Caring for our Future. Draft Consultation Response ADASS West Midlands v 0.2 (22 nd October 2013)

Transcription

1 Caring for our Future Draft Consultation Response ADASS West Midlands v 0.2 (22 nd October 2013)

2 Care Funding Reform About the Consultation Structure of the Response Bullet point summary Expressed views from LAs Research & analysis Working Group discussion

3 A cap will be introduced on the costs that people have to pay to meet their eligible needs (from April 2016): The cap will be set at 72,000 in April 2016 for people of state pension age and over. The total cost of meeting a person s eligible needs which could be paid by either the person, their local council or a combination of the two will count towards the cap, rather than the person s financial contribution only. People of working age who develop care needs before retirement age will benefit from a cap that s lower than 72,000. People who turn 18 with eligible needs will receive free care and support to meet those needs. Financial support will be provided to more people to help them with care home costs (from April 2016): This will help people with their care home costs if they have up to 118,000 (including the value of their home) rather than only those with up to 23,250, as happens currently. Where the value of someone s home is not counted, we intend to provide financial support with care costs to people who have up to around 27,000. This could help people who have a partner or dependent living in the home, and people who are receiving homecare.

4 We will introduce the option to defer paying care home costs. This will mean that people do not have to sell their home in their lifetime to pay for residential care (from April 2015). People in care homes will remain responsible for their living costs if they can afford to pay them. These reflect the types of costs that people would have to meet if they were living in their own home such as food, energy bills and accommodation. We are introducing a personal contribution to living costs of around 12,000 a year from (April 2016) and this will not count towards the cap. The most financial support will be targeted at those who need it most: A combination of the council contribution towards care costs and the increase in financial support will mean many people will not have to pay the full cap amount themselves. The most financial support will still go to those with the greatest care needs and the least wealth.

5 Financial Pressures Inflation & demographic pressures

6 Government Funding Preparing for reform 335m for 2015/16 to prepare for reforms Basis of allocation not yet known (RNF, local projections etc.?) Specific costs include: Care user assessments Additional carer assessments Care account management costs IT systems improvements Carer support Information & Advice systems Deferred Payments administration Timing appears late (engaging & assessing self funders; developing IT and Information systems, workforce development) Ongoing costs Formula Funding set to change As with all areas of spend, local authorities need to find efficiency savings to meet the demand pressures on the system.

7 Financial Pressures Increase in cost pressures 2016/17 to 2019/20 Inflation & demographic pressures

8 Financial Pressures Inflation & demographic pressures Increase in cost pressures 2016/17 to 2019/20 Years to reach the cap

9 Consultation Themes Staying independent planning & prevention Assessment of the care you need Paying for care Meeting eligible needs When the cap is reached Making it Happen Consultation Questions CQ 1-8 CQ 9-11 Call for Evidence Questions CFEQ 1-3 CFEQ 4-7 CFEQ 8-25 CFEQ CFEQ CFEQ Imp n Questions IQ 1-5

10 ADASS West Midlands Response Strategic / high level Consultation Questions Implementation Questions Key Evidence Regional position statement & challenge Broad consensus view Reflecting individual LA views Reflecting wider research Sign-off & submission 25 th October 2013

12 Staying Independent

13 Key Evidence Call for Evidence Questions 1 to 3 Staying independent planning & prevention Raising Awareness Recognise the importance of information and advice pre-crisis Different level of information needed for those already in the system Support the need to raise awareness of how care and support works. Need to increase societal awareness so information should be available to all National campaign, standardised information, repetition, multiple channels Timing an issue not receptive until too late? Comparable to pension planning Need to set expectations about well-being, need to reduce needs, extent of likely LA funding, benefit of using community assets to reduce / delay needs Greater emphasis on asset-based approaches and on personal responsibility. Information needs to stress the risks / consequences of early self-referral to care / asset depletion / choice of high cost care options Significant role for partners in reinforcing key messages (VCS, Providers, GPs etc.) Potential to link to existing interactions (e.g. Health Check programmes) Emphasis on prevention must be reflected in resources allocated by LAs & HWBBs Clarity around different funding rules / streams healthcare, social care, housing related etc.

