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3.5 Future Funding Reforms

CARE ACT 2014

The Act introduced a cap on the care costs which a person pays over their lifetime, along with a ‘care account’ which tracks how individuals progress towards the cap (now postponed until April 2020; delayed from 2016). It also extended the financial support provided by local authorities to adults with eligible care and support needs.

RELEVANT CHAPTER

The Care Act 2014

RELEVANT INFORMATION

Chapter 23, Transitions to the New Legal Framework, Care and Support Statutory Guidance (Department of Health, 2016)

1. Introduction

April 2020 will see the introduction of significant funding reforms to care and support which is likely to result in more people contacting their local authority. It is vital that local authorities start to plan and prepare for these changes in advance to ensure that people are able to benefit immediately.

The Care and Support Statutory Guidance will be updated and re-published alongside the necessary regulations in April 2019, one year in advance of implementation, to set out how the capped cost system will impact practically on the processes and requirements of the Care Act 2014, and how the obligations of local authorities will change. In summary, the key reforms will be:

  • cap on the care costs which a person pays over their lifetime. How a person progresses towards the cap will be based on what the cost of meeting their eligible needs would be to the local authority. Where a local authority is arranging a person’s care, this will be provided through the personal budget. Where they are not, this will be provided through an ‘independent personal budget’;
  • keeping track of how people progress towards the cap and providing a record of progress to the person. Every person with assessed eligible needs will need to have a ‘care account’. This will keep track of what they are paying, what the local authority is paying and what their progress is towards the cap. Local authorities will need to provide regular statements;
  • extending the financial support provided by the local authority. This will mean that more people with modest assets are able to receive financial support to meet their eligible needs.

2. Understanding Likely Demand

The local authority should take steps to understand the additional likely demand for support as a result of the funding reforms. It is anticipated that a significant number of people who would previously have arranged and paid for their own care may approach the local authority for support in accessing care, or for an assessment of their needs. This is needed so that the local authority can record the cost of meeting their eligible needs for the purposes of establishing their care account, and counting costs towards their cap.

In order to prepare for the implementation of the capped costs system, the local authority should take steps to identify the number of ‘self-funders’ (i.e. people who arrange and pay for their own care and support) in their local area. This group are unlikely to currently be in contact with the local authority, and local authorities should work with other partners who may be better placed to scope the local population, including for example the local NHS, provider organisations and the voluntary sector.

In identifying people who currently arrange their own care, the local authority should consider specific groups who would benefit most from the introduction of the cap on care costs, and may be most likely to approach the authority – for example:

  • people who currently arrange their own care and support, and would be likely to have eligible needs if assessed by the local authority. People already living in care homes who are not funded by the local authority may be most likely to fall into such a category, and may be reasonably estimated using Care Quality Commission registration data or information available from providers themselves;
  • people with modest assets, who would benefit from the rise in the upper capital limit, and may become eligible for financial support from the local authority;
  • working age adults whose needs for care and support are likely to meet the eligibility criteria.

In estimating the impact of additional demand, the local authority should take into account other factors in their local population which may influence the likelihood of individuals seeking care and support. For example, information on existing access to universal services by self-funders (for example any universal reablement service) may provide a useful indication of the willingness of such groups to contact the local authority. Similarly, information derived from contact centres or existing information and advice services may also indicate the preferences of such groups. Other local services (for example local GPs) may also have information and experience with the same groups.

3. Awareness Raising

The local authority should take steps to raise awareness of the reforms, in keeping with their obligations for providing information and advice on the care and support system (see Information and Advice). In order to predict and manage additional demand, the local authority should seek out groups, for example those identified above, for targeted communications and the local approach to implementation. The local authority should consider how to contact any specific groups who may benefit from earlier information, for example individuals who may be at risk of losing mental capacity in the near future. In targeting information and communications, the local authority should follow the same factors of proportionality and appropriateness as in providing any other information and advice.

Communications which raise awareness of the capped costs system should in particular reflect the aims of the reforms to support people to plan for future care costs and make more informed decisions which reduce needs over time. Earlier contact with professionals who may support financial planning, for example, could support the local authority in managing demand over the longer-term. Information should include helping those targeted to access different types of support, including those options available in the local community, to prevent needs, delay deterioration or prepare for the future wherever possible.

4. Carrying Out Early Assessments

Where the local authority identifies groups who would be likely to approach them for support under the capped costs system, they should consider carrying out the relevant processes early in order to manage capacity and workload over a longer period. For example, early needs assessments may be carried out in order to predetermine eligible needs and record the cost of meeting those needs for people who would benefit.

The local authority should consider which groups of individuals may benefit most from such an approach. One such example may be those self-funding people with eligible needs who are in the most settled populations, where needs are least likely to change, such as care home residents. However, groups that are difficult to reach or particularly vulnerable may also benefit from early assessment given the potential challenges thereafter; and it may be helpful for the local authority to understand the practicalities of these assessments well in advance of April 2020 to ensure that they have robust processes in place.

