Care Act 2014 – Staff Briefings
Reshaping Trafford Council
Key themes of today

Overview and main principles of the Act

Information and advice

Assessment and eligibility

Care and support planning

Financial assessments and payment processes

Deferred payments

Personal budgets and direct payments

Transitions
Care Act 2014
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Objectives
By the end of the session you should be able to;
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Describe the main themes of the Care Act 2014
Define the eligibility criteria
Identify the key principles of financial assessment and eligibility
Review the changes around care and support planning
Understand the changes to the deferred payments scheme
Define how Personal Budgets will work
Understand the role you will play to deliver the Care Act changes
Ownership of Council resources
3
Care Act 2014
Introduction
 The Care Act received Royal Assent on 14 May 2014
 The Act is in three parts:
1. Care and support
2. Care standards
3. 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
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Care Act 2014
Overview of timescales
Date
Milestone
May 2014
Received Royal Assent
Jun 2014
Publication of draft guidance and regulations (Part 1)
Oct 2014
Publication of final guidance and regulations (Part 1)
Feb 2014
Publication of draft guidance and regulations (Part 2)
Feb 2015
National communications campaign – phase 1
Apr 2015
Part 1 Care Act implemented – Care & support reforms
Jul 2015
National communications campaign – phase 2
Oct 2015
Publication of final guidance and regulations (Part 2)
Oct 2015
Early assessments for self-funders
Apr 2016
Part 2 Care Act implemented – Funding reforms
5
Care Act 2014
The Care Act 2014 replaces many
previous laws
National
Assistance Act
1948
1948
1960…
NHS and
Community
Care Act 1990
1970…
Chronically Sick
and Disabled
Person Act 1970
1980...
Community Care
(Direct
Payments) Act
1996
1990…
2000…
2010…
Carers
(Recognition and
Services) Act
1995
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Care Act 2014
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
7
Care Act 2014
An integrated Act
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Different sections of the Act are designed to work together
Local authority wide
Overlap with Children and Families, including transitions
Partnerships and integration
Leadership
8
Care Act 2014
The framework of the Act and its
statutory guidance
Underpinning
principle
Wellbeing
General
responsibilities and
key duties
Prevention
Information, advice
and advocacy
Diversity of
provision and
market oversight
Integration,
partnerships and
transitions
Safeguarding
Carers
Key processes
Assessment and
eligibility
Charging and
financial
assessment
Care and support
planning
Cap &
threshold
Personal budgets
and direct
payments
Review
9
Care Act 2014
The wellbeing principle
“The general duty of a local authority, … in the case of
an individual, is to promote that individual’s wellbeing”.
 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 wellbeing
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Care Act 2014
Wellbeing
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
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Care Act 2014
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
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Care Act 2014
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
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Care Act 2014
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
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Care Act 2014
Changes to assessment, eligibility and
financial assessment processes
Person appears
to have needs
Assessment
Are their
needs
eligible?
YES
Deferred
payment
agreement
Care and
support
planning
Financial
assessment
NO (written
explanation)
Advice and
information
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Care Act 2014
What might this mean for people
needing care and support?
April 2015





Better access to information and advice, preventative services, and assessment
of need
An entitlement to care and support, plans and reviews
Personal budgets on a statutory footing for the first time
Universal deferred payments scheme
A common system across the country:
 Continuity of care
 Fair Access to Care Services (FACS) replaced by a national eligibility
threshold
April 2016


