The Care Act in Practice Adult Social Care

The Care Act in Practice – Adult Social Care Monthly Journal June 2015

Welcome To Our 1st Edition!

The Care Act came into force on the 1st April 2015. The New Act modernises and consolidates the legal framework for adult social care into one piece of legislation. It replaces much of the previous care-related law, regulations and guidance, including the NHS and Community Care Act 1990, the National Assistance Act 1948 and Fair Access To Care Services (FACS) 2002. It has not replaced The Mental Capacity Act (MCA) 2005 and The Mental Health Act (MHA) 1983, 2007, that both work in conjunction with it. The Care Act’s other aims are to:  Create a new National Eligibility Threshold (replacing FACS)  Clarify entitlement to support and create a fairer system  Embed and extend personalisation

For further information about the Care Act please see:  The Care Act Easy reference guide (Southwark Council)  Letter templates re eligibility decisions (Southwark Council)  The Tri-X Care Act Statutory Guidance Summary accessible via Citrix on our Southwark ASC Policy and Procedures portal (Tri-X).  The Care And Support Statutory Guidance (issued under the Care Act, DOH, October 2014) available as a PDF document to print out.

Other useful websites to learn more about the Act include:  Skills for Care www.skillsforcare.org.uk  SCIE www.scie.org.uk  The College of Social Work www.tcsw.org.uk  TLAP www.thinklocalactpersonal.org.uk

Staff Training on the New Act A variety of training options have been offered to ASC operational staff to date regarding The Care Act and its implications for practice. - Alice Khursandi (Project Manager in the Transformation Team) has visited 14 operational teams to deliver the Care Act Overview training. This was followed up by 2 days of Care Act surgeries at Queens Rd. She also presented to Mental Health services staff at their Integrated Assessment Workshops. - Kusam Bedi and her colleagues in Organisational Development (OD) have offered a number of opportunities for staff to learn more about the Care Act, including general training by Michael Mandelstam, Assessment & Eligibility half day sessions with Pippa Quinn (further dates for this are 16th and 24th July). Pippa also ran a day workshop with the CASC team. - In addition, there are now some very useful E-learning modules about the Act available for internal staff via My Learning Source.

Care Act Compliant Forms The Assessment forms we had been using have had to be changed to reflect the new eligibility framework that the Act introduced. This as now been done and the forms are operational. With the move to Mosaic planned for later this year – the carefirst forms will be replaced with others that have been drafted specifically with the new eligibility framework in mind. ASC Policy Officer Dean Thomas has also created some templates to use when writing to clients regarding eligibility decisions. These have been cascaded to social workers and are able to be tailored for each team’s specific needs (available via Tri-X).

Carers Assessments, Support Plans and Personal Budgets The Carer’s Assessment and Support Plan forms are now available on Carefirst. Please contact Project Manager Claire Hine if you have any queries regarding how we assess and support carers in Southwark ([email protected]). Claire is producing a Carers Assessment & Personal Budgets information sheet that will be distributed asap. Meanwhile please see the guidance for filling in the forms.

Independent Advocacy The Care Act introduces a duty for local authorities to ensure that individuals are as involved as possible in making decisions about their care and support. If someone is having ‘substantial difficulty’ doing this, and they do not have an appropriate person to represent their views/wishes, we have a duty to refer for independent advocacy. For more information about this please see the attached file below:

Cambridge House currently has the contract to provide independent advocates where required, so please contact them directly to make a referral. IMCAs and IMHAs are also available via a referral to Cambridge House. Their new referral form will soon be available on Tri-X but for now please contact them directly at:  www.ch1889.org ph 020 7358 7000

Cambridge House staff are available to visit operational team meetings to talk about this service, as requested. Local Offer Website and factsheet development As part of the Care Act requirement for local authorities to produce information and advice to the local community about what support we can provide, the Transformation Team are creating a new website called the ‘Local Offer For Adults’, which will soon be launched. The team are also producing factsheets on all elements of the Social Care Process that will be available for both staff and the public to download from the site. ______We’d like to hear from you how you are getting on …… If you have any queries or interesting case studies about how the Care Act is changing your practice, please contact us at [email protected] ______

Care Act Practice Questions & Answers Section

PRACTICE QUESTION 1 Under the new Care Act Eligibility Criteria how will social workers record in the assessment 2 specific outcomes that people sometimes can’t achieve? These would regularly be mentioned under the old FACS criteria but I’m not sure where they would be recorded now? 1) Inability to manage own finances 2) Inability to take medication without prompting ie needing help to take medication It is clear how the inability to achieve these things would affect certain of the areas of wellbeing, but not under which ‘specified outcome’ they would be listed in part 2 of the eligibility threshold.

