Consultation on Draft Regulations and Guidance for Implementation of Part 1 of the Act 2015/16
The Care Act 2014
Consultation on draft regulations and guidance for implementation of Part 1 of the Act 2015/16
Sight loss sector response
This response is from RNIB, Thomas Pocklington Trust, Diabetes UK, Lincoln and Lindsay Blind Society, SeeAbility, Sunderland and North Durham Royal Society for the Blind, Action for Blind People and is also informed by the UK Vision Strategy outcomes, Seeing it My Way and priority actions.
The response has also been shaped by RNIB member representatives from across England. Member representative are blind and partially sighted who represent members in their regions and help to shape and set organisational priorities.
1. Introduction
Thank you for providing the opportunity to comment on the regulations and guidance which will underpin the Care Act. We broadly support much of the guidance, and welcome sections on prevention, assessment and eligibility and information and advice.
It is important that the care needs of blind and partially sighted people are reflected if the Care Act and regulations and guidance are fit for the future. In a period of 20 years, from 2011 the population living with sight loss is estimated to increase by 55 per cent, from 1.5 million to just 2.4 million (www.rnib.org.uk/datatool).
We have chosen to answer the questions which have the most relevance for blind and partially sighted people. RNIB are members of Care Support Alliance and we support their responses to each of the sections.
Our key asks and comments of the consultation are;
1. Assessment;
· That blind and partially sighted people have a specialist assessment that is conducted by a specialist assessor.
· That assessment guidance makes it clear that assessment regulations apply to the whole of the assessment process. Starting from initial contact with the local authority.
2. Eligibility
· That “basic care skills” include support with medication, laundry and reading of communications. A number of blind and partially sighted people with substantial support needs already receive support with these activities.
· That sight loss is included in the definition a set out in 2(1) (a) of the regulations
3. Preventing, reducing or delaying needs
· We welcome the inclusion that rehabilitation for blind and partially sighted people should not be limited to six weeks and that it should be delivered to meet the needs as set out in the assessment. We also welcome the encouragement to local authorities not to charge for rehabilitation beyond six weeks given it benefits in preventing long term care needs.
· Guidance should also set out that preventative support should be available as and when a person has a need and not just at the onset of a disability. That rehabilitation should also be available in a timely manner, and six months after a person has been assessed.
4. Information and Advice
· Clearly define what is meant by "accessible formats"
· Ensure local authorities plans and strategies are developed that put a clear process in place for securing the provision of information in accessible formats. Action plans must set out how local authorities will make information and advice available in alternative formats, and how they will ensure that people accessing other information are able to receive it in an accessible format. Plans should set out clearly how this will happen.
· Clearly define what is involved in providing universal information and advocacy services. Whilst it is right that this must include providing information at points where people are more likely to access information, i.e. hospitals, primary care services, local information etc, there must be a clear central point which the public can contact to request information and support, to request alternative formats and to receive verbal information and advice.
2. General duties and universal services
Wellbeing
1. Does the draft guidance provide local authorities with the information they need to embed wellbeing into the way that they work?
2. Can you suggest some examples to illustrate how the wellbeing principle could be applied?
We support the Care Support Alliance consultation response however; we would like to make the following observations concerning blind and partially sighted people.
Paragraph 1.5
Guidance on wellbeing is welcome, and we are pleased that paragraph 1.5 clearly sets out that there is no hierarchy of needs. This is essential if the Act is to meet its objective to ensure that people receive support to meet their individual needs.
Paragraph 1.9
It is welcome that paragraph 1.9 sets out that ‘meeting needs’ means recognising that everyone has different and personal needs. It is also welcome that guidance recognises that there are a range of ways in which needs can be met. However, we do not think that it is helpful to distinguish between modern and traditional models of services. Local authorities should be meeting the needs of individuals through services and support which deliver outcomes and best meet their needs. For some people this may involve domiciliary or residential support. There should be no hierarchy given over any particular service provision.
Paragraph 1.18
We welcome inclusion of defining independent living and clearly linking this to the principals of wellbeing.
Paragraph 1.22
Should clearly set out what is meant by the provision of information. Everyone will have a universal right to information and advice, and local authorities will have to put in place a service to ensure that this happens.
Guidance should reflect that information and advice is important to ensure that people are able to take control of their care and support and to choose the options that are right for them, but that it will not be enough to meet support needs.
Preventing, reducing and delaying needs
We support the Care Support Alliance consultation response; however, we would like to make the following observations concerning blind and partially sighted people.
The guidance on preventing, reducing or delaying needs is broadly positive and we welcome the priority that is given to meeting care needs. The description of primary, secondary and tertiary is useful and we welcome the inclusion of rehabilitation within the tertiary category.
Priorities
We welcome the inclusion that rehabilitation for blind and partially sighted people should not be limited to six weeks and that it should be delivered to meet the needs as set out in the assessment. We also welcome the encouragement to local authorities not to charge for rehabilitation beyond six weeks given it benefits in preventing long term care needs.
