Adult social care

By Mitharn Samuel on April 17, 2008 in Adult safeguarding, Adults, Residential care

Adult social care refers to a system of support designed to maintain and promote the independence and well-being of disabled and older people, and informal carers.

While often associated with the provision of personal care and accommodation, it also includes support to help people perform parenting roles, participate in their communities and manage other day-to-day affairs.

Specific adult social care services include:

• Care homes.

• Nursing homes.

• Home care (domiciliary care).

• Reablement services to support people to regain independence after a crisis.

• Short breaks or respite for carers.

• Shared Lives care, in which people are supported in the homes of trained carers.

•Extra care housing, in which people have their own accommodation but can access round-the-clock care.

Who does it support?

Adult social care supports the following groups:

• Older people.

• People with mental health problems.

• People with physical disabilities.

• People with learning disabilities.

• People with sensory disabilities.

• People with autism.

• People with HIV/Aids.

• Homeless people.

In England, in 2009-10, 1.7 million received social care services through a local authority, with 1.46 million receiving community-based services and the rest receiving care in a residential or nursing home.

Who is responsible for it?

In England, Scotland and Wales, publicly-funded adult social care is the responsibility of local authorities, while in Northern Ireland it is the responsibility of the health and social care board. These organisations are responsible for funding, planning and purchasing support.

In England, Scotland and Wales, overall responsibility for the management of adult social care sits with a local authority director. In Wales, these are directors of social services, also responsible for children’s social care. In England, these are mainly directors of adult social services, who do not have responsibility for children’s services, but are often responsible for other services such as housing, leisure or community safety. In Scotland, there is a mixture of generic directors of social work, with responsibility for children’s and adults’ services, and adult-specific directors.

Assessment and care management

A key part of councils’ role is to assess people who appear to have care needs for their eligibility for support. Councils are supposed to fund all eligible needs, subject to the means-testing of service users, but can set their own threshold for care at one of the following levels – critical, substantial, moderate or low – based on risks to individuals’ health, well-being and independence.

Assessments are carried out by professional social workers or other council adult social care staff.

Those deemed eligible for public funds have their care managed by a social worker or other social care staff member, which involves reviewing their needs every year to respond to changes.

Personal budgets

In England, many service users receive their support through a personal budget, a sum of money which they can use to purchase services that will meet their eligible needs. The size of the budget is based on their eligible and calculated using a resource allocation system. Through support planning, council staff, or in some cases independent brokers, help service users decide on how to use their budget. Scotland is also planning to roll out a similar system, though Wales is not.

Who provides social care?

In England, Scotland and Wales, most residential, nursing or domiciliary care is purchased from private or voluntary sector organisations and the rest are provided by local authorities themselves. In England, the proportion of in-house services is being reduced year-by-year as councils outsource provision. In Northern Ireland, most services are provided by the public sector, in the shape of health and social care trusts.

Who pays for it?

Publicly-funded social care in England, Scotland and Wales is funded by a mixture of central government grants and funding raised by local authorities through council tax and means-tested charges on service users. In Scotland, personal care – in the home or in care homes – is not means-tested, but provided free to all.

There is also a significant private market for care, funded by individuals themselves.

Funding shortfalls

Population ageing and the longer life expectancy of disabled people is putting increasing pressure on the social care system and has called into question its long-term viability. The 2011 Dilnot commission report provides proposals for reforming the way social care is funded in future and the UK government will decide whether to take forward these proposals in England in a White Paper in 2012.

Adult social care law and policy

Key adult social care statutes include:

• The National Assistance Act 1948.

• The Chronically Sick and Disabled Persons Act 1970.

• The Mental Health Act 1983.

• The NHS and Community Care Act 1990.

• The Adults with Incapacity (Scotland) Act 2000

• Mental Health (Care and Treatment) (Scotland) Act 2003

• The Mental Capacity Act 2005.

• Adult Support and Protection (Scotland) Act 2007

• The Health and Social Care Act 2008.

In 2011, the Law Commission proposed to create single statutes to govern adult social care in each of England and Wales to resolve complexities and confusions in the current law. The UK government will respond in 2012 about reforming the law in England.