The Care Act (2014) Doug - PowerPoint Presentation

Slide1

The Care Act (2014)

Doug

Feery

Barrister

Amanda Murphy

Independent Social Worker

25 November 2016

Blackburn and

Darwen

Carers CentreSlide2

An agenda

The main provisions of the Care Act 2014

What has changed and what remains

The underpinning principles

New duty - giving of information & advice

Assessment & eligibility threshold’s - care & support

Carer entitlements ☺

S117 aftercare - Mental Health Act – What’s changed?

Access to advocacy

SafeguardingSlide3

…the most significant piece of legislation since the establishment of the welfare state.

(SCIE)Slide4

Points for reference

Care Act 2014

Explanatory Notes

Care Act 2014

2014 CHAPTER 23Updated 27 Oct 2016 - onlineSlide5

Background / timetable

2014 – Royal

Assesent

2015 – Partial implementation

2016 – The Dilnot (cap on costs) reforms to be implementedSlide6

Legislation to be repealed includes:

National assistance Act 1948

Chronically Sick & Disabled Persons Act 1970 (but only for adults)

Health & Social Services & Social Security Adjudications Act 1983

NHS & Community Care Act 1990

Carers Act

Health and Social Care Act 2001 (the Act that concerns direct payments)Slide7

To illustrate

1948 1960… 1970… 1980... 1990… 2000… 2010…Slide8

To illustrate

1948 1960… 1970… 1980... 1990… 2000… 2010…

National Assistance Act 1948Slide9

To illustra

te

1948 1960… 1970… 1980... 1990… 2000… 2010…

National Assistance Act 1948

Chronically Sick and Disabled Person Act 1970Slide10

To illustrate

1948 1960… 1970… 1980... 1990… 2000… 2010…

National Assistance Act 1948

NHS and Community Care Act 1990

Chronically Sick and Disabled Person Act 1970Slide11

To illustrate

1948 1960… 1970… 1980... 1990… 2000… 2010…

National Assistance Act 1948

NHS and Community Care Act 1990

Chronically Sick and Disabled Person Act 1970

Community Care (Direct Payments) Act 1996Slide12

To illustrate

1948 1960… 1970… 1980... 1990… 2000… 2010…

National Assistance Act 1948

NHS and Community Care Act 1990

Carers (Recognition and Services) Act 1995

Chronically Sick and Disabled Person Act 1970

Community Care (Direct Payments) Act 1996Slide13

What’s not repealed & remains relevant…Slide14

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights ActSlide15

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights Act

Mental Capacity ActSlide16

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights Act

Mental Health Act

(As amended)

Mental Capacity ActSlide17

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights Act

Deprivation of Liberty Safeguards

Mental Health Act

(As amended)

Mental Capacity ActSlide18

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights Act

Health & Social Care Act

Deprivation of Liberty Safeguards

Mental Health Act

(As amended)

Mental Capacity ActSlide19

What’s not repealed & remains relevant

2000 2005… 2007… 2009... 2012… 2014…

Human Rights Act

Care Act

Health & Social Care Act

Deprivation of Liberty Safeguards

Mental Health Act

(As amended)

Mental Capacity ActSlide20

A new context

Mental Health Act

(As amended)

Human Rights Act

Mental Capacity Act

Deprivation of Liberty Safeguards

Care ActSlide21

What is the Act trying to achieve?

That care and support:

Is

clearer

and fairer (new national standards)Promotes people’s wellbeing

Enables people to

prevent

and

delay

the need for care and support

Personalisation: putting

people

in

control of their lives so they can pursue opportunities to realise their potential (supported by Personal Budgets / DPs)Slide22

Framework of the Act & Statutory Guidance

General Duties & Responsibilities

Key Processes

Prevention

Integration, partnerships and Transition

Information, advice and advocacy

Diversity of provision and market oversight

safeguarding

Assessment and eligibility

Charging and financial assessment

Care and support planning

Personal budgets and direct payments

Review

Wellbeing

Slide23

Wellbeing – What does this mean?

