Mr A was discharged, independently mobile using a frame, independent transferring using equipment and stair climbing with supervision. To fulfil its duty under section 4 of the Act, a local authority is likely to need to go further than providing information and advice directly though direct provision will be important by working to ensure the coherence, sufficiency, availability and accessibility of information and advice relating to care and support across the local authority area.
Importantly, this duty to establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system. Local authorities cannot fulfil their universal information and advice duty simply by meeting eligible needs, and nor would information and advice always be an appropriate way of meeting eligible needs.
The service should also address, prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required. This chapter of guidance should therefore be read in conjunction with guidance throughout this document, including:. Local authorities should ensure that people are able to access all of these types of financial information and advice which help people plan and pay for their care. In doing so local authorities should take account of the services currently in place and actions already taken and plans with partner organisations resulting from Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies.
The information and advice service must cover the needs of all its population, not just those who are in receipt of local authority funded care or support. For example, people may often require information and advice before they need to access care or support services, to consider what actions they may take now to prevent or delay any need for care, or how they might plan to meet the cost of future care needs. When a local need for additional information and advice services is identified, local authorities should recognise the relevance of independent and impartial advice and should consider carefully whether services should be provided by the local authority directly or by another agency, including independent providers.
This is a very broad group, extending much further than people who have an immediate need for care or support. It will only be achieved through working in partnership with the wider public and local advice and information providers. This may include information and advice on:. Information and advice must be open to everyone who would benefit from it. People access information and advice from a wide variety of sources. The authority should take account of information standards published by the Information Standards Board for Health and Social Care under the provisions of the Health and Social Care Act Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it.
Local authorities will need to take steps to evaluate and ensure that information and advice is understood and able to be acted upon. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained. Local authorities must seek to ensure that all relevant information is available to people for them to make the best informed decision in their particular circumstances, and omission or the withholding of information would be at odds with the duty as set out in the Act.
Local authorities should consider when this might most effectively be provided by an independent source rather than by the local authority itself. This is particularly likely to be the case when people need advice about how and whether to question or challenge the decisions of the local authority or other statutory body.
Depending on local circumstances, the service should also include, but not be limited to, information and advice on:. These include:.
Local authorities should particularly be aware of the needs of individuals with complex but relatively rare conditions, such as deaf-blindness. Reasonable adjustments could include the provision of information in accessible formats or with communication support. The duty in the Care Act will not be met through the use of digital channels alone, and information and advice channels are likely to include all of the following:. Local authorities must ensure that their information and advice service has due regard to the needs of these people.
These include, but are not limited to:. From the point of first contact with or referral to the authority consideration of the duty to provide for independent advocacy to support involvement in assessment, planning and reviews should be undertaken see chapter 7 on independent advocacy. More complex issues may require more intensive and more personalised information and advice, helping people to understand the choices available to them, while general enquiries may require a less intensive approach.
For example, providing a person with too much information, more than they can take in, perhaps at a time of crisis, can be counter-productive.
Extra care housing
This can prevent them asking the right questions and can mask the articulation and identification of needs that they have, for which they could benefit from information and advice. All contact for information and advice should take account of this and be able to respond with an assessment of needs when appropriate see chapter 6. This could include enabling access to the support of registered social work advice for those providing information and advice to people contacting the local authority. The focus should be on enabling people to access what they need through a tailored range of services that assists people to navigate all points and aspects of their journey through care and support.
People with good and impartial financial information and advice have a better understanding of how their available resources can be used more flexibly to fund a wider range of care options. This section should be read in the context of the overarching chapter and all requirements set out in this chapter, for example on accessibility and proportionality, must also be applied to financial information and advice. It should provide some of this information directly to people in its community.
However, where it would not be appropriate for a local authority to provide it directly, the local authority must ensure that people are helped to understand how to access independent financial advice. The local authority must have regard to the importance of identifying those who may benefit from financial advice or information as early as possible. This should be complemented by broader awareness raising about how care and support is funded.
Local authorities may also include how care and support costs interact with retirement decisions. Actions taken by a local authority to do this should include:. This long-term outlook means that people will want to access financial information and advice at different points in their journey to enable them to make sustainable plans to pay for their care. The local authority should provide a service that covers this breadth and that facilitates access to the full spectrum of financial information and advice — from basic budgeting tips to regulated advice — to ensure that people within its area who would benefit can access it.
