The Care Act: Reforming Care & Support Healthwatch Consultation Event 21 January 2015

1. The Care Act:Reforming Care & SupportHealthwatch Consultation Event21 January 2015 Janet Cole Head of Early Intervention, Prevention & Rehabilitation Jeremy DeSouza, Assistant Director Finance and Resources

2. 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

3. 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

4. Summary of Care Act Duties

5. Care Act - Timeframes Phase One: • Draft Guidance/Regulations published May 2014 and consulted on throughout summer • Final Guidance/Regulations issued end October 2014 • Implementation commences April 2014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

6. Prevention Strategy Janet Cole Head of Early Intervention, Prevention and Reablement

7. Introduction • Whatthe 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

8. Care Act - Three levels of prevention

9. 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

10. 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

11. 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

12. Engagement • Two workstreams have been developed to cover residents’ varying adult social care needs

13. 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

14. Questions about Prevention

15. Social Care Charging Jeremy DeSouza Assistant Director – Finance and Resources

16. Changes to Social Care Charges

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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

23. 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

24. 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

25. 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.

26. 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

27. Questions about Social Care Charges