1.
Chris Davies
Associate Director, RiPfA
Patrick Hall
Practice Development Manager, SCIE
Implementing the Care Act
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2.
Aims for today
We will
• Examine organisational and process-based
challenges to implementation
• Ask how you can orient practice around the
outcomes that will improve people’s wellbeing
• Address barriers and enablers to partnership
working
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3.
We will ask how the Care Act will
affect
• Your relationships with people who use services
and carers
• Your working practices
• Your relationships with providers and other
agencies
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4.
The format for today
1. Final regulations and guidance: headline news
2. Wellbeing, eligibility and outcomes
3. Working in partnership
4. Concluding remarks
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5.
Where are we at?
• Last month, the final Care Act
guidance and regulations were
published
• Consultation on the regulations
and guidance received 4000+
responses
• Local Authorities are now able
to go ahead with their plans for
implementation
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6.
Your initial views
• How have the final guidance and regulations
affected your planning?
• Are there particular process-based challenges you
are facing to do with implementation?
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7.
1. Final regulations and guidance:
headline news
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8.
The funding question
Respondents to the consultation said:
• ‘Adequate funding for the reforms … is essential’
(LGA/ADASS)
DH said:
• £470m to support reforms (announced 2013).
• National cost modelling exercise has led to adjustments to
impact assessment.
• £100m per year to be reallocated from areas where the
impact is ‘not likely to be as great as previously assessed’
Better Care Fund
• 30th Oct: DH announces BCF now totals £5.3bn
• 151 plans received and 97% of these have been approved
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9.
Prevention
The guidance has been strengthened to make
clear that prevention is not a one-off activity.
In preparation by SCIE, for launch in January
2015:
Prevention Library of
• Good practice examples
• Evidence
• Evaluated practice
examples
Submit your examples at
scie.org.uk
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10.
Information and advice
No additional funds to support this
new duty; however, DH promises
generic text, tools and web-based
resources.
Support material is currently available
from RiPfA, TLAP and Skills for Care
Download from:
• ripfa.org.uk
• skillsforcare.org.uk
• tlap.org.uk
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11.
Advocacy
• Local authorities have a
new duty to ensure that
people have access to
independent advocacy
• SCIE publish guide to
Commissioning
Independent Advocacy
Access at scie.org.uk
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12.
Provider failure and service
interruption
You asked:
• How are local authorities to gauge the financial ‘health’ of
providers?
• What is best practice in developing contingency plans for
interruptions?
DH said:
• We might commission support materials.
• CQC plans to publish guidance in the new year on how it will
oversee the most ‘difficult to replace’ providers
From now until Dec 2014: CQC is developing its approach
and methodology.
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13.
Carers
All the relevant changes for carers
will be put into a single ‘at a glance’
document.
The final guidance strengthens the
economic case for avoiding the
excessive charging of carers.
New safeguarding expectation that
carers will be listened to in
relation to abuse or neglect.
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14.
Young Carers
As with any young person who has care needs and is
approaching adulthood, young carers are entitled to
a ‘transition assessment’ provided by Adult services.
The key is to prevent a ‘cliff edge’ between Children’s
and Adult Services
Over to you:
• How prepared are you for this duty?
• How are you working with children’s services to prepare for
this?
• What would support you in this duty?
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15.
Safeguarding
The Care Act enshrines in law what is already good
practice:
• Duty to carry out a safeguarding enquiry – ‘wherever there is
reasonable cause to think that the person is experience, or is
at risk of, abuse or neglect’
• Duty to cooperate with other organisations (i.e. share
information)
• Safeguarding Adults Boards need to report annually
• Self-neglect is now included under abuse and neglect
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16.
Making Safeguarding
Personal
Making Safeguarding Personal
means safeguarding:
• Is person-led
• Is outcome-focused
• Enhances involvement, choice and
control
• Improves quality of life, wellbeing
and safety
(Care Act Guidance)
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Download from
lga.org.uk