They should also be aware and provide for the fact that some people will be less able to protect themselves from theft, fraud and financial exploitations see chapter 14 on safeguarding. This must include the charging framework for care and support, how contributions are calculated from both assets and income and the means tested support available; top-ups see chapter 8 on charging ; and how care and support choices may affect costs. In the case of top-ups, the local authority should ensure that someone is willing and able to pay for them — this information will be fundamental in helping with this.
The local authority should use the knowledge it has of the local care market — types of care and local providers of information and advice — to complement and develop the overarching narrative on how care funding works at the national level. This would include both domiciliary and residential care.
This will be of particular relevance where a person will be meeting the total cost of care and support themselves or may be considering taking out a deferred payment agreement see chapter 9 on deferred payments or purchasing a financial product. At the lower end of the spectrum, people may just need some basic information and support to help them rebalance their finances in light of their changing circumstances.
Topics may include welfare benefits, advice on good money management, help with basic budgeting and possibly on debt management. The local authority may be able to provide some of this information itself, for example on welfare benefits, but where it cannot, it should help people access it. In many situations the role of the local authority will be to understand the circumstances of the person, understand their preferences and help them to access the tailored information and advice that they need to make well-informed decisions.
Where a person lacks capacity, the authority must establish whether a person has a deputy of the Court of Protection or a person with Lasting Power of Attorney acting on their behalf. The local authority may consider the timing and context of any retirement decisions a person might be making and how this interacts with paying for their care and support. They should advise people of the ways to pay that others in similar circumstances would usually consider and the range of information and advice they should be considering to help make their decision.
The local authority should take a role in joining up information and advice organisations locally so they can work collaboratively. The local authority should help information and advice providers and people to understand the role of each information and advice provider so people can access the right provider at the right time and not be sent round in circles.
Local authorities should provide and publicise links and information on access to wider sources of information and advice, including those available nationally. Staff should have the knowledge to direct people to the financial information and advice they need, explaining the differences and potential benefits from seeking regulated or non-regulated financial advice.
This should include both generic free and fee-based advice as well as services providing regulated forms of financial advice. Local authorities should make people aware which independent services may charge for the information and advice they provide. The local authority should ensure that they do this on a transparent basis. But this must not mean preventing them making their own choices and having control over their lives. Everyone in the community should understand the importance of safeguarding and help keep people safe see chapter 14 on safeguarding.
The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on how the local Safeguarding Adults Board works. The local authority must make its own arrangements for dealing with complaints in accordance with the regulations. The information and advice service should be aligned with wider local authority strategies such as market shaping and commissioning, and with joint area strategies with health. The development of such plans should have regard to some common principles, including:.
These national resources include guidance on principles for local information and advice strategies, case studies and practice examples. It must also co-operate more generally with each of its relevant partners taking account of their respective functions see chapter 15 on integration, cooperation and partnerships. The plan and the resulting service should adapt to changing needs and as a result of feedback and learning on what works best.
The plan should be reviewed at agreed intervals.
As a minimum, the process of developing a local plan should include:. Some of the factors and circumstances that local authorities should consider in doing this will often be identified in Joint Strategic Needs Assessments. These factors may include, but are not limited to:. This may be another statutory party, such as a GP or other NHS professional, other professionals, such as a solicitor or funeral director, care and support and housing providers, or a local group, user-led or charitable organisation, rather than the local authority itself.
Local authorities should consider whether independent sources of information and advice may in some circumstances be more trusted — and therefore more effective — than the local authority itself see chapter 15, para. In particular, people should be signposted to appropriate independent information and advice when they are entering into a legal agreement with a local authority or other third party, such as a deferred payment agreement or committing to a top-up, or they wish to question, challenge or appeal a decision of the local authority or other statutory body.
A local authority plan should therefore allow for the urgent provision of information and advice when necessary. Local authorities should work with health organisations and other partners to provide targeted information and advice to people in these critical situations and where people have long-term health conditions such as dementia see paragraph 3. Where appropriate, local authorities should signpost or refer people to national sources of information and advice where these are recognised as the most useful source. Examples might include:. Local authorities are encouraged to explore how they can make the most of cost-effective partnership opportunities with national providers.
Referral or signposting to national sources should only occur where this is deemed to be in the best interests of the person and their circumstances and should not take the place of local services necessary for local authorities to discharge their duty under the Act. Local authorities will need to find the appropriate balance between local and national provision to cost-effectively meet their local need. The role of the local authority is critical to achieving this, both through the actions it takes to commission services directly to meet needs and the broader understanding of and interactions it undertakes with, the wider market, for the benefit of all local people and communities.