14 Key Evidence Call for Evidence Questions 1 to 3 Staying independent planning & prevention Advice on Financial planning More robust financial support needed Contract with IFAs, VCS orgs to provide financial advice Avoid any perceived conflict of interest. Info to allow families to support financial planning. IFA Fact Finding to always consider planning for future care needs regardless of age Planning to Pay Transparency re the cost of care / eligible needs Tools and solutions that inform and promote early planning and preparation. Employers could offer salary contribution schemes.

16 Assessments

17 Key Evidence Call for Evidence Questions 4 to 7 Assessment of the care you need Accessing the cap assessments & eligibility Limited opportunity to influence care & support choices of those self-funders already receiving services Proportionate and risk-based approaches to assessment needed, within a national framework Self-assessment tools, telephone assessments and online care calculators linked to the local funding mechanisms Partners role enhanced supported self-assessment trusted assessments Councils retain accountability for sign-off, safeguarding and risk management. Joint assessment preferred to integrated or single assessments. Clear guidance needed over responsibility to trigger joint assessment Potential for additional demand to come from better access for protected groups Potential to shift assessment practice before legislation is enacted

18 Key Evidence Call for Evidence Questions 4 to 7 Assessment of the care you need Financial assessments Ability to contract out financial assessments National standard for financial assessment would aid consistency Power to take action against fraudulent declarations Need evidence to support financial disclosure Improved local sharing across public services e.g. DWP, Benefits Is free provision for Carers affordable or equitable? Financial assessment of carers would lead to a reliable indicator of ability to pay and end the anomaly of free provision for very wealthy carers. Financial Assessment principles & limits should align to DWP policy

20 Paying for Care

21 Consultation Questions 1. Do you agree that the future charging framework should be based on the suggested principles? Broadly agree Cautious support subject to clarification contained within regulations Some potential for perverse incentives (e.g. local charging policy favouring residential over home care) Local discretion over charges may result in post code lottery type issues Would expect the principles to reflect ability to pay and equity / fairness (e.g. does the proposed deferred payment system favour the more wealthy? National charging approach urged to integrate CRAG and Fairer Charging and support portability across areas Need clear rules for addressing situations where people transfer or deplete assets before seeking care

22 Consultation Questions 2. Do you agree that the decision on the level of the cap on care costs set for working age adults between the ages of 18 and state pension age should be based on these principles? Broadly agree, subject to further definition Concern about the future costs of social care has been linked to attitudes about risk, based upon prevailing income levels not age. Contributions should be based on personal circumstances rather than age. Concern that levels of debt aren t adequately recognised within the cap model Concern that free care may be locked in unnecessarily e.g. S.117 Mental Health episodes at age 18 Need to reflect changes in circumstances e.g inheritance Should be based on ability to pay, not age

23 Consultation Questions 3. Do you agree that in order to support transitions from children to adult care and support we should extend free care for eligible needs to young people up to age 25? Or are there alternatives we should consider through integration between child and adult care and support and the guidance provided on how to set the level of the cap? Mostly disagree Means testing threshold will provide protection for people entering adulthood without assets Financial assessment of means, rather than arbitrary age range, should be the determinant of eligibility for people with needs Extending free care is likely to increase or engender dependency More effective to support a young person through transition rather than making financial concessions of this kind Potential inequitable treatment for those with a disability but not (at age 17) in receipt of LA funded support Needs alignment with DWP approach to payment of benefit Extension of free care would increase the burden on children s services, who don t have the ability to claim on benefits that become payable from age 18

24 Consultation Questions 4. Do you agree the contribution a person makes to daily living costs should be calculated on the same basis as financial assistance with care costs taking into account both a person s income and assets? Broadly agree Broadly welcome a standardised approach Strong concerns expressed over the basis of the 230 p/w calculation (regional cost variations, misalignment to State Pension / Pension Credits and ONS data) Need to align daily living costs calculation across whole range of entitlements & benefits calculations Would support achieving equity between those who rent and those have bought houses. Challenge for providers to present a breakdown of costs / show separate lines for cost of care and daily living costs. Would expect to be able to claim living costs directly from DWP or through Universal Credit system, to aid income collection

