‘The key test of the Care Act is whether it is making people happier’

Six months into the implementation of the Care Act, local authorities must keep the focus on improving wellbeing, says Ewan King of the Social Care Institute for Excellence

September 13, 2015 in Adults, Care Act 2014, Social care leaders

By Ewan King, Social Care Institute for Excellence

The Care Act 2014 is nearly six months old. For many local authorities, it’s time to take stock and test the temperature on how far they have come on this important set of reforms. Those conducting these internal reviews are seeking to reassure themselves that many of the practical and technical changes they need to deliver, for example, new IT systems or carer’s assessments, are on track.

Equally, at a national level, much of the focus has been on making sure that staff have the confidence to deliver the Care Act and the government knows what technical support they require. Certainly, that is largely the focus of the recent review by the Local Government Association, Department of Health and Association of Directors of Adult Social Services, the fourth of their “stocktakes” on progress with the act.

Are we making people happier?

Less reported, at least from what I have read so far, is how local authorities feel they are doing on one of the guiding principles of the Care Act – the duty to promote wellbeing (section 1 of the act). Putting it simply, do we know if we are making people happier, more resilient and more in control of their own lives? Are we promoting people’s dignity and control by the individual over day-to-day life?

To remind ourselves, the ‘wellbeing principle’ places wellbeing at the heart of care and support. It is comprised of nine areas that local authorities must take into account in exercising their care and support functions, including personal dignity and protection from abuse and neglect. But how do we ensure this principle – albeit broadly defined – is not forgotten, or not seen as a bolt-on to other changes being rolled out?

Equal partners

Firstly, there is co-production. Co-production – involving people who use services as equal partners in service design – is one way to secure the wellbeing principle in how services are delivered. People know what brings them wellbeing, and good co-production can make sure services are shaped in ways that promote wellbeing, as this Think Local Act Personal resource argues.

The London Borough of Islington, for instance, have set up a board comprising people who use services to oversee all the work they are doing to personalise and improve care and support services.

Person-centred assessment

Wellbeing can also be promoted by designing good person-centred assessment and care planning approaches. In Shropshire, for instance, when people have their needs assessed, a personal profile is completed. This covers what is really important to the service user or carer when it comes to ‘having a good life, staying independent and living in the community’. In Cornwall and Greenwich, ‘conversations’ are used as a technique during the assessment process to discover more about what a person wants and what will improve their wellbeing.

And we do need more effort to measure and report on progress on wellbeing. This is not an easy ask when money is tight. But expensive local evaluations are not always necessary. In Camden, local people are encouraged to complete simple online forms to report on their experiences of care and support and they are involved in co-producing an annual account of progress. This provides a really powerful summary of the extent to which social care is improving wellbeing.

Measuring the intangible

There is also a growing body of evidence of how to measure more intangible areas like wellbeing, integration and person-centred care, which can be drawn upon to design measurement tools.

Focusing on the overarching goals of the Care Act is far from straightforward, especially when money is so tight and when there are just so many substantive changes to oversee. But getting it right on wellbeing, and ensuring it remains at the heart of the reforms, is the only way to bring about lasting improvement. So next time we are conducting a review on the Care Act, we need to ask: are we increasing wellbeing?

Ewan King is director of business development and delivery at the Social Care Institute for Excellence (Scie). Scie provides resources and support on implementing the Care Act.

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4 Responses to ‘The key test of the Care Act is whether it is making people happier’

Andrew Reece September 14, 2015 at 11:27 am #

I think it is too simplistic (in the headline) to equate well being with happiness. My wellbeing may have improved, in that I have more control over the things that matter to me, I may be able to make choices and I may be safer or at less risk, but that won’t always make me happier.

I would hope that improved wellbeing would leave to improved happiness for the majority of peoples in the long term, but I do not think the author is justified in assuming a direct correlation between happiness and wellbeing.

Of real risk, in my view, would be a model of practice that focuses on making people happy. Sometimes the difficult messages at the core of good Social Work interventions can make people anxious (about taking greater risks for example) or even angry (when challenging dependencies). Practitioners who focus on making people happy may avoid or miss the more challenging interventions that deliver the greatest chance for sustainable improvements in wellbeing.
John Burton September 14, 2015 at 12:07 pm #

I agree with Andrew Reece: “happiness” is a flimsy and superficial objective, even if Ken Dodd rated it as the “greatest gift” that he possessed. It bobs around on the “have a nice day / are you happy with your purchase?” level of human relations.
Like most legislation, The Care Act can be viewed and experienced in different ways: “New duties and responsibilities for Local Authorities and care providers to implement to drive up the quality of care and support”? In other words, a new opportunity for everyone outside your service to dictate how it is to be run. Sounds like a lot of extra work to please government and regulators and divert you from your core task.
I see the Care Act just a restatement and reordering of all those ideas and actions that the very best care providers have been working at for many years now. Most of it should be welcomed as the backing needed to grab the initiative and lead well coordinated care services in the direction we need them to go.
Overall, in the long-run, such services (including prevention) will be less costly, but – and it’s a big but – initially local authorities and care providers have to have the money to get this so-called “transformation” started.
Patrick Graham September 16, 2015 at 12:05 pm #

Whilst I am all for the principles of the Care act being enacted – the idea that if any individual, from any research institute for excellence or any other managerial concept, took a random sample of the Adult Social Care service recipients and asked them if they were happier, or felt better, due to the Care Act,
my guess is,
99% of them would say “The what?”
Josephine September 18, 2015 at 12:11 am #

In the context of adult residential homes, the success of the Care Act- ‘individual wellbeing’ lies largely on the team of front line carers delivering care and support following the person-centred care approach.

If a person-centred care is to keep the individual at the heart of everything we do, then carers are at the heart of delivering the person centred care. The standard and quality of person centred care hence is only as good as the standard and quality of Carers

Despite the huge responsibility of carers to deliver a high standard of care, the carer job is deemed as least attractive due to the perceived menial nature of what the role entails, it is rewarded by low wages and therefore suffers from high staff turn-over.

It is a concern that while there seems to be unlimited budgets to come up with endless principles and guidelines of care, there does not seem to be any budget to provide attractive wages to carers.

‘The key test of the Care Act is whether it is making people happier’