criteria Recognised that training is needed to extend skills in prevention

‘Substantial difficulty’ in involvement Consider if a person might have substantial difficulty in being involved with the care and support process or safeguarding Areas of difficulty: – understanding the information provided – retaining the information – using or weighing up the information as part of the process of being involved – communicating the person’s views, wishes or feelings. Areas of difficulty are the same as those listed in section 3 of the MCA when considering capacity

Supporting a person’s involvement 31  Duty to arrange for independent advocate Is there an ‘appropriate individual’ – a carer, friend or relative – that can facilitate their involvement?  Agree ‘appropriate individual’  Provide support and make adjustments Yes No Might this person have difficulty in being involved? Can they be better supported to enable their involvement? [Reasonable adjustments under the Equality Act 2010] Yes Do they still have ‘substantial difficulty’ in being involved? Yes

‘Sufficiency’ of the personal budget  The personal budget must: – always be sufficient – reflect the cost to the local authority of meeting the person’s needs  Direct payments are not intended to be less than is required to purchase care and support on the local market