A cap on care expenditure comes into effect from April 2016 (£72,000 for non
working age adults)
Increase asset threshold to £118,000 (when include value of the property)
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Care Act 2014
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
 Duty to identify and refer young carers
 Children and Families Act 2014
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Care Act 2014
What this means for Trafford
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New duties and responsibilities
Changes to local systems and processes
More assessments and support plans
Responsibilities towards all local people
Better understanding of self funders
Continued understanding of care market
Training and development of the workforce
Costs of reforms
On-going preparation for reforms
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Care Act 2014
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
Care Act 2014
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9
Sources of Information and advice
Reshaping Trafford Council
What is information and advice?
Self-help
information
Assisted
information
Advice
Specialist advice
and advocacy
Websites,
leaflets, NHS
Choices etc
Telephone
helplines,
directories,
libraries, one
stop shops,
CAB, charities,
information
centres, GPs,
frontline staff
etc
Telephone lines,
information
centres, one
stop shops,
CAB, support
groups, carers
centres, CIL,
social workers,
GPs, outreach
staff/workers etc
Independent
financial
advisers, legal
help on
complex
matters in
specific areas
of law,
independent
advocates
No interaction
Limited to
moderate
interaction
Moderate to high
interaction
High interaction
Care Act 2014
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1
A duty on local authorities
 Section 4 of the Care Act places a duty on local authorities to ensure
the availability of information and advice services for all people in its
area, regardless of whether or not they have eligible care needs
 Local authorities do not have to provide all elements of this service
Care Act 2014
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2
What needs to be provided?
 Information about how the local care and support system works
 How people can access care and support services
 What types of care and support are available
 Financial information and advice, including how to access
independent financial advice
 How to raise concerns about the safety or wellbeing of someone who
has care and support needs
Care Act 2014
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3
Accessibility and proportionality
 Information should be accessible to all who would benefit from it:
 A range of delivery mechanisms
 Staff aware of accessibility issues and appropriately trained
 Materials are adapted as necessary e.g. easy read versions
 The type, extent and timing of information and advice provided should
be appropriate to the needs of the person:
 The right level needs to be provided at the right time
 More complex issues may require more intensive and more
personalised information and advice
Care Act 2014
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4
Information & Advice at Trafford
 Information and advice services reviewed in 2013 to ensure effectiveness
 On-going work to consolidate existing advice offer across CFW
 Council information and advice
 Access Trafford
 Screening & Signposting
 MyWay, Trafford Service Directory websites
 Welfare Advice Team
 Community advice services
 Citizens Advice Trafford
 Housing Options
 Healthwatch Trafford
 Carers Centre
 MyChoice eMarketplace
 Other voluntary sector organisations
 Developing signposting for indep financial advice
 Expanding advocacy provision
25
Care Act 2014
Care Act 2014
Assessment and eligibility
Reshaping Trafford Council
Outline of content
 Appropriate and proportionate assessment
 Preventing needs
 Taking a holistic, strengths-based approach
 Supporting a person’s involvement
 Roles, responsibilities and expertise
 National eligibility framework
 Next steps and informing individuals
 Summary
Care Act 2014
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7
Assessment
 Assessment is both a key process AND a critical intervention in
ensuring the person independence is maintained or further developed
 An assessment should identify:
 Clearly define and evidence care and support needs
 what outcomes the individual is looking to achieve to maintain or
improve their wellbeing
 how care and support might help in achieving those outcomes
 Draw on personal, community and family assets to promote
independence
Care Act 2014
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Refusal of assessment
 The local authority is not required to carry out assessment where a
person with possible care and support needs or a carer:
 feels that they do not need care
 may not want local authority support
 This can be overridden where they:
 lack capacity to take that decision and an assessment would be in
their best interests
 are experiencing, or at risk of experiencing, any abuse or neglect
Care Act 2014
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9
Appropriate and proportionate
assessment
 People should receive an assessment that is appropriate and
proportionate – as extensive as required to meet a person’s needs.
 The process can be flexible and include e.g. telephone (screening &
signposting), on-line (being developed at Trafford), face to face and
combined assessments (utilising carer assessments where appropriate)
 To be appropriate assessments should meet the person’s
communication needs
 Appropriate assessments can include the use of reablement, or aids
and adaptations to ensure greater understanding of need
Care Act 2014
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0
Integrated assessments
 All of the agencies involved should work closely together to
prevent a person having to undergo a number of assessments at
different times
 To achieve this local authorities should:
 ensure healthcare professionals’ views and expertise are taken
into account
 work with healthcare professionals to ensure people’s health and
care services are aligned and set out in a single care and
support plan
 In cases of abuse, the local authority should lead the assessment
and ensure that all agencies follow the local multi-agency
procedures to ensure coordination of information and possible
evidence
Care Act 2014
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1
Fluctuating needs
 In establishing the on-going level of need local authorities:
 must consider the person’s care and support history over a
suitable period of time to take account of potential fluctuation of
needs
 may also take into account at this point what fluctuations in need
can be reasonably expected based on experience of others with a
similar condition
 Particularly where people lack capacity
Care Act 2014
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Supported self-assessment –
check eligibility
 The local authority must offer the individual the choice of a
supported self-assessment if they are able and willing.
 The person should be asked to complete the same assessment
questionnaire that the authority uses in their needs or carer’s
assessments
 The individual must have capacity to fully assess and reflect their
own needs
 The local authority must assure itself that the person’s supported
self-assessment is an accurate and complete reflection of their
needs because there may be a difference of opinion
 Regardless of the format a needs assessment takes, the final
decision on eligibility is with the local authority
Care Act 2014
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Preventing needs
 Assessment is a key element of any prevention strategy
 The assessment must consider whether the person concerned would
benefit from the available preventative services, facilities or
resources
 The guidance refers to three levels of preventative activity:
 primary prevention, which involves promoting wellbeing
 secondary prevention, which involves early intervention
 tertiary prevention, which involves maximising independence
Care Act 2014
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4
A strengths-based approach
 The local authority must also consider what - other than the provision of
care and support - might help the person in meeting the outcomes they
want to achieve: a strengths-based approach
 This strengths-based approach recognises personal, family and
community resources or ‘assets’ that individuals can make use of
 Trafford Reshaping Social Care Offer – developing local directory of
alternative solutions
 Trafford Panel briefing in June 2014
 Further training in March 2015
Care Act 2014
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5
Whole family approach

Takes a holistic view of a person’s needs

Considers the impact of needs on family and wider networks

In particular any children providing care:
 The impact of the person’s needs on the young carer’s wellbeing, welfare,
education and development
 Whether their caring responsibilities are appropriate

Sees the family and wider network as a source of support, where they are
willing and able
Care Act 2014
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Supporting a person’s
involvement
Might this
person have
difficulty in
being
involved?
Do they still
have
‘substantial
difficulty’ in
being
involved?
Care Act 2014
Yes
Can they be better
supported to
enable their
involvement?

