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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views


Question 41: Is this definition clear and does it conform to your understanding of intermediate care and reablement? Is there any way it can be improved?

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3 comments

  1. Anonymous says:

    Yes, very helpful, nothing additional needing to be added.

  2. Anonymous says:

    In our view, chapter 11 of the draft guidance reflects current practice and we particularly support the guidance relating to the use of personal budgets for carers.
    The only risks we wish to raise relates to the key main point made in our introduction – how can we be sure that the additional activity from carers and service users wanting personal budgets will be resourced if grant provisions are not sufficient to meet all new requirements.
    We also have concerns around basing personal budgets on an “amount that reflects the cost to the local authority of meeting a person’s needs”. The cost of quality provision will almost always be cheaper for the local authority than it is for the public and direct payments may prove insufficient as a result.
    There are a few areas where we recommend that the drafting of the guidance is reconsidered in the interests of clarity. We have set out our key concerns and suggested adjustments.

    Suggested adjustments to the Personal Budgets draft guidance
    1. Introduction
    The first bullet point at paragraph 11.2 is poorly drafted and unclear. It seems to imply that financial assessments are completed before the care and support plan. Is this so? The bullet also appears to imply that the approach is resource-led, rather than based on needs.
    2. Mixed packages
    The end of paragraph 11.7 states that a person can have some of their personal budget as a direct payment and paragraph 11.8 states that a person can have a mixed package of care and support. Are the two paragraphs intended to say the same thing? We believe the guidance needs further clarification and/or any repetition removed.
    3. Other public money
    Paragraph 11.10 stipulates that a personal budget may also set out other amounts of public money (plural) that the person is receiving and gives the sole example of a personal health budget (singular). It is not clear what other sources of public money might be included (e.g. benefits) and we believe this requires clarification.
    4. Exclusions from the personal budget
    The first sentence of paragraph 11.18 is overly complicated. It could be redrafted to say simply that reablement should not be included in personal budgets.
    5. Equitable outcomes
    Paragraph 11.21 refers to the “method used for calculating the personal budget produc(ing) equitable outcomes”. However, the precise meaning of ‘equitable’ cannot be defined until it is confirmed whether the intended effect is to produce ‘equitable outcomes’ within or between local authority boundaries.
    6. Individual service funds (ISFs)
    Real case examples of concerning ISFs should be provided in the guidance.
    7. Use of personal budgets
    The guidance needs to clearly set out the principles of self-directed support. A web link is insufficient for such critical information. The guidance should also explicitly state that the principles must be followed. It is confusing and vague to state that this is “implied”.
    8. Appeals and disputes
    The right of appeal to a third part needs to be made explicit, as reference to the 2009 regulations is not helpful for lay persons.

  3. Anonymous says:

    Spent a lot of time reading the text and clarifying what it meant

    No – definition is not clear – you shouldn’t have to read between the lines -its been written for professionals with an understanding of the already confusing terminology

    Words like “instruction” should be avoided – this is a legal term – stress independent support – its not always about formal high coast support

    If it’s the same thing – call it the same – use plain English – easy read – do you need to differentiate if it’s the same thing?
    This section is really confusing – too many words

    Move section 11.19 and have this as the first section – there’s too much pre-able before this

    Useful if a weblink could be put in giving access to more detail – currently too much confusing detail in the main body of the text.
    This section is dense and hard to read

    No – this section is confusing

    11.19 should move to the top of this section

    In section 11.15 – there is a confusing use of “must” and “should” – which one is it – leaves it open to interpretation

    There should be a statement on who’s devivering the service
    11.4 – what does timely mean ?

    What’s the flexibility around charging – more information please ?

    There shouldbe scope for discretion but national parameters

    A clear set of criteria/definitions is need in the section about what reablement and intermediate care are.

    Reablement – should it be “a must” ? Should there be circumstances which warrant discretion? With more discretion you build in flexibility and opportunity to target resources more effectively – general disagreement