This can be considered a duty to facilitate the market, in the sense of using a wide range of approaches to encourage and shape it, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost-effective outcomes that promote the wellbeing of people who need care and support.
Local authorities have a vital role in ensuring that universal services are available to the whole population and where necessary, tailored to meet the needs of those with additional support requirements for example housing and leisure services. Market shaping and commissioning should aim to promote a market for care and support that should be seen as broadening, supplementing and supporting all these vital sources of care and support.
Commissioning and market shaping are key levers for local authorities in designing and facilitating a healthy market of quality services. Market shaping activity should stimulate a diverse range of appropriate high quality services both in terms of the types of services and the types of provider organisation , and ensure the market as a whole remains vibrant and sustainable. It also includes working to ensure that those who purchase their own services are empowered to be effective consumers, for example by helping people who want to take direct payments make informed decisions about employing personal assistants.
From the s onwards care services have been increasingly procured from the independent sector for example, not directly commissioned from and provided by an authority itself and covered all services that the authority arranged for people receiving state funding. Since when personalisation became a mainstream policy, commissioning has also covered activity to ensure that sufficient and appropriate services are available to meet the needs of growing numbers of people with personal budgets and direct payments.
This has changed the commissioning role, as purchasing decisions have been increasingly devolved to individuals and families and direct procurement using block contracts has reduced. Commissioning has come to be shaped more by the outcomes commissioners and individuals identify, rather than volumes of activity expected and commissioners have sought to facilitate flexible arrangements with providers for other forms of service to support choice and control, such as Individual Service Funds ISFs.
Contract management is the process that then ensures that the services continue to be delivered to the agreed quality standards. Commissioning encompasses procurement but includes the wider set of strategic activities. Market shaping, commissioning, procurement and contracting are inter-related activities and the themes of this guidance will apply to each to a greater or lesser extent depending on the specific activity.
Outcomes should be considered both in terms of outcomes for individuals and outcomes for groups of people and populations. Local authorities should consider the emerging revised Care Quality Commission standards for quality and any emerging national frameworks for defining outcomes.
Local authorities should ensure that achieving better outcomes is central to its commissioning strategy and practices, and should be able to demonstrate that they are moving to contracting in a way that has an outcome basis at its heart. Local authorities should consider emerging best practice on outcomes-based commissioning.
Moving to an outcomes-based approach therefore means changing the way services are bought: from units of provision to meet a specified need for example, hours of care provided to what is required to ensure specified measurable outcomes for people are met. Moving to an outcomes-based approach will need to recognise that some outcomes are challenging to assess and local authorities may wish to consider involving service providers when considering how service evaluations can be interpreted. Outcomes should be used as a principal measure for quality assurance of services.
Whilst payments-by-outcomes may be theoretically the most appropriate approach for outcomes-based services, it is recognised that proxies for outcomes may be required to make the approach practical. Care logs documenting punctual assistance in meal preparation, in conjunction with positive feedback from the person receiving care about support received might be used as part of the basis of payment. It is also recognised that whilst these mechanisms are more commonplace in other types of commissioning, they are in their infancy for adult social care.
Any move to payments by outcomes should be achieved such that smaller, specialist, voluntary sector and community-based providers are not excluded from markets or disadvantaged, because for example, they did not have appropriate IT systems. For example:. This guidance is intended to support peer review and self-assessment of local authority commissioning, and represents a practical approach that underpins the themes of this statutory guidance.
This includes how the authority facilitates and commissions services and how it works with other local organisations to build community capital and make the most of the skills and resources already available in the area. In doing so, they must have regard to ensuring the continuous improvement of those services and encouraging a workforce which effectively underpins the market through:.
The quality of services provided and the workforce providing them can have a significant effect on the wellbeing of people receiving care and support, and that of carers, and it is important to establish agreed understandable and clear criteria for quality and to ensure they are met. High quality services should enable people who need care and support, and carers, to meet appropriate personal outcome measures, for example, a domiciliary care service which provides care 2 days a week so that a carer who normally provides care can go to work, is not a quality service if it is not available on the specified days, or the care workers do not arrive in time to allow the carer to get to work on time.
For example, a working age person should be able to choose care and support tailored for their situation, and not be faced with only a choice of facilities designed for older people, as this is unlikely to be appropriate to their situation, regardless of how high quality the facilities may be in their own contexts.
Local authorities should consider care and support services for their appropriateness for people from different communities, cultures and beliefs. This is particularly important, for example, for young people with care and support needs and young carers transitioning to adulthood. For instance, many young people with learning disabilities leave full-time education at around this age and require new forms of care and support to live independently thereafter.
