CARE ACT 2014
Under the Act local authorities have a duty to carry out their care and support responsibilities with the aim of joining up services with those provided by the NHS and other health related services, for example, housing or leisure services. This includes support and prevention services for carers.
Under the Care Act 2014, the local authority has a duty to carry out their care and support responsibilities – including carer’s support and prevention services – with the aim of joining up services with those provided by the NHS and other health related services, for example, housing or leisure services.
The duty applies where the local authority considers that integration of services would promote the wellbeing of adults with care and support needs – including carers, contribute to the prevention or delay of developing care needs, or improve the quality of care in the local authority’s area.
2. Integrating Care and Support with other Local Services
There is a requirement that:
- the local authority must carry out its care and support responsibilities with the aim of promoting greater integration with NHS and other health related services;
- the local authority and its relevant partners must cooperate generally in performing their functions related to care and support; and supplementary to this
- in specific individual cases, the local authority and its partners must cooperate in performing their respective functions relating to care and support and carers wherever they can.
This applies to all the local authority’s care and support functions for adults with needs for care and support and for carers, including:
- preventing needs (see Preventing, Reducing or Delaying Needs);
- providing information and advice (see Information and Advice);
- shaping and facilitating the market of service providers (see Market Shaping and Commissioning of Adult Care and Support), safeguarding (see Adult Safeguarding);
- cross border placements (see Cross Border Placements);
- transition to adult care and support (see Transition to Adult Care and Support).
The local authority is not solely responsible for promoting integration with the NHS, and this responsibility reflects similar duties placed on NHS England and the local Clinical Commissioning Group (CCG) to promote integration with care and support. There is also an equivalent duty on local authorities to integrate care and support provision with health related services, for example housing.
In Manchester, work to achieve integration is already at an advanced stage with Manchester Local Care Organisation (MLCO) now in place and commissioned by Manchester Health and Care Commissioning (MHCC) to deliver a ten year improvement plan aligned to the Locality Plan.
3. Strategic Planning
The Devolution Agreement for Health and Social Care has given Greater Manchester control over the £6 billion health and social care resources for the region as from 1 April 2016, and provides the opportunity to fundamentally transform how health and social care are delivered in the region. In order to do this, a Locality Plan has been developed, which is the foremost strategy on the transformation of the health and care system in the city. The plan outlines three mutually interdependent pillars which underpin the transformational change required. These are:
- a single commissioning system ensuring the efficient commissioning of health and care services on a city wide basis, with a single line of accountability for the delivery of services;
- a single hospital service delivering cost efficiencies and strengthened clinical services, with consistent and complementary arrangements for the delivery of acute services;
- one team delivering integrated and accessible out of hospital services through community based health, primary and social care services within neighbourhoods.
The Manchester approach, outlined in the Locality Plan, will ensure a clear focus on place and the needs of residents and that a stronger service offer addresses health and social care needs earlier, while supporting residents to take responsibility for their own wellbeing. It will ensure that the City continues to be at the fore of clinical excellence and continue to attract world leading clinicians, and that these front line staff are professionally fulfilled in the demanding roles that they undertake.
Importantly the commissioners and providers of health and social care will come together demonstrating their commitment to integration, cooperation and partnerships to ensure duplication and fragmentation of service provision is removed, that unnecessary costs are minimised, and that the clinical leaders shape the model of delivery most suited to meet the needs of residents in Manchester, ensuring that in future they get the right care, at the right time, in the right place.
Accordingly, MHCC will host the Strategic Commissioning function to provide a strategic steer on commissioning priorities and evaluation, whilst a significant number of health and social care commissioners will be deployed into MLCO to deliver tactical and operational commissioning, aligning objectives with health and care services to deliver joined-up commissioning and improve outcomes.
To ensure greater integration of services, the local authority are developing different mechanisms through which it can promote integration, for example:
- planning: using adult care and support and public health data to understand the profile of the population and the needs of that population, for example, using information from the local Joint Strategic Needs Assessments (JSNA) to consider the wider need of that population in relation to housing (see Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies);
- commissioning: utilising JSNA data, joint commissioning can result in better outcomes for populations in the local area. This may include jointly commissioned advice services covering healthcare and housing, and services like housing related support that can provide a range of preventative interventions alongside care;
- assessment and information and advice: this may include integrating an assessment with information and advice about housing options on where to live, and adaptations to the home, care and related finance to help develop a care plan, and understand housing choices reflecting the person’s strengths and capabilities to help achieve their desired outcomes;
- delivery or provision of care and support: this is integrated with an assessment of the home, including general upkeep or scope for aids and adaptations, community equipment of other modifications could reduce the risk to health, help maintain independence or support reablement or recovery.
Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies are, therefore, key means by which local authorities work with CCGs to identify and plan to meet the care and support needs of the local population, including carers.
4. Cooperation of Partner Organisations
Cooperation between partners should be a general principle for all those concerned, and all should understand the reasons why cooperation is important for those people involved. There are five aims of cooperation relevant to care and support, although the purposes of cooperation should not be limited to these matters:
- promoting the wellbeing of adults needing care and support and of carers;
- improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
- smoothing the transition from children’s to adults’ services;
- protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect;
- identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.
4.1 Who must cooperate?
The local authority must cooperate with each of its relevant partners, and the partners must also cooperate with the local authority, in relation to relevant functions. There are specific ‘relevant partners’ who have a reciprocal responsibility to cooperate. These are:
- other local authorities within the area (in multi-tier authority areas, this will be a district council);
- any other local authority which would be appropriate to cooperate with in a particular set of circumstances (for example, another authority which is arranging care for a person in the home area);
- NHS bodies in the authority’s area (including the primary care, CCGs, any hospital trusts and NHS England, where it commissions health care locally);
- local offices of the Department for Work and Pensions (such as Job Centre Plus);
- police services in the local authority areas and prisons and probation services in the local area.
There may be other persons or bodies with whom a local authority should cooperate, in particular independent or private sector organisations for example care and support providers, NHS primary health providers, independent hospitals and private registered providers of social housing, the Care Quality Commission and regulators of health and social care professionals.