25 Consultation Questions 5. Do you agree our proposed criteria for determining who qualifies for a deferred payment? Are there any examples of where greater flexibility might be necessary to ensure people do not have to sell their homes in their lifetime to pay for care? Broadly agree subject to further clarification Need to ensure that publicity material and financial advice are clear on this matter Local discretion may result in inequitable treatment (e.g. in neighbouring areas) Pragmatic approach needed in some cases e.g. for those whose assets fluctuate in value at or around the limit Clarification needed over shared / complex ownership arrangements flexibility needed Exclusion of those receiving home care might act as perverse incentive in favour of residential care Potential exists for contentious property valuations / disputes High potential debt to equity ratio could result in shortfall in the event of property market downturn Potential for debt + interest to exceed equity on death / termination of DPA. Equity margin (similar to maximum loan to value restrictions for mortgages) required If property is left empty, potential exists for disrepair affecting end value. Should maintenance costs be included in DPA? Responsibility for repairs & maintenance rests with individual / representatives. Potential for rental income to offset cost of care or reduce DPA. Need guidance re foreign property ownership

26 Consultation Questions 5. Do you agree our proposed criteria for determining who qualifies for a deferred payment? Are there any examples of where greater flexibility might be necessary to ensure people do not have to sell their homes in their lifetime to pay for care? Broadly agree subject to further clarification Need more detail CRAG is weak Preference is for financial services market to develop appropriate products e.g. flexible equity release schemes, insurance products Repayment of DPA how many DPAs result in residual debt? How much do LAs lose via DPAs? Concerned about risk transfer without appropriate reward Concern re cashflow impact of the scheme do LAs have the cash to support DPAs at scale?

27 Consultation Questions 6. Do you agree with the principle that local authorities should have the discretion to introduce reasonable safeguards to ensure deferred payment agreements can be repaid? If so how can this be done in a way it supports people s choice of care home? Broadly agree Local discretion could lead to inconsistencies so needs to be within a national framework Transparency & consistency needed over the consequences of asset / equity depletion, particularly where the person has chosen high cost accommodation Some sensitivities required as the person s life expectancy could become an important determinant of the DPA decision Safeguards needed to avoid significant risk / debt burden Need national criteria consistent process and rules on equity requirements, clear information for clients Clarification needed in the event the person moves to another area. Will DPAs be portable? Who assumes risk / has responsibility for collection? Will Choice of Accommodation directions reflect DPA arrangements / 3 rd party collections?

28 Consultation Questions 7. Do you agree local authorities should normally wait for up to 3 months after someone has died before actively seeking repayment? Are there circumstances in which the local authority should wait longer? Disagree Repayment should be dealt with through the personal representatives at an early juncture Early notification of debt will be necessary for estate planning / help personal representatives to understand the extent of liabilities and plan to maximise the value of the estate Recognition that property may take more than 3 months to sell Need to be clear with relatives up front about timescales and potential action What are the options open to councils to actively seek repayment? Notification of debt on death should not be considered an act of actively seeking repayment

29 Consultation Questions 8. Do you agree that local authorities should have additional flexibility to go beyond what they would normally cover and allow people to defer care charges to help them get the care they want in wider circumstances such as domiciliary care? Tend to disagree Flexibility needs to be within the context of a national framework Need to understand the additional risks associated with wider application / potential for deferred payment to be extended significantly for home care clients Preference is to encourage people towards commercial lenders Joint ownership issues more prevalent in homecare clients However, some concern that exclusion of DPA for homecare clients might encourage more residential placements Need to consider the implications of equity-derived liquidity on financial assessment Problematic to extend DP to home care clients in the event that enforcement action required during life of clients. No option to sell home unless client goes into residential care. Further evaluation of implications re homecare needed suggest exclude for 2015 (with potential to bring into scope once fully evaluated)

