1. Housing, Wellbeing & the Care Act Integrated approaches to prevention
Liz Greer
North East ADASS Care Act Programme Manager

2. 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

3. 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.

4. Cuts in Council spending
Adult social care spending has fallen in real terms from 2011/12 to end of 2013/14

5. 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

6. 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

7. 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.

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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.”

14. 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

15. Discussion