Ensuring that services are made available to meet those needs is better for the quality of life of the young person in question. This could include things such as employment support, training, developing friendships or advice on housing options. It is equally important to think about ways of supporting carers at this time: some parent carers need extra support to juggle caring and paid work after their child leaves full time education.
Similar issues can affect young carers. Local authorities must consider how to help foster, enhance and appropriately incentivise this vital workforce to underpin effective, high quality services. And have regard to funding available through grants to support the training of care workers in the independent sector:. Local authorities should consider encouraging the training and development of care worker staff to at least the standard of the emerging Care Certificate currently being developed by Health Education England, Skills for Care and Skills for Health.
Remuneration must be at least sufficient to comply with the national minimum wage legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments. Guidance on these issues can be found on the HMRC website. This should support and promote the wellbeing of people who receive care and support, and allow for the service provider ability to meet statutory obligations to pay at least the national minimum wage and provide effective training and development of staff.
It should also allow retention of staff commensurate with delivering services to the agreed quality, and encourage innovation and improvement. Local authorities should have regard to guidance on minimum fee levels necessary to provide this assurance, taking account of the local economic environment. This assurance should understand that reasonable fee levels allow for a reasonable rate of return by independent providers that is sufficient to allow the overall pool of efficient providers to remain sustainable in the long term.
The following tools may be helpful as examples of possible approaches:. Local authorities should consider the skills and capabilities needed to support new approaches to commissioning, for example, outcomes-based and integrated commissioning. Local authorities should have regard to the emerging skill levels and qualifications being developed for commissioning staff by Skills for Care. This will ensure that there are a range of appropriate and high quality providers and services for people to choose from.
Where needed, based on expected trends, local authorities should consider encouraging service providers to adjust the extent and types of service provision. This could include signalling to the market as a whole the likely need to extend or expand services, encourage new entrants to the market in their area, or if appropriate, signal likely decrease in needs — for example, drawing attention to a possible reduction in care home needs, and changes in demand resulting from increasing uptake of direct payments.
The process of developing and articulating a Market Position Statement or equivalent should be central to this process. The local authority may be the most significant purchaser of care and support in an area, and therefore its approach to commissioning will have an impact beyond those services which it contracts. Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality, for example, by setting fee levels below an amount which is not sustainable for providers in the long-term.
Local authorities should review the intelligence they have about the sustainability of care providers drawn from market shaping, commissioning and contract management activities. For example, where a local authority has arranged services for people with a provider that appears to be at risk, undertaking early planning to identify potential replacement service capacity.
Where it is apparent to a local authority that a provider is likely to imminently fail financially, either through its own intelligence or through information from the CQC , the authority should prepare to take steps to ensure continuity of care and support for people who have their care and support provided by that provider see chapter 5 on managing provider failure.
This is important in order to facilitate an effective open market, driving quality and cost-effectiveness so as to provide genuine choice to meet the range of needs and reasonable preferences of local people who need care and support services, including for people who choose to take direct payments, recognising, for example, the challenges presented in remote rural areas for low volume local services.
This may be achieved by encouraging different types of service provider organisation, for example, independent private providers, third sector, voluntary and community based organisations, including user-led organisations, mutual and small businesses. Local authorities should note that the involvement of people with specific lived experience of the type of needs being met, may lead to better outcomes for people who use services and carers as they directly empathise with service users.
This should recognise that the different underpinning philosophies, cultural sensitivity and style of service of these organisations may be more suited to some people with care and support needs. Local authorities should consider encouraging and supporting providers or taking other steps to promote an appropriate balance of provision between types of provider , having regard to competition rules and the need for fairness and legal requirements for all potential providers who may wish to compete for contracts.
The TLAP guidance commissioning for provider diversity may be helpful to commissioners. If the authority decides to augment such universal services by directly contracting itself with one or more provider organisations, it should nevertheless continue to ensure that the overall mix of available services presents meaningful choice to people who need these services. Alongside the suitability of living accommodation in Section 1 of the Act, Local authorities should consider how they can encourage the development of accommodation options that can support choice and control and promote wellbeing.
Personalised care and support services should be flexible so as to ensure people have choices over what they are supported with, when and how their support is provided and wherever possible, by whom. The mechanism of Individual Service Funds by service providers, which are applicable in many different service types, can help to secure these kinds of flexibilities for people and providers.
