Care Act 2014 – State of Readiness

1. Care Act 2014 – State of Readiness ADASS President David Pearson

2. Purpose of the Care Act Session • What does the review by the Major Projects Authority tell us about our work so far and the risks? • What does the stocktake of Local Authorities tell us? • Feedback from regions • What are the areas of greatest risk and how are we tackling them? • Detailed work on tables to assist with some of the high profile areas

3. Overview • Care Act received Royal Assent on 14th May 2014 • Very high degree of collaboration with amendments in the final stages of the bill and in drafting regulations and statutory guidance • Widespread support for principles of health and wellbeing, personalisation, and co-commissioning / co-production • The Act is a platform for the next few decades albeit in tough times • Regulations and statutory guidance will shape the experience of the Act

4. Major Projects Authority Project Assurance Review • Independence of DH and the Programme Board • Aim to identify the key threats to delivery of the Programme and help improve delivery confidence • Scope both 16/16 and 16/17 implementation covering: • Policy, Business Context Programme delivery • The Summary case for change • Management of intended outcomes, and Stakeholder engagement • Approach to managing Risks and Issues • Readiness for the next stage • Over 40 cross programme interviews over 5 days

5. MPA: Findings Delivery Confidence Assessment • 15/16 Amber “Strong commitment and support across system but inherent challenge and risk“ • 16/17 Amber/Red “Greater complexity & funding uncertainty” Areas that are working well • ‘A very strong tripartite relationship and joint programme office’ that should be protected • Disparate policy initiatives pulled together in a single programme and coherent direction • Consistent understanding of vision, objectives and main issues • Energy within the programme

6. MPA: Findings Areas of concern • “a major issue is funding” sufficiency and allocation mechanism • could threaten the strong collaborative approach to delivery • Residual risks around workforce and informatics that are greater for the 16/17 deliverables • The Programme would benefit from greater programme management rigour but not at expense of relationships • 11 recommendations to strengthen the programme

7. Local Authority Stocktake (LAS) Implementation Stocktake • Developed and run by the PMO with sector input • 100% response rate • Focus on 9 proxy responses as an overall readiness indicator • More detail in full report, including regional analysis • Traffic lights indicate where councils should be /progress at this stage • Surveyed before regulations and guidance consultation began • Report does not make recommendations

8. LA Stocktake: Findings Programme Management & Governance Q1 – Council has plan/programme to deliver the Care Act reforms Confidence Q2 – How confident that the Care Act can be delivered Councils with 3 or more ‘red’ proxy indicators 17% have self-assessed as having slightly slower progress

9. LA Stocktake: Findings Local preparedness • On the whole a fair to good level of preparedness based on self-assessment with almost all having a plan in place • Good level of awareness with local systems leaders • Reasonably good progress in identifying people and carers who may have care and support needs • Significant concerns around the costs of the reforms • Workforce, informatics and communications are areas of concern

10. Major Projects Authority & Local Authority Stocktake Areas of Concern • Both assurance exercises broadly highlighted the same 4 areas of concern: • Informatics • Workforce • Communications • Affordability

11. “Wicked issues” from the East Midlands Region • Self funders – Do we know enough about them and how to influence their behaviour? • Information and advice – Some of what we are going to have to provide will be very specialist e.g. BSL, Easy Read, prisoners. Would national products be a good idea? • Carers – Do we really know what demand to expect? • Prevention – We need to prepare care managers to be able to provide a lot more information than they have done to date • Financial impact – a lot of new responsibilities creep in almost under the radar, has the Impact Assessment really captured the costs of these? • Workforce - “right sizing” the workforce when it is hard to precisely quantify the impact of the changes. • Continuing Health Care and the Care Act • Disabled Facilities Grants in two-tier council systems

12. “Wicked issues” from the Eastern Region Unknown costs of implementing the reforms Additional carers’ assessments and personal budgets Readiness of ICT systems Workforce Communication strategy/plan/materials Public expectations

13. “Wicked issues” from the North East Region • The higher rates of deprivation and unemployment in the region in combination with low home ownership means a large percentage of people accessing social care would fall beneath the proposed £17,000 means tested threshold lower limit. This means that LAs would still be required to meet the vast majority of the full costs of care. • The proposed ‘substantial’ eligibility criteria is more ‘generous’ than current offer from some LAs in the region meaning a possible significant increase in numbers. The region already currently has the highest rates for people accessing ASC per 100,000 population. • Identifying the numbers of potential self funders and carers who may be approaching local authorities for assessment. • As a result of low property prices many people in the North East would still lose the full value of their property even with the £72k care cap. The lower care costs in the region would also mean many people would not benefit from the £72k cap. •Significant additional responsibilities – market management, advice and assistance to those not eligible – without appropriate levels of funding at a time when social care is already under considerable pressure

14. “wicked issues” from the North West Region (1) In the NW a Task & Finish Group is scoping and preparing. Over 40 members have volunteered to participate (not all attend every meeting). Two sessions have identified that we want to: • Share information and analysis undertaken individually or in groups • Highlight good practice • Encourage collaboration and lead roles to reduce duplication • Communicate the ‘must-do’s’ • Make recommendations about the improvement play deployment of resources including the NW grant allocation • Liaise and feed back information with LGA and DH named individuals • Method for identifying self-funders. Local authorities can be broadly aware of self-funders in residential care, but less clear for those in non-residential care. Clarity on how to identify unknown demand without additional resource and within a reducing budget. • Method for identifying the local costs of implementation in 15/16. There are concerns that the allocation for the new duties will be underestimated.

15. “wicked issues” from the North West Region (2) • The daily living cost if still set at £12k per year will have an impact locally – given that the NW have lower residential fee rates. We understand that there will be a new funding formula – and only the care element of the residential fee rate will be covered. • Establish additional demand from carers – given a good NW network to help scope. • Method identifying the numbers of deferred payment agreements that will be required and how existing arrangements (workforce, IT and finance systems) can meet these. • Providing programme management guidance/resources. Request for a clear breakdown of activity at the national – regional – sub-regional tiers with local ‘must do’s’ to avoid duplication. • Sharing information and good practice – to potentially manage demand • IT support systems – understanding what is required and the software companies’ responses • Prisons. We have a number of large prisons in the NW and the impact is not yet clear.

16. “Wicked issues” from the South East Region • Governance and programme management - in place for counties, much less developed in UAs, need for additional resource • Number of self funders estimated or advanced progress by counties. UAs report moderate/early progress – some not yet started • Less progress with estimating carers’ assessments • Cost modelling underway – half of UAs just started /not done any work • Engagement with key groups about the Care Act has hardly started • Workforce reviews have started - no development plans in place • Greatest risk - total implementation cost and funding, as well as additional demand for assessment

17. Summary • Assessment is positive about tripartite arrangement. • MPA and LA Stocktake consistent on areas of risk and no surprise to programme board. • Regulations and Statutory guidance need full participation to improve . • 16/17 paying for care costs still subject to discussions about the gap in assessment of costs with PSSRU support. • Further work needed on carers and workforce to assure progress and reduce risk.

19. ADASS Business Unit Local Government House Smith Square London SW1P 3HZ Tel: 020 7072 7433 Fax: 020 7863 9133 EMAIL:team@adass.org.ukWEB:www.adass.org.uk