The Care Act reforms aim to shift social care towards prevention, personalization, and proactivity. Key changes include universal deferred payment agreements allowing homeowners to defer care home fees, an extended means test assessing more people for state support, and self-funders being able to request local authorities arrange their care. Implementation challenges include ensuring quality information and advice, facilitating support for families, and targeting local authority resources to those most in need while encouraging self-funders to arrange their own care when possible. The local authority consultation seeks views on proposals and solutions to smooth the transition.

1. The Care Act:
Reforming Care & Support
Healthwatch Consultation Event
21 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
Key requirements Timing
Duties on prevention and wellbeing From April
2015Duties on information & advice (inc paying for care)
Duty on market shaping
Assessments (including carers’ assessments)
National minimum threshold for eligibility
Personal budgets and care and support plans
Safeguarding
Universal deferred payment agreements
Extended means test From April
2016Care accounts
Capped charging system

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 Draft Guidance/Regulations published May 2014 and consulted on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
 What the 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
Key requirements Timing
Duties on information & advice re paying for care From April
2015New charging framework in line with national eligibility
for service users/carers
Universal deferred payment agreements
Entitlement for self-funders to ask Council to arrange
their care
Extended means test – more people to access state
funded support (capital limit increased to £118,000 from
£23,250 for care homes)
From April
2016
Lifetime cap on care costs introduced (£72,000)
Care Accounts – to track progress towards the cap on
care costs

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