The ‘failed’ Care Act 2014 must be properly implemented as part of a radical shift in adult social care from a ‘transactional’ to an ‘enabling’ service, peers have said.
This should be underpinned by a fully-funded long-term plan for the sector based on the ambition of promoting ‘gloriously ordinary lives’ for disabled and older people and a better deal for carers, said the House of Lords adult social care committee, in a report published today.
The report, which has been strongly endorsed by groups representing disabled people and carers, also called for work to improve social workers’ skills in co-production, to engineer a shift away from a system that required them to be “checklist completers and box-tickers”, in the words of one witness.
The committee, which took written and oral evidence from April to October 2022, found that many disabled and older people were denied choice and control over their lives, largely due to a lack of adult social care funding, and had to battle to access basic support as councils acted as ‘gatekeepers’ in the face of financial shortfalls.
At the same time, unpaid carers were left exhausted by the “pressure to provide care that is placed on them by the assumption, held by our society and policy makers, that social care happens first and foremost in the family circle”.
In contrast, it pointed to the vision of the system articulated by Social Care Future, a group including disabled people that seeks to reimagine social care:
We all want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us.”
Failure to implement Care Act
The report found that the Care Act 2014 articulated these principles. Notably, this occurred through the duties on councils to promote individual wellbeing (section 1), prevent, delay or reduce care and support needs (section 2), identify people’s preferred outcomes and how they could be met in assessments (section 9) and to provide support for eligible carers (section 20).
However, it said: “Far from ensuring individuals’ wellbeing, care services tend to be reduced to a minimum and designed to enable people to survive, rather than to live and thrive. Choice and control seem to exist mostly in legislation, whether for older adults and disabled people, or for unpaid carers. Many witnesses directly linked the failures of the social care system to the failure to implement the Act, pointing to the “disparities” between the ambitions laid out in the Act and the experiences of practitioners, unpaid carers and people with lived experience on the ground.”
Peers linked this to councils’ dearth of resources, citing Health Foundation figures showing a 12% drop in adult social care spending per person from 2010-11 to 2018-19, on the back of government cuts to authorities’ budgets.
Though expenditure levels have recovered since, and the committee welcomed the additional funding allocated to adult social care for 2023-25 in the recent autumn statement, it said the latter should not have come at the expense of a two-year delay to planned funding reforms, including the cap on care costs. It also criticised the settlement’s reliance on council tax, “a regressive source of funding”, and said that, overall, it was “another failure to sustainably address the challenges faced by the social care system as a whole”.
‘A penny-pinching approach to assessment’
The Lords committee found that the “need to stretch inadequate budgets across as many people as possible can lead to the codifying of a penny-pinching approach to assessment, which is at odds with the purpose of adult social care”.
People were expected to adapt to “the narrow range of services that are on offer”, with disabled and older people not seen as experts in their lives. Many witnesses praised some social workers for supporting a vision of adult social care as enabling equal lives, but they said practitioners were “met with a system that requires them to become ‘checklist completers and box-tickers'”.
The report said that “better training and upskilling for social workers was frequently described as critical to enable the success of co-production and cultural change within local authorities”.
It also found that unpaid carers were frequently not identified, either by themselves or professionals, leaving them unsupported, with many struggling to access short breaks despite the emotional and physical challenges of their role.
They often lived on the margins of poverty due to the low level and restrictiveness of carer’s allowance – currently worth £69.70 a week for those doing at least 35 hours’ of care, so long as they earn less than £132 a week – and also struggled to combine work and care.
These issues were compounded by the low pay and status of care work, with the 52% rise in vacancies in 2021-22 contributing to increases in unmet and undermet needs, while the lack of clearly defined career pathways or professional recognition in many roles acted as a deterrent for people to stay in the workforce.
Adult social care should be ‘national imperative’
The committee urged the government to make adult social care a “national imperative”, through an “appropriate and long-term funding settlement”, alongside a workforce and skills plan that included action to tackle low pay.
This should support the achievement of the vision of adult social care set out by Social Care Future, which the committee said the government should ensure was endorsed in principle by social care bodies including Social Work England, Skills for Care and the Care Quality Commission.
It also called for an “independent public review” of the Care ACt 2014 and for government to work with councils to ensure its full implementation by the end of this Parliament (late 2024).
In addition, the committee said ministers should work with councils, providers and the voluntary sector to embed the principles of co-production, including through “working with
social care staff to enable them to acquire the support and skills necessary to co-produce care and enable a shift in power from staff to individuals who draw on care and support”.
Alongside this, it urged the creation of a commissioner for care and support within the next 12 months, tasked with acting as an effective champion and upholding the rights of disabled
adults, older people and carers. This should be held singly or jointly by a person with lived experience, it added.
For carers, the committee said ministers should dedicate ring-fenced funding to boost the availability of short breaks, introduce unpaid carer’s leave, as it has committed to do, and improve access to carer’s allowance by reducing the caring hours threshold and increasing the earning limit in line with rises in the national living wage. It also said the Department for Work and Pensions should carry out a 12-month review of the benefit, recognising that, “as the lowest benefit of its kind, it is not reflective of the value of unpaid carers’ work”.
