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A consultation on the 2016 reforms under the Care Act

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Overview

Discussion

Introduction

Cap on care costs

Appeals

Questions

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Introduction

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Dilnot Commission

Report___________

July 2011

• Caring for our Future White Paper• Draft Care and Support Bill• Progress report on funding______________

July 2012

Consultation on reforming what and how people pay for their care & support________________

July 2013

Care Act receives

Royal Assent __________

May 2014

Announcement on funding

reform______________

Feb 2013

Implementation_____________

April 2015 – April 2016

The reform timelineThis consultation is the latest step in delivering the Government’s Vision for Adult Social Care document and White Paper.

Draft Regs & Guidance for

2015 published

__________Oct 2014

Draft Regs & Guidance for

2016 published

__________Oct 2015

Consultation on draft regulations

and guidance______________

Feb – March 2015

Election______________

7 May 2015

Care Act comes into force

______________April 2015

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The Care Act• Realises the vision set out the Care and Support White Paper

published in 2012• It sets a new framework for the future that will enable the

system to respond to the challenges of an ageing population• To do that, the system must enable people to stay well and

independent by:– Promoting people’s wellbeing– Enable people to prevent and postpone the need for care and

support– Put people in control of their lives so they can pursue opportunities to realise their potential

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TimelineWhen? What?23 October 2014 Final regulations & guidance that will come into force on

1 April 2015 published4 February 2015 Consultation on draft regulations and guidance for the

cap on care and policy proposals for an appeals systemFebruary 2015 Launch consultation events

March 2015 ADASS/DH financial modelling exercise for 16/17 costs

30 March 2015 Consultation closes

April 2015 2015 package of regulations and guidance come into force

7 May 2015 General Election

October 2015 Final regulations and guidance that will come into force on 1 April 2016 published

April 2016 Cap on care costs and appeals comes into force

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This consultation• Covers the cap on care costs and appeals• For the cap on care costs it:

– Sets out draft regulations and guidance– Responds to the last consultation– Sets out work since

• For appeals it:– Sets out policy proposals

• The consultation will run until 30 March 2015

We want to hear what you think• We welcome views on the draft regulations & guidance. Do they

provide a robust framework? What have we missed?• What do you think of the policy proposals?• It is available at www.careact2016.dh.gov.uk

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The Cap on Care Costs

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Why is reform needed?• Care and support has never been free, but most people do not realise.• Current system is no longer fit for purpose:

– It is outdated in how we define rich and poor – It was created in 1948 when average life expectancy was 68 - it is now 80

and rising.

• Those unlucky enough to have high care needs for a long period risk losing nearly everything they have to meet that cost.

20103 million

20304.5 million

20508 million

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Funding Reform – what is it?

• And for the first time creates protection from the risk of catastrophic lifetime care costs for those unlucky enough to face them.

• Limits the amount people have to pay towards their eligible care and support needs and extends the point at which help is available.

• This creates a new partnership between the individual and the state that is fair for all.

£0k

£50k

£100k

£150k

£200k

£250k

£300k

0% 20% 40% 60% 80% 100%

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The aim is to protect people against catastrophic costs

0%

20%

40%

60%

80%

100%

Assets on going into care

Indi

cativ

e as

set d

eple

tion

Current72K Cap with increased ucl72K Cap

• Current system can force people with average and lower wealth to spend >80% of their assets on care & support

• The cap provides protection from costs rising above £72,000• But it is combining the cap with the extension to the means test

that delivers protection from significant asset depletion

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• Everyone with eligible needs will be able to progress towards the cap.• The cap will be set at £72,000.• The rate at which they progress will be based on what the cost is, or in

the case of self-funders would be, to the local authority.• This cost will be set out in a personal budget or an independent

personal budget. • Progress towards the cap will be recorded in a care account.• The local authority will maintain the care account and provide people

with annual statements so they are informed of their progress.• Consulting on 3 different options for working age adults.

Cap on care costs:How will it work?

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Cap on care costs:What counts towards the cap? • Only the cost of care to meet a person’s eligible needs.

