On 7 September 2021, government set out its new plan for adult social care reform in England. This includes reform of how local authorities should charge for adult social care, introducing: - a new lifetime cap on the amount anyone in England who enters care after October 2023 will need to spend on care; - a more generous means-test and further roll-out of section 18(3) of the Care Act to allow more self-funders to access local authority care rates

Policy paper: National strategy for autistic children, young people and adults: 2021 to 2026 The government's national strategy for improving the lives of autistic people and their families and carers in England, and implementation plan for 2021 to 2022.

From: Department of Health and Social Care and Department for Education
Published 21 July 2021
Last updated 22 July 2021

The care account, among other things, records the costs a person drawing on care has accrued towards the cap and can be used to help the person plan their finances to meet their needs until such time as they reach the cap.

The person drawing on care, who has approached the local authority for support to meet their care needs or to start accruing spend towards the cap on cost.

The module within a local authority's existing social care case management system that supports the creation and management of a care account.

A statement provided by the local authority to the person drawing on care every 12 months to inform a person of their progress in accruing towards the care cap. It will also include the following information: - the current level of the cap; - the total cost of meeting the person's eligible needs; - their rate of progress towards the cap; - any daily living costs; - adjustments to their accrued costs (since the last statement); - an indicative date of when the person is expected to reach the cap (when the statement is issued within 18 months of the person reaching the cap)

The cap on care costs protects people from unpredictable care costs by limiting the costs a person in England will need to face to meet their eligible care and support needs in their lifetime. From October 2023 the cap will be set at £86,000. After this an annual review will determine changes to the cap based on inflation.

To ensure fairness between residential and domiciliary care, everyone in residential care will remain responsible for meeting their DLCs (representing spend towards things like rent, food and utility bills). The regulations set a national, notional amount that is attributable to DLCs, which is £200 in 2021 to 2022 prices. The amount is to be reviewed annually and uprated as considered appropriate. Costs attributable to DLCs will not accrue towards the cap, and people remain responsible for paying DLCs once they reach the cap and continue to receive care in a residential home.

Deconditioning is a change in physical fitness due to inactivity – including the loss of physical, psychological and functional capacity due to inactivity. It can occur rapidly in older adults and is not straightforward or quick to remedy. It has a range of negative health impacts, including falls, depression, type II diabetes, cardiovascular disease and musculoskeletal problems.

Pathways for the discharge to assess model

(Adapted from John Bolton model for persons aged 65 and over, and when used across all 18+ age groups, it is expected that a greater percentage than detailed will be allocated to pathways 0 and 1.)

Pathway 0 (likely to be minimum of 50% of people discharged): simple discharge home

- no new or additional support is required to get the person home or such support constitutes only:
- informal input from support agencies
- a continuation of an existing health or social care support package that remained active while the person was in hospital

Pathway 1 (likely to be minimum of 45% of people discharged): able to return home with new, additional or a restarted package of support from health and/or social care. This includes people requiring intensive support or 24-hour care at home.

- Every effort should be made to follow home first principles, allowing people to recover, reable, rehabilitate or die in their own home.

Pathway 2 (likely to be maximum of 4% of people discharged): recovery, rehabilitation, assessment, care planning or short-term intensive support in a 24-hour bed-based setting, before returning home.

Pathway 3 (for people who require bed-based 24-hour care): includes people discharged to a care home for the first time (likely to be a maximum of 1% of people discharged) plus existing care home residents returning to their care setting (for national data monitoring purposes, returning care home residents will count towards the 50% figure for pathway 0).

Those discharged to a care home for the first time will have such complex needs that they are likely to require 24-hour bedded care on an ongoing basis following an assessment of their long-term care needs.

This guidance sets out how NHS bodies (including commissioning bodies, NHS trusts and NHS foundation trusts) and local authorities can plan and deliver hospital discharge and recovery services from acute and community hospital settings that are affordable within existing budgets available to NHS commissioners and local authorities. It applies to NHS bodies and local authorities exercising health and adult social care functions in England and should be used to inform local service planning and delivery.

This guidance applies in relation to adults being discharged from acute hospitals and community rehabilitation units in England, excluding maternity patients.

