healthwatch care act consultation january 2015
TRANSCRIPT
The Care Act:Reforming Care & Support
Healthwatch Consultation Event21 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 DutiesKey requirements Timing
Duties on prevention and wellbeing From April 2015Duties 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
Safeguarding
Universal deferred payment agreements
Extended means test From April 2016Care accounts
Capped charging system
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Phase One: Draft Guidance/Regulations published May 2014 and consulted on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
consultation Final guidance/regulations October 2015. Autumn 2015 existing service users assessed for Care Accounts April 2015 full implementation
Introduction
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
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
mapping Identify best practices &
innovation Identify gaps Consultation Recommendations on
services that need re-shaping or commissioning
Strategy completed spring 2015
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 services
Promote & provide tools for self care
Changes to Social Care ChargesKey requirements Timing
Duties on information & advice re paying for care From April2015New 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 funded support (capital limit increased to £118,000 from £23,250 for care homes)
From April 2016
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
loan Interest rate - max rate set by DH (currently 2.65%) –
updated twice yearly Interest charges compound basis - added every six
months 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 non-property 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 £30,368
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 charge
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 Council
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 service
Providing information about local care provision so that self-funders have the right information to arrange their own care
Case StudyAnne 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.
Consultation This event forms part of our consultation process on
proposals for April 2015 regarding services for self-funders
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 identified