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Care Act Roadmap

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by

Laura Power

on 5 November 2014

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Transcript of Care Act Roadmap

Initial Roadmap for Local Authorities
The Care Act: from legislation to implementation
Our Methodology

The Care Act represents the most significant change to social care legislation in 60 years reforming the way care and support for adults is provided and paid for.

Under the Act, local authorities will take on new functions to make sure that people who live in their areas:

receive services that prevent or delay their care needs
can get the information and advice they need to make good decisions;
have a range of providers offering a choice of high quality, appropriate services.

The Act makes changes in relation to eligibility for support, the way that support is provided advocating a focus on outcomes and an extends LA's duties to cover carers and self-funders.

The financing of care will also be impacted by the new legislation with the implementation of a cap on care costs.
“For far too long people's needs assessments have been driven by the service on offer… such an approach fails to recognise the richness
and complexity of people's lives and fails to support or promote truly person-centred care"
Care Quality Commission
Overview of the Care Act 2014
Define As-Is
analyse current systems and processes in place to deliver the required changes
determine how the changes fit with local drivers and priorities
Ensure engagement of key stakeholders
set project management and governance structure
identify project sponsor
set up communications
Analyse needs
identify main barriers, strengths and needs
define appetite and objectives for the project/ implementation
Where are we up to?


This road map will consider the implications of three of the key areas of responsibilities for LA's impacted by the Act and highlight areas where we feel we could offer support and value to your LA in meeting these requirements. The key areas are:

Information and Advice
Market Shaping
Assessments

We feel these areas are priorities for LA's as they are fundamental to achieving system change and impact on many of the other changes required. The areas identified are not wholly independent of each other so there is likely to be cross over with progress in one area impacting on another.

They will be considered in relation to the different client groups: service users, carers, self-funders and the whole population.
Requirements
The Act sets out that LA's
must
establish and maintain a service for providing people in its area with information and advice relating to care and support. This does not require LA's to provide all elements of the service but they are expected to understand, co-ordinate and make effective use of other statutory, voluntary and/ or private sector information and advice resources available locally.

They
must
provide information on:

types and range of care and support that are available
the process to access care and support
how people can raise concerns about the safety or wellbeing of someone with care/ support needs.

LA's
must
also help people to benefit from independent financial advice, so that they can get support to plan and prepare for the future costs of care.

The information and advice service
must
cover the needs of all its population and provided in formats that are accessible and help people to understand, regardless of their needs
.

Audit local information:
Review existing advice and information services including advocacy services to identify duplication, inconsistency and gaps and assess the quality of what is available.

Determine user behaviour:
Engage with citizens and key stakeholders to assess how information is accessed locally and what improvements would be helpful.

Improve quality of information:
Work with providers to improve the information supplied and stimulate a joined up approach to the provision of information and advice services.

Provide accessible information:
Through a variety of formats including an online presence.
West Sussex – Key Statistics

821,370 residents
Growing and aging population
12,000 adults receive social care, including 2,400 older people in long stay residential and nursing care.
Increasing need for personal and social care, much of this is self-funded.
Concern that supply is not keeping pace with increasing demand.
Over 84,000 people (10% of the population) identified themselves as unpaid carers (2011 Census).
Of these, 16,800 people provided 50 hours or more of unpaid care a week and a further 9,280 people provided 20-49 hours a week.

Sources: West Sussex JSNA 2014
What does this mean for different user groups?
Service User
Service users will need to be able to access consistent and accurate information relevant to their needs including:
When and how to get an assessment and the eligibility criteria for care and support
Independent advocacy
Services that are available in the community that can help to prevent needs escalating
Financial advice
Any charges for support and how they are calculated
The needs and capacity of individuals in this group will be wide ranging and therefore the information will need to be provided in a variety of formats to ensure accessibility.
Carer
Carers will need to be able to access consistent and accurate information relevant to their needs including:
When an assessment might be appropriate and how to get one
Support available in the community
Breaks from caring
Caring and advice on wider family relationships
Carers’ financial and legal issues
Caring and employment
A carer’s need for advocacy
The average age range of carers is between 50 - 64 many of which will be used to accessing information online.
Self-Funder
Self-funders will require much of the same information as service users in terms of eligibility for support and information about services available locally. They will also need to be informed about:
The cap on care costs and care accounts
Advice on how to make decisions about care and support
How to ensure they purchase quality services
Charges and how they are calculated
Financial advice to ensure they can afford their care over the course of their lives
Whole Population
All individuals locally should be able to access general information that will support them to:
Continue to care for their own care and support needs
Take steps to improve their health and well-being
Plan for their future care and support needs
Know where to go when additional support might be required
We can help you to:
Requirements
Market shaping means the LA collaborating with partners, including individuals with care and support needs, carers and families to facilitate the whole market. LA's
must:


ensure the outcomes individuals require are central
facilitate markets to offer continuously improving, high-quality, appropriate and innovative services
develop markets for care and support that ensure the overall provision of services remains sufficient
encourage a range of different types of service providers to enable genuine choice
understand local markets and develop knowledge of current and future needs and understand providers’ businesses.

