The government has published the Care Bill, which was published in draft form as the Care and Support Bill. The draft Bill set out some positive changes to social care, attempting to make the system more future focused and preventative, with more scope for assessments and processes to consider what people can do for themselves, particularly at an early stage, as well as what services can do for them. We think a system of this kind creates the space for approaches which focus on supporting family and community contributions and community development, which fits the ethos of our members, who deliver Shared Lives, Homeshare and micro-enterprises, very closely.
We had a number of conversations with the Bill team and the Joint Committee scrutinising the draft Bill, which made lots of very positive recommendations. The Joint Committee Chair, Paul Burstow, chaired a roundtable at RSA where we discussed strengths-based approaches and he wrote the foreword to a pamphlet, the New Social Care: strengths-based approaches, published by RSA which I edited (www.SharedLivesPlus.org.uk).
So have any of the changes we were arguing for happened?
In summary: yes. Councils will in future have to fund or commission agencies which reduce or delay the risk of people needing care and support (Clause 2). There should be much more useful information provided to anyone at risk of needing a care service (Clause 4). Whilst the Bill does not categorically set out the wide entitlements to up-front planning support, regardless of eligibility tests, for which we argued, the Bill and the accompanying explanatory note are clear that the most recent changes are intended to ensure that the Bill is the bones of an ‘assets’ or strengths-based approach which can be fleshed out in regulations and guidance.
My initial conversations with colleagues in the sector have tended to be about whether the new parts of the Bill which are intended to maximise the resilience of individuals, families and communities, create a risk of reducing entitlements to state services for those who need them. I believe that is the right question to ask, as long as we don’t lose sight of the arguably bigger risks of maintaining the cost and failure of the current system. But I think the risk is manageable, providing the government continues to work closely with people who use services and people at the front line, as the Bill is turned into a new system. The risk is manageable in my view, because there is an important separation in the Bill, between a) assessments and b) what support must then be provided.
The assessment system is designed to ensure that assessors can look much more holistically at a person’s strengths, capabilities and potential (‘assets’), as well as at the contributions which those around them do or could make. Assessments must consider the “impact of the adult’s needs for care and support” upon their well-being (defined broadly in Clause 1, to include control over day-to-day life; participation in work, education, training or recreation; family and personal relationships; ability to be an active citizen). They must also consider how “the adult’s own capabilities and any support available to the adult from friends, family or others” could contribute to the achievement of “the outcomes that the adult wishes to achieve in day-to-day life”. That balance between looking at needs but also at capabilities seems to be well struck.
I understand that there is also an intention to ensure it becomes clearer that assessments cannot ignore a person’s needs just because those needs are currently being met by a family carer or some other ‘informal’ source of support, as sometimes happens now, with the result that carers’ contributions become invisible, and that people need a new care assessment if their carer stops providing care (this is the intention of 18(7), which allows such needs to be identified without creating a duty to duplicate the support already being provided by a carer).
Councils will always need to take into account the impact upon an individual’s family of their care needs (Clause 12) and it will be possible to link adults’ assessments which would make it easier to create whole-family support plans for those families which wanted one.
It is crucial to achieving a less stigmatising, more creative assessment process, that there are no perverse incentives to focus entirely on needs, or to play down possible sources of informal support, so it is very positive that the Bill makes space for assessments to feel more like collaborative planning processes.
Duties to meet eligible need
In contrast, the Bill does not move away from a narrow focus upon needs, rather than capabilities, in the parts which set out duties to determine which needs meet eligibility criteria (which will be defined by national regulations – Clause 13) and to provide a response to those needs. So the Bill is careful not to water down existing entitlements to support. Whilst the risk of changes being implemented perversely can never be eliminated, the Bill makes it harder for councils not to offer to meet people’s eligible needs, even for those people deemed able to pay for services, who are currently sometimes screened out at an early stage. There are clear powers to meet non-eligible needs and a duty to offer to arrange services for people who have to pay for their own care, rather than send them away with a list of care homes, which sometimes happens now.
Where families are able to meet their own care needs, it will be harder to ignore or refuse to support those contributions, with the first ever legal entitlement to public support for carers (Clause 20), who will be entitled to a carer’s assessment regardless of the level of care they carry out or their level of needs. The right to a personal budget is now set out in law for the first time (Clause 26).
It seems likely that eligibility tests will look fairly similar to the current ones, whereas we think there is an opportunity for a more rights-based approach to eligibility, through extending the well-being principle in Clause 1 to define minimum acceptable levels of well-being (is someone safe, able to live with dignity, able to carry out family and parenting roles, able to connect to those around them, able to be an active citizen?). A new approach to eligibility would be to offer a service whenever someone is unable to achieve that minimum acceptable level of well-being without a service response.
I’ve only looked at the parts of the Bill most relevant to our agenda, but there are lots of positive changes in it, with few clauses which look like backwards steps. There is, though, clearly lots of work to do, to ensure that the intentions turn into well-made regulations and to reassure the sector that adding in opportunities to have more creative conversations at an early stage, does not entail weakening rights to services for those who really need them. Whilst some councils are already defying budget cuts and restrictive regulations to invest in communities and early interventions, some will inevitably implement whatever system is created with a view to restricting support to the smallest possible group. What difference this Bill makes to people is still all to play for.