Discharges from mental health hospitals are not within the scope of this guidance. However mental health trusts are encouraged to embed some of the principles, adapted for mental health care pathways. Separate guidance will be published for those being discharged from mental health settings in due course.

This guidance is applicable from 1 April 2022.

To help manage the overall demand for assessments, local authorities may conduct needs and financial assessments of self-funders (newly captured for the means test or seeking to access the cap) where appropriate from April 2023 onwards (6 months in advance of 'go live'). Local authorities have discretion to determine when (following April 2023) and for whom assessments are conducted early.

6.106 The Eligibility Regulations set out a range of outcomes. Local authorities must consider whether the adult is unable to achieve 2 or more of these outcomes when making the eligibility determination. The following section of the guidance provides examples of how local authorities should consider each outcome set out in the Eligibility Regulations (which do not constitute an exhaustive list) when determining the adult’s eligibility for care and support:

a) Managing and maintaining nutrition - local authorities should consider whether the adult has access to food and drink to maintain nutrition, and that the adult is able to prepare and consume the food and drink.

b) Maintaining personal hygiene - local authorities should, for example, consider the adult’s ability to wash themselves and launder their clothes.

c) Managing toilet needs - local authorities should consider the adult’s ability to access and use a toilet and manage their toilet needs.

d) Being appropriately clothed - local authorities should consider the adult’s ability to dress themselves and to be appropriately dressed, for instance in relation to the weather to maintain their health.

e) Being able to make use of the home safely - local authorities should consider the adult’s ability to move around the home safely, which could for example include getting up steps, using kitchen facilities or accessing the bathroom. This should also include the immediate environment around the home such as access to the property, for example steps leading up to the home.

f) Maintaining a habitable home environment - local authorities should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe. A habitable home is safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas.

g) Developing and maintaining family or other personal relationships - local authorities should consider whether the adult is lonely or isolated, either because their needs prevent them from maintaining the personal relationships they have or because their needs prevent them from developing new relationships.

h) Accessing and engaging in work, training, education or volunteering - local authorities should consider whether the adult has an opportunity to apply themselves and contribute to society through work, training, education or volunteering, subject to their own wishes in this regard. This includes the physical access to any facility and support with the participation in the relevant activity.

i) Making use of necessary facilities or services in the local community including public transport and recreational facilities or services - local authorities should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments.

j) Carrying out any caring responsibilities the adult has for a child - local authorities should consider any parenting or other caring responsibilities the person has. The adult may for example be a step-parent with caring responsibilities for their spouse’s children.

6.122 The Eligibility Regulations set out a range of outcomes. Local authorities must consider whether the carer is able to achieve these outcomes or if due to the nature of their needs they are unable to achieve any of the outcomes. The carer will have eligible needs met if they are unable to achieve any of these outcomes and as a result there is, or there is likely to be, a significant impact on their wellbeing.

6.123 The following section of the guidance provides examples of how local authorities should consider the outcomes set out in the Eligibility Regulations when they determine whether a carer meets the eligibility criteria. To be eligible, a carer must be unable to achieve any of the following outcomes:

Criteria / Examples of how to interpret the criteria

(i) carrying out any caring responsibilities the carer has for a child
Local authorities should consider any parenting or other caring responsibilities the carer has for a child in addition to their caring role for the adult. For example, the carer might be a grandparent with caring responsibilities for their grandchildren while the grandchildren’s parents are at work.

(ii) providing care to other persons for whom the carer provides care
Local authorities should consider any additional caring responsibilities the carer may have for other adults. For example, a carer may also have caring responsibilities for a parent in addition to caring for the adult with care and support needs.

(iii) maintaining a habitable home environment
Local authorities should consider whether the condition of the carer’s home is safe and an appropriate environment to live in and whether it presents a significant risk to the carer’s wellbeing. A habitable home should be safe and have essential amenities such as water, electricity and gas.

(iv) managing and maintaining nutrition
Local authorities should consider whether the carer has the time to do essential shopping and to prepare meals for themselves and their family.

(v) developing and maintaining family or other significant personal relationships
Local authorities should consider whether the carer is in a position where their caring role prevents them from maintaining key relationships with family and friends or from developing new relationships where the carer does not already have other personal relationships.