Guidance should also set out that preventative support should be available as and when a person has a need and not just at the onset of a disability. That rehabilitation should also be available in a timely manner, and six months after a person has been assessed.
Additional comments
Paragraph 2.35
The guidance states that an ‘appearance of need’ is ‘likely’ to trigger an assessment. In the previous legislation an appearance of need would definitely trigger a duty to provide an assessment and this is also set out in the Care Act, i.e. where it appears that they may have a need for care and support. Guidance should reflect existing legislation and the Care Act. If there is an example of where an appearance of need is only likely to trigger an assessment, then this could perhaps be reflected in a case study.
Assessments
Paragraph 2.40 and 2.41
We welcome that local authorities are required to provide information about what can be done to prevent, delay, or reduce needs as a part of a care and support plan; and that if a person’s needs are not met that then they must be provided with the reason as to why in writing.
However, guidance should state that this information must be provided in an accessible format which is readable for the individual. An individual must have control over their own care and support and inaccessible information is a barrier to achieve this.
Charging for preventative support
Paragraph 2.47
We welcome that guidance sets out that preventative support should be made available to a person whether or not they are eligible for ongoing care and support. This is vital in ensuring that people receive the support that they need to reduce, prevent or delay the need for care support.
Section 2 of the Care Act sets out that preventative measures may also be provided as part of a package of care and support to meet eligible needs. Guidance must provide further clarification. It is our understanding that rehabilitation and reablement services may be put in place and run concurrently with a care support package. It must be made clear in the guidance that even if a reablement or rehabilitation service is offered as part of a package of care that it must not be subject to eligibility criteria.
Paragraph 2.48
We strongly welcome that guidance sets out very clearly that whilst intermediate care and reablement “are both time-limited interventions, neither intermediate care nor reablement should have a strict time limit, since the period of time for which the support is provide should depend on the needs and outcomes of the individual”. We are pleased that the guidance demonstrates the importance of meeting needs and reflects the reassurances from the Minister on this issue.
We also welcome the example that a person with a visual impairment may need to receive rehabilitation beyond six weeks and again this reflects the reassurance received from the Minister. However, we would ask ‘for a person who has recently become sight-impaired’ to be changed to ‘for a visually impaired person’. Rehabilitation is not only appropriate for those who are newly diagnosed, but also for those that have had a visual impairment for a number of years. A person’s circumstances can change, i.e. their sight may deteriorate further, they move, a friend/carer/family member is no longer able to support them etc.
We also welcome the inclusion that local authorities should consider continuing to provide rehabilitation free of charge beyond six weeks, in view of the clear preventative benefits and the reduced risk of hospital admissions. This reflects ADASS position statement on rehabilitation, reissues in December 2013 http://www.adass.org.uk/position-statement-on-visual-impairment-rehabilitation-in-the-context-of-personalisation/
It also reflects assurances from the Minster for Care. We would however ask, for the opening line ‘Whilst the local authority does have the power to charge for such types of support’ to be removed, as this is a repetition of what has previously been set out in paragraph 2.43 and 2.44.
It is essential that the principal of free rehabilitation support for blind and partially sighted people beyond six weeks remains in final guidance. As explained by a person with a visual impairment;
“It takes longer than 6 weeks to adapt to being blind. Apart from the emotional devastation, losing what most people take for granted. You have to learn everything again; this takes time and can cause a lot of frustration. You lose your independence completely, and have to learn everything from scratch. Even simple things as making a sandwich can become a hard task. Let alone going outside and navigating the world. If new situations come up after the 6 weeks, as in having to move house, move area, you have to learn it all again”.
Preventative service at the point of need
As set out above rehabilitation services are vital to support people to adapt to living with their sight loss. However, preventative support should not just be available at time of diagnoses, but should be available when a person has a support need. Guidance must set out that preventative services are not just relevant at the start of a person’s diagnosis, but should be accessed at any time that a need is presented.
The guidance should explicitly state this principal, as in its current draft it could be interpreted that rehabilitation and reablement is to be provided at the time a person is diagnosed with a disability.
The importance of rehabilitation made available when required is explained below;
“Rehabilitation for blind and partially sighted people is essential because we are not able to pick up skills and visual clues from others as easily as those with full vision. Although starting rehabilitation early is essential for people losing their sight in order to equip them with the skills and knowledge they need before the worst comes, people who have been blind for a long time, even from birth, should still be offered services.
Mobility is an ongoing need because someone might move house, start a new job, want to visit shops, family, friends or leisure facilities they haven't been to before and would need someone to go through the route with them. If this service is not provided, either people with a severe sight impairment won't go out of the house very often or they will rely on family and friends to teach them the geography of the area and the route they choose might not be as safe as if a qualified rehabilitation had taught.”
Timely support
It is essential that preventative services should be made available within a timely manner and people should not have to wait up to six months for an assessment. Registers guidance (chapter 22) states what should happen in terms of people with a visual impairment and we would urge that prevention guidance either links to this section or reflects what is set out in the guidance.