Yes
Provide
support and
make
adjustments
Yes
Agree
‘appropriate
individual’
No
Duty to
arrange for
independent
advocate
[Reasonable
adjustments under the
Equality Act 2010]
Yes
Is there an
‘appropriate
individual’ – a
carer, friend or
relative – that can
facilitate their
involvement?


3
7
Roles, responsibilities and expertise
registered social workers
occupational therapists
rehabilitation officers
social care assessors
expert assessors
S
Care Act 2014
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8
National eligibility framework
 After completion of the assessment process, the local authority will
determine whether the individual has eligible needs
 The Act introduces a 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
 Local authorities can also decide to meet needs that are not
deemed to be eligible if they chose to do so
Care Act 2014
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Interpreting the eligibility criteria
The specified outcomes are:
 Managing and maintaining nutrition
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
 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
Care Act 2014
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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.
Care Act 2014
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Eligibility threshold
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.
Care Act 2014
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
42
Wellbeing
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
43
Care Act 2014
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
 Local authorities can also decide to meet carers’ needs that are not
deemed to be eligible if they chose to do so
Care Act 2014
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4
Interpreting the carers’ eligibility
criteria
The specified outcomes are:
A carer meets the eligibility
criteria if:
 Their needs are caused
by providing necessary
care for an adult. As a
result:
 their health is at risk
 or they are unable to
achieve specified
outcomes
 As a consequence there
is or is likely to be a
significant impact on the
carer’s well-being
Care Act 2014
 Carrying out any caring responsibilities
the carer has for a child
 Providing care to other persons for
whom the carer provides care
 Maintaining a habitable home
environment
 Managing and maintaining nutrition
 Developing and maintaining family or
other personal relationships
 Engaging in work, training, education
or volunteering
 Making use of necessary facilities or
services in the local community
including recreational facilities or
services
 Engaging in recreational activities
45
Record-keeping and informing
individuals
Informing the
individual of
their eligibility
determination
• The local authority must:
• produce a written record of whether any of
the individual’s needs meet the eligibility
criteria, and the reasons for why they do and
why they do not
?
Informing
individuals who
are not eligible
Care Act 2014
• Where the individual does not have eligible
needs, the local authority must also provide:
• information and advice on what support might
be available in the wider community; or
• what preventative measures might be taken
to prevent or delay the condition progressing
4
6
Next steps
Assessment
• What are the
needs and
outcomes the
person wants
to achieve?
Eligibility
determination
• Are the
person’s
needs
eligible?
Met needs
Unmet needs
• What needs
can be/are
being met
through nonservice
provision?
• Are included
in the
personal
budget
• (via personal,
family and
community
resources)
Care Act 2014
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Summary
 Assessment based on appearance of need for care and support:
 Consider the person’s needs and the outcomes they want to
achieve
 Be appropriate and proportionate
 Maximise the person strengths (personal, family and community
resources and telecare)
 Involve the person needing care in the assessment, and
consider if they would have substantial difficulty being involved
 Throughout the process, also consider if the person lacks capacity
or is at risk of abuse
 National eligibility threshold, for people needing carer and carers,
based on outcomes and wellbeing
Care Act 2014
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Care and support planning
Reshaping Trafford Council
Outline of content

Introduction

Production of the plan

Planning for people who are at risk of harm

Planning for people who lack capacity

Combining plans

Sign off and assurance

Summary
Care Act 2014
50
Care & Support Plans Defined
Care Plan (SW/ SCA)

How needs identified in the assessment will be met to achieve
outcomes and improve wellbeing
Support Plan (provider)

Details of how needs are met on a day to day basis
Care Act 2014
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Personalisation in social care
and health
The Care Act 2014
Our Health, Our
Care, Our Say
Putting People
First
Direct
payments
Community
Care
Reforms
Griffiths
Report
Care Act 2014
52
Person centred care and support
planning
Person not
services
Person has
control
Person centred
planning
First person
Care Act 2014
53
Emphasis
on assets
and
capabilities
The Care Act and person-centred
planning
 Care and support planning should put people in control of their care
 The person must be actively involved and influential throughout the
planning process
 Independent advocates must be instructed early in the planning
process for those who have substantial difficulty and have no other
means of accessing appropriate support to facilitate their involvement
Care Act 2014
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Person-centred care and support
planning
Care Act 2014
55
Production of the plan
 Involving the person
 Key elements
 Context
 Further considerations
 Direct payments
 Constraints
Care Act 2014
56
Involving the person

The local authority must take all reasonable steps to involve the person, their
carer and relevant others

