the event presentation

The Care Act:
Reforming Care & Support
Healthwatch Consultation Event
21 January 2015
• Janet Cole Head of Early Intervention, Prevention & Rehabilitation
• Jeremy DeSouza, Assistant Director Finance and Resources
What is the Care Act?
“reforms mark a generational shift in our system
of care, a shift from a system that is essentially
paternal, reactive and prescribed to one that is
preventative, personalised and proactive in its
care approach.
A system that focuses on people's strengths, that
seeks to secure personal wellbeing replacing one
that focuses on deficits and meeting need.”
Jon Rouse Director General for Social Care, Dept. of
Health, May 2014
What is the Care Act?
• Biggest change in Adult Social Care
legislation for over 60 years:
• Based on principle of wellbeing
• Encompasses whole population
• The Act is a platform for the next few
decades albeit in tough times
Summary of Care Act Duties
Key requirements
Duties on prevention and wellbeing
From April
Duties on information & advice (inc paying for care)
Duty on market shaping
Assessments (including carers’ assessments)
National minimum threshold for eligibility
Personal budgets and care and support plans
Universal deferred payment agreements
Extended means test
Care accounts
Capped charging system
From April
Care Act - Timeframes
Phase One:
 Draft Guidance/Regulations published May 2014 and consulted on
throughout summer
 Final Guidance/Regulations issued end October 2014
 Implementation commences April 2014
Phase Two
 Draft Guidelines to be issued January 2015 for 12 week
 Final guidance/regulations October 2015.
 Autumn 2015 existing service users assessed for Care Accounts
 April 2015 full implementation
Prevention Strategy
Janet Cole
Head of Early Intervention,
Prevention and Reablement
What the Care Act says about prevention
Current preventative services
Scope of the strategy
Approach to developing the local strategy
Approach to engagement
What the strategy is aiming to achieve
Care Act - Three levels of prevention
Prevent (Primary Prevention)
• Aimed at individuals who have no current particular health or care and support needs
• These services may help an individual avoid developing needs for care and support, or
help a carer avoid developing support needs by maintaining independence and good
health and promoting wellbeing
• E.g. LiveWell Richmond, NHS Health Checks
Reduce (Secondary Prevention)
• More targeted interventions aimed at individuals who have an increased risk of
developing needs
• The provision of services, resources or facilities may help slow down any further
deterioration or prevent other needs from developing
• E.g. Telecare, Falls Prevention Service
Delay (Tertiary Prevention)
• Interventions are aimed at minimising the effect of disability or deterioration for people
with established health conditions, complex care and support needs or caring
• This includes supporting people to regain skills and reduce need where possible
• E.g. Reablement, Rehabilitation
Current services in Public Health & Social Care
 Public Health
 Primary Prevention services: Livewell, Stop Smoking, NHS Health
Checks, Winter warming
 Social Care
 Wide range of services across all levels of prevention e.g.
Rehabilitation, Falls, Equipment, Information and Advice, Home
Maintenance. Many joint funded with CCG
 Wide and comprehensive offer compares favourably to other councils.
 However services developed incrementally over time; some in place for
a long period. Must now assess whether these services meet the
needs of the resident population
Scope of the Prevention Strategy
 Borough wide strategy with health, social care, other council
departments and community representatives
 Preventative services to meet resident’s identified needs
within existing resources.
 Includes information & advice services
 Partnership approach and a wider offer - not just health and
social care
 Prevention services targeted for different groups
 Impact and outcomes long term
Approach to developing the strategy
 Multi agency steering group
 Needs analysis and service
 Identify best practices &
 Identify gaps
 Consultation
 Recommendations on
services that need reshaping or commissioning
 Strategy completed spring
 Two workstreams have been developed to cover residents’ varying
adult social care needs
Target Audience: All residents
over 18
Online survey
Covers the different ways people help to
keep themselves healthy and well, which
services people currently use to do this
and how these can be improved
Care Act Survey:
Information and
Target Audience: Adults with care and
support needs and their carers
Partner organisations have distributed the
link to the online survey
Focus groups arranged for January and
February to gather more detailed feedback
Covers the types of services, information and
advice available and the ways these can be
improved. Explores the use of new
technologies to achieve this
What the Strategy is aiming to achieve
 Shift in approach for:
• 1) the public (doing more for themselves);
• 2) professionals (making every contact count).