If needs change, the local authority will be required to carry out a further assessment, and authorities should consider how to mitigate such risks in the approach adopted. The local authority should consider when would be an appropriate time to begin to carry out assessments solely for the purpose of preparing for the capped costs system, bearing in mind the likelihood of needs changing. However, this must not lead to a refusal of an assessment where the local authority would be under a duty to carry out an assessment subject to the usual provisions in the Care Act.

The assessment carried out should meet the same legal obligations as for any other needs assessment (see Assessment). However, where the local authority carries out such an assessment, this should be assumed to be on the basis that the person does not wish for the authority to meet the person’s needs at that time (because the purpose of the assessment is to predetermine eligible needs and care costs, in advance of April 2020, and not to seek local authority support) and this should be made clear to the person. However, if the person subsequently asks the local authority to meet their eligible needs, then the usual obligations under the Care Act would apply and the local authority would be required to do so. The local authority should make this clear to the individual at the outset.

Having carried out an assessment, the local authority must determine whether the individual has eligible needs for care and support (see Eligibility). If the person does not have eligible needs, then the authority must provide information and advice. If the person does have eligible needs, then provided the person concerned does not wish for the local authority to meet their needs, the authority will not be required to do so. The local authority should provide the individual with a written record, which includes:

  • a record of the assessment and eligibility determination setting out the needs assessed, and of those which needs are eligible;
  • the cost to the local authority of meeting the eligible needs. This should use the processes which the local authority will already have in place for calculating indicative personal budgets, in order to provide an interim cost of meeting the needs;
  • information and advice on how to prevent or delay needs, how to access financial advice, and the anticipated process for confirming their care account from April 2020.

The cost of meeting the person’s eligible needs which is calculated at this point may form their independent personal budget from April 2020, provided that their needs do not change. The costs will not start counting towards the cap and their care account will not begin before this date, and there is no retrospective element. This should be made clear to the person, and if appropriate their family, in the manner in which the information above is provided.

Where the local authority has carried out an assessment and predetermined eligible needs, it should contact the person concerned around April 2020 to satisfy itself that the needs or other circumstances (for example, the person’s financial resources) have not changed. The person may ask the local authority to review their needs, and the local authority should respond to such a request. If the needs or circumstances have not changed, or if no request for a review is made, then the authority may take the record of the needs and costs as accurate, and provide an independent personal budget and start the care account on that basis. This must be communicated to the individual in writing.

5. Managing Capacity

The local authority should consider the steps that could be taken to manage capacity issues associated with early assessments as described above, as well as additional assessments after April 2020. This could include, for instance, the role of self-assessment in supporting individuals to identify their own needs and make a judgement on eligibility. It may also include adopting a more proportionate approach to the financial assessment for those individuals with assets substantially above the financial limits, or using powers to delegate some or all such assessments to other organisations. Practical guidance has been developed to support local authorities to consider their own capacity and workforce requirements.

The local authority should develop a clear understanding of their current workforce and future needs in determining their approach to delivering additional assessments. They may consider a role for strategic partners in the voluntary sector or others who are already in touch with some of the people concerned and who would be open to being trained to carry out assessments on the authority’s behalf. Where authorities pursue such an approach, they should consider the effect on other elements of the care and support process and how to manage interactions between the organisations (for example, the audit process put in place by the local authority to assure the assessments carried out on their behalf).

Where a person carries out a self-assessment, the local authority should consider how the self-assessment is verified and how this links with subsequent steps, such as calculating the cost of meeting eligible needs. Where this is delegated to an external organisation there should be clear protocols in place for quality assurance and ongoing monitoring.

6. Systems and Training Requirements

All these changes will place new requirements on local information systems and processes. The local authority should review the impact on their information systems in conjunction with their suppliers and consider whether new systems and technology is required and carefully consider their procurement approach. In particular, the local authority should take into account the wider health and care technology strategy, including use of open APIs, when making decisions in this area. They should also consider whether business processes also need to be reviewed and changed in parallel to changes in systems.

In particular, informatics systems for ongoing case management will need to be revised to incorporate the additional requirements for independent personal budgets, care accounts, deferred payment agreements and changes to charging and assessments (for both people with care and support needs and carers). In addition, the authority should consider how digital approaches can put citizens in control by making systems open and accessible, including online assessment, care planning, access to records and care accounts. Local authorities will also need to consider how systems can be made open and accessible to people where digital internet systems are not accessible, or even not permitted, such as in prison.

The local authority should consider the training needs of staff, and in particular the needs of those who carry out the relevant assessments to ensure that there is sufficient understanding of the new system. Where the local authority proposes to commission or delegate some activities to other organisations, they should ensure that staff are trained to the same standard. Practical learning and development modules to support the training of staff to implement the technology is required. The local authority should start early conversations with suppliers to identify the changes required Care Act are under development to support this process.

The local authority should also review their provision of financial advice and relationships with existing local independent providers,  should take steps to identify sources of independent advice which are accessible to local people, and make arrangements for future signposting.

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