(vi) engaging in work, training, education or volunteering
Local authorities should consider whether the carer can continue in their job, and contribute to society, apply themselves in education, volunteer to support civil society or have the opportunity to get a job, if they are not in employment.

(vii) making use of necessary facilities or services in the local community Local authorities should consider whether the carer has an opportunity to make use of the local community’s services and facilities and for example consider whether the carer has time to use recreational facilities such as gyms or swimming pools.

(viii) engaging in recreational activities
Local authorities should consider whether the carer has leisure time, which might for example be some free time to read or engage in a hobby.

A financial assessment is carried out by local authorities to determine how much they should charge a person drawing on care to meet their eligible needs.

This guidance sets out how NHS bodies (including commissioning bodies, NHS trusts and NHS foundation trusts) and local authorities can plan and deliver hospital discharge and recovery services from acute and community hospital settings that are affordable within existing budgets available to NHS commissioners and local authorities. It applies to NHS bodies and local authorities exercising health and adult social care functions in England and should be used to inform local service planning and delivery.

This guidance applies in relation to adults being discharged from acute hospitals and community rehabilitation units in England, excluding maternity patients.

Discharges from mental health hospitals are not within the scope of this guidance. However mental health trusts are encouraged to embed some of the principles, adapted for mental health care pathways. Separate guidance will be published for those being discharged from mental health settings in due course.

This guidance is applicable from 1 April 2022.

Where a local authority is not responsible for meeting a person's eligible needs or a self-funder is arranging their own care they will be provided an independent personal budget. This will set out what the cost would be to the local authority if the local authority was meeting the person's eligible needs and the amount of DLCs (where applicable). The amount set out in the IPB of what it would cost the local authority, less DLCs (where applicable), will be the amount that accrues towards the cap.

3.8 In this section of guidance, the term ‘information’ means the communication of knowledge and facts regarding care and support. ‘Advice’ means helping a person to identify choices and/or providing an opinion or recommendation regarding a course of action in relation to care and support.

3.9 This section of guidance also uses the term ‘advocacy’ to mean supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need.

3.10 This guidance talks about ‘financial information and advice’ which includes a broad spectrum of services whose purpose is to help people plan, prepare and pay for their care costs. In places it talks of ‘independent’ financial information or advice which in this document means services independent of the local authority. This guidance also refers to ‘regulated’ financial advice which means advice from an organisation regulated by the Financial Conduct Authority (FCA) which can extend to individual recommendations about specific financial products. 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.

Assets below the lower capital limit are not chargeable. The LCL is set at £20,000 from October 2023. Individuals with capital below this limit may still contribute to care costs through any chargeable income.

The rate at which an individual's expenditure progresses towards the care cap. This will either be the amount they are charged towards the cost of meeting their eligible needs as set out in their PB (less DLCs if they are in residential care), or the costs set out in their IPB (less DLCs if they are in residential care). Also identified as 'rate of progress towards the cap'.

Description of the minimum requirements of the system enabling the care account module.

The Nearest Relative currently has a number of important rights and functions under the MHA, including:

a. The right to require an assessment to be made with a view to admitting the patient to hospital (section 13(4)).
b. The right to apply for compulsory admission or guardianship (sections 2,3,4 and 7).
c. The right to be consulted or informed before an AMHP makes an application for detention under section 3 or guardianship (section 11(3)-(4)).
d. The right to object to section 3 admission or guardianship (section 11(4)).
e. The right to order discharge of the patient (sections 23 and 25).
f. The right to information given to the detained patient or patient subject to supervised community treatment (section 132(4)).
g. The right to apply to the MHT (sections 66 and 68(1).

[The draft Mental Health Bill 2022 proposes to replace the role of Nearest Relative (NR) with a role of Nominated Person (NP). This is defined differently from the current definition of Nominated Person as it applies to direct payments. The following is an extract from the Bill's explanatory notes.]

