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The Care Act: Delivery and Expectation

21st November 2014

Glen Mason Director of People, Communities and Local GovernmentDepartment of Health

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Care and Support affect a large number of peopleMany people need some extra care and support during their adult years to lead an active and independent life. Three-quarters of people aged 65 will need care and support in their later years…

48 per cent of men and 51 per cent of women will

need domiciliary care only

33 per cent of men and 15 per cent of women will never need formal care

19 per cent of men and 34 per cent of women will need residential care

Who needs care? At age 65, what are your chances of needing different types of care within your lifetime?

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Drivers for Change in the English Care System

• Demographic pressure

• Unprecedented financial challenges

• Raising expectations

• Technological Change

• Systems failure eg: Mid Staffs Hospital and Winterbourne View

• A drive to integrate services

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We will change care and support in two fundamental ways:

The Care and Support Act – our vision

1. The focus of care and support will be to promote people’s independence, connections and wellbeing by enabling them to

prevent and postpone the need for care and support.

2. We will transform people’s experience of care and support, putting them in control and ensuring that services respond to what they

want.

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A shift in the care and support system

From To

RepairFocusing only on response after a crisis

PreventionActing earlier to prevent or delay needs

FragmentationIsolated services focused internally

IntegrationJoined-up services working as partners

PaternalState knows best

PersonalPerson knows best

Exclusive“Doing to”

Inclusive“Doing with”

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Choice, control and quality

People can choose between a range of high quality options, or create their own

People develop their own care and support plan

People have clear

information to make good

choices about care

People are in control of their own

budget

People’s views are heard and

help improve services

In the new, person-centred system...

i

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The Care Act is built around people

• People’s well-being will be at the heart of every decision

• Carers rights on the same footing as those they care for• Freedom and flexibility to encourage innovation and

integration• Preventing and delaying needs for care and support• Personal budgets giving people greater control over

their care

• Information and advice about the care and support system

• New guarantees to ensure continuity of care

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The Care Act is built around people

• Promoting the diversity and quality of the local care market, shaping care and support around what people want

• Ensure that no one goes without care if their providers fails

• Puts adult safeguarding on a statutory footing for the first time

• Young adults receive care and support during transition

• Reforms what and how people pay for their care and support

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• Funding: Estimates of additional costs arising from the reforms, and sufficiency of baseline funding for social care.

• Links to Better Care Fund and integration which are a key part of delivery of social care reform.

• Local authority readiness: Scale and complexity of the task facing local authorities and the demands on capacity, and competition for attention.

• Need to maintain engagement in key areas of policy, regulation and guidance, and consider further support needs for implementation.

• Communications challenge to ensure public awareness and local readiness for reforms.

• IT – meeting the requirements of the Act but also the future challenge of integration, shared records and customer access.

• Workforce – developing the skills, ensuring capacity, at the pace required to meet local needs and respond to local challenges.

Implementing the reforms: challenges ahead

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Implementing the reforms: support offerFinancial clarity on the costs of the reforms 1. Work is jointly underway to better understand both the short and long term costs2. Includes provision of models to use in financial planning, FAQs, and advice notes 3. Additional support and guidance has been provided to councils within each region

Information and tools to support planning for implementation1. Major sets of information have been made available (e.g. draft regulations and guidance) or are

about to be made available (e.g. timescales for the public awareness campaign and its resources for local communication teams)

2. L&D resources and final versions of capacity planning tools will be published immediately following the publication of regulations and guidance in mid-October

3. A range of products requirements identified by ADASS & DH policy leads to be available over autumn and details for each product are being communicated to the sector

4. Additional support needs identified in Sep / Jan national stocktakes of readiness

Change capacity management• £19m direct to authorities and £2.7m to establish 9 regional delivery partnerships for Care Act

implementation and BCF• Exploring additional support at a regional level to address local capacity needs in relation to

L&D of the workforce• Work planned to examine how best to manage the national asks of programmes such as Care

Act and BCF

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Better use of resources

Coordinated approach

Organised around users

Reduction in need to go to hospital

Bring skills together around the user

Services 7 days a week

Better outcomes for users

Benefits of integrated care

The Better Care Fund

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What is Government doing to support this?

The Better Care FundThe Better Care Fund

June 2013 announcement:

£3.8bn to be deployed locally in

2015/2016 on health and social care through pooled

budget arrangements

June 2013 announcement:

£3.8bn to be deployed locally in

2015/2016 on health and social care through pooled

budget arrangements

Local authorities and NHS Clinical Commissioning Groups must

agree a joint plan to deliver better, person-centred

care before receiving funding

Local authorities and NHS Clinical Commissioning Groups must

agree a joint plan to deliver better, person-centred

care before receiving funding

Part of the £3.8bn allocated to local

authorities includes a payment for performance element to

incentivise ambition and real change

Part of the £3.8bn allocated to local

authorities includes a payment for performance element to

incentivise ambition and real change

Autumn Statement

December 2013:Pooled budgets

will be an enduring part of

framework in future years

Autumn Statement

December 2013:Pooled budgets

will be an enduring part of

framework in future years

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The Better Care Fund (BCF) narrative

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The Better Care Fund (BCF) will accelerate the local integration of health and care services to deliver better outcomes for people

NHS and social care services are

now caring for people with increasingly

complex needs and multiple conditions.

There is consensus that to respond to

this care should be organised around

the person who needs it, and that

person’s care team should work

together to keep them better for

longer.

The Better Care Fund is one of the

most concrete steps ever towards

making this change happen

everywhere. This is the start and pooled budgets

are here to stay.

Areas put in draft plans in April, and

local areas are now revisiting

these to make sure they are as clear

and strong as possible to kick

start the change we need from next

April. As ever with

system transformation –

success depends on the people

who are leading it to make it

happen locally – people taking bold

steps to move away from their old

ways

The BCF has accelerated and made happen

conversations that have never

happened before about joint working across agencies.

Now we want this to happen

everywhere and we are

committed to support local

areas to achieve this. Local areas teams and local

government regions will have a crucial part to play.

It is challenging, and will

undoubtedly get harder before it

gets easier – but we have seen in

small pockets the immense value of

the prize for patients, users, families, carers

and staff.

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Examples of where it’s happening

Greenwich – avoided 2000 patient admissions with a joint emergency team

South Devon & Torbay – reduced physio waiting times from 8 weeks to 48 hours by bringing professionals together

Tri-borough in London have produced new joint model to help people manage chronic conditions

In Greater Manchester 10 local authorities and 12 CCGs have joined forces to support a large scale reconfirguation

of hospital services

The Better Care Fund

Northamptonshire - targets have been exceeded by 14% on preventing emergency inpatient admissions- targets on

preventing excess bed days exceeded by 4%

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Thank you and any questions?

Glen Mason

Director of People Communities and local Government

Department of Health

DH – Leading the nation’s health and care