• This is based on what the cost is, or in the case of self-funders would be, to the LA of meeting those needs.

• Where a person is in a care home the LA will deduct £230 per week for daily living costs to work out how much counts towards the cap.

• This will not affect how much the provider receives

• Other costs do not count:o Top-up feeso NHS-funded care

• Only costs from April 2016 onwards count

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• When a person reaches the cap the local authority will take over paying for the care component of a person’s care package.

• The person will remain responsible for paying their daily living costs and any top-up they have chosen to pay.

Cap on care costs:What happens when a person reaches the cap?

Before reaching the cap self–funder contributes:

Care CostsDaily living costs

“Top Up”

Counts Doesn’t count

After reaching the cap :

Care CostsDaily living costs

“Top Up”

LA contributes: Person contributes:

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Increased financial support• We are increasing the capital limits

used to determine what people can afford to pay.

• This will mean more people get financial help as they progress towards the cap.

• We are also making a change to ensure no-one is worse off as a result of the interaction with benefits.

.

Is the person receiving care

in a care home?

Do they own a property?

Is the property

disregarded

Apply £27,000

upper capital limit

Apply £118,000

upper capital limit

Apply £118,000

upper capital limit

Apply £27,000

upper capital limit

Yes

Yes

Yes

No

No

No

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Policy proposals for appeals

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The Appeals Proposals• Means of redress – The Appeal system is a means to review council decisions

relating to care and support.

• Work with the existing complaints system – The intention is that the appeals system will only cover key care and support decisions. The complaints system will deal with all other areas.

• Independence – The Appeals system will introduce an independent review of the local authority’s decision.

• Openness and assurance – The Appeals system is intended to provide both the person and local authority with a clear line of sight on the rationale and recommendation of the Independent Reviewer (IR).

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Why Appeals?• We are putting forward proposals for an appeals system that we think

can provide an efficient, cost effective, open means of redress.

• Currently there is a lack of formal means to appeal care and support decisions.

• Hull City Council noted that “there appears to be a lack of potential

dispute resolution within the prescribed legislation” and suggested that this can lead to “costly challenges”. - Law Commission consultation on Care and Support, paragraph 14.21, March 2011.

• Bring in line with DWP Benefits, Education & NHS – all have appeals systems – adult social care doesn’t currently have an appeal system.

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Appeals Potential Benefits

• People avoid the stress and cost of going to court while councils could reduce the administrative and cost pressures of legal challenges, freeing up resource.

• The proposed Appeals system has early resolution built in as a primary focus of the policy. The emphasis is to talk through issues between a person and the local authority.

• People are helped to understand why decisions have been made in a particular way and have their concerns addressed quickly. This helps protect a vulnerable cohort where disagreements arise.

• The Appeals system introduces an independent review of the local authority’s decision. This means people can be confident that they have received a fair and equitable review of their appeal. Councils receive a cost effective, independent means of ensuring they are getting their care and support decisions correct.

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Proposed Appeals System- 3 stage process

Appeals Consultation

EARLY RESOLUTION

- An Independent Reviewer (IR) is appointed to make a recommendation to the LA

The Local Authority makes a final decision with reference to IR’s recommendation

- LA and the person work together to try and resolve differences, early, wherever possible

NON CONFRONTATIONAL

GOOD COMMUNICATION

INDEPENDENT REVIEW STAGE FINAL DECISION

MEET TO RESOLVE ISSUES

LA & PERSON WORK

TOGETHER

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Rest of the day

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Agenda• Questions!• Workshops:

1. Overview of the cap & extension to the means test2. Independent Personal Budgets & metering3. Appeals4. Working Age Adults

• Break• Workshops – same again• Plenary• Planning & preparing for implementation• Close

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Please respond to the consultation• Comment online: www.careact2016.dh.gov.uk

• Email us at: careactconsultation@dh.gsi.gov.uk

• Share your thoughts: #careact2014

• Write to: Care and Support Funding Reform & Appeals Consultation

Department of HealthRoom 313B, Richmond House, 79 WhitehallLondon, SW1A 2NS

Please make sure all responses are received by 30 March 2015

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Questions