The Care Act 2014 received Royal Consent on 14 May 2014 and becomes law in April 2015. In the ensuing period just about everyone with responsibility to apply the Act will be busy putting pen to paper, conducting consultations, preparing the regulations and publishing interpretive opinion, guidance and advice. The sector will see hundreds and thousands of pages of this, innumerable internet communications, countless Government and Department of Health statements, TV and radio interviews with politicians and accredited experts, the list is endless. And at the other end of the process is the care provider who is trying to make sense of what all this means to them whilst continuing to deliver quality care in the best interests of the people they care for, as they have done since time began.
All this is pretty daunting for providers, so what does it all mean for them? Firstly, it should be acknowledged that the legislation is largely welcomed by the sector. For instance there is a fairness to be drawn from it about assessments and their mobility across the country together with the capping system on self-funder expenditure on care. However, the shortcomings show that the capping system will not bring very many self-funders into eligibility but Local Authorities will, nevertheless, be required to assess them from the outset to set the ‘clock ticking’. The greatest impact for providers is that self-funders will have the option to ask their Local Authority to manage their care and that would be commissioned at the Local Authority fee rate, creating a severe pressure on business resilience.
In all, there are 14 key elements to the Act, having varying degrees of impact on providers. These are:
1. Improving information – Local Authorities (LA) have the job of providing information to the public about all services that are available, not just the headline ones about residential and domiciliary care. This is good for providers in terms of greater visibility of their services but advice to providers is to build on this with good quality websites and ensuring their marketing material appears in all the key areas such as NHS Choices and their local care association membership website.
2. Entitlement to public care and support – this seems a bit nefarious but centres on wellbeing through the newly formed Health and Wellbeing Boards and thus the LA’s responsibility to promote diversity in the provision of services. This can only be good for providers.
3. Assessment and eligibility – again this is a LA responsibility to provide assessments and determine eligibility to a common standard but the downside for providers is noted above in terms of LA managed self-funder care packages.
4. Personalisation – Designed to give choice and control to those being cared for and their carers. The underlying tension is the extent to which they decide to manage their ownbudgets or leave that to the LA. For providers, this will, in the longer term, be good for domiciliary care providers but will affect residential providers where LAs reduce admissions as part of their market shaping responsibilities.
5. Financial assessment – this means what it says and links to the care cap (Dilnot).
6. Care Caps – again, the same problem for providers where self-funders leave the management to the LA.
7. Deferred payments – this draws from the public and media attention to people having to sell their property to pay for care. There is no profound provider impact.
8. Safeguarding – placing Safeguarding Boards on a statutory footing is good for everyone. Where LAs choose to appoint independent Chairs the sector is more likely to see a more proportionate response to safeguarding which could ease the increasing investigatory burdens on providers.
9. Carers – this is about fairness and will generally improve the support they need.
10. Transportability – this is mentioned in the opening paragraph and is about having a common system across the country.
11. Provider failure – largely prompted by Southern Cross. LAs will build more robust assessments into their contract management processes and quality assurance programmes. The trick is to ensure good risk judgement processes are built in to processes so we do not see disproportionate placement embargoes on providers.
12. Transition from youth to adult – very important for the individual service user.
13. Market shaping – the sustainability of the market will be the key point in market shaping and this places a stronger responsibility on LAs to have regard to the true cost of care.
14. Duty of candour – need to find a different word to describe this if the public are to understand it but the principle is already embedded in CQC standards. The advice to providers is to keep a close eye on what to Notify to CQC and if in doubt, to do it.
The challenges to providers will vary in depth and impact and it will be some time before we see any substantial and useful clarification. For instance, will the LA responsibility to assess self –funders have a delaying impact on them choosing to move into residential care and what will be the extent of the impact if so? Self-funders choosing to go into residential care will have a better understanding of fees and could challenge the private fees asked for by providers, which are necessarily higher because they cross subsidise state fees. LAs are not necessarily business minded and with their increased responsibility to shape the market could run aground if not challenged locally.
Albert Goodman Care Briefing proposes to follow the key challenges for providers as regulation and clarity develops running up to the April 2015 deadline and brief their readers accordingly. Of course, you are very welcome to call or e-mail Julie Hopkins should you wish to single out any particular subject for briefing.
Julie Hopkins, Partner
Tel: 01935 423667