Underpins the Care Act – A principle

Starting assumption that

the individual is best-placed to judge their wellbeing

Local Authorities

must

promote an individual’s wellbeing when carrying out any care and support function

Applies equally to adults with care and support needs and their carers. Slide24

Underpinning principles – S.1

No statutory principles

Has a

general duty to promote wellbeing

of individuals (Adults and Carers)Duty applies to local authorities

Underpinning principle – Wellbeing - What does this mean?Slide25

Wellbeing

Care & support statutory guidance – p.7Slide26

Meaningful relationships

Wellbeing

Care & support statutory guidance – p.7Slide27

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide28

Suitable living accommodation

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide29

Contribution to society

Suitable living accommodation

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide30

Contribution to society

Personal dignity

Suitable living accommodation

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide31

Contribution to society

Personal dignity

Suitable living accommodation

Protection from neglect & abuse

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide32

Contribution to society

Personal dignity

Suitable living accommodation

Protection from neglect & abuse

Being in control of day to day life

Meaningful relationships

Physical & mental emotional wellbeing

Wellbeing

Care & support statutory guidance – p.7Slide33

Contribution to society

Personal dignity

Suitable living accommodation

Protection from neglect & abuse

Being in control of day to day life

Meaningful relationships

Physical & mental emotional wellbeing

Participation in work, play & education

Wellbeing

Care & support statutory guidance – p.7Slide34

In other words…

Promoting wellbeing means:

Seeking improvements in the aspects of a persons wellbeing when carrying out a care and support function (i.e. an assessment)

Covers an intentionally broad range of domains across a person’s life

There is no set approach to delivery of care – each case to be assessed on its own meritsSlide35

Key Headlines

LA – primary responsibility – promoters of individual wellbeing

Shift away from duty to provide services to meeting needs – recognising that everybody's needs are different

Need to recognise individual needs - not a one size fits all –

person centred planning!Focus on preventing or delaying the need for support; LAs may need to invest / utilise existing community resources, facilities, assets etc., to prevent needs unnecessarily escalatingSlide36

Cont…

Carers are given significant new entitlements under the Act.

Information and advice service.

LAs must facilitate a diverse, vibrant and sustainable market for care & support services that benefit the whole population.

Eligibility thresholds established: instead of a council assessing levels of need, it will ask if people can achieve certain outcomes.Slide37

Prevention rather than crisis management

New duties to provide

preventative services to maintain the health of service users

rather than dealing with people after they have had an emergency or reached a crisis point.

This is why the provision of Information & Advice is so important, as it can empower people to make informed and considered decisions about the care and support they need before hitting a crisis. Slide38

The right to information and advice

Information & Advice services

must be:

…in place by April 2015.

…“accessible to and proportionate to the needs of those for whom it is being provided”.LAs must ensure that they enable people to access independent financial advisors to help them get to grips with the complexities of financing social care. Information and advice provision will need to include information on health conditions and management of long term conditions (as well as on social care provision).Slide39

Appropriate & Proportionate

The process is flexible and adaptable so it best fits with the person’s needs, this might be face to face, telephone, online…

A

combined

assessment with the carer, an integrated assessment or specialist assessment (e.g. with a deafblind person)Self-supported assessment –

LA is final decision maker

Should meet persons communication needsSlide40

Appropriate & Proportionate

The

key consideration

is whether the assessment is

proportionate to the severity of need & complexity of the situation (not insufficient or overly intrusive / burdensome)

Where needs are easily recognisable, the assessment may be carried out by phone or online, but

assessors

must have the

training & experience

to be able to recognise issues around

mental capacity

and

further underlying needsSlide41

Assessment & EligibilitySlide42

S.9 – An ‘Adult’ needs assessment

If it appears that an adult

may

have needs for care and support, the local authority

must identify what those care and support needs are - regardless of the level of those needs and the adults financial resources.An assessment

must

include:

an assessment of the

impact

of the adult’s needs for care and support

the

outcomes

that the adult wishes to achieve in day-to-day life, and to what extent the provision of care and support could contribute to the achievement of those outcomes.