17.
Safeguarding
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2. Wellbeing, eligibility and
outcomes
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19.
Wellbeing
The wellbeing principle:
‘Local authorities must promote
wellbeing when carrying out
any of their care and support
functions in respect of a
person.’
What issues have emerged in
your area relating to the
wellbeing principle?
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20.
Wellbeing
• Wellbeing underlies the central ideas of dignity
and control
• Wellbeing underlies Care Act approaches to:
• Integration
• Prevention
• Personalisation
• Safeguarding
• Wellbeing is also central to the new National
Eligibility Criteria
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21.
National Eligibility Criteria
• To be eligible, it is the case that an adult needs to:
• be unable to achieve two or more outcomes from a finite
list
that this is related to a ‘physical or mental impairment or
illness’
and that this has a ‘significant impact on the adult’s
wellbeing’
• The language of ‘basic care activities’ has been
replaced by the language of ‘outcomes’
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22.
Centrality of assessment
RiPfA’s Assessment Change Project
found:
1. Assessments need to be proportionate
2. Assessors need the right capabilities
3. Assessors need the right support.
Professional judgment is still key to
making the best use of resources.
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23.
Resources
It is unclear how the new system will differ from the present
one, in which:
• Eligibility is determined by available resources rather than
any objective criteria of need
• Different thresholds under FACS make no significant
difference to spending levels
• Under FACS, variations in spending levels are not determined
by different eligibility threshold but by other factors (e.g.
overall spending; age group)
(Slasberg/Beresford 2014)
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24.
A focus on ‘outcomes’
Two different senses of ‘outcome’:
1. The list of 10 ‘specified
outcomes’ given in the eligibility
criteria
2. The outcomes a person wishes to
achieve in their day-to-day life,
as identified in their assessment.
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25.
A change of culture
From To
Doing things for people Doing things with people
Risk assessment as Prevention Risk assessment as an enabler
Focus on what’s important for
people
Focus on what’s important for
people and what’s important to
them
People have disabilities People have abilities
See the problem See the person
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What issues are you facing in shifting to an
outcomes approach?
Stirk and
Sanderson, 2012

26.
Supporting an
outcomes approach
RiPfA Working with outcomes tool
• Helps staff address barriers and
enablers to outcome
conversations
• Supports conversations to
identify a person’s outcomes
• Provides means to enable,
review and measure outcomes
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27.
Approaches that work
1. Introduce new service responses
2. Commission providers to deliver
outcomes
3. Engage and empower people
4. Enhance social work practice
5. Make changes to documentation and key
processes
6. Practice a person-centred approach to
risk
7. Lead culture change
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28.
Commissioning for better outcomes
Good commissioning is
• Person-centred and outcome
focussed
• Inclusive
• Well led
• Sustainable and diverse
market
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Download from
adass.org.uk

29.
Over to you
• What issues are you facing in shifting to an
outcomes approach?
• What issues have emerged relating to the
wellbeing principle?
• Are you changing how people in your area learn
about, engage with and shape social care?
• What is the role of Health and Wellbeing Boards in
these changes?
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30.
3. Working in Partnership
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31.
Co-production
Published
this week
Download from
kingsfund.org.uk
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32.
Integration
Integration under the Care Act 2014:
• Local authorities must aim to promote greater
integration with NHS and other health-related
services;
• Local authorities and their partners must cooperate
generally and specifically in relation to care,
support and carers wherever they can.
Integration is a means to promote wellbeing,
prevention and improving the quality of care and
support.
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33.
Integration
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Where roles are changing:
• Negotiate roles with the relevant
parties across the whole system
(not just within one organisation)
• Review responsibilities
periodically to ensure boundaries
are clear and duplication is
avoided
King’s Fund 2014
Download from
kingsfund.org.uk

34.
Integration
Promoting multidisciplinary working
by
• Considering the person’s whole
care pathway
• The practitioner’s role changes
from ‘cowboy’ to ‘pit crew’
(Gawande 2011, cited in King’s Fund 2014)
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Download from
kingsfund.org.uk

35.
Learning from Pioneer sites
• Large scale service changes take time
• Define intervention clearly
• Be explicit about outcomes at the outset
• Intervention + context = outcome
• ‘Chicken and egg problem’ – tackle by
involving all stakeholders
• Track implementation as well as
outcome
• Carefully consider evaluation models
• Work with what you have
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Download from
nuffieldtrust.org.uk

36.
Co-production
‘Transformative co-production’
• involves genuine power-
sharing between people and
professionals
• recognises and uses people’s
assets
• develops and delivers
services accordingly
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Download from
tlap.org.uk

37.
Over to you
• How will you increase cooperation with partners in
health, housing and elsewhere?
• To what extent is there strategic link-up between
these services?
• What approaches to getting ready for the Care Act
have worked well in your area?
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38.
Summary
We have
• Examined the organisational and process-based
challenges to implementation
• Asked how you can orient practice around the
outcomes that will improve people’s wellbeing
• Addressed barriers and enablers to partnership
working
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39.
Contact
www.ripfa.org.uk
help@ripfa.org.uk
@ripfa
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