The government plans to reintroduce inspections of