In carrying out a needs assessment, the local authority

must

involve:the adult, any carer that the adult has, and any person whom the adult wishes to be involved. where the adult lacks capacity, the local authority should involve any person who appears to be interested in the adult’s welfare. An assessment

must also consider:whether the adult would benefit from anything under Preventative Services / Information & Advice Services / anything which might be available in the community. Slide43

Should not be seen merely as a gateway to services... But rather,

a crucial means of helping the person to understand their needs

, how they can be met, and how they can achieve their outcomesSlide44

S.10 – A ‘Carers’ needs assessment

“Carer” means an adult who provides or intends to provide care for another adult (an “adult needing care”) and is not paid, contracted or ‘volunteers’.

If it appears that an carer

may

have needs for care and support, whether currently or in the future, the local authority must

identify what those care and support needs are - regardless of the level of those needs and the carers financial resources.

A carer’s assessment

must

include an assessment of:

whether the carer is

able

, and is

likely to continue to be able

, to provide care for the adult needing care,

whether the carer is

willing

, and is likely to continue to be willing, to do so, the impact of the carer’s needs for support have on their wellbeingthe outcomes that the carer wishes to achieve in day-to-day life, and

whether, and if so to what extent, the provision of support could contribute to the achievement of those outcomes. A local authority must have regard to whether the carer works or wishes to do so, and whether the carer is participating in or wishes to participate in education, training or recreation. Slide45

What if a person doesn’t want an assessment?

The LA

is not

required to carry out an assessment where a person with possible needs, or a carer:

Feels that they do not need careMay not want LA supportHowever, this can be overridden where they:Lack mental capacity

Or are experiencing, or at risk of experiencing, any

abuse or neglect....Slide46

‘

Adult

’ Eligibility Criteria

46

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

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

M

aking 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

Skills for Care 2015Slide47

What does ‘unable to achieve’ mean?

47

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.

Skills for Care 2015Slide48

A carer meets the eligibility criteria if:

Their needs are caused by providing

necessary

care for an adult.

And, as a result:

their health is at risk

or they are

unable to achieve

specified outcomes

And, as a consequence:

there is or is likely to be a significant impact on the carer’s well-being

A carer is to be regarded as being

unable to achieve

an outcome if the carer:

is unable to achieve it

without

assistance;

is able to achieve it without assistance but doing so causes

significant pain, distress or anxiety, or is likely to endanger health or safety

The

specified outcomes

are:

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

M

aking use of necessary facilities or services in the local community including recreational facilities or services

Engaging in recreational activities

Carers

’ eligibility criteria

48Slide49

Case study

An older man lives alone with some support from his daughter who works full-time. He needs occasional personal care to remain living independently with dignity, and it is likely that these needs will increase. He has lost contact with family and friends following his wife’s death and rarely goes out without support from his daughter who is restricted to taking him out at weekends because of work commitments.

An assessment would consider all of his needs,

including those currently being met by his daughter

, along with the outcomes he wishes to achieve. A separate carer’s assessment offered to his daughter (or a combined assessment if both father and daughter agreed) would establish the daughter’s willingness and ability to care and continue to care

and how best to

promote her own wellbeing

, for example by having regard to the outcomes she wishes to achieve.

This joint assessment would look at issues such as the possible

impact on the daughter

of supporting her father while in full-time employment as well as the father’s isolation, ability to connect with others or be an active citizen.Slide50

Case study continued

Community groups, voluntary organisations, and buddying services could support the father to reduce the social isolation that he may be feeling and maximise opportunities to look after his own health and wellbeing and participate in local community activities.

This, in turn could

lessen the impact of caring on his daughter and enable her to continue to support her father effectively alongside paid employment.

Such support can be identified/suggested alongside other, perhaps more formal services to meet personal care needs, and can be an effective way of promoting wellbeing. In this example, the aspects of wellbeing relating to social wellbeing and family relationships might be promoted.Slide51

Record-keeping and informing individuals

51

?Slide52

The impact of the Care Act on S.117 Aftercare (MHA 1983)

Section 75 Care Act amends s117 MHA by:

defining 'after-care services';

referring to 'ordinarily resident' (rather than 'resident') and providing for disputes to be resolved by the Secretary of State;

permitting regulations to deal with top-up fees for preferred accommodation. Slide53

S.117 Aftercare

“after-care services” means services which have both of the following purposes:

(a)meeting a need arising from or related to the person’s mental disorder; and

(b)reducing the risk of a deterioration of the person’s mental condition (and, accordingly,

reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder).Slide54

Ordinary Residence

The Act confirms that OR for the purposes of S.117 is determined by where a person was based immediately before they were detained and give the

SoS

power to resolve OR disputes.