LA's also have a temporary duty to ensure that the needs of people continue to be met if their care provider becomes unable to carry on delivering regardless of what type of care they are receiving or how it is funded.

Analyse your population:
build on local data and carry out deep dives to determine current and future needs and demands particularly in the areas of self-funders and carers.

Audit your market:
identify providers, analyse the different services available, map against local need and identify gaps and opportunities to develop the market with clear strategies on how to deliver these.

Facilitate a vibrant market:
implement an e-market place offering choice, transparency and accessibility and identify opportunities for collaboration to stimulate joined up approaches that support sustainability.

Improve quality:
work with providers and the LA to improve internal systems and processes by clearly establishing what currently happen, the requirements moving forward, the gap and the process to address this gap quality of their offer and identify opportunities

Develop your workforce
: carry out a skills audit internally and more broadly and work with staff to embed changes through training and awareness raising
We can help you to:
Requirements
LA's
must
undertake an assessment for any adult who appears to have any level of needs for care and support, regardless of whether or not these are thought to be eligible.

An assessment
must
:
be person centred, involving the individual and any carer or any other person they want involved
seek to establish the total extent of needs before their eligibility is considered and what types of care and support can help
be proportionate and flexible to each individual case. It may be carried out over the phone or online where an individuals' needs are easily recognisable
consider the impact of the person’s needs for care and support on family members or other people the authority may feel appropriate.

LA's also have a duty to appoint an independent advocate where the individual has substantial difficulty in being involved and no other individual is identified.
What does this mean for different user groups?
Service User
The assessment of need will give this group:
more control and influence over how their needs are determined and what support is identified to help support them
empower this group to take ownership of their care and support needs supported by self-assessment and reviews

It will also enable LA's to pick up emerging needs of those individuals that are not yet eligible for support but may be in the future.
Carer
This assessment will mean carers will:
have more control and influence over the support they receive
be empowered to identify their own needs and support required supported by self-assessments and reviews
receive support they need to maintain their role and also flag any potential future support they might require

Maintaining carers in their roles is crucial to prevent increases in demand on LA services.
Self-Funder
By opening up the assessment process to self-funders this should:
give more choice and control highlighting care and support they may not have been aware of
increase an individual's ability to control and review their own needs through self-assessment where appropriate
enable LA's to target support more effectively and inform future planning of service provision

High quality information and advice will be critical to support this process.
Whole Population
A clear and transparent assessment process will enable this group to:
Understand the process and know who to contact should they or someone they know need support
Be aware of support available without requiring an assessment which could prevent future needs
Be aware of and plan for future needs

A light touch self-assessment at this point could help inform LA's understanding of future needs and likely demand.
Why is information and advice a priority?

Information helps to promote people's wellbeing by increasing their ability to exercise choice and control
It is vital in preventing or delaying people's need for care and support.

Why is market shaping so important?

High-quality, personalised care and support can only be achieved where there is a vibrant, responsive market of service providers.
The LA's role is critical to achieving this through services directly commissioned to meet needs, and the broader understanding and interactions it facilitates with the wider market.
What does this mean for LA’s?

End goal:
A care system that is person-centred, outcome focused and enables individuals to manage their own care needs with real choice and control.

To achieve this

goal

significant change

is required within restricted budgets. A focus on
empowering
individuals becomes crucial in order to manage down demand on LA services and improve outcomes.

This shift in focus will also require the current workforce to adapt:
Commissioners moving from a focus on contracting and monitoring to facilitating and shaping the market
Social Workers moving from putting a limited number of services in place in response to needs to focusing on the outcomes an individual wants to achieve and the support they required to get there.


What does this mean for different user groups?
Service User
A market which offers real choice and control by:

responding to current and emerging needs
offering high quality services that meet these needs

This should enable more individuals to plan and manage their own care and support reducing the role for LA's in the process and also in direct provision.
Carer
The market will provide choice and control for carers in relation to care and support to meet needs for both the individual they care for and support they require themselves.
Self-Funder
Again, self-funders will experience the same choice and control from the market but a vibrant market will also enable them to access services that are priced competitively and drive up quality standards.
Whole Population
This diverse and responsive market will mean that there will be range of services available including preventative services that this group may need to draw upon at some points. The information and advice that supports this group will be crucial.
We can help you to:

Employ effective processes
: review and adapt assessment criteria and processes identifying opportunities for rationalisation and employing alternative models of delivery such as an online self-assessment tool.

Supply clear and accessible information:
developing resources to support the processes so that all stakeholder groups understand the system.

Join up practices and processes
: work with key stakeholders to analyse assessment processes and make recommendations on areas where these can be integrated potentially across health, social care and more broadly.

Develop your workforce
: carry out a skiils audit and identify support required to ensure staff fully understand and embed new processes taking a person-centred approach.



Why is the assessment process so important?

The assessment is the key interaction between the local authority and an individual.
It should not just be seen as a gateway to care and support, but as a critical intervention helping people to understand their situation and the needs they have, to reduce or delay the onset of greater needs, and to access support when they require it.
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