Clauses 21, 22 and 23 of the draft Mental Health Bill introduce a new statutory role to the Mental Health Act (MHA) – the nominated person (NP) – to replace the nearest relative (NR). The MHA provides for the role of the NR. It sets out a hierarchical list of ‘relatives’ and includes a number of rules for identifying the NR from this list. The Independent Review highlighted that service users and stakeholders consistently found the current model of family and carer involvement outdated and insufficient. This was found to be particularly true of the current NR provisions.

122. The general intention of this reform is that, in place of the NR, a patient would be able to personally select the NP to represent them and exercise the relevant statutory functions which the draft Bill extends. This supports the policy objective of improving support for detained patients and is linked to the wider policy intention to ensure that the views, experiences and expertise of patients are taken into account more fully and more seriously in their care and treatment, by allowing an individual to express their wishes through someone they know and trust. In doing so, these measures support the principle of choice and autonomy.

Carried out by the local authority to assess a person's eligible needs.

[The draft Mental Health Bill 2022 proposes to replace the role of Nearest Relative (NR) with a role of Nominated Person (NP). This is defined differently from the current definition of Nominated Person as it applies to direct payments. The following is an extract from the Bill's explanatory notes. Note that this proposed definition of Nominated Person is NOT yet in force.]

Clauses 21, 22 and 23 of the draft Mental Health Bill introduce a new statutory role to the Mental Health Act (MHA) – the nominated person (NP) – to replace the nearest relative (NR). The MHA provides for the role of the NR. It sets out a hierarchical list of ‘relatives’ and includes a number of rules for identifying the NR from this list. The Independent Review highlighted that service users and stakeholders consistently found the current model of family and carer involvement outdated and insufficient. This was found to be particularly true of the current NR provisions.

122. The general intention of this reform is that, in place of the NR, a patient would be able to personally select the NP to represent them and exercise the relevant statutory functions which the draft Bill extends. This supports the policy objective of improving support for detained patients and is linked to the wider policy intention to ensure that the views, experiences and expertise of patients are taken into account more fully and more seriously in their care and treatment, by allowing an individual to express their wishes through someone they know and trust. In doing so, these measures support the principle of choice and autonomy.

Everyone whose needs are met by the local authority must receive a personal budget as part of the care and support plan, or support plan. The personal budget is an important tool that gives the person clear information regarding the money that has been allocated to meet the needs identified in the assessment and recorded in the plan. It will also record how much of that cost the adult will be charged by the local authority, and the amount that the local authority pays (that is, the balance). It is only the amount that the person is charged by the local authority, minus DLCs where applicable, that will count towards the cap. Any financial contribution a local authority makes towards meeting a person's care and support needs does not accrue towards the cap.

Where the person drawing on care completes the assessment themselves and the local authority assures itself that this is an accurate reflection of the person's needs. This is out of scope for the MVP but some local authorities may use existing capabilities to offer this to their community.

Source document now superseded
[Needs are defined as] Substantial-- when
- there is, or will be, only partial choice and control over the immediate environment; and/or
- abuse or neglect has occurred or will occur; and/or
- there is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or
- involvement in many aspects of work, education or learning cannot or will not be sustained; and/or
- the majority of social support systems and relationships cannot or will not be sustained; and/or
- the majority of family and other social roles and responsibilities cannot or will not be undertaken.

This guidance sets out how NHS bodies (including commissioning bodies, NHS trusts and NHS foundation trusts) and local authorities can plan and deliver hospital discharge and recovery services from acute and community hospital settings that are affordable within existing budgets available to NHS commissioners and local authorities. It applies to NHS bodies and local authorities exercising health and adult social care functions in England and should be used to inform local service planning and delivery.

This guidance applies in relation to adults being discharged from acute hospitals and community rehabilitation units in England, excluding maternity patients.

Discharges from mental health hospitals are not within the scope of this guidance. However mental health trusts are encouraged to embed some of the principles, adapted for mental health care pathways. Separate guidance will be published for those being discharged from mental health settings in due course.

This guidance is applicable from 1 April 2022.

An initiative to support local authorities to improve their online self-service capability which can support better management of demand.

A local authority that has agreed to go live with charging reform earlier in 2023 - including business change and system implementation.

Individuals with chargeable assets above the UCL will be responsible for the full cost of their care. The UCL has been set at £100,000 with effect from October 2023.