Care Act 2014 – implications for Occupational Therapy

The occupational therapy role in delivering
social care in the next five years
College of Occupational Therapists– 5th June 2014
Glen Mason
Director of People, Communities and
Local Government
Department of Health
DH – Leading the nation’s health and care
Care and Support affect a large number of people
Many people need some extra care and support during their adult years to lead an active
and independent life. Three-quarters of people aged 65 will need care and support in
their later years…
Who needs care? At age 65, what are your chances of
needing different types of care within your lifetime?
19 per cent of men and 34
per cent of women will
need residential care
48 per cent of men and 51
per cent of women will
need domiciliary care only
33 per cent of men and 15
per cent of women will
never need formal care
DH – Leading the nation’s health and care
Care and support affects a large number of
… are
In England there
…around 310,000
people in residential
care, 60% of whom
are state-supported
…around 680,000
people in domiciliary
care, 60% of whom
are state-supported
…and around 5 million
people caring for a friend
or family member.
…1.8 million people
working as care
• There are 800,000 people living with dementia and it is forecast that 1 in
3 people currently over 65 will develop dementia
• 178,000 people receiving direct payments
• More and more people are living with one or more long term conditions
e.g. heart disease, hypertension, diabetes, etc.
DH – Leading the nation’s health and care
Drivers for Change in the English Care System
• Demographic pressure
• Unprecedented financial challenges
• Raising expectations
• Technological Change
• Systems failure eg: Mid Staffs Hospital and Winterbourne View
• A drive to integrate services
DH – Leading the nation’s health and care
The Care and Support Act – our vision
We will change care and support in two fundamental ways:
1. The focus of care and support will be to promote people’s
independence, connections and wellbeing by enabling them to prevent
and postpone the need for care and support.
2. We will transform people’s experience of care and support, putting
them in control and ensuring that services respond to what they want.
DH – Leading the nation’s health and care
“For adult care and support in England to respond to
challenges it must help people to stay well and independent”
The Care Act and other reforms will:
• Promote people’s wellbeing
• Enable people to prevent and
postpone the need for care and
• Put people in control of their lives so
they can pursue opportunities to
realise their potential
• People have greater certainty and
peace of mind over the costs of
meeting care and support needs
DH |–Implementing
Leading the nation’s
the Carehealth
Bill and care
A shift in the care and support system
Focusing only on response after a crisis
Acting earlier to prevent or delay needs
Isolated services focused internally
Joined-up services working as partners
State knows best
Person knows best
“Doing to”
“Doing with”
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Shifting the focus – from crisis to wellbeing
The new system will promote wellbeing and
independence at all stages to reduce risk of people
reaching a crisis point, and so improve their lives
Living well
People will be given better
information and advice to plan
ahead to prevent care needs,
and will be better connected to
those around them.
Low-level needs
More support within
communities, better housing
options and improved support
for carers will help people
maintain their independence
and avoid a crisis.
Need for
care and
DH – Leading the nation’s health and care
Re-ablement services and crisis
response will help people regain
their independence at home
after a crisis.
Choice, control and quality
In the new, person-centred system...
People can choose
between a range of
high quality options,
or create their own
People have
to make
good choices
about care
develop their
own care and
support plan
DH – Leading the nation’s health and care
views are
heard and
help improve
People are in
control of
their own
The Care Act is built around people
People’s well-being will be at the heart of every
Carers rights on the same footing as those they care for
Freedom and flexibility to encourage innovation and
Preventing and delaying needs for care and support
Personal budgets giving people greater control over
their care
Information and advice about the care and support
New guarantees to ensure continuity of care
DH – Leading the nation’s health and care
The Care Act is built around people
Promoting the diversity and quality of the local care
market, shaping care and support around what people
Ensure that no one goes without care if their
providers fails
Puts adult safeguarding on a statutory footing for the
first time
Young adults receive care and support during
Reforms what and how people pay for their care and
DH – Leading the nation’s health and care
What does the Occupational Therapy
Workforce in Social Care look like now?
• 1.5 million people working in adult social care in total
• Of these, 3,800 are occupational therapists
• 2,800 occupational therapists work in a statutory setting and
1,000 work in an independent setting
• Occupational therapists have been working in social care
since 1970
• The workforce is mainly female (93%)
• Occupational therapists deal with between 35-45% of local
authority referrals and yet make up only 2% of the workforce
DH – Leading the nation’s health and care
Pioneers Programme and Better Care fund
Benefits of integration
Co-ordinated approach to health and social care
Better use of existing resources for health
and care services
Putting users at the heart of the service
Better outcomes for users
Bring together a greater range of
skills and expertise
Access to care and support 7 days a week
Reduction in demand on acute services
DH – Leading the nation’s health and care
Examples of where it’s happening
In November 2013 the Department of Health announced the 14 pioneers which will lead the
way in co-ordinated care. These pioneers are driving the integrated care agenda forward by
taking innovative new approaches in transforming the way health and care services are
In Greenwich 2,000 patient admissions have already been avoided thanks to interventions
by the Joint Emergency Team. The team responds to alerts within care homes, A & E
departments and GP surgeries.
• At South Devon and Torbay they have found that by bringing professionals closer
together it has cut waiting times. Patients used to have to wait 8 weeks for physiotherapy
service, now they wait only 48 hours.
The Tri-borough calculated that 20% of the local population account for 77% of health and
social care costs. It’s new model designed to help people manage chronic conditions
more effectively and reduce hospital admissions, is estimated to deliver £38m net savings
per year.
• In Greater Manchester the 10 authorities and 12 Clinical Commissioning Groups have
joined forces to support the largest reconfiguration of hospital services in the National Health
Service. Projected to save £270 million over 5 years.
DH – Leading the nation’s health and care
What is Government doing to support this?
The Better
Care Fund
June 2013
£3.8bn to be
deployed locally in
2015/2016 on health
and social care
through pooled
Part of the £3.8bn
allocated to local
authorities includes
a payment for
element to
incentivise ambition
and real change
DH – Leading the nation’s health and care
Local authorities
and NHS Clinical
Groups must
agree a joint plan
to deliver better,
care before
receiving funding
December 2013:
Pooled budgets
will be an
enduring part of
framework in
future years
DH – Leading the nation’s health and care
Role of Occupational Therapists in
adult social care
• Helping people to remain in their own homes and carry out
activities safely
• Promote and support personalisation
• A key to the delivery of re-ablement services
• Assess need for technology to support people to live
independently in their own home
• Home safety checks
• Review care packages
• Assess and problem solve manual handling issues
DH – Leading the nation’s health and care
The contribution of Occupational
Therapists to social care
A significant contribution is made by a small workforce:
• Provision of equipment reduces care package costs
• Housing adaptations can reduce or remove the need for
daily care visits
• Prevention of falls at home leads to significant savings to
health sector
• Postponing entry into residential care through adapting
people’s homes results in significant cost savings
• Telecare can save costs where it replaces traditional care
DH – Leading the nation’s health and care
Care Act 2014 – implications for Occupational
• Many Acts you have been familiar with have been
• Introduction of the well being principle – this is
fundamental to OT philosophy
• Duty of candour now enshrined in law
• Introduction of prevention where OTs have a key role to
• Integration is in the act
• Please get involved in the consultation response on the
guidance note. Julia Skelton is leading response from
DH – Leading the nation’s health and care
Thank you and any questions?
Glen Mason
Director of People Communities and local Government
Department of Health
DH – Leading the nation’s health and care