30 Key Evidence Call for Evidence Questions 8 to 25 Paying for care Fees & charges National charging framework seen as equitable Concerns re local variation in costs / people in low cost areas paying more than market costs National framework ignores local democratic accountability / prioritisation Appropriate to pass on set-up, contracting and payment costs Waive costs for e.g. Direct Payment clients as an incentive Need to link charging regime to independent financial advice being provided No fee if care linked to safeguarding action Charging a fee needs to be seen as a value adding activity, not a budget-filler. May encourage people to take more control of arranging their own care Increased expectations of quality and recourse associated with charges

31 Key Evidence Call for Evidence Questions 8 to 25 (cont d) Paying for care (cont d) Cap on care costs Disposable income calculation for working age adults should reflect personal circumstances (e.g. child care costs) not age The age at which a person becomes eligible for benefits in their own right should be the age at which they contribute to their care. The cap should only apply for chargeable services Self funded care needs to be calculated at the same rate as the LA would pay Deferred Payment Arrangements Clear action plan, including information, brokerage and assessment, would help maximise the 12 week disregard period. Complex ownership arrangements, property valuation, existing secured borrowing, mental capacity and expected deferral period are all factors for consideration re DPAs Independent Financial Advice is critical Deferral should only be considered when disposable income is insufficient to meet care costs (risk sharing with LA needs to be proportionate). Unavoidable household expenses should be taken into account (e.g. council tax, standing charges for utilities, service charges). Reasonable costs of supporting dependents

32 Key Evidence Call for Evidence Questions 8 to 25 (cont d) Paying for care (cont d) Support for homeowners Enhanced information offer, signposting relevant community organisations providing advice Encourage arrangements with homeowner and RSL to rent vacant properties (particularly where adaptations have been made which would benefit others) Information packs should be based on those provided by commercial lenders to people taking out a mortgage DPA fees should reflect administrative costs incurred (no profit element) Option to reflect interest charges in care costs if preferred by client Preference remains for commercial arrangements. The role of the IFA in signposting the most appropriate equity release product (inc. DPA) is critical.

34 Meeting eligible needs

35 Consultation Questions 9. Do you agree with the proposed principles for calculating the independent personal budget and personal budget? Agree but with some reservations Concern that IPBs will be perceived as minimum necessary for basic care rather than promoting a person s wellbeing, leaving the council open to challenge Concern that there are wide differences between RAS and actual care costs further work needed to assure RAS assessments Need to ensure that reducing care needs is actively pursued regardless of who funds care. The absence of a care and support plan for self-funders risks the cap being reached far faster and through the use of inappropriate costly interventions where free or lower cost support might be more beneficial for the person and the budget. Need to reflect proportionate periodic review of IPB calculation. Is it being proposed that the budget attached to the equivalent of a carer s assessment is also a contribution to reaching the cap? (para 211)? If so, this would appear to need further development / clarification on how this would operate in practice.

36 Consultation Questions 10. Do you agree that local authorities should have flexibility on providing annual updates where a person has not had care needs for many years, or they have already reached the cap? In what other circumstances should discretion be given? Agree Preference is to issue annual updates for all (including historic cases) where information is held within IT systems (i.e. subject to IT and data protection constraints) Guidance should specify the situations in which LAs need not produce an annual update (e.g. after a person has not had care needs for x years). Suggest providing a statement of care costs on leaving care (a P60 for care!) Share info when a person moves area copy of latest Care Account to receiving LA People should be able to receive an update if they request one, regardless of their current circumstances (e.g. someone who has not had care needs for a number of years may request an update on developing new needs). Produce online statements, with the onus on the individual to access / check them.

37 Consultation Questions 11. Do you agree that the principles above should underpin mechanisms for providing redress and resolving complaints? Agree Subject to clarification of some of the terms used e.g. independent review of complaints should be in line with established complaints systems which allow for review by someone not involved in the original decision. Good practice allows for access to Advocacy services for those who need support when complaining Complaints re provision of independent financial advice should be handled by the provider, with escalation to the FSA. Consider the role of the HWBB as an independent party / escalation point for unresolved complaints