It also introduces a S.117A that provides for regulations to introduce a limited choice of accommodation for persons subject to S.117.Slide55

A basic human right!

People receiving publicly funded or publicly arranged (even if privately funded) care are now protected by the Human Rights Act.

This means they can argue that substandard care has breached their human rights and they will have their human rights protected by the law in such a situation.

However, this protection is not afforded to people who self-fund and privately arrange their own care.

Note link to the revised MHA CoP

April 2015Slide56

Increased help & protection for people who want to move areas

The Care Act sets out in law a clear process for local authorities to follow if a person in receipt of care wishes to move to another area.

There is evidence that some people are afraid to move as they cannot be sure of receiving appropriate care in a new area. Slide57

Market oversight and provider failure

Increased responsibilities for checking on care providers in their area.

If care provider fails or goes bust, LA will have a duty to ensure that people’s care needs are met seamlessly and not disrupted.

CQC to assess which care providers would be ‘hard to replace’ should they go bust or fail.

CQC can request information from care providers about their financial sustainability, in order to spot potential problems earlier. Slide58

Safeguarding – S.42- 47

The Act places on a statutory footing some of the safeguarding obligations that are at present, only located in guidance.

No new power is provided to protect adults from abuse, merely process obligations

No power of entry is providedSlide59

Safeguarding – core duties

The local authority must:

start an enquiry if it believes an adult is experiencing or is at risk of abuse and neglect

ensure that the person is able to be involved as far as possible, for example by providing an interpreter where a person has a particular condition affecting communication – such as autism or

deafblindness

appoint an independent advocate if the person has substantial difficulty in being involved in the safeguarding enquiry or safeguarding adult review, and if there is no appropriate individual to support them – this should be done at the earliest opportunity in the process.Slide60

Contined

…

s.42 - The safeguarding duties apply to an adult who:

has needs for care and support

(whether or not the local authority is meeting any of those needs)

is experiencing, or at risk of, abuse or neglect

; and

as a result of those care and support

needs is unable to protect themselves

from either the risk, or the experience, of abuse and neglect.

If at any point the local authority suspects or receives information from another person or agency that an adult is experiencing, or is at risk of, abuse or neglect, it must make enquiries, or cause others to do so. Slide61

What is an Enquiry…?

An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place.

An enquiry may be a conversation with the adult, or, if the adult lacks capacity or has substantial difficulty in understanding the enquiry, a conversation with their representative or advocate, prior to initiating a formal enquiry under Section 42, right through to a much more formal multi-agency plan or course of action. Slide62

The objectives of an enquiry into abuse or neglect are to:

establish facts

ascertain the adult’s views and wishes

assess the needs of the adult for protection, support and redress, and how they might be met

protect the adult from the abuse and neglect in accordance with their wishes

make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect

enable the adult to achieve resolution and recovery.

If the local authority decides that another organisation should make the enquiry, for example a care provider, then it should be clear about timescales, the need to know the outcome of the enquiry and what action will follow if the enquiry is not completed.Slide63

Continued…

Once enquiries are completed, the outcome should be notified to the local authority which should then determine with the adult what, if any, further action is necessary and acceptable.

One outcome of the enquiry may be the formulation of agreed actions for the adult which should be recorded on their care plan.

This will be the responsibility of the relevant agencies to implement. Slide64

Cont..

In relation to the adult this should set out:

what steps are to be taken to assure their safety in future

the provision of any support, treatment or therapy including ongoing independent advocacy

any modifications needed in the way services are provided (e.g. same gender care or placement; appointment of an Office of the Public Guardian [OPG] deputy)

how best to support the adult through any action they take to seek justice or redress

any ongoing risk management strategy as appropriate

any action to be taken in relation to the person or organisation that has caused the concern.