Radical reforms?
The Care Act 2014 has received Royal Assent and is now law. Given the context and the constraints that care providers face on a daily basis I wonder the extent to which the progress of the legislation is fully understood by providers and whether they have considered the possible implications and consequences.
The reforms within the legislation will be introduced in two stages from April 2015 (I'll come back to this point). The Care Act is intended to make the system fairer by putting people in control of their care and limiting the amount anyone may have to pay for the support they need. It brings together 60 years of legislation into a single statute. At the time of writing the Department of Health consultation on the draft regulations and guidance for Part 1 of the 2014 Care Act has just closed and we await further amendment ahead of local authorities being given 6 months (from 1 October 2014) to prepare for implementation. A huge task therefore to get ready for the changes and an ambitious timetable in which to do it.
Launching the new legislation, Norman Lamb MP, Care and Support Minister described the Care Act as:
[ …] the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care. And, crucially, the Act delivers key elements of the government's response to the Francis Inquiry into the awful events at Mid Staffordshire hospital, increasing transparency and openness and helping drive up the quality of care across the system.
Care and support is something that nearly everyone in this country will experience at some point in their lives; even if you don't need care yourself, you will probably know a family member or friend who does, or you may care for someone. And many more of us will need care in the future so it is important for us to have a modern system that can keep up with the demands of a growing ageing population.
Until now it's been almost impossible for people who need care, carers, and even those who manage the care system, to understand how the previous law affecting them worked. Over nearly 70 years it has been added to again and again and is out of date and confusing. The Care Act has created a single, modern law that makes it clear what kind of care people should expect.
There can be little doubt that the Care Act introduces significant reforms to the legal framework for adult care and support in England – including the concept of ‘wellbeing’, the rights of those in need of care and support, and their carers, and the way in which the system is funded. In so doing it will add major new duties and responsibilities to local authorities. These changes will impact on the way councils offer information and guidance, commission and shape and oversee the market for care and support services. Whilst the Act will equally have an impact on care providers and user organisations together with their roles in the delivery of care, it is the expectations and duties placed on local authorities by the new legislation that has so far tended to be the focus of attention. In my view it is vital that care providers are fully engaged with the process in preparation for the implementation of the reforms as local authorities cannot deliver the necessary changes on their own!
Although local authorities will have the primary responsibilities under the Act (as they did previously) it is a fact that few local authorities are now involved in the direct delivery of care and support services. The gradual outsourcing of care and support, boosted by the Community Care Act legislation of the early 1990s, has led to a situation in which most adult social care services are now delivered by ‘independent’ sector providers. This means that around 70% of such services are now operated by private/for-profit providers, a little more than 20% is operated by not-for-profit or voluntary sector providers with slightly less than 10% still within public sector ownership. With these changes in composition there has also been a steady loss from local authorities of the experience and expertise to manage the provision. This is the inevitable consequence (and I would argue, cost) of a policy of shifting local authorities from providers to commissioners of services. So now local authorities will acquire enhanced duties and responsibilities at the very time when they have been endeavouring to cope with year on year substantial reductions in their funding.
Developing the regulations and guidance
The draft regulations and guidance were developed by working with expert groups which have included users of care and support, local authority staff, workforce groups, voluntary sector organisations and national representative bodies. The regulations and guidance will be the means by which councils seek to make the reforms in the legislation a reality.
The consultation documents consisted of 32 separate sections (chapters) running to some 800 pages. The government has sought feedback on every aspect of the regulations and guidance grouped into sections covering: general duties and universal provision; first contact and identifying needs; charging and financial assessment; person-centred care and support planning; integration and partnership working; adult safeguarding; moving between areas: inter local authority and cross-border issues. In addition the documentation includes proposals for significant changes to the responsibilities for market oversight and business failure by the Care Quality Commission and local authorities. So, a necessarily comprehensive package to underpin the legislation. Implementation of the Act will also have significant implications for the adult social care workforce in England and Skills for Care has been commissioned by the Department of Health to deliver two programmes of work as part of the preparation for the implementation of the Care Act in April 2015: the first on workforce capacity planning and secondly a learning and development programme.
What will happen next?
There is a huge agenda relating to the desire to further integrate social care and health services and, I guess, many compromises to be negotiated to make this a success. Skills for Care have produced a diagram to illustrate implementation of the Care Act: http://www.skillsforcare.org.uk/Document-library/Standards/Care-Act/Implementing-the-Care-Act-diagram-June-2014.pdf. It is a useful summary of the complex range of factors to be considered (especially from a perspective of workforce issues). However as noted in my introduction the Act is being implemented in two stages: the first in April 2015 will see eligibility and assessment and market-shaping enacted; the key reform of funding will not become effective until April 2016. In fact because funding reform is not happening until 12 months later, the Department of Health is not expected to consult on the detail relating to funding and finance until January 2015. Everyone with an interest in adult social care faces massive change to a challenging timeframe in the context of considerable pressures on resources. Here's the rub – the means by which these radical reforms will be funded in the future is not yet final.