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Implementing the Care Act – assessment, care/support planning and review

Implementing the Care Act – assessment, care/support planning and review. November 2014. The Care Act 2014. Replaces almost all existing adult social care law, except MHA and MCA Changes to the legal framework to be implemented from April 2015 (Funding reform scheduled for April 2016)

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Implementing the Care Act – assessment, care/support planning and review

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  1. Implementing the Care Act – assessment, care/support planning and review November 2014

  2. The Care Act 2014 • Replaces almost all existing adult social care law, except MHA and MCA • Changes to the legal framework to be implemented from April 2015 • (Funding reform scheduled for April 2016) • Final guidance now out – www.tinyurl.com/CareActGuidance

  3. The intentions of the Act • Guiding principle is promoting wellbeing • Prevention a formal duty for the first time • “Co-produced” assessments and plans • New rights for carers: • Right to assessments extended • Duty (not just power) to meet carer needs • National eligibility criteria • More specific duties to provide information • “Modernised” law

  4. Key requirements The new framework is much more prescriptive than before about processes and documentation: • Option of supported self-assessment must be offered • Assessments must describe all needs, eligible or not and whether or not to be met by carers • Assessments, explanations of eligibility decisions and care/support plans must be given to people in writing • People should be told in advance the questions they are going to be asked • Must give personalised written advice about prevention • Advocacy may be a duty if people would have “substantial difficulty” in being involved

  5. New and changed language • “Care and support needs” • Either there are some tasks which the person can’t comfortably do without help, or there are some situations in which they face unpredictable risks [our working definition] • “Needs assessment” • “Care and support plan”/ “support plan” • “Personal budget” • “Review” (as distinct from “reassessment”) • checking whether person’s needs have changed & whether care/support plan is working

  6. Our proposed approach • Ensure people can make informed decisions about whether to accept an assessment • (Act says must be one unless person refuses) • Make carer assessment a standard part of all assessments where there is a carer • Break process down into stages, which may be carried out in different places • Separate reviews from reassessments

  7. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  8. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  9. Early interventions • Includes SPA, ERCs, IRTs, HtH, STSS & one-off therapy interventions • Functional assessments • Not Care Act needs assessments • Where possible record info in such a way that it could be passed on for needs assessment • Must offer options guidance before exit

  10. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  11. Options guidance • All early intervention services will need to be able to give options guidance • Guidance usually given at the point when people are ready to leave the service • Needs to be given to both ill/disabled people and carers • Support planners available when fuller advice is needed – but not an alternative to each service giving guidance

  12. Ongoing care and support needs? • Either some tasks which the person can’t comfortably do without help, or some situations in which they face unpredictable risks • Any needs the person cares about (not just eligible) • Any areas of life (not just the areas targeted by the short-term intervention) • Includes needs met by carers • Includes needs to be met privately • Answer is “no” only if people have recovered to the point where there is no ongoing impact on their life • For instance anyone getting AA/DLA/PIP should normally be assumed to have care and support needs

  13. Ongoing carer needs? • Carers include any family member/friend meeting any care & support needs • Not just substantial or regular support • A carer has needs if there will be any unwelcome impact of caring on their lives • Potential future as well as current needs • Not just risk of not being able to carry on • Includes not being able to work/study

  14. If there are no ongoing needs • Must provide general advice about how to prevent or delay future needs • Need to document that there are no ongoing needs and how that decision was taken

  15. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  16. “Refusing” assessment? • The Act says we must assess people with needs (users + carers) unless they refuse an assessment • But many people won’t want an assessment if they know it won’t lead to services and that advice is available without it • Unnecessary formal assessments can be a burden for disabled people and carers and divert resources from meeting needs. Options guidance needs to include: • Explaining what the benefits of assessment are (and are not) • Offering advice and information without an assessment • We must assess people at risk of abuse/neglect; and must assess people without the capacity to refuse unless we believe it would not be in their best interests.

  17. Information and advice • Relevant at all stages of the process • Particularly important if someone with care/support needs refuses assessment • Will need to include: • Details of mutual support groups (Carers’ Northumberland, Alzheimer’s Society…) • Advice about relevant resources in the community • Info about sources of financial advice • Guidance says must be personalised – not just standard leaflets/web addresses

  18. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  19. The CSP1 and the CSP2 • One form for all stages of needs assessment, care and support planning and review (CSP1) • Parallel form, linked and usually completed together, for carer(s) (CSP2) • Hope to eliminate all/most other forms (SAQ, SDS1, BAR, CP2, MC1, PB offer letter) • Initially, at least, will be a Word document – like CP1, but hiding sections that aren’t relevant • Designed throughout as a document to be shared with users and carers • Aim to give all needs assessors mobile technology so the form can be completed/edited with users/carers