Many local authorities, for example, are utilising web-based systems such as e-Marketplaces for people who are funding their own care or are receiving direct payments to be able to search for, consider and buy care and support services on-line, consider joint purchases with others. This often involves offering information and advice about, for example, the costs and quality of services and information to support safeguarding. This should include facilitating organisations that support people with direct payments and those whose care is funded independently from the local authority to become more informed and effective consumers and to overcome potential barriers such as help to recruit and employ personal assistants and to assist in overcoming problems and issues.
This should include where appropriate through services to help people with care and support needs understand and access the systems and processes involved and to make effective choices. This is a key aspect of the new duty to establish and maintain a universal information and advice service locally as set out in Section 4 of the Care Act. Services should be encouraged that allow carers who live in one local authority area but care for someone in another local authority area to access services easily, bearing in mind guidance on ordinary residence. The TLAP guidance on co-production may be helpful, in particular the web-based tool People not process — Co-production in Commissioning.
Local authorities should have in place published strategies that include plans that show how their legislative duties, corporate plans, analysis of local needs and requirements integrated with the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy , thorough engagement with people, carers and families, market and supply analysis, market structuring and interventions, resource allocations and procurement and contract management activities translate now and in future into appropriate high quality services that deliver identified outcomes for the people in their area and address any identified gaps.
JSNA is a process that assesses and maps the needs and demand for health and care and support, supports the development of joint Health and Wellbeing Strategies to address needs, understands community assets and informs commissioning of local health and care and support services that together with community assets meet needs. Strategies should be informed by and emphasise preventative services that encourage independence and wellbeing, delaying or preventing the need for acute interventions.
The ambition is for market shaping and commissioning to be an integral part of understanding and delivering the whole health and care economy, and to reflect the range and diversity of communities and people with specific needs, in particular:. Local authorities should publish and make available their local strategies for market shaping and commissioning, giving an indication of timescales, milestones and frequency of activities, to support local accountability and engagement with the provider market and the public.
It may be helpful for Market Position Statements from neighbouring local authority areas to be coordinated to ensure a degree of consistency for people who will use the documents; this is particularly true for urban areas. Local authorities should consider how their strategies related to care and support can be embedded in wider local growth strategies, for example, engaging care providers in local enterprise partnerships.
Standards should be in line with the codes of practice drawn up by the Department of Communities and Local Government. While the duties under section 5 of the Care Act fall upon local authorities, successful market shaping is a shared endeavour that requires a range of coordinated action by commissioners and providers, working together with the citizen at the centre.
Extra care housing schemes | North Yorkshire County Council
Local authorities should engage and cooperate with stakeholders to reflect the range and diversity of communities and people with specific needs, for example:. In determining an approach to engagement, local authorities should consider methods that enable people to contribute meaningfully to:. Local authorities should consider engagement with significant suppliers of services to provider organisations, where this would help improve their understanding of markets, for example, engaging with employment and training services that might enable local authorities to gain access to frontline insights on care provision and the local workforce supply and training.
Local authorities should consider the adequacy and effectiveness of these routes and processes as part of their engagement and trust-building activities. This is important so that authorities can articulate likely trends in needs and signal to the market the likely future demand for different types of services for their market as a whole, and understand the local business environment, to support effective commissioning.
This should include reference to underpinning demographics, drivers and trends, the aspirations, priorities and preferences of those who will need care and support, their families and carers, and the changing care and support needs of people as they progress through their lives. This should include an understanding of:. The RNIB has a tool to help local authorities scope the needs of people with sight impairment. It should also include information about likely changes in requirements for specialist housing required by people with care and support needs.
Data collection should include information on the quality of services provided in order to support local authority duties to foster continuous improvement. This could be achieved, for example, by collecting and acting on feedback from people who receive care, their families and carers alongside information on the specific nature of the services people receive for example, regularity and length of homecare visits.
This will allow for an assessment of correlation between customer experience and service provision. Data collection must be sufficient to allow local authorities to meet their duties under the Equality Act Local authorities should understand the trends and likely changes to the needs of carers in employment, so as to better plan future support. It should also include an analysis of those self-funding people who are likely to move to state funding in the future. Where appropriate, needs should be articulated on an outcomes basis. Information about both supply and expected demand for services should be made available publicly to help facilitate the market and empower communities and citizens when considering care and support.
Smaller care providers should be included in engagement. Consideration should be given to whether such services might better be commissioned and facilitated regionally. This will include understanding and signalling to the market as a whole the need for the market to change to meet expected trends in needs, adapt to enhance diversity, choice, stability and sustainability, and consider geographic challenges for particular areas. To this picture, local authorities should add their own commissioning strategy and future likely resourcing for people receiving state-funding.
