Queen’s Speech announces adult social care overhaul as cuts deepen

Care and Support Bill will modernise adult care law, provide new rights to support for carers and implement cap on self-funders' care costs, but concerns persist over how effective it will be amid squeeze on council budgets.

The government will legislate to overhaul adult social care this year to deliver a cap on self-funders’ costs, a right to support for carers and put adult safeguarding on a statutory footing, it confirmed in today’s Queen’s Speech.

However, though ministers have dubbed the Care Bill the biggest reform to the system in 65 years, sector leaders are questioning how impactful it will be in the light of cuts to adult social care; it was revealed today that 20% has been wiped off adult social care budgets since the coalition’s cuts programme began in 2011.

The legislation, which will be published shortly, will be based on the draft Care and Support Bill published last year; though substantially designed to modernise and simplify existing adult care law, it also includes a host of new duties on local authorities to:

  • commission preventive services and information and advice;
  • promote a market of diverse and high-quality services;
  • assess adult carers and provide support for those who meet eligible needs;
  • comply with a new national minimum threshold for care and support;
  • ensure continuity of support for people who move between local authority areas;
  • make enquiries into suspected abuse or neglect of adults with care and support needs;
  • establish safeguarding adults boards to oversee local safeguarding arrangements;
  • meet the care costs of people whose historic care costs have exceeded £72,000.

The legislation would also tighten regulation for providers by introducing new quality ratings for social care providers and introduce a system of financial oversight of large providers to guard against adverse consequences for service users if they go bust.

Under-funding and cuts

Though the government has earmarked money to implement the legislation – including £1bn a year to establish the cap on care costs and an extension of means-tested support to people in residential care, and £175m a year to support carers – local government leaders have warned that it is far from sufficient. The Association of Directors of Adult Social Services (Adass) and Local Government Association have also said that chronic under-funding of adult social care will create significant barriers to implementing the central objective of the legislation: a social care system that promotes well-being rather than responds to crisis.

This has been thrown into sharp relief by today’s publication of Adass’s annual budget survey, which shows that £2.68bn has been taken out of adult social care budgets in real terms since 2011, equivalent to a reduction of almost 20%. The Adass survey showed that 87% councils now set their care threshold at ‘substantial’ or above, meaning support is restricted to people unable to carry out the majority of personal care tasks or family responsibilities or at risk of abuse.

The government’s costings point to a national minimum threshold that will be set at the equivalent of ‘substantial’. However, the Care and Support Alliance, which represents major charities for older people, carers and disabled adults and care provider associations, said the threshold needed to be set at the more generous ‘moderate’ level.

Call for ‘moderate’ care threshold

“Unless this changes it means  those people who are unable to carry out tasks such as washing, preparing a meal, or dressing, those who are unable to continue to work without support and those whose carers cannot cope anymore would not get any funded social care support or have their expenditure on care count towards a lifetime cap,” said a statement from the alliance. However, this would cost an additional £2bn a year on top of the costs already allocated to the legislation, without covering existing shortfalls in funding for care.

Labour’s shadow care minister Liz Kendall said the bill’s measures “won’t go anywhere near far enough in tackling the crisis in care”, in a speech yesterday to the Fabian Society. She reiterated Labour’s ambition to establish a “single care service”, delivering social, hospital and mental health care to older people and those with long-term conditions, delivered through integrated support teams and pooled budgets. Labour has set up a policy review and independent commission to examine how this idea could work in practice.

She also said that Labour wanted to increase communities’ capacities to care for those in need to reduce pressure on council budgets, through investment in options such as Shared Lives, where paid carers support adults in need in their own homes, and in voluntary forms of support. This view is gaining ground more widely, with the publication this week of a pamphlet from think-tank the RSA on promoting approaches to social care that build on people’s strengths, not their perceived deficits, with a foreword by ex-coalition care minister Paul Burstow.

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