I was at a Dept Health briefing on the new Care and Support Bill today, which set out a useful overview of the story the Bill was trying to tell about the new social care system. The Bill starts with an overarching principle, which is that the purpose of social care is to promote well-being, rather than just to respond to crises. The Care Services Minister has noted that rest of the Bill will have to be read in the light of that first clause, which sets a very positive tone for interpretation of everything else. It then sets out some duties on councils which are at the population level – things councils must have in place for everyone who lives in that area. The prevention and information / advice provisions are in this bit (clauses 2 – 7). Then the Bill moves focuses in on an individual’s journey through the care and support system, looking at assessment, care planning and personal budgets.
As I’ve said in an earlier blog, I think there are a lot of places in the White Paper and the Bill where there are deliberate attempts to create ‘assets’ thinking about people’s skills, potential and responsibilities, where previously social care law was all about assessment of needs, vulnerability and (limited) entitlements. But the Bill in particular could go farther in enabling and not getting in the way of an asset-based system. It’s great that the Bill team are up for exploring how to do this and keen to meet with groups of people who use and provide care and support to discuss how.
One of ways in which I think the Bill could be improved will be to look at the distinction outlined above: between population-level / whole-area duties, and individual entitlements. The distinction as it stands is attractively clear, but I think it needs breaking down. Whole-population duties are hard to enforce, particularly duties to have certain broad types of service. At the moment things that are ‘preventative’ fall into this whole-area space, and only service responses for those with higher needs have the clarity of being duties towards individuals.
If the duty to offer support to produce an action plan became as wide and inclusive as the proposed (and existing) duty to assess need, we could reduce the risk of recreating the needs, vulnerability and poverty tests which are currently wrapped around the social care system like rusty barbed wire. In a time of scarce resources we can’t afford for social workers to be assessing people’s needs without producing something useful as a result for those who don’t meet eligibility thresholds. Instead, every assessment should result in a plan. For those with high needs it will often have a strong focus on services. For those with lower needs, or no eligible needs, it may focus entirely on what else is around them in their community and the options open to them outside of state services. Either way it should be portable and for those with increasing needs will make it less likely that the first support planning that takes place is during a crisis.
Equally, there is a need to link more clearly the assessment and support to which individuals are entitled, with whole-area planning. At the moment the Bill has a duty to note unmet need, which narrowly interpreted, could be seen as merely requiring a headcount of people with social care needs who are not receiving state support. Recording unmet need should be part of the individual assessment duty. And councils should be required to report on that unmet need in their strategic needs-assessment and planning processes.
Shared Lives Plus and the other partners who wrote a recent report on reforming the ‘front end’ of social care will, I’m sure, be getting together again to lobby on these issues. I met a number of members of the Think Local, Act Personal community capital network who wanted to contribute to that thinking on Monday. If you want to link up with us on this, please get in touch.