 Key cultural change
 Resource Directory
 Council & CCG reshaping re-commissioning current
services to meet need – wider determinants of health,
education, housing, employment, environment, etc.
 New technologies to replace or complement existing
 Promote & provide tools for self care
Questions about Prevention
Social Care Charging
Jeremy DeSouza
Assistant Director – Finance and Resources
Changes to Social Care Charges
Key requirements
Duties on information & advice re paying for care
From April
New charging framework in line with national eligibility
for service users/carers
Universal deferred payment agreements
Entitlement for self-funders to ask Council to arrange
their care
Extended means test – more people to access state
From April
funded support (capital limit increased to £118,000 from 2016
£23,250 for care homes)
Lifetime cap on care costs introduced (£72,000)
Care Accounts – to track progress towards the cap on
care costs
Universal Deferred Payments
 Prevents people from having to sell their home in their
lifetime to fund their care (in a care home)
 Allows payments to be made after the service user’s
death when the property is sold
 Must be made available to all home owners receiving
care in a care home
 Interest charges will apply
 Costs of setting up/monitoring the agreement to be
recovered from service users
Universal Deferred Payments
 Administration fee of £2,500 paid upfront or added to the
 Interest rate - max rate set by DH (currently 2.65%) –
updated twice yearly
 Interest charges compound basis - added every six
 Debt secured by first charge on the property
 Equity Limit is 90% of property value less £14,250 (e.g.
Property worth £500,000 Equity Limit is £450,000 –
14,250 = £435,750
Criteria for Deferred Payment
 Someone with eligible care needs requiring care in a
care home
 Someone with less than £23,250 in savings/ other nonproperty assets
 Someone whose property is taken into account in their
financial assessment i.e. home not occupied by spouse
or dependent relative
Case Study
 Joan needs residential care @£670pw and has savings
of £15,000 and house worth £300,000
 Joan has to pay for her care as assets above £23,250,
but only has £15,000 easily accessible in savings
 Joan enters into a Deferred Payment agreement with
the Council and agrees to charge on her property
 The Council pays the care home fees £670 pw
 Joan makes a contribution of £86 pw from her income
and defers £584 pw
Case Study continued
 After 1 year Joan sells her house with her family’s help
 Joan repays the Council £33,311 which includes interest
of £443, admin fee of £2,500 and care home fees of
 The overall cost to Joan is £2,463 more than the current
scheme (due to the admin fee and interest)
 Joan chose to retain the maximum disposable income
allowance of £144 pw from her income – she may have
chosen to retain less disposable income and reduce the
amount deferred.
 Joan could have rented out her property, providing
additional funding towards her care home fees.
Implementation Issues
Ensuring quality information and advice
Ensuring the scheme is accessible
Encouraging homes to remain in use
Facilitating support to families with property
rental arrangements
 Protecting the public purse/ensuring recovery of
deferred payment loans
Self Funders
 Can now request Council to arrange their care at home
(criteria - eligible care needs & savings above £35,000)
 Does not apply to care in a care home (expected to be
introduced in 2016)
 Does not apply where someone cannot make own
arrangements; Council must arrange care and not
 Charges can be made to cover costs (i.e. brokerage
administration, contract monitoring, quality assurance,
invoicing and debt recovery)
 Proposal that charges will fully recover costs of making
arrangements, so this change will be cost neutral to the
Implementation Issues
Ensuring the Council’s resources are targeted at those
with the most need
Encouraging self-funders to make their own
arrangements where it is practical to do so
Supporting local providers who may wish to provide this
Providing information about local care provision so that
self-funders have the right information to arrange their
own care
Case Study
Anne is aged 80 and needs some support to live at home
and is able to make her own care arrangements through a
local care provider and also has a son living nearby who is
willing to help with this. Her savings are £70,000.
Anne asks the Council to arrange her care. The weekly
cost of her care is £260 and the fee for arranging her care
is £50pw.
Alternatively Anne can receive information and advice from
the Council and voluntary organisations about her care
and either make her own arrangements or through an
organisation such as RUILS, which would charge a fee.
This event forms part of our consultation process on
proposals for April 2015 regarding services for selffunders
Consultation will be open to residents and local
organisations via the Council’s website
Purpose of today to seek views and develop practical
solutions to address any implementation issues
Questions about Social Care Charges