  20. Needs-based assessment forms • The basic structure of the CSP1 and CSP2 will be a list of needs • As the forms move through the process, more will be added about each need, e.g.- • You told us you need help with A, B, C, D because… • We think you need help with B, C, D, E because… • C, D, E are eligible needs, C will be met by your carer • D can be met by us supplying equipment/by you taking up entitlements to support from other sources • E will require […] level of support... • Support with E will be provided by…

  21. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  22. Gathering & validating needs • Can and often will, but need not, be carried out by social care needs assessors • Initial list of needs could be gathered: • By online self-assessment • By early intervention services • By other professionals • List could be (provisionally) validated: • By early intervention services • By other professionals

  23. Gathering needs – for example: • I need help getting out of bed and getting dressed [because…; the help I need is…] • I need help keeping my garden tidy • I need help to get to the shops • I am at unpredictable risk all the time because I may have seizures • I am at unpredictable risk when I am with people I don’t know because I get anxious and lose control of my behaviour

  24. Gathering needs: the online option • Online option by April 2015 • Background info, needs, outcomes sought • Probably accessed by link sent by SPA • Same structure for needs as CSP1/CSP2: • Tasks you need help with • Unpredictable risks you need protection from • Pulled into CSP1/CSP2 as starting point • Could be used for supported needs-gathering with other professionals/VCS advisers

  25. Validating user/carer needs • Validation is confirming whether needs exist, not whether they are eligible for support • Validation will involve asking: • Is there any doubt this is the person’s own view? • Might there be conflicts/safeguarding issues? • Might there be issues about mental capacity? • Might needs be under- or over-stated? • Are there solutions other than personal support? • Initial validation may be by early intervention services/other professionals • Some validation may be by phone • In complex situations, additional face to face validation will always be needed

  26. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  27. Eligibility and level of support • Recommendations by needs assessors • Decisions by budget holders • As now, level of support will be expressed as notional number of hours of support • (But hours will generally be linked to specific needs on the CSP1/CSP2) • Users/carers may be sent completed assessment including level of support (& tariff cost for this) instead of PB offer letter

  28. Eligibility – the new criteria • FACS gone from April 2015; national eligibility criteria replace it • Eligible if: • Ill or disabled or substance misuse problems • Unable to achieve specified key outcomes • Consequence is a significant impact on wellbeing • Little practical difference from current FACS criteria • National eligibility criteria for carers for the first time – probably similar in effect to our existing eligibility criteria • Some oddities which may not matter practically – “two or more” outcomes required to make user eligible

  29. Assessing eligibility • The CSP1 and CSP2 will list: • Some needs which are always eligible, if they have been validated (getting out of bed; being able to eat/drink enough…) • Some needs which are eligible only if not meeting them would have a significant impact on the person’s wellbeing (+ write-in needs will be in this category) • Needs that a carer meets may be eligible • No service is required immediately to meet them • But if the carer is ill etc. we must then meet them

  30. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  31. Brokerage/DPs • CSP1/CSP2 with validated needs, eligibility decisions & approved support levels will be sent to brokers/DP team for action • May be no need for further budget holder approval unless either: • The costs are more than tariff/standard preferred provider rates • The proposed arrangements are unusual • May be scope for other brokers

  32. Early interventions(Initial referral, urgent support, STSS, etc.) No ongoing needs Options guidanceAre there ongoing care/support needs?If so, do person/carer want assessment? Assessmentdeclined AssessmentGathering information about needsValidation and consideration of alternativesEligibility decisionDecision about level of support required Changes CSP1 and CSP2 Care/support planningBrokerage/DP support ReviewMay but need not result in reassessment No changes

  33. Review • Review is not reassessment – just a check of: • Have the needs changed? • Is the care/support plan working • Only if the answers are not “yes” is reassessment needed – reassessment will involve revisiting the whole of the CSP1/CSP2 • Reviews need not always be visits by social care needs assessors. Could sometimes be by: • Other professionals • Phone checks with user/carer(s) • Providers (where this is appropriate)

  34. What next? • We want your views – now and on reflection • Aim to finalise forms by January • Training programme February/March • Implementation from 1 April • Expect to pilot new approaches (online needs gathering/phone validation) – won’t rush these • Changeover from CP1 at reviews

  35. For further information • National guidance at: www.tinyurl.com/CareActGuidance • Updated information/FAQs at:www.northumberland.gov.uk/CareAct Email for queries and comments: CareAct@northumbria.nhs.uk

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