38 Key Evidence Call for Evidence Questions 26 to 36 Meeting eligible needs Personal Budgets / Independent Personal Budgets Need to allow proportionate element for independent advice Concern that RAS and RAS-like systems are proposed for a purpose for which they weren t designed. There is often a delta between RAS allocation and actual PB and whilst this may be a feature of poorly calibrated RAS, the underlying issues have not been resolved. Moderation of RAS indicated budget for self-funders may be problematic is self-funder chooses care that costs more than RAS and more than LA funded packages The RAS principles proposed here apply more appropriately to care and support plans, which should be the starting point for PB and IPB discussions. Reviews must be more consistently performed and extended to self-funders major cost implication

39 Key Evidence Call for Evidence Questions 26 to 36 Meeting eligible needs Care Account Projections must be accompanied by a clear disclaimer Systems requirements for projected costs must be proportionate. Simple rate of spending calculation preferred Projections likely to ignore future revision of cap, so inherently inaccurate. Cap may expose local variations in care costs (e.g. across LA boundaries) and incentivise cross-area placements Likely to expose price differential between LA-funded and self-funded care risk for Provider viability if prices come under further pressure Expect minimal change as a result of ordinary residence rules Complaints Existing processes should be adequate, subject to local policy refresh in line with legislation / guidance Separate Tribunals system bureaucratic, costly and unnecessary Local Appeals Panel seems like an unquantified and open-ended risk. Level of complaints and resolution success rates unknown at this stage suggest such a system might be a later addition if necessary.

41 When the cap is reached Transition to LA support Direct payments in residential care Top-ups

42 Key Evidence Call for Evidence Questions 37 to 38 When the cap is reached Awareness & visibility of self-funders needs should facilitate better demand management and care & support planning but funding differentials likely to leave issues of choice unresolved. Consider it appropriate to align needs assessment with IPB allocation / review Providers need to demonstrate what top-up payments are buying (in terms of added value services) Need honest assessment of the affordability of top-up arrangements at the outset, to avoid potential moves when the person s money runs out.

44 Implementation Questions Transition to the new arrangements Distribution of funding Workforce development Information system development Market shaping and oversight Direct payments in residential care

45 Implementation Questions Transition to the introduction of the cap 1. Do you agree local authorities should conduct assessments of people who are funding their own care and support up to 6 months before the introduction of the cap on care costs? Broadly agree dependent on resources Contact should come between 3 6 months of introduction of reforms to minimise potential for significant changes in assessed needs. Contact should encourage self-funders to adopt preventative and community-based solutions alongside traditional care educating people about the care & support system and what to expect once the cap is reached. Early preparation needed to identify self-funders well in advance of initial contact (start now). Programme of briefings for care home residents (jointly facilitated by Providers); early engagement with homecare recipients less straightforward. Impact of self-funder assessments won t be felt evenly across all LAs some may need to start engagement earlier than others Timing of legislation imposes fixed deadline for LAs recruitment / development of additional capacity needs to be scheduled to allow for high volumes as soon as contact with self funders commences. Implementation must be done with input from & support of partners Opportunity to address existing issues e.g. around CHC framework. Concerned that the regional resource pool will be too small to meet demand Urgently need better / more reliable self assessment tools as basis for risk-based assessment approach

46 Implementation Questions Transition to the introduction of the cap 2. How could local authorities use reviews they have planned with individuals throughout 2015 to prepare for introduction of the cap on care costs in 2016? Reviews should be used in support of wider communication campaign must be in place early in 2015 at the latest (earlier if possible) Anticipate extra pressure on resources at review as more time needed for discussion on funding reforms Providers have a responsibility to ensure their clients are briefed work with provider orgs and VCS to agree programme of communication Important that communication & engagement is not restricted to a single event or intervention (e.g. review). Complex messages, will need repetition and reinforcement Consider piloting a new review process in 2014, allowing time for learning and change Essential that work to develop national frameworks & approaches is funded centrally and not by top-slicing the 335m set aside for LA implementation.

