Care Act Implementation and Risk Overview of social care history and policy context Description of the Dilnot Report and Recommendations Overview of the Care Act 2014 The NW architecture Exploring risk within Care Act implementation Andrew Burridge, - PowerPoint PPT Presentation

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Care Act Implementation and Risk Overview of social care history and policy context Description of the Dilnot Report and Recommendations Overview of the Care Act 2014 The NW architecture Exploring risk within Care Act implementation Andrew Burridge,

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Title: Care Act Implementation and Risk Overview of social care history and policy context Description of the Dilnot Report and Recommendations Overview of the Care Act 2014 The NW architecture Exploring risk within Care Act implementation Andrew Burridge,


1
Care Act Implementation and Risk Overview of
social care history and policy contextDescription
of the Dilnot Report and RecommendationsOverview
of the Care Act 2014The NW architectureExplorin
g risk within Care Act implementationAndrew
Burridge, Policy Manager (Health) GMIST
2
Complex legal framework
  • 1960s series of scandals based around large
    psychiatric institution see a move to community
    based care
  • Local Authority Social Services Act (1970)
    establishing social services committees, the
    formal role of Director, and the need to act
    under the general direction of the Secretary of
    State.
  • Chronically Sick and Disabled Persons Act (1970)
    introduced a duty on the LA to assess the
    individual needs of adults who met the criteria
    within the National Assistance Act
  • Disabled Persons Act 1986 enabled individuals
    and carers to request an assessment.
  • Social Security Act 1986 replaced Supplementary
    Support with Income Support, with a tighter
    financial criteria.
  • 1988 Independent Living Fund introduced small
    direct payments to people with severely
    disability and low incomes
  • NHS and Community Care Act 1990 established the
    duty to provide a service if needs are
    established as eligible. New arrangements for
    assessment and care management and individuals
    receiving individual tailored packages of care.
    As long stay hospitals closed an assumption that
    people will receive care in their own homes.
  • Community Care and Direct Payments Act 1996
    local authorities enabled to provide cash
    payments to people rather than provide a service.
  • Health and Social Care Act 2001 mandatory to
    provide direct payments
  • Health and Social Care Act 2008
  • Health and Social Care Act 2012

3
Policy trends
Increasing focus upon well-being and prevention
Assumption of a persons ability, rather than
disability
People receiving care seen as individuals with
unique needs
Local authorities to become commissioners of
care, rather than providers.
Increasing use of direct payments and
personalisation
Social workers to take on roles of assessment and
care management
Diverse market of providers developing private
and third sector
4
Councils are facing significant and increasing
demand and financial pressure.
Financial pressures
  • Since 2011/12 central revenue support for
    councils has reduced by c10 each year (c39 by
    end of 2014/15). This is equivalent to a
    reduction in spending power of c4-5.
  • Impact varies locally some councils have seen
    spending power reduce by c7 each year.
  • Many councils have still given relative
    protection to ASC compared to some other
    services.
  • Overall councils have reduced spending on ASC by
    c8.5 in real terms over three years to end
    2013/14, consistent with 3 national efficiency
    assumption.
  • User numbers have also reduced significantly over
    the SR period, particularly for 65s
  • 19 fewer over-65s receiving community care
  • 2 fewer over-65s receiving residential/nursing
    care
  • Reported outcomes and satisfaction have remained
    stable, but data limited to people receiving care.
  • Adult social care spending has fallen by c8.5 in
    real terms from 2011/12 to end of 2013/14
    (2013/14 prices)

Overall councils have delivered savings whilst
maintaining outcomes and satisfaction levels.
5
Within ten years local authority revenue budgets
will be entirely taken up by Adult SC
expenditure, childrens services, and Council Tax
Benefit
6
Background to the Dilnot Recommendations
  • 1. The current adult social care funding system
    in England is not fit for purpose and needs
    urgent and lasting reform.
  • 2. The current system is confusing, unfair and
    unsustainable. People are unable to plan ahead to
    meet their future care needs.
  • 3. A major problem is that people are unable to
    protect themselves against very high care costs.
  • 4. Most people are realistic about the need for
    individuals to make some contribution to the
    costs of care in later life, but they want a
    fairer way of sharing costs and responsibility
    between the state and individuals and they want
    to be relieved of fear and worry. There is
    consensus on the need for reform.
  • 5. To support a strategic and cultural shift in
    care and support towards wellbeing and
    prevention.

7
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8
Background to the Dilnot Recommendations
  • 1. The current adult social care funding system
    in England is not fit for purpose and needs
    urgent and lasting reform.
  • 2. The current system is confusing, unfair and
    unsustainable. People are unable to plan ahead to
    meet their future care needs.
  • 3. A major problem is that people are unable to
    protect themselves against very high care costs.
  • 4. Most people are realistic about the need for
    individuals to make some contribution to the
    costs of care in later life, but they want a
    fairer way of sharing costs and responsibility
    between the state and individuals and they want
    to be relieved of fear and worry. There is
    consensus on the need for reform.
  • 5. To support a strategic and cultural shift in
    care and support towards wellbeing and
    prevention.

