By Elizabeth Rylan*
The Care Act 2014 recently had its first birthday and is hopefully well on its way to being embedded in mindsets and working practices as well as in processes and IT systems.
The positive rhetoric surrounding the act praised the focus on wellbeing, prevention, equity and transparency. I was very much in favour of a ‘tidying up’ of the patchwork of social care law that had been in place for over 60 years and welcomed greater clarity both for practitioners and those who access services.
By the time of the act’s implementation, I had worked for three local authorities in three different community teams (two urban and one rural) which all operated to a ‘substantial’ level of eligibility criteria. I saw variations between all three areas, some of which I would expect and welcomed as they reflected the specific needs of the local population. However, I also witnessed examples where one person would or wouldn’t receive a service when I was fairly confident the opposite would have happened if they had lived elsewhere.
Yet as with any theory, the real test is in the application and how it works in practice. With the first anniversary just gone, I have been reflecting on how I have found this change. In particular, before the act’s implementation I was very keen on a national eligibility criteria and being able to better evidence decisions that are made by linking them to particular outcomes. However, I have been surprised to find that on occasions this has been what has frustrated me the most.
Sometimes I can’t help but feel that in separating out the outcomes and requiring a ‘yes’ or ‘no’ response to whether the person can achieve them has driven an even more ‘tick box’ approach. Can you meet your own nutritional needs? Check. Can you maintain your own social networks? Check. Can you manage your own personal care? Hmm, perhaps a cross in the box for that one… This can seem like a reductionist style and might not capture those with more unusual needs or the impact that the environment or wider factors can have on individuals.
One aspect that I have found particularly difficult is applying the eligibility criteria to people who just don’t ‘fit’.
We work with complex people in complex situations and there are occasions when it simply isn’t possible to capture a person’s circumstances and condense them into a black and white list.
The main challenges I have encountered have come when working with people at different ends of the age spectrum. I have noticed a trend in recent years of more and more younger people being referred to adult social care who perhaps don’t have a set diagnosis or health condition which their difficulties can be neatly pinned on. Instead they have been disadvantaged by circumstances often beyond their control and are struggling with life itself.
They may have come through the care system and although they may be able to attend to their basic needs and function on a day-to-day basis, they are not fully independent. There also seems to be an increase of younger adults with autistic spectrum disorders. Often concerns are expressed about their ‘vulnerability’ and I have had both relatives and clients express reservations that their particular condition isn’t well served by the revised assessment format.
And what about older people who may be remarkably well in some ways, without a litany of health concerns and a cocktail of tablets to take every day, but are, quite simply, old. I remember one woman I visited who was over 100 and her few health conditions included mild arthritis and sight loss, neither of which were directly the cause of her reduced abilities.
Rather she, and her body, were worn out and daily tasks were just too much for her to manage by herself. She had been receiving a service for many years but now I had to consider whether she was technically Care Act eligible. Did her needs arise from a physical or mental impairment or illness? Perhaps not. But what would the impact be of withdrawing the service, not just on the client, but also on her daughter who was the main carer and over 80 herself?
In this case, common sense prevailed and the client – and by extension her daughter – remained in receipt of assistance. However, it brought into focus the interpretation of the law and how different perspectives on implementation can easily occur. These differences could arise between practitioners or between local authorities which could again give rise to talk of a ‘postcode lottery’.
This could particularly be the case when the person in question may be experiencing what seem to be loosely defined terms such as frailty or has reduced independence due to obesity which has been described both as a health condition and a social construction.
Sharpened assessment skills
Over recent months, I have actively sought ways to develop my practice in line with the Care Act and to seek solutions to any difficulties presented. I have found that I have become clearer in my wording and in directly linking statements to the outcomes and eligibility statement provided. This has helped in evidencing the range of needs a person may have and I feel it has sharpened my assessment skills, both in terms of seeking the information, but also in how to accurately and tactfully put this to paper.
I have also been prompted to pause and identify that while the person may well have difficulties in some areas of their lives, they have been able to maintain their independence in others and I have been able to use the assessment documentation as a positive framework to capture and record this achievement.
The future of adult social care can seem surrounded by uncertainty with talk of restricted budgets and increasing demand. So we need to make the most of the Care Act. And I’m excited to see what opportunities will arise for practitioners, clients and carers to shape the development of best practice and case law.
*Elizabeth Rylan is a pseudonym for an adults’ social worker based in a local authority in the south of England