LEGAL RESPONSE: Good question. It’s not entirely clear and appears to be a problem with the drafting of the Act and regulations. I think the guidance acknowledges the regulations are not entirely satisfactory or sufficiently comprehensive where it appears to say at para 6.107 that the outcomes specified in the regulations do not constitute an exhaustive list - but there is no suggestion of this in the regulations which are expressed in specific terms. One way through this problem lies in the distinction the Act and guidance (unevenly) draws between a need and its impact (ie its effect on outcome). It is the outcomes that are specified in the eligibility regs and so it is possible to say a need to have help to for example, manage finances impacts on the person ability to for example maintain a habitable home environment. The guidance suggests that this outcome should be understood to include where an adult may require support to sustain their occupancy of the home and to maintain amenities such as water electricity and gas which obviously involves paying bills etc. While this is a wide interpretation of the outcome it is consistent with the intention of the regulations which is that the adverse practical effect of need gives rise to eligibility. It is less clear how this analysis can be comfortably applied to the need for prompting to take medication. It is possible this would fall within the outcome (i) which is making use of necessary facilities or services - which I guess includes GP's and other health services including pharmacies. The guidance does say by way of illustration of this outcome that although LA's do not have responsibility for the provision of NHS services they should consider the need for support when an adult is attending a healthcare appointment. By analogy it is possible to say that prompting to take medicine would be about the persons ability to make use of medical services. Alternatively the LA has a power to provide services to meet ineligible need - but presumably the LA's preferred position would be to provide services to eligible needs only.

PRACTICAL SOLUTION FOR SOCIAL WORKERS – please continue to record within the assessment if the individual is unable to manage their finances or requires prompting to take medication – the new assessment forms (in Mosaic) to be used from later this year will have space and prompts to record these needs.

PRACTICE QUESTION 2 A colleague and I were just wondering the following in relation to the new Care Act:  person A has difficulty washing every day independently and would like help  person B has difficulty washing every day independently but feels one shower per week is sufficient and has enough strength to have a shower once a week  person C has difficulty washing every day independently, wishes to have a daily shower but his wife is helping him daily and they don’t wish for formal carers to assist Do all three cases have an eligible need? Or just A and C? Or just A? We were wondering because we understood that under the Care Act, though two people might be the same functionally, they won’t necessarily have the same eligibility.

RESPONSE (ALICE KHURSANDI) Presumably you have been using as a reference the 3 point eligibility threshold as defined in the Care Act. If we can assume that all 3 people in your example have: 1) Needs due to a physical disability And 2) an inability to achieve 2 of the specified outcomes – maintaining personal hygiene and being able to make use of the home safely (bathroom use)

Then for: Person A) check that the ‘would like help’ is an actual need, then see if there is a significant impact on their wellbeing, if so they would be considered eligible for support in this area. Person B) this person, although not able to easily give themselves a daily shower, doesn’t feel that they want one. So, if a weekly shower is considered adequate to maintain their hygiene, then they would not be considered eligible in this area as there is no significant impact on their wellbeing. Person C) this person meets 1 & 2 of the 3 point threshold, but currently there is no significant impact on their wellbeing - because the need is currently being met by an informal carer. So, they are not eligible because they do not satisfy the 3rd criteria point. Also – they do not wish to have support at this time from ASC. If the carer were for some reason unable to continue to provide this support then the person may become eligible for support around this need. How the need affects the individual’s ability to carry out specified outcomes (2 or more), and THEN how this in turn affects their wellbeing, are what you need to consider when working out if someone has an eligible need.

(Remember there has to be a significant impact on their wellbeing – which means you have to consider how their need/inability to achieve certain outcomes impacts on the 9 areas of wellbeing. For eligibility - there has to be an impact on at least one of the areas of wellbeing in a significant way, or the effect on a number of the areas means there is a significant impact on the overall wellbeing of the individual).

LEGAL RESPONSE: I agree with Alice save I think that person C has an eligible need (because assessment is carer blind) but there is no need to provide a service because the need is currently being met.