Local authorities should consider co-ordinating these market shaping and related activities with other neighbouring authorities where this would facilitate better outcomes. Local authorities should publish, be transparent and engage with providers and stakeholders about the needs and supply analysis to assist this signalling. A Market Position Statement is intended to encourage a continuing dialogue between a local authority, stakeholders and providers where that dialogue results in an enhanced understanding by all parties is an important element of signalling to the market.
Market Position Statements for care and support services should combine, cross-refer or otherwise complement other similar statements for related services, particularly where there is an integrated approach or ambition, for example, housing. This could include:. Market interventions may also be planned as part of the market shaping and commissioning strategies where there is an immediate need for intervention. Following this the Council undertook a full review of Dementia Community Support. This included evaluating the role of services funded by the NHS and the Council and also those provided directly by the voluntary and community sector.
The Council held an engagement event to establish what customers and carers want dementia Community Support services to look like and deliver. This identified the gaps between supply and demand in more detail and at a local level. The event also gathered information from providers and voluntary and community groups about the challenges of delivering services. Providers identified commissioning models which promote strong and stable service delivery whilst still allowing flexible responses to meet individual needs as particularly useful.
As a result of this activity, the Council is now in the process of procuring a new service model for Dementia Community Support. The model will include information and advice, community services, building-based respite and specialist support. It gives a duty to NHS England, clinical commissioning groups, Monitor and Health and Wellbeing Boards to make it easier for health and social care services to work together to improve outcomes for people.
Section 3 of the Care Act places a corresponding duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services, such as housing. Further information can be found in the chapters of this statutory guidance on integration chapters 15 to NHS guidance and LGA case studies on integration may be helpful, together with the toolkit for integration developed by North West London Whole System Integrated Care particularly chapter 7 on budget pooling, governance arrangements and commissioning issues in general.
These will include consideration of: joint commissioning strategies, joint funding, pooled budgets, lead commissioning, collaborative commissioning, working with potential service providers to consider innovative ways of arranging and delivering services, and making connections to public health improvement. Achieving value for money may mean arranging service provision collaboratively with other authorities, in order to secure viable, quality services that meet the demands identified, for example, low-volume services.
Re-commissioning and replacing services represents a particular challenge and should be carried out so as to maintain quality and service delivery that supports the wellbeing of people who need care and support and carers, and guards against the risk of a discontinuity of care and support for those receiving services. For example, multiple contracts terminating around the same time may destabilise local markets if established providers lose significant business rapidly and staff do not transfer smoothly to new providers.
Care and support for independent living
Local authorities should be aware that there is significant flexibility in procurement practices to support effective engagement with provider organisations and support innovation in service delivery, potentially reducing risks and leading to cost-savings. The Office of Fair Trading produced guidance to help public purchasers understand the flexibilities so as to support service transformations through better commissioning.
The Market Shaping Toolkit , produced by the Institute of Public Care includes a section summarising recent changes to procurement rules, including EU procurement rules and the implications for commissioners. Government has also produced guidance on when reserved contracts may be allowable for organisations employing a significant number of disabled people these documents may be helpful to commissioners. Contract management should take account of feedback from people receiving care and support. For example, short home-care visits of 15 minutes or less are not appropriate for people who need support with intimate care needs, though such visits may be appropriate for checking someone has returned home safely from visiting a day centre, or whether medication has been taken but not the administration of medicine or where they are requested as a matter of personal choice.
This should include assuring themselves, through their contracting arrangements, that a provider is capable and competent in responding to allegations of abuse or neglect, including having robust processes in place to investigate the actions of members of staff. Local authorities should be clear what information they expect from providers for example, where there are allegations of abuse, what action the provider is taking or has taken and what the outcome is and where providers are expected to call upon local authorities to lead a Section 42 enquiry where the management of the provider is implicated for instance , or to involve the CCG for health matters or police for example, in the case of potential crimes.
There should be clear agreement about how local partners work together on investigations and what their respective roles and responsibilities are. Contracts and contract management should manage and eliminate poor performance and quality by providers and recognise and reward excellence. Local authorities should consider using this duty to promote added value in care and support both when letting contracts to deliver care and support, and for wider goods and services.