9
Dilnot Recommendation (2011) Care Act (2014)
Cap lifetime contributions towards their social care costs should be capped at 35,000 Cap set at 72,000 from April 2016 and lower for working age adults. Requires the introduction of Care Accounts.
People should contribute a standard amount to cover their general living costs, such as food and accommodation, in residential care - We believe a figure in the range of 7,000 to 10,000 a year A standard contribution to living costs of around 12,000 a year will be set from April 2016 this will not count towards the cap.
The means tested threshold should be increased from 23,250 to 100,000 The threshold for support is increased to 118,000 in assets (including their home).
People should not have to immediately sell their homes and therefore to introduce a national deferred payment scheme. People will the option to defer paying care home fees from April 2015, so that people do not have to sell their home in their lifetime to pay for residential care
National eligibility and portable assessments Introduced
To encourage people to plan in later life the Government needs to plan a major communications campaign and introduce an information and advice strategy in partnership with the financial sector. Public Health England to support local comms and a national strategy in 15/16 Unclear picture regarding financial products
10
Care Act 2014Headline reform on social care
funding and support
  • Places well-being, and outcomes, is at the centre
    of every decision
  • Focus on prevention and delaying needs, and
    integration and partnership working is reinforced
  • Provides a single framework for social care
    addressing
  • Assessment (extending rights to self-funders)
  • Carers
  • Charging and financial assessment
  • Advocacy
  • Person centred care and support planning
  • Adult safeguarding
  • Integration and partnership working
  • Moving between areas (portability) and
    transitions
  • Delegating functions (third party assessments)
  • Prisons
  • Sight registers (visual impairment)
  • Managing provider failure
  • Presentation attempts to focus upon those areas
    with the most pressing risks.

11
  • Formal consultation.
  • Establish a partnership between Department of
    Health, LGA and ADASS and work together on
    detailed implementation plans to ensure effective
    preparation for and implementation of reforms.

Summer Autumn 2013
2013 2014
  • Government response to the consultation setting
    out more detailed plans.
  • Continued engagement with local authorities,
    providers, voluntary and community sector,
    financial services organisations and individuals
    and carers on details including regulations and
    guidance.
  • May 2014 Care Bill granted Royal Assent

April 2015
  • Introduction of a range of duties around
    assessment, charging, care planning and review
  • Introduction of deferred payments and preparation
    for introduction of cap using the 335m allocated
    in the Spending Review.
  • National minimum eligibility standard and fairer
    charging framework.

April 2016
  • Introduction of cap on care costs, care accounts
    and extended access to financial support.
  • An expectation that local authorities organise
    early assessments for self funders from November
    2015

12
Northwest Task Finish Group
  • Stuart Cowley (Director, Wigan Council) agreed to
    act as lead DAS.
  • Representatives from all NW local authorities
    with links to NHS England.
  • The Group is
  • Identifying the workstreams required to
    successfully implement the Bill.
  • Allocating tasks across the collective NW
    resource, and creating new architecture where
    necessary.
  • Agreeing use of regional funding allocations.
  • Championing Northwest analysis and exploring
    lobbying opportunities.
  • Communicating across NW ADASS.

13
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14
  • Risk assessment
  • Suggestions taken from
  • NW Task Finish Group
  • NW Finances and Resources Group (developed a
    submission into the National Finance Group)
  • Local risk registers

15
Assessment and eligibility
  • A new framework for assessment and eligibility
  • based around wellbeing.
  • A shift from duties to provide particular
    services, to the concept of meeting need.
  • A requirement to consider prevention and
    independent living (pre-formal assessment).
  • Implications for local policy and capacity.
  • New right for carers to request an assessment.
  • A national eligibility criteria. Concern that the
    wording of the legislation extends thresholds
    into moderate, not the substantial levels
    that most NW Councils have set.
  • Risks relating to consultation, process design,
    staff training, increased costs to the local
    authority, availability of workforce.

16
Charging and financial assessment
  • A new duty to provide an assessment to all
    people, regardless of finances or whether the LA
    thinks they will be eligible.
  • Self funders will have a right to ask the local
    authority to arrange their care for them.
  • From April 2016 the local authority will need to
    maintain a Care Account for anyone that asks for
    one.
  • Local authorities can currently charge for
    services. We retain the discretion to decide
    when to charge. We will be allowed to charge
    admin fees to self funders when we arrange their
    care.
  • Local authority will be allowed to carry out
    light touch financial assessments where thinks
    this is appropriate.
  • We will need clear policies for charging,
    charging self-funders administration fees, and
    charging carers and Deferred Payment Agreements
    local consultation required?
  • If we want to carry out 'light touch assessments'
    local policy needs to be agreed, unanswered
    questions about proportionality and financial
    risk.
  • Increased requirement for financial assessments
    based on numbers of self funders.
  • New financial tools and training implications
    arising from Care Accounts and Deferred Payment
    Agreements.
  • Risk around allowing rental income for properties
    that have a DPA.
  • Financial context places increased pressure upon
    the local authority to recoup costs.
  • Ongoing potential for legal challenge legal
    literacy training to follow.

