When the Care Act comes into force in April, it will represent the biggest change to adult social care in more than 60 years, introducing significant new responsibilities for local authorities. The act has been welcomed: David Pearson, chief executive of the Association of Directors of Adult Social Services (Adass), describes it as “a piece of legislation that sets the stall for a care service that’s fit for 21st century.” But, he points out, it comes into force after four years in which cuts to social care funding have reached £3.53bn.
The principle underlying the act is individual wellbeing. It requires councils to focus on prevention – supporting people to live independently for as long as possible rather than responding only when there is a crisis. Local authorities must provide people with clearer information about their options, and offer them a wider range of choices for care. Carers - who already have the right to assessment -will be entitled to support if eligible.
There will also be a change to payment for care. Once an individual has paid £72,000 towards their own care costs, the local authority will have to pay for their care and open care accounts to monitor people’s progress towards the cap, although crucially this will exclude “hotel costs” in care homes. People who fund their own care will be entitled to support in arranging it. These financial changes, however, do not come into force until April 2016.
The biggest impact on local authorities will undoubtedly arise from the new cap and the need to support self-funders. Gill Ford, head of performance and quality assurance at Richmond, which has a particularly high number of self-funders, says that the hardest issue has been the difficulty in calculating demand when the new rules come into place: arranging care for self-funders will, she says, require more staff time – but nobody knows how much more.
A stocktake in October by the programme management office (PMO), set up by the government to support local authorities in implementing the changes, found that 97% of councils (pdf) say that they are either very or fairly confident that they will be able to deliver reforms from April 2015. The same survey found that the authorities had particular need of support in the areas of “costs, IT, workforce, information and advice, carers and market shaping.”
The remaining challenges for local authorities vary, says Andy Hughes, head of implementation at the PMO: “Some will be well on top of the personalisation agenda, for example, and this is just confirmation of what they’ve been doing already. For others it will be an opportunity for a more radical rethink of how they’re doing their work.” Richmond, for example, already has a well-established programme on prevention, offering people minor adaptations to their homes, employment, telecare and reablement after illness.
Councils are finding three areas particularly pressing. Workforce issues are key to implementation: councils will need to recruit and train more staff to cope with the demands of an ageing population. Central Bedfordshire council is using funding it has received for training and development to provide staff with safeguarding skills required by the Act but, says Patricia Coker, head of partnerships and performance at the council: “Finding the right level of skilled competent workforce that would support vulnerable people and make sure they are safeguarded in their communities is going to be a challenge.”
Steve Carefull, adult social care specialist at PA Consulting Group, added: “Central Bedfordshire is not alone in finding it challenging to access a sustainable care workforce of the right quality – many local authorities know that their domiciliary care workforce is stretched to breaking point. Hampshire county council is seeking to build capacity by working with the independent sector to promote care work as a satisfying and worthwhile career, through a new recruitment campaign. Market shaping interventions like these are essential if the Care Act’s aims are to be deliverable in practice.”
Like most councils, Nottinghamshire county council is carrying out face-to-face training with all its assessment and care management staff. But because the act mandates that adult social care departments work with partners, it is also developing an e-learning package for partners in health, housing, libraries and the community voluntary sector explaining key principles such as wellbeing and prevention.
The second area that councils find pressing is the fundamental requirement of the act to provide carers with an assessment. Emily Holzhausen, director of policy at Carers UK, says: “Those caring round the clock are twice as likely to be in bad health as non-carers so it is vital that local authorities look at ways in which they can support carers’ mental and physical health.” This could include ensuring that there is enough care in place to allow carers to attend medical appointments and working with the NHS so that carers can access training.
It is hard to quantify the scale of the task. Coker says that Central Bedfordshire has given assessments to 1,500 carers, and is aware of 3,000 carers registered with the Carers in Bedfordshire charity. In the 2011 census, however, 25,000 people in the county identified themselves as carers. The challenge is knowing how many of those will require assessments.
In preparation, the council is working with GPs to create greater awareness that for every individual diagnosed with a serious condition there may be another individual caring for them who needs support.
Finally, the requirement to provide information to people about services is also a demanding piece of work. Ford says it has entailed reviewing all the information services in the borough. “We’re looking at everything we’re providing and saying ‘is this right’ or ‘is this enough’ or ‘is it too much’?” Nottinghamshire is working with partner organisations to create a single directory of services, with the working title ‘help yourself’. It has been a “massive” piece of work, says Jane North, Care Act programme manager at Nottinghamshire county council. “It will enable people to find out what services are available to them at the earliest point so they can plan their future care needs and make sure they get the care at the right point.”
Almost all the changes will need to be underpinned by new IT systems, and will require some degree of integration with partnership organisations such as the NHS. Not only is this a substantial technical undertaking, but it will require information governance procedures to be put in place.
Perhaps the biggest change, however, is as Coker says, is a “cultural” one for staff “from focusing on just those who are vulnerable to taking this universal approach to how we provide care and support and being person-centred”.
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