Local authorities should consider the range of funding mechanisms that are available to support market interventions to support community based organisations such as seed funding and grants. Where functions and activities are delegated, local authorities should ensure that appropriate elements of this statutory guidance are included in contractual conditions, for example, allowing engagement in developing Market Position Statements.
Local authorities should also consider providing support to people who wish to use direct payments to help them make effective decisions through, for example, Direct Payment support organisations. The Department also funded a project to develop commissioning standards, Commissioning for Better Outcomes , which are designed to support local authorities, through peer challenge and self-assessment to move towards commissioning practices which underpins the themes of this statutory guidance.
This guidance explains how the Care Act makes provision to ensure that, in such circumstances, the care and support needs of those receiving the service continue to be met. It provides guidance to local authorities on the exercise of those powers and the discharge of those duties.
An example is when a provider of services faces commercial difficulties that put the continuation of their business under threat. In , Southern Cross Healthcare, then the biggest provider of residential care services in the United Kingdom, ran into financial difficulties and it was possible the business would have to close down, putting services to residents at risk.
While Southern Cross was a provider of services in all parts of the country, smaller local providers can also encounter commercial issues which cause uncertainty for people receiving care and support. Local authorities have an important role in situations where a provider is unable to continue to supply services because of business failure. Some may impact on the whole business — for example, a provider decides to close the business down — while others impact on a particular service — for example, a meningitis outbreak at a care home.
Local authorities should use their powers to act in such cases, as set out below. Business failure is defined by a list of different events such as the appointment of an administrator, the appointment of a receiver or an administrative receiver the full list appears in the Regulations.
The duty applies from the moment the authority becomes aware of the business failure. The actions to be taken by authorities will depend on the circumstances, and may include the provision of information. The duty is to meet needs but authorities have discretion as to how they meet those needs. It may have no impact on residents or the people who use the services. However, if a provider of any size is unable to continue because of business failure, the duties on local authorities are as follows. This often may happen in insolvency situations where an administrator is appointed and continues to run the service.
It does not matter whether or not the authority has contracts with that provider, nor does it matter if all the people affected are self-funders for example, arranging and paying for their own care. Local authorities must ensure the needs are met but how that is done is for the local authority to decide, and there is significant flexibility in determining how to do so, as set out in section 8 of the Care Act. It is not necessary to meet those needs through exactly the same combination of services that were previously supplied.
However, when deciding how needs will be met, local authorities must involve the person concerned, any carer that the person has, or anyone whom the person asks the authority to involve see chapter 10 on care and support planning. The authority must take all reasonable steps to agree how needs should be met with the person concerned.
It should seek to minimise disruption for people receiving care, in line with the wellbeing principle and, although authorities have discretion about how to meet needs, the aim should be to provide a service as similar as possible to the previous one. This may involve, for example, up-to-date records of the people who are receiving services from that provider, to help the local authority to identify those who may require its support. Neither is it necessary to complete those assessments before or whilst taking action.
Similarly, authorities must meet needs irrespective of whether those needs would meet the eligibility criteria. In particular, how someone pays for the costs of meeting their needs — for example, in full by the person themselves — must have no influence on whether the authority fulfils the duty. However, an authority may charge the person for the costs of meeting their needs, and it may also charge another local authority which was previously meeting those needs, if it temporarily meets the needs of a person who is not ordinarily resident in its area.
The charge must cover only the actual cost incurred by the authority in meeting the needs. No charge must be made for the provision of information and advice to the person. The duties of the NHS in such situations are covered elsewhere and as such are beyond the scope of this guidance. The duty of cooperation applies equally where the needs being met previously were paid for in full or in part by another authority through a direct payment to the person concerned. If applicable, English authorities can also recover costs from the person themselves other than the costs of needs being met or funded by the authorities mentioned above.
The Care and Support Market Oversight Criteria Regulations set out the entry criteria for a provider to fall within the regime. These are intended to be providers which, because of their size, geographic concentration or other factors, would be difficult for one or more local authorities to replace, and therefore where national oversight is required. CQC will determine which providers satisfy the criteria using data available to it.
It will notify the providers which meet the entry criteria. CQC will inform local authorities once it is satisfied the provider is unlikely to be able to carry on because of business failure. If the CQC is of the view that a provider is likely to become unable to continue with its activity because of business failure, the CQC should work closely together with the affected local authorities to help them fulfil their temporary duty. In exercising its market oversight functions, CQC must have regard to the need to minimise the burdens it imposes on others.
