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Will the Care Act Drive Personalisation? Martin Routledge, In Control
What is the Care Act supposed to achieve? Vision • To promote people’s independence and wellbeing by enabling them to prevent and postpone the need for care and support. • To transform people’s experience of care and support, putting them in control and ensuring that services respond to what they want.
The reform timeline Engagement and pre-legislative scrutiny on draft Bill _Jul 2012 – Jan 2013 Law Commission Report _____ May 2011 Vision for Adult Social Care ______ Nov 2010 Caring for our future engagement _______ Sept - Dec 2011 Dilnot Commission Report _____ July 2011 • Caring for our Future White Paper • Draft Care and Support Bill • Progress report on funding _______ July 2012 Care Act in Parliament _____ May 2013 – May 2014 Announcement on funding reform _______ Feb 2013 Implementation _______ April 2015 – April 2016 Consultation on draft regulations and guidance _______ _ Jun - Aug 2014
Impact comes from Act, Guidance, Context Primary legislation – the Care Bill The legal duties and powers Secondary legislation – the regulations More detail on critical requirements, often related to processes. The scope of regulations will depend on the powers specified in the Bill. Statutory guidance Guidance on how to meet legal obligations in the Bill. Will set out at a high-level the expectations of local authorities when exercising their functions. These are not mandated requirements, but the LA must have “cogent” reasons that it can legally justify if it wants to take another course. The Care Bill: reforming care and support Practice guidance Best practice guidance, toolkits and other products which help support implementation. These do not have any legal status, so may be used by LAs, or not. They will vary from one area to another, and should be agreed/co-produced with stakeholders to ensure buy-in.
Some important parts for personalisation • A new statutory principle which embeds individual well-being as the driving force underpinning the provision of care and support. • Population-level duties on local authorities to provide information and advice, prevention services, and shape the market for care and support services. These are supported by duties to promote cooperation and integration to improve the way public authorities work together. • Following the individual journey through the care and support system, clarifying rights and entitlements. Including putting eligibility framework in law, and new rights: to request local authority support, for carers to have needs met, and to plans and personal budgets • New rights for family carers
Some important parts for personalisation • Duty of advocacy for “most vulnerable” • New provisions on portability, to ensure care needs are met when a person moves areas. • New provisions to support better transition from children’s services for young people, young carers and parent carers • Provides for a single national threshold for eligibility
Implications? • All this being done at time when local council budgets being cut, numbers of people supported being reduced – so some real challenges • What can VCS and disabled people’s organisations do to maximise opportunities, minimise problems?
Importance of Guidance • Statutory guidance especially, practice guidance to some degree important • Consultation closed, Oct final version • Can be used to encourage/challenge delivery • Practice guidance can be used to show what delivery could and should look like
Thoughts on the draft guidance? • Welcome the stated core purpose of adult care “to help people achieve the outcomes that matter to their life”. Also welcome the comprehensive definition of well-being – • But requires a very major cultural adjustment for local authorities and their partners – still risk of focus on “meeting needs” alone reinforcing a deficit model which is contrary to the demands of the wellbeing principle • Good that independent living is a core aspect of the wellbeing principle (para 1. 17). Our observation is that in too many places today independent living is in fact being compromised where councils require people to live in more institutional situations on cost grounds
Thoughts on the draft Guidance • We welcome chapter 3 on Information and Advice and note that key points from this important chapter are reiterated throughout the guidance. This has been an area of weakness in many localities to date • First contact and identifying needs: Pleased to see the emphasis given to the requirements that citizens are fully informed about the process throughout; that they are supported through the process; that they are always involved in the process; and are encouraged to take as much responsibility as they wish/are able to take through a process of supported self-assessment.
Thoughts on the draft Guidance • Welcome the emphasis given to self-assessment (paras. 6. 51 to 6. 59 and regulation para. 2) we believe additional guidance might be added specifying that a citizen’s selfassessment and the consequent determination of eligibility will normally stand, unless the authority has good reason to believe it to be flawed • Sections of the guidance on integrated assessments and combined assessments are helpful and should enable citizens to achieve more seamless support through a simpler process; however it is of critical importance that parallel guidance is provided for local authorities’ statutory partners
Thoughts on the draft Guidance • Person centred care and support planning: welcome much of the guidance provided in chapter 10 on care and support planning reflects the learning about the power and reach of person-centred thinking and planning. • Guidance insists that the person “must be actively involved and influential throughout the planning process” and that the ability to meet needs by taking a direct payment must be clearly explained to the person in a way that works best for them”. (para 10. 2). We are broadly pleased to see the expanded role of independent advocates in the process • Our experience is that there is extremely variable practice across local authority areas in relation to arrangements for the preparation of plans and that this is a critical area for which authorities should be held to account
Thoughts on the draft Guidance • Pleased to see the expectation at para. 3. 29 that people should be free to choose innovative forms of care and support from a diverse range of sources including nonservice options; however we believe that this should go further and a form of words devised which makes it clear that the core purpose of planning is to develop and hone such arrangements, with traditional service options as the exception • Strongly support para. 10. 65 which limits the use of approval panels for plans. Our experience suggests that in most instances such panels are not inclusive or transparent and that the vast majority of “sign-off” decisions can readily be taken closer to the person
Thoughts on draft Guidance • It is important to be clear about who “owns” the plan: it appears from the guidance (particularly the list at 10. 18) that this is a local authority plan, which the citizen may be able to prepare on their behalf. Our strong preference is a process where citizens own and prepare their own plans with help if necessary • chapter 11 on personal budgets the Act makes personal budgets “the norm for people with support needs” (para. 11. 1). Para. 11. 2 important: that people know how much their personal budget is likely to be before planning begins empowers them to make good plans and this drives the process from that point on
Thoughts on draft Guidance • Particularly pleased to see the sufficiency principle our concern here is that many local authorities have not adhered to this principle to date and we are interested to learn how in a period of further austerity they will now be held to account • Ch 12 promotes direct payments as the preferred approach for the delivery of personal budgets; sets out a clear role for the local authority in promoting and providing or commissioning the necessary support; but is clear that there must never be any element of compulsion or undue pressure (para. 12. 10 “Local authorities must not force people to have a direct payment”. )
Thoughts on draft Guidance • The issue of the use of DPs by people who lack capacity and the important link to the Mental Capacity legislation is dealt with helpfully • Change in the regulations (reflected in the guidance at para. 12. 35) which now empowers the local authority to pay a family member living in the same household for administering/managing the direct payment • Para. 13. 4, states that the “review must not be used as a mechanism to arbitrarily reduce the level of the person’s personal budget. ” • Proportionality in the review system is critical if personal budget holders are not to have undue burdens placed on them. It is important to frame reviews as an opportunity for growth and learning.
Some thoughts on positive influence • Be aware of advice from LGA to councils • Get involved in work that checks results of personalisation/personal budgets with local people and involves them in improvements (POET, Making it Real) • Don’t be limited to health or social care – influence Health and Well-being boards to act on inclusion, independent living across the board of universal as well as targeted services • Support efforts to ensure older and disabled people can join up and get control of all resources for their support in all areas of life – support, housing, employment • Influence regional and local delivery arrangements and peer reviews
Further information • In Control www. in-control. org. uk/ • Think Local Act Personal www. thinklocalactpersonal. org. uk • Personal Health Budgets www. nhs. uk/personalhealthbudgets • Care Act http: //bit. ly/1 n. M 6 c. GB • People hub www. peoplehub. org. uk • http: //www. local. gov. uk/care-support-reform