47 Implementation Questions Workforce development 3. We welcome views on the implications for commissioners and workforce leads from the potential use of partners resources to help manage the demands on local authorities from the introduction of the cap on care costs and how this should be addressed within the workforce development strand of the implementation programme. We expect that providers and partners will play a big part in this and are already planning to engage them in developing a whole sector approach Further work required to define & develop a programme of support for providers Early training needs analysis required National resources are required to support the development of expertise across the sector Need to understand the implication of future changes in housing benefit on available resources

48 Implementation Questions Market Shaping and Oversight 4. We welcome views on how local authority commissioning and care and support provider provision should adapt to take advantage of the opportunities provided by the introduction of funding reform and respond to the challenges it may present. Increased importance of brokerage to successful commissioning. Potential for market dynamics to disrupt / change pricing practice, with risk of market / provider failure as a result Increased transparency of price differential (self funded v. LA funded) may put downward pressure on cost or lead to a rebalancing of price at a higher point than currently supported by LAs Need to drive outcomes focus amongst providers Improved intelligence about self-funders is likely to help commissioners make better informed decisions about market shaping. Potential to extend the remit of Local Authority Trading Companies to embrace wider responsibilities arising from reform (information, financial advice, assessment etc)

49 Implementation Questions Market Shaping and Oversight 5. We welcome views on how funding reform and increased transparency will affect the shape of local markets for types of care and support, and evidence to understand how the demands on local authorities to arrange care on behalf of people who arrange their own care and support may change. Expect a significant shift towards measures to prevent, delay & reduce care needs (LA and Providers) Expect pressure to end cross-subsidisation of LA-funded care by self-funders, leading to (a) cost pressures for LAs (b) viability risks for providers and (c) further strain on cost v quality relationship. Potential for significant risk to market sustainability if self funders seek to take advantage of LA buying power Expect the dialogue between LAs and Providers to shift towards sustainability and evidence, with LAs seeking more open-book transparency. Expect LAs to find different ways to influence provider behaviours, with less reliance on contractual terms and more reliance on relationship drivers The provider market will need to expand to accommodate demand for information & advice services (inc. independent financial advice and brokerage) Providers may become far more selective in the range of services they offer as price pressures drive down margins. This may counteract LA actions to stimulate diversity There is the risk that people become more dependent and abandon some choice & control over their care as a result of accepting LA funding.

50 Key Evidence Call for Evidence Questions 39 to 40 Making it happen SDS processes expected to be used Timing of assessment is key. Demand management (via prevention, reablement, assistive technology etc.) must be given the chance delay or reduce needs before assessment crystallises demand at an artificially high level. Need to set expectation that universal entitlement to assessment is subject to effective initial period of support. Encouragement for people to access assessments must be alongside encouragement of preventative measures. Information campaign must position assessment in that context. Little point in assessing people too far in advance of the legislative changes. Potentially significant resource implications, concern that funds allocated for transition aren t adequate.

51 Regional Position Statement ADASS WM broadly welcomes the funding reforms contained within the Care Bill, and would highlight: Urgent need for regulations, guidance and clarification to allow LAs to begin preparations Need for greater consistency and clarity to avoid tension between national approaches and local discretion Need for a national information campaign to drive understanding of how the system is to work and to provide firm basis for (early) engagement with self funders, providers, partners etc. Need for flexibility to apply proportionate & risk-based approaches Concern that insufficient attention is being given to driving behavioural change amongst self-funders need to encourage self funders towards no / low cost community based support, prevention etc. Agreement that national & local engagement with financial services market is required Need for further work nationally to align policy implications across Care and Benefits systems Desire amongst West Midlands LAs to support and participate in the national workstreams that are taking the development of guidance forward. Concern that funding over the next 2 years will be inadequate to prepare for, implement and operate the new system Funding settlement has to be seen in the context of current significant budget challenges Financial impact assessment performed before the detailed proposals were available further modelling required Other system pressures (e.g. health) likely to compete for integration pooled budgets, eroding capacity to make changes Potential for significant upward pressure on LA funded care costs as makeweight to end cross-subsidisation by self-funders Risk of provider and market failure arising from downward price pressures on providers

52 Further research (links) Care and support funding reform cost implications for London (London Councils) A Cap that Fits: the capped costs plus model (Strategic Society Centre) Home truths (impower demand management project) ADASS report on self-assessment