Agenda item - The Care Act

Brian Doughty – Head of Assessment, BHCC.

Brian Doughty explained that he was providing an update on the implementation of the Care Act (Part One) since 1^st April 2015. The council had done a significant amount of preparatory work and was 97% compliant with the ‘must do’s, which had involved a tremendous effort. The other 3% would be done once the situation arose, because they were cross-border cases. The ‘should do’s’ needed to have decisions made about their appropriateness or priority, but there was still room for improvement. Services for carers are continuing, to offer support and reduce the impact of the changes. The Act has meant they? can charge for deferred payments, but this activity was down.

There was independent advocacy, but it was a big commissioning issue to ensure there were sufficient advocates and these resources were used appropriately. A key role was to ensure that the right advice and information was provided at each stage. Comprehensive advice needed to be offered in a range of formats, alongside the website, e.g. leaflets. The website had been revamped (using MyLife) and there had been a dramatic increase in hits since April. A dedicated team were engaging with users and carers to develop and test the website.

There needed to be a focus on prevention and reablement. These services can have the greatest impact, but Adult Social Care (ASC) could not provide them alone. A citywide approach was needed.

Since April 2015 actions included redesigning the assessment service to look at the role of qualified professionals (such as social workers and occupational therapists) and the tasks they carry out (such as deprivation of liberty and safeguarding). The workforce was being reshaped to ensure there was the right number of professionals. For the first time safeguarding adults was a statutory duty on councils. Brighton & Hove had a safeguarding adults board, with an independent chair who also chairs the safeguarding children’s board.

Part 2 of the Care Act has been deferred by government until 2020. A relief as the council was unsure how it could have met the additional demands, at a time of diminishing resources. So no responsibility to assess self-funding and not picking up responsibility for those with significant capital. People will have to continue to use their own assets to pay for care. There was a concern about the impact of this being deferred for four years, but there may be changes to the thresholds for getting local authority funding. There was currently no indication about the funding going forward, and funding for ASC would not be known until this November.

The council welcomed how positively the staff had responded to the Care Act, for example their awareness of the new responsibilities and focussing on better outcomes. It was a good start to the journey.

Q: Welcome an emphasis on prevention, but it is always difficult to set aside funds for this. What measures will you take to keep this emphasis?

A: We will always respond to emergencies. We are working with Public Health (who have money & resources) and the third sector to develop preventative services and the Better Care Fund. A lot can be done without dipping into the ASC fund, by drawing on the city’s assets.

Q: This is trying to implement the impossible. A crisis of care is happening with increasing costs and decreasing resources. There is a National Pensioner Convention meeting on October 23 to look at this. What were the flaws of Part 2 of the Act?

A: These proposals meant that the council would have had to set up a Care Account even for those who were buying care privately. When more than £72,000 had been spent by the individual, then government would have to step in. This has been deferred to 2020 to re-evaluate. There were not the people and resources to assess and set up Care Accounts. If this was implemented in 2020, hopefully they would be given sufficient time and resources.

Q: Does increasing demand and reduced services lead to greater use of A&E services? Are the cost savings to the council being picked up by the health service and how are these effects being linked up?

A:  There is a joined up approach using the Health & Well-Being Board. This was not an issue of volume but complexity. The people who need our services, really need them and they are costly to provide. If the resources are not made available then the system will break down.

Q: Could you give an example of safeguarding? Which kind is most prevalent?

_A.                                                This can include protecting vulnerable people from sexual or physical abuse or financial pressure. I could make a presentation about this to the OPC as this is our most important role. Before April 2015 the process was very timetable driven, but now it is tailored to individual need. The Care Act dropped the local authority role to investigate, but now we work with people to find out what they want to happen. The majority of cases refer to poor care in care settings or their own home, the remainder mainly relating to physical and financial abuse.

Q:   As a member of Age UK (who provide independent advocacy) and only has a paid member of staff for 14 hours per week, wanted to query why there must be a paid member of staff to respond to the Care Act

A: I would also question this regulation.

Q: I understand that the delay in implementing the £72,000 cap has resulted in £6bn savings, where has this gone?

A: The means testing threshold has also been deferred, so no relief is being given for older people (a result of the Dilnot Report looking at people losing their homes to pay for care). The Living Wage will have a significant impact on local authorities and the cost of care. In other ways the Living Wage will help stop so many people leaving the sector due to low wages. The council needs to help lobby government about how it can meet these costs. The caps have not been reviewed for years, but a review of income levels could be announced in November.

Q: There is a concern that the third sector may not have sufficient resources to provide the information and advice needed. Is this made worse by the overspend in ASC?

 A: There is a statutory duty on the council to meet eligible care needs, which can be done in a range of ways. The council is working to address this overspend, including scrutinising how to best meet eligible needs. This will involve difficult decisions. In some complex cases it can now be cheaper to go into residential care. But if the situation carries on the council will go bankrupt.

Q: Do you have the resources to inspect services and ensure that people are making best use of these services e.g. not getting carers they don’t need?

A: There are no resources to inspect. ASC assess people to enable them to get the services they are entitled to, and do reassess to see if getting the right services.

Q: What will the redesigned service look like?

A: The assessment services will be reduced as we ask the 3^rd sector to take on greater responsibilities. The more qualified staff will focus on the most complex cases which could be a danger to themselves.

Q: A question for the Fairness Commission: if the focus is on complex and difficult cases, will this reduce services for those in lesser need?

A: We will be asking the 3^rd sector to carry out the simpler tasks such as assessment, rather than get it done by a qualified social worker and the council will quality assure them.

Q: Will you ask organisations like RSLs Registered Social Landlords ) to help and can they refuse to?

A: While RSLs can refuse, we need to get them on board.

Q: Even if you involve the 3^rd sector, the council will still be responsible for assessing clients. Will there be an appeal mechanism if you are not happy with a voluntary sector assessment?

A: The responsibility rests with the council even if another organisation helps them discharge their duty. This can be done using the ASC complaints process, which works well. There is also a need to quality control to ensure that services are effective.