Report drew on ‘insight and expertise’ of those with lived experience
Social Care Future, whose co-convenor, Anna Severwright, acted as a special adviser to the committee from the vantage point of lived experience of social care, said it strongly weclomed the report.
“The committee listened to Social Care Future at the outset of the inquiry, and as a result heard directly from witnesses whose insight and expertise comes from drawing on social care,” it said.
In relation to the committee’s call for Social Care Future’s vision for the sector to be adopted, it said: “We believe this ‘north star’ – that everyone should be able to live in the place we call home, with the people and things that we love, in communities where we look out for one another – will help everyone to re-imagine the role social care can and could play in improving our lives, and to think more creatively about how it can and should be organised to support us.
“We share the committee’s frustration that positive developments such as the Care Act 2014 have not been followed by meaningful resources or action to implement them.”
Potential blueprint
For the Local Government Association, community wellbeing board chairman David Fothergill said it supported the report’s recommendations, particularly around funding and a workforce strategy.
He added: “This excellent report could be a blueprint for the way forward for adult social care and we fully support the central message that social care should be seen as a “national imperative”. The positive framing of social care and the core focus on people who draw on care and support is particularly welcoming.”
Carers UK was also supportive of the report’s recommendations for carers, as well as those on funding and to create a commissioner for care and support.
In response to the report, a Department of Health and Social Care spokesperson said: “We want to ensure our health and social care system provides the care people need, when they need it. That is why it was prioritised health in the autumn statement and up to £7.5bn will be made available to support adult social care over the next two years – the biggest funding increase in history.”
This is a reference to the government’s package for adult social care set out in the autumn statement, providing up to an additional £2.8bn in 2023-24 and £4.7bn in 2024-25. However, only £1bn in 2023-24 and £1.7bn in 2024-25 is new. Of the rest, £3.2bn over the two years comes from pausing the funding reforms, with this money being available to spend on children’s, as well as adults’, social care. The remainder – £0.5bn in 2023-24 and £1.1bn in 2024-25 – is potentially available should councils take advantage of increased flexibility to raise council tax and spend all of this on adults’ services, but local government leaders have questioned how feasible this is.
The spokesperson added: “Specifically for unpaid carers, we are also providing local authorities with over £290m for short breaks and respite services, as well as additional advice and support.”
This refers to money to implement the Care Act 2014 provisions on improving support for carers that is now delivered through the Better Care Fund.
On the workforce, the spokesperson said: “We have also launched our annual domestic recruitment campaign, Made With Care, to encourage people to take up a career in adult social care and are also investing £15m to increase international recruitment into the sector.“
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Personally, I believe that the massive shortage of resources is very important, but so would be the creation of a National Care Service
I’m an adult mental health social worker and AMHP. The council I work with tries, but it has too many responsibilities, too many projects, and social care in my view needs an organisation that has a sole goal not one of many. In a local authority it’s a one size fits all approach and it isn’t helpful to aid work and to create a vision
We have mountainous bureaucracy, no admin support at all, and a complete scarcity of carers and support workers. They are unsung heroes and heroines and deserve better pay and conditions
The lives of people we work with are getting more and more complex and services aren’t keeping pace, in my view. A dedicated NCS service may help
The NHS isn’t perfect but at least it is focused on health
From a passionate but tired social worker
In this report professional and political leaders call once again for social workers to change how they practice and for enough funding as the twin solutions to achieve their vision for the delivery of social care. But neither will happen if political and professional leaders cling to a system that calibrates need to resources. Despite protestations to the contrary, this is what the so-called ‘eligibility process’ does. It kills the Care Act vision. Investments in re-training social workers to be ‘person centred’ are pointless when the system requires them to be resource led; it is pointless calling for sufficiency of resources when the system has not the first idea how much money is needed.
The Barnet Forum for Independent Living ,of which I am a member, agrees that implementing the Care Act holds the key to real change. But people need to be aware of exactly what that will take. We have been examining in depth the exact mechanisms one council is using to tell the public it is delivering the Care Act, when it is covertly doing the exact opposite. We will shortly be in a position to publish the full findings.
Every time there is any discussion about the lack of resources to implement the Care Act 2014 there is never any acknowledgement that people who need services are expected to contribute towards the cost of their care. Under the Care Act, the Local Authorities have a duty to carryout a financial assessment on all individuals who require care provision. Indiviudals who have savings above a certain threshold are expected to fund their own care (known as self funders). Whilst individuals who are only in receipt of welfare benefits they often see part of the PIP and/or DLA deducted to meet the cost of their care. The Care Act has created a 2 tier care system that mainly benefits the middle classes.. Those people who are able to afford to top up the cost of their care with the financial support from the Local Authority. These individuals often have choice and control over how their care is provided. . Whilst those individuals on welfare benefits find their choices are often limited or they have no choice and go without the care they need due to fear of spiralling debt, Of course there is another group who do have the means to afford private care but who go without due to fear of the spiralling cost of private care provisio. There needs to be a complete overall of the Adult care system including allocation of more resources, and a rethink of the way services are delivered and the relationship between health and social care.