The local authority must instruct an independent advocate if there is no one
else that can facilitate involvement
Care Act 2014
57
Key elements of the care plan
Needs and assets
Assessed and eligible
Co produced outcomes
Final plan must
include
How needs will be met/
reduced
Care Act 2014
58
Personal budget
Own financial contribution
Direct payments
Context
Take a holistic
approach
Record needs being
met by carer
Consider a combined
plan to meet both the
person’s and carer’s
needs
Consider universal
services and
community-based
and/or unpaid
support
Care Act 2014
59
Further considerations for the
plan
Be
proportionate
but compliant
with rules
Care Act 2014
Take account
of fluctuating
needs
60
Make sense to
the person
Must be
agreed with
the person or
their
representative
Direct payments

The local authority must inform the person which, if any, of their needs could
be met by a direct payment

The person should be provided with appropriate information and advice
concerning the usage of direct payments and how they differ from traditional
services

People should be empowered to make informed decisions about how to best
meet their needs

Already offered and in place at Trafford
Care Act 2014
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Constraints

There should be no constraint on how assessed, eligible, unmet needs are met
as long as this is reasonable

The local authority has to satisfy itself that the decision is an appropriate and
legal way to meet needs

Limited list of prescribed providers must be avoided
Care Act 2014
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The person prepares the plan jointly
with the local authority
Appropriate
people
Secured
Information
Person’s
Best
Interests
Care Act 2014
63
Planning for people who are at
risk of harm

The person will have been subject to and/or remain at risk of abuse or
neglect

They will have been subject to a local authority section 42 enquiry into their
situation and will have an agreed safeguarding plan

The plan must actively involve the person in agreeing what outcomes they
want and how they will be achieved

While aiming to meet the person’s outcomes the plan must also balance risk
appropriately by using the least restrictive options

The plan will be subject to review under the local multi-agency safeguarding
procedures
Care Act 2014
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Planning for people who lack
capacity

The Mental Capacity Act 2005 (MCA) requires local authorities to assume that
people have capacity and can make decisions for themselves, unless otherwise
established

A person must be given all practicable help to make specific decisions before
being assessed as lacking capacity

Where an individual has been assessed as lacking capacity, the local authority
must commence care planning under the ‘best interests principle’ within the
meaning of the MCA

The duty to involve the person remains throughout the process
Care Act 2014
65
Minimising and authorising
deprivation of liberty for people
who lack capacity

The Mental Capacity Act 2005 (MCA) provides legal protection for acts of
restraint only if the act is:
 necessary to prevent harm to the person
 a proportionate response to the likelihood of the person suffering harm and
the seriousness of that harm, and
 in the person’s best interests

If the degree and intensity of restrictions and restraints are so significant that
they amount to a deprivation of liberty, this must be authorised under the
Deprivation of Liberty Safeguards (DOLS) under the MCA
Care Act 2014
66
Combining plans
Consider if multiple plans exist
Obtain consent from all parties
Establish a lead organisation
Care Act 2014
67
Sign-off and assurance
Sign off
Should
Occur
when
• Sufficient time has been taken to ensure the plan is
appropriate to meet identified needs
• There is consensus on the factors in the plan
• Addresses how the needs in question will be met
• Includes the final personal budget
• Final agreement is recorded
Care Act 2014
68
Sign-off and assurance

In the event that the local authority decides that it cannot sign-off a plan, or
where a plan cannot be agreed, it should state:
 the reasons for this
 the steps which must be taken to ensure that the plan is signed-off

The local authority must give a copy of the final plan to:
 the person for whom the plan is intended
 any other person they request to receive a copy
 any other person the individual requests to share it with
 their independent advocate if they have one
Care Act 2014
69
Summary

The person must be actively involved throughout the planning process

An independent advocate must be instructed at an early stage if a person
has substantial difficulty in engaging in the process

The plan must describe what needs the person has, and which needs the local
authority is to meet

The plan must include: the personal budget and direct payments

The local authority must inform the person which, if any, of their needs may be
met by a direct payment

The local authority must give a copy of the final plan to the person and others
requested by the person in an accessible format

The local authority has a duty to keep the person’s plan under review
Care Act 2014
70
Review/ reassessment

The aim of review is to ensure all people with a care and support plan, or
support plan have the opportunity to reflect on:
 what’s working
 what’s not working
 what might need to change

The review process should be:
 person-centred
 outcomes focused
 accessible
 proportionate to the needs to be met

The process must involve the person needing care and the carer where
feasible, and an independent advocate where relevant
Care Act 2014
7
1
Care and support planning
Care Act 2014
7
2
Keeping plans under review
Changes to
circumstances
New
outcomes
Personal
budgets
What’s
working
Outcomes
achieved
Changes to
support
networks
Any required
changes
Is person
satisfied with
plan
What’s not
working
Care Act 2014
7
3
Routes to reviewing/ reassessing
Planned review
• Date set with the
individual during
the planning
process
Care Act 2014
Unplanned
review
• Resulting from a
change in needs
or circumstances
Requested
review
• Person, carer,
advocate or
interested party
makes a request
7
4
Revision of the plan

The development of a revised plan must involve the person, their
representative or independent advocate