General Extra Care: The Full Facts
It will be for CQC to apply those regulations and decide which providers are included. There are many thousands of providers in England and only a relatively small number of providers fall in the regime. The providers outside the regime will in the main be those with small and medium size businesses. Despite the CQC having a market oversight responsibility, local authorities have responsibility to ensure continuity of care in respect of business failure of all registered providers.
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An Administrator represents the interests of the creditors of the provider that has failed and will typically try to rescue the company as a going concern. It is not for local authorities to become involved in the commercial aspects of the insolvency, but they should cooperate with the Administrator if requested. They place duties on the local authority. If the circumstances described in the sections apply and the needs are eligible, the local authority must meet the needs in question. These duties apply whether or not business failure is at issue.
In particular, section 19 3 permits a local authority to meet needs which appear to it to be urgent. This is likely to be the case in many situations where services are interrupted but business failure is not the cause. The power in section 19 3 can be exercised in order to meet urgent needs without having first conducted a needs assessment, financial assessment or eligibility criteria determination. The local authority may meet urgent needs regardless of whether the adult is ordinary resident in its area. This means the local authority can act quickly if circumstances warrant.
The power to meet urgent needs is not limited by reference to services delivered by particular providers and is thus available where urgent needs arise as a result of service failure of an unregistered provider for example, a provider of an unregulated social care activity. The power may also be used in the context of quality failings of providers if that is causing people to have urgent needs. Whether or not to act is a decision for the authority itself but authorities should consider the examples which follow.
Not all situations where a service has been interrupted or closed will merit local authority involvement because not all cases will result in adults having urgent needs. On the other hand, the local authority might wish to be satisfied that the alternative home can adequately meet the urgent needs. Whether to act under this power is a judgement for the local authority to make in the first instance. The local authority may wish to be involved to help with this. Similarly, an emergency closure or planned closure may be involved. What matters in deciding whether to meet needs is whether the needs of the people affected appear to be urgent.
These powers are not intended to inhibit the effective operation of a market in improving choice, quality and investment. Or are they making a net contribution which benefits those already here and allows us to fund the NHS more generously than if they had not come to the UK?
This is an inexact science, and different researchers come to different results. For example, two studies have been carried out on immigrants living in the UK between and —one by academics at UCL , and another by the campaign group Migration Watch. Both studies agree that immigrants from the European Economic Area Norway, Iceland and Liechtenstein plus all EU countries made a more positive contribution than UK natives — and a far more positive contribution than immigrants from outside the EEA.
However, over this period the UK as a whole ran a budget deficit, which means that the population as a whole received more in public spending than it paid in tax. In this context the studies disagree on whether EEA migrants contributed enough more to actually be net contributors overall. As the studies cover sixteen years in which several trillion pounds were gathered and spent by the British state, these are relatively small differences, suggesting that EEA migrant tax revenues have been at least in the same ballpark as the money spent on them.
Both studies agree that recent immigrants those arriving since have made a more positive contribution to the public finances than those covered by their longer studies — as we might expect given that this does not include older groups who use more welfare and are more likely to be retired. But the existence of freedom of movement makes it very difficult to predict movements in the longer term. Vote Leave campaigners have emphasised the possibility of more countries joining the European Union and have argued that this could place a particular burden on the NHS.
This involves even more completely unknown factors. The country talked about most, Turkey, is a candidate to join the EU. Again, whatever happens, the critical consideration in terms of pressure on the NHS would be not just the numbers who arrive, but whether they cover the costs they incur. There are several arrangements under which care in the EEA is charged to the country whose citizen is treated abroad in this way. The most notable are the European Health Insurance Card EHIC , which covers health care for short term visitors, and the S1 document which covers the health care costs of expatriate pensioners.
The size of the difference between the amount the UK pays out and the amount it receives is partly because foreign citizens in Britain run up less than half as many costs which might be covered under these schemes as British citizens abroad. This means the UK effectively gets a poor deal from these schemes.
But the discrepancy is not closely linked to the fact of EU membership. Government papers suggest that this is because NHS trusts find it easier not to record that they are owed money from abroad , thereby getting full payment from the standard system without the extra admin involved in tracking foreign visitors. Britain could remain one of these even if it left the EU. European immigrants would then fall under the charging system for general immigrants, which the government has also acknowledged has some issues with the NHS not demanding payment when it should.
British tourists and pensioners abroad would have to cover health care costs from their own pockets or from travel insurance, without EHIC cards or S1 documents. A replacement deal could be negotiated: the UK also has arrangements to cover the costs of people visiting countries such as Australia. However, this might take time in which visitors had to go without cover, and might not apply to all European countries.