17
Increased activity and financial risk
  • Two national models are being used to identify
    costs.
  • Lincolnshire Model (15/16)
  • Surrey Model (16/17 and beyond)
  • Lincolnshire model not yet reported. Surrey Model
    is still not sufficiently robust to produce
    aggregated results.
  • National collection of local data and results
    postponed until January/February 2015
  • Joint ADASS/DoH/LGA advice for forward financial
    planning is that the costs of funding reform will
    be fully funded.
  • Extremely important that we influence and secure
    appropriate funding of the reforms
  • Understanding the number of self funders is
    extremely hard 0 ? 120-180k?
  • There is also a similar but different gap
    regarding carers - and how many additional
    assessments and support will be required as a
    consequence of the Care Act proposals.  350k ?
    720k?
  • How can we workforce plan and design processes
    effectively without making assumptions?

18
Personalised care and support planning
  • Local authorities will have to provide individual
    support plans and personal budgets.
  • Individuals will have strengthened rights to ask
    for direct payments.
  • The Local Authority must not stifle choice and
    innovation.
  • The Local Authority must be satisfied that the
    direct payment is being used to meet eligible
    care and support needs.
  • Direct payments raise questions about fraud and
    error. 2012 Audit Commission report looked at
    102 cases totalling 2.2m.
  • Reputational risks around the choices that
    services users make.
  • Financial safeguards and political sensitivities
    need to be balanced against transforming peoples
    lives by giving them control.

19
Workforce
  • These changes have major implications for the
    social care workforce.
  • Staff across the social care and health sector
    may not have the understanding to do the job
    under the new legislation
  • Capacity of staff to deal with new / additional
    demand driven by Care Act
  • Impact of local restructure and authority wide
    financial pressure mean management and leadership
    around Care Act implementation lose focus
  • It is important that Councils look to manage down
    this risk as far as possible
  • New joined up approaches to assessment
  • Proportionate or light touch assessment
  • Third party assessment
  • Some Councils are looking at workforce redesign
    so that higher paid qualified social workers
    quality on DOLS, BIA, Continuing Healthcare and
    complex multi-agency working.
  • Process mapping has identified a range of simple
    admin functions that unqualified social workers
    can carry out.
  • NW Group looking at commissioning training at the
    NW or sub-regional level, and focused work
    looking at the potential for social care
    officer roles.
  • Financial risks and the costs of training, and
    implementation risks around scheduling training
    and identifying the appropriate providers.

20
Market shaping
  • A duty to support a market for adult social care
    that delivers a wide range of care and support
    services.
  • Risk of upward pressure on market fees in
    residential and nursing care particularly the
    top-up subsidy issue.
  • From April 2015 the right of a self funder to
    request LA support in arranging for needs to be
    met is likely to see transfer of private payers
    to lower local authority fee levels.
  • Duties on local authority to manage provider
    failure. Local authorities would ultimately
    already by likely to step in and should have
    contingency plans. The threshold is for large
    providers (1000 beds) so large rural counties
    might need closer relationships with small
    providers.

21
Safeguarding Adults
  • A clear legal framework for how LAs should
    protect vulnerable adults requirements for
    Adult Safeguarding Boards.
  • Systems should already be in place not
    featuring as a major risk, but could see
    increased referrals.
  • Advised that auditors need to be included in
    safeguarding reviews.

22
Strategic risks
  • Political and reputational
  • Government creates unrealistic and unaffordable
    expectations of the offer available from local
    councils, and the gap between expectations and
    reality impacts on local citizens views of the
    county council.
  • Other government reform programmes (eg Pensions,
    prisons, welfare reform) make Care Act
    preparation and implementation hard to deliver
    effectively.
  • Failure to deliver major elements of the
    requirements of the Care Act.
  • Legal
  • Litigation from individuals or groups
    dissatisfied with offer or process.
  • Financial
  • Magnitude of gap between Government funding and
    local expenditure related to the Care Act is
    uncertain and / or significant.
  • Care Act ICT
  • Systems changes are not delivered in time (Care
    Accounts / Deferred Payments).
  • Partnership / relationship management
  • Care Act implementation divorced from Better Care
    Fund and wider strategic integration agenda.
  • Project governance
  • Project management and leadership capacity to
    deliver.
  • Insufficient understanding of interdependencies
    and risks associated with other. projects not
    hitting key milestones

23
Local risk registers?
24
Recommendations / implications for audit
  • Be aware of the Act and understand who the local
    Care Act lead is
  • Explore involvement in local programme management
    teams
  • Support the development of local risk registers
  • Representation on the NW Care Act Task Finish
    Group

25
Contacts
  • a.burridge_at_agma.gov.uk
  • http//www.local.gov.uk/care-support-reform
  • Care and Support statutory guidance (June 2014)
    https//www.gov.uk/government/uploads/system/uploa
    ds/attachment_data/file/315993/Care-Act-Guidance.p
    df
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