Where a revision is necessary, the local authority must where appropriate carry
out a re-assessment, using process involved in the original assessment and
care planning processes, revising the plan and personal budget accordingly

The re-assessment process should not start from the beginning, but pick up
from what is already known about the person and should be proportionate
Care Act 2014
7
5
Timeliness and regularity of
reviews

In the absence of any request for a review, or any indication that circumstances
may have changed, the local authority should conduct a periodic review of plan
no later than every 12 months

The review should be performed as quickly as is reasonably practicable

It should not contain any surprises and must not be used to arbitrarily reduce
a care and support package

Any reduction to a personal budget should be the
result of a change in need or circumstance
Care Act 2014
7
6
Personal budgets
Reshaping Trafford Council
Outline of content
 Introduction
 Elements of the personal budget
 Calculating the personal budget
 Agreeing the final budget
 Use of a personal budget
 Use of a carer’s personal budget
 Appeals/disputes
 Summary
78
Care Act 2014
Introduction
 The Care Act places personal budgets into law for the first time,
making them the norm for people with care and support needs.
 It is vital that people:
 are clear how their budget was calculated
 have confidence that the personal budget allocation is correct and
therefore sufficient to meet their care and support needs
 Personal budgets enable the person to:
 exercise greater choice
 take control over how their care and support needs are met
79
Care Act 2014
Elements of the personal budget
 The personal budget must always be an amount sufficient to meet the
person’s care and support needs
 The overall cost must be broken down into:
 the amount the person must pay (following the financial
assessment)
 the remainder of the budget that the authority will pay
81
Care Act 2014
Other costs that may be
presented or excluded
Presented
• Local authority brokerage fee
Presented
• Any additional payment or a “top-up”
Excluded
• Costs for intermediate care or
reablement must be excluded
82
Care Act 2014
Calculating the personal budget
Transparency
Timeliness
Sufficiency
83
Care Act 2014
Sufficiency of the personal
budget and implications for
direct payment
 The personal budget must:
 always be sufficient
 reflect the cost to the local authority of meeting the person’s
needs
 be open to challenge
 Direct payments are not intended to be less than is required to
purchase care and support on the local market
84
Care Act 2014
Agreeing the final budget
 The final budget should be agreed at the end of the planning process
 Sign off should take place if
 the plan is within the indicative budget (or justifiably above it)
 the proposed use of the money is:
 appropriate
 legal
 meets the needs identified in assessment
85
Care Act 2014
Use of a personal budget
Third party
managed PB
(ISF)
Local authority
managed PB
Direct
payments
Mixed package
Maximum
possible
range of
options
86
Care Act 2014
Appeals/disputes
 The local authority must make its own arrangements for dealing with
complaints in accordance with the 2009 regulations
87
Care Act 2014
Current Position At Trafford
 Personal Budgets
 At Trafford the RAS, which gives a personal budget allocation is
used
 RAS currently is being revised – Reshaping Social Care Offer
 This will now refer to the total amount needed to meet someone's
care and support needs that are not being met
 Direct Payments
 Currently have approx. 680 (across CFW) on direct payment
 Renaming personal budget team to fit with national terminology
88
Care Act 2014
Summary
 The Act places personal budgets into law for the first time, making them
the norm for people with care and support needs
 Personal budgets are designed to enable people to exercise greater
choice and take control over how their care and support needs are
met
 The personal budget must:
 always be sufficient to meet the person’s care and support needs
 include the cost to the local authority and the amount the person
must pay
 exclude the provision of intermediate care and reablement
 The carers personal budget must enable the continuation of the carer
role and must have regard to the wellbeing principle of the act
 The local authority is under an ongoing duty to keep the person’s plan
and personal budget under review
89
Care Act 2014
Charging and financial assessment
Reshaping Trafford Council
Outline of content
 Introduction
 Conducting the financial assessment
 What charges can be made?
 Choice of accommodation and top-up fees
 Charging to support carers
 Recovery of debts
 Summary
Care Act 2014
9
1
Introduction – Already in place at
Trafford
 Local authorities may charge a person needing care or a carer, but certain
types of care and support must be arranged free of charge
 If a local authority has chosen to charge a person for a service it is
arranging it must undertake a financial assessment of one level or
another
 The detail of how to charge is different depending on whether someone is
receiving care in a care home, their own home, or another setting
 The rules for charging are split into those for:
 A care home; and
 All other settings
 Local authorities should develop and maintain a policy on charging in
settings other than care homes (see later slide)
Care Act 2014
9
2
Charging and financial assessment
principles from the statutory
guidance
1. Ensure that people are not charged more than it is reasonably
practicable for them to pay
2. Reduce variation in the way people are assessed and charged
3. Be clear and transparent
4. Promote wellbeing, social inclusion, and support the vision of
personalisation, independence, choice and control
5. Support carers
6. Be person-focused
7. Apply the charging rules consistently
8. Encourage and enable those who wish to stay in or take up
employment, education or training
9. Be sustainable for local authorities in the long-term
Care Act 2014
9
3
Where Care Act charges must not be
made – Already in place at Trafford




Intermediate care including reablement (for up to six weeks)
Aids, and minor adaptations of less than £1,000
Care and support provided to people with CJD
After care/support provided under Mental Health Act 1983
s117
 NHS services
 Any services which an authority is under a duty to provide
through other legislation
Care Act 2014
9
4
Financial assessment – Already
in place at Trafford
 In a financial assessment, both capital and income must be assessed,
which will be either disregarded, partially disregarded or included
 Some capital and income must be disregarded and local authorities
have discretion to disregard assets in some other circumstances
 The value of a person’s main or only home must be disregarded
where they are receiving care in a setting that is not a care home or
where a qualifying relative occupies the property as their main or only
home
 To help encourage people to remain in or take up employment earnings
from current employment must be disregarded
 Notional capital and income can be taken into account
Care Act 2014
9
5
‘Light-touch’ financial assessments
– Trafford is expanding this role
 A local authority may choose a ‘light touch financial assessment’ for
instance where:
a) The person has significant financial resources, and does not wish
to undergo a full financial assessment for personal reasons
b) There is a small or nominal charge for a particular service, and
carrying out a financial assessment would be disproportionate
c) An individual is in receipt of certain benefits e.g. Jobseekers
Allowance
 The authority must be sure the person is able to pay any charges due
 A person must be informed that they have the right to request a full
financial assessment should they so wish, and so, in effect, agree to a
light touch assessment
 At Trafford conducting more desk based assessments and risk based
approach at e.g. checking DWP information prior to assessments
Care Act 2014
9
6
Information and advice
 Accessible information and advice, including: (Shared on MyWay and
leaflets available at Trafford – all being refreshed)
 Independent financial information and advice
 Operation of top-ups
 Deferred payment agreements (DPA)
 Complaints
 The person must be given a written record of the financial assessment
which includes: (Already in place at Trafford)
 Explanation of how it has been carried out
 What the charge will be
 How often it will be made
 The reason for any fluctuation in charges
Care Act 2014
9
7
If the person lacks capacity –
Already in place at Trafford
 At the time of the assessment of care and support needs, the local
authority must establish whether the person has capacity
 If the person lacks capacity, the local authority must find out if the
person has someone with legal powers to act on their behalf, as the
appropriate person will need to be involved
 If there is no such person, then an approach to the Court of Protection
is required – at Trafford the court can appoint the local authority
Care Act 2014
9
8
Capital limits
A person with more in capital than the upper capital limit is
responsible for arranging and funding their own care and support
Upper capital limit
Lower capital limit
Care Act 2014
Below the upper capital
limit, a person is
entitled to access
means-tested local
authority support
Where a person’s
resources are below the
lower capital limit they will
not need to contribute to
the cost of their care and
support from their capital
9
9
Deprivation of assets – Already in
place at Trafford
 Deprivation of assets refers to where a person has intentionally
deprived themselves of or decreased their overall assets in order to
reduce the amount they are charged towards their care
 If a person deliberately tries to avoid care and support costs through
deprivation of assets, the local authority may charge the person as if
they still possessed the asset
 Deliberate deprivation may occur when someone knows they have a
care and support need and that they would be charged and reduces
their assets in order to avoid those charges
Care Act 2014
1
0
What charges can be made?
 The rules for charging are split into those for a care home and all
other settings
 Charges should be reasonable and not leave people with less than a
specified amount of income
 Where a person has capital between the upper and lower limit, they
may be charged a ‘tariff income’ of £1 per week for every £250 in
capital between the two amounts
 A local authority must not charge more than the cost that it incurs in
meeting the assessed needs of the person

A local authority cannot charge an administration fee for arranging
care and support
Care Act 2014
1
0
Choice of accommodation and
top-up fees
 The local authority must provide for the person’s preferred choice of
accommodation, subject to certain conditions (within council agreed
value)
 This choice applies between providers of the same type
 The local authority must offer at least one option that is affordable
within a person’s personal budget, and should offer more than one
 A person can choose a more expensive setting, through a ‘top-up’
from a third party (or the resident in some circumstances)
 The local authority must ensure that the person paying the ‘top-up’ is
willing and able to meet the additional cost, and enters into a written
agreement with the local authority, agreeing to meet that cost
Care Act 2014
1
0
Charging to support carers
 Carers play a vital role in the care and support system
 Local authorities are not required to charge a carer for support, but they
may do so
 If the local authority chooses to charge for it, replacement care should be
charged to the adult needing care and not the carer seeking a respite
break
 Local authorities should ensure that any charges do not negatively
impact on a carer’s ability to look after their own health and wellbeing and
to care effectively and safely
 Charging of carers must be in accordance with the non-residential
charging rules
 A local authority should carry out a financial assessment to ensure that
charges are affordable, but it is likely that a light-touch financial
assessment will be appropriate
 Trafford does not currently charge carers
Care Act 2014
1
0
Recovery of debts

The existing powers under S22 of HASSASSA 1983 will no longer apply from
1 April 2015

From then on local authorities must use the provisions under S69 of the Care
Act:

Must offer a DPA whenever possible

Trafford will start recovering debt under debt recovery policy where DPA’s
are not agreed

Ultimately an authority has powers to recover
money through the county court


Principles of the approach to debt recovery:

Court action should be the last resort

The local authority should act reasonably

Affordable repayments

Debts and repayments discussed with the person
New policy being agreed with members and new board established
Care Act 2014
1
0
Summary
 The local authority may charge people for care and support services,
and for arranging them, but some services must be free of charge
 The local authority must carry out a financial assessment of both
capital and income if it is going to charge for services
 A ‘light touch’ financial assessment may be appropriate
 There should be choice of accommodation for individuals whose
needs are best met outside their own home
 Top-up fees can be charged if a person chooses a more expensive
residential care option
 Debts may continue to be recovered under the new legal framework,
but from 1 April 2015 HASSASSA 1983 will no longer apply
Care Act 2014
1
0
Deferred payment agreements
Reshaping Trafford Council
Outline of content
•
Introduction
•
Eligibility for a deferred payment
•
Information and advice
•
How much can be deferred?
•
Making the agreement
•
Interest rates and charges
•
Termination of the agreement
•
Summary
Care Act 2014
1
0
Introduction – Already in place at
Trafford
 The Act places a duty on all local authorities to operate a deferred
payment scheme and to offer deferred payments to people meeting
the acceptance criteria for the scheme
 By taking out a deferred payment agreement (DPA), a person can
‘defer’ or delay paying the costs of their care home until a later date
 A deferral can last until death, however people may choose to use a
deferred payment agreement as a ‘bridging loan’ to give them time and
flexibility to sell their home when they choose to do so
 Payment is deferred and not ‘written off’. This must be stressed to the
individual
108
Care Act 2014
Paying for care and support
 A person could meet the costs of their care and support from a
combination of any of four primary sources:
Income,
including
pension
A financial
product
Savings or
other assets
A Deferred
Payment
Agreement
109
Care Act 2014
Who is eligible for a deferred
payment agreement? – Tightens
eligibility criteria at Trafford
 A deferred payment agreement (DPA) must be offered to anybody
who has ‘adequate security’ and:
 Whose needs are to be met by the provision of residential care
 Who has less than the upper capital limit in assets excluding the
value of their home
 Whose home is not occupied by a spouse or dependent relative
 However, some discretion may be exercised – local authorities may
offer DPAs to others who don’t meet the criteria, including people in
supported living accommodation
 Permission may be refused in certain circumstances e.g. where there
is insufficient security
110
Care Act 2014
Adequate security – New for
Trafford
 A local authority must have adequate security in
place when entering into a DPA
 They must accept a ‘first legal mortgage charge’ as
adequate security and they have discretion to accept
other security
 The security should be revalued periodically
(Enough equity in the property for a user to self-fund for
one year – still to be agreed).
111
Care Act 2014
Example
 Lucille develops a need for residential care. She lives alone and is the
sole owner of her home. Her home is valued at £100,000, and she has
£15,000 in savings.
 Lucille meets the 3 criteria governing eligibility for a deferred payment:
 she has been assessed as having eligible needs which the local
authority decides should be met through residential care
 she has less than the upper capital limit of £23,250 in assets
excluding the value of their home
 her home is not occupied by a spouse or dependent relative.
112
Care Act 2014
Exercising discretion
 Local authorities can offer DPAs to people in residential care who do
not meet the criteria. For example:
 If someone would like to use wealth tied up in their home to fund
reasonable top-ups
 If someone has other accessible means to help them meet the cost
of their care and support
 If a person is narrowly not eligible e.g. because they have slightly
more than the asset threshold
 Local authorities may offer DPAs to people in extra care settings in
some circumstances
113
Care Act 2014
Refusing a deferred payment
agreement – Tightens criteria at
Trafford
 A local authority may refuse a request for a DPA in certain
circumstances
 This is intended to provide local authorities with a reasonable
safeguard against default or non-repayment of debt e.g. where:
 the local authority is unable to secure a first mortgage charge on
the property
 someone wishes to defer a larger amount than they can
sustainably afford
 a person’s property is uninsurable and
they are unable to provide adequate security
114
Care Act 2014
Refusal to defer any more charges –
Already do this Trafford
 A local authority may refuse to defer any more charges for a person
who has an active DPA for example:
 when a person’s total assets fall below the level of the means test
and the person no longer needs to defer their care costs
 where a person no longer has relevant residential care (or where
appropriate extra care) needs
 where a spouse or dependent relative has moved into the
property after the agreement has been made
 where a relative who was living in the property at the time of the
agreement subsequently becomes a dependent relative
 Local authorities must also cease deferring further amounts when a
person has reached the ‘equity limit’ setting out the maximum that
they are allowed to defer
115
Care Act 2014
Information and advice- Via MyWay
and leaflets available at Trafford – all
being refreshed
 The local authority should tell people about the DPA scheme and how
it works, if they feel someone might benefit from having a DPA
 The explanation should include:
 The criteria for obtaining a DPA and the requirements
 Interest and admin charges
 The types of security that the authority is prepared to accept
 Implications for income, benefit entitlements and charging
 Termination of the DPA and options for repayment
 What happens if the person doesn’t repay
 The overall advantages and disadvantages of DPA
 The suggestion that people may want to consider taking
independent financial advice.
116
Care Act 2014
Information and advice
 The local authority should also:
 Consider potential issues around loss of capacity, and offer advice
on options for deputyship, legal power of attorney and advocacy
 Advise people that they will need to consider how they plan to use,
maintain and insure their property
 Keep people informed about the DPA as it continues and provide
necessary information on termination
117
Care Act 2014
Interest rate and administration
charge
 The DPA scheme is intended to be run on a cost-neutral basis, with
local authorities able to recoup:
 the costs they may incur in deferral of charges via an interest rate
(national rate is lower then Trafford, will need to adjust local rate)
 administrative costs associated with DPAs – Already do this
 Local authorities will have the ability to charge interest on any amount
deferred
 Local authorities should maintain a publicly-available list of
administration charges that a person may be liable to pay – available
on Trafford websites
118
Care Act 2014
Termination of the deferred
payment agreement
Voluntary
repayment
Sale of property
/security
Death
119
Care Act 2014
Summary
 Local authorities have a duty to operate a deferred payment scheme
and are required to offer DPAs when the person:
 has adequate security
 meets the acceptance criteria for the scheme, and
 will agree to the DPA terms and conditions
 Additionally, local authorities have a fairly broad discretion including:
extending DPAs to extra care settings; agreeing top-ups; and of the
security they will accept
 The amount that can be deferred is dependent on there being
adequate security, and whether the amount deferred is sustainable
 Interest on deferred costs, and administrative costs can be charged,
but the scheme should run on a cost neutral basis
120
Care Act 2014
Transition to adulthood
Reshaping Trafford Council
Why does transition to adulthood
matter?

It’s a complex transition for anyone

More children and young people with complex conditions in early childhood
are now surviving into adulthood

Getting it wrong can lead to poor outcomes

Getting it right can set young people up for the rest of their lives
Care Act 2014
1
2
Children and Families Act 2014 and
SEN reform
Care Act 2014
Care Act 2014: transition
assessment

A local authority has a duty to carry out a transition assessment for a young
person or carer, in order to help them plan, if they are likely to have needs once
they (or the child they care for) turn 18

There are 3 groups of people who have a right to a transition assessment:
 Young people, under 18, with care and support needs who are approaching
transition to adulthood
 Young carers, under 18, who are themselves preparing for adulthood
 Adult carers of a young person who is preparing for adulthood

Local authorities must assess the needs of an adult carer where there is likely
to be a need for support after the young person in question turns 18
Care Act 2014
1
2
Transition assessment:
significant benefit

If a young person or young carer is likely to have needs when they turn 18, the
local authority must assess them when it considers there is “significant
benefit” to the individual in so doing

The timing of this assessment will depend on when it is of significant benefit to
the young person or carer

Local authorities should consider how they can identify young people who will
need an assessment but are not receiving children’s services

Trafford transition models and protocols are being updated to reflect Care Act
and Children and Families Act requirements
Care Act 2014
1
2
Transition assessment: key
requirements

The assessment process itself must :
 be person-centred throughout
 ensure that the wellbeing of each young person or carer is taken into account
 include any other person who the young person or carer wants to involve
 always be appropriate and proportionate to the complexity of the person’s
needs

The process must establish:
 current needs and how these impact on wellbeing
 whether the young person or carer is likely to have eligible needs
 the outcomes the young person or carer wishes to achieve
Care Act 2014
1
2
Joint legislative framework






Together the Children and Families Act 2014 and the Care Act 2014 create a new
comprehensive legislative framework for transition:
 Focus on personalised, outcome-based approaches
 New focus on carers across both Acts - families transition rather than just the
young person
Duties in both Acts are on the local authority:
 a variety of operating models
 joined up information and advice service
The EHC plan requirement for preparation for adulthood to begin at 14 is a good
default position for transition planning generally
At Trafford from 16, more intensive dialogue between children's and adults
A flexible framework where transition can be a personalised evolution from 14-25 to
reduce the "cliff-edge" transition at 18
At Trafford, formal transition from children's to adults and reassessment still takes
place at 18
Care Act 2014
1
2
Tools & Resources
Care Act factsheets
www.gov.uk/government/publications/care-act-2014-part-1-factsheets
Trafford Care Act Webpage
www.trafford.gov.uk/thecareact
Trafford Care Act Intranet Site – coming soon
E-learning – coming soon
SCIE website
http://www.scie.org.uk/care-act-2014/
Skills for Care website
http://www.skillsforcare.org.uk/Standards/Care-Act/Learning-anddevelopment/Learning-and-development.aspx
Reshaping Social Care Training – coming in March
Management/ Team Briefings – Advocacy, carers – Coming in March
Care Act 2014
128