Care assessments would be contracted out to provide clients with choice over who carries them out, under plans set out in the care and support White Paper, launched by health secretary Andrew Lansley today.
The paper also includes plans to appoint principal social workers in every council, promote the deployment of social workers in community development roles and establish a statutory framework for safeguarding adults, including consulting on giving practitioners the power to enter homes where abuse is suspected. However, it offers only £300m in new funding for social care from 2013-15, well short of what sector leaders believe is necessary to tackle existing funding shortfalls and much of which will have to be used by councils to implement new duties.
While community care assessments are mostly carried out by council-employed care managers, the government said it wanted “many more new providers to offer assessment services” to increase choice. It said the creation of a plurality of assessment providers would be supported by the Department of Health’s right to provide initiative, which enables council staff to set up social enterprises to deliver functions they currently provide.
The accompanying draft Care and Support Bill includes powers for councils to delegate assessment and care management – and other functions – to a third party, though with relevant statutory duties staying with the council.
The details of the scheme will be considered through a working group set up next March to develop and test options for a new assessment and eligibility framework for social care. The group will also consider proposals in the White Paper to set a national minimum threshold for social care – removing councils’ current power to set their own threshold – and to enable people to retain eligibility for care when they move between local authority areas.
Social work reforms
The paper also proposes the appointment of principal social workers for adult services in every council – matching existing plans for children’s services – and the deployment of social workers in community development roles.
The DH said it would work with The College of Social Work to “ensure that community development is built into future practice”, so that social workers could effectively support people to build community networks to help maintain their independence and well-being.
This would be supported by a new duty on councils in the draft bill to commission or provide services that prevent, delay or reduce the need for care and support.
Safeguarding on a statutory footing
The draft bill would put the safeguarding of adults at risk on a statutory footing by mandating the establishment of safeguarding boards in every area, convened by councils and with compulsory membership from the NHS and the police.
Councils would be placed under a duty to make enquiries where they reasonably suspect that an adult with care and support needs is at risk of abuse or neglect. The DH will also consult on giving councils the power to gain access to a person at risk where they would otherwise not be able to carry out a safeguarding enquiry.
Safeguarding boards would also be under a duty to carry out “safeguarding adult reviews” – similar to serious case reviews – where an adult in need dies following abuse or neglect.
The government will transfer £300m from the NHS to councils from 2013-15 to implement measures in the White Paper that carry a cost and to further develop integrated services with the NHS. This supplements about £2.7bn in funding transfers from the NHS to councils for social care from 2011-15.
The King’s Fund has calculated that a funding gap of £1.2bn a year could open up between 2011-15 due to the government’s 28% real terms cuts to council budgets over this period. Councils have already taken almost £2bn out of social care budgets since 2011 – mostly through efficiency savings – and have warned that services will be cut without additional resources.
However, the DH maintained its line in the White Paper that councils could maintain services at 2011 levels through efficiency savings and better commissioning, as a result of the spending review settlement.
As widely predicted, the DH said it accepted “in principle” proposals from the Dilnot commission to cap the lifetime care costs of older people and increase the means-test threshold above which people must fully fund their own care. But it did not commit to implementing either measure and said they would be subject to the Treasury’s next spending review, due in 2013 or 2014.
In a progress report on funding reform, it even suggested that the care costs cap could be provided on a voluntary basis, under which people would receive it if they paid a premium to the government, thereby minimising the impact on taxpayers.
The government has retained its controversial target of moving all users of community-based services on to personal budgets by April 2013, should they want them.
Under the draft bill, all users of council-funded support would be given a personal budget as part of their care and support plan.
The government also plans to pilot the extension of direct payments to residential care to test the costs and benefits.
Other key proposals
- A right to an assessment for carers who may need support and an entitlement to council support if they meet a new eligibility threshold for carers;
- £200m in funding over five years to develop specialised housing for older and disabled people;
- Pilots to test the idea of free social care for people who are dying and are registered on end-of-life care registers;
- A duty on councils to provide information and advice on care and support, with £32.5m in start-up funding for councils to develop online information services;
- A duty on councils to develop and maintain a diverse range of providers in their areas;
- Action to stop councils contracting for home care by the minute in partnership with the Association of Directors of Adult Social Services;
- The development of “quality profiles” for all regulated care providers, including information on compliance with essential standards, performance against quality standards developed by the National Institute for Health and Clinical Excellence and families’ views, drawn from “high-quality” consumer ratings sites;
- An ambition to double the number of care apprenticeships to 100,000 over the next five years;
- The potential development of a personal assistants index to enable service users to compare PA services that are available locally;
- As previously announced, minimum training standards and a code of conduct will be developed for adult social care workers by September 2012;
- A consultation this autumn on whether there should be greater financial oversight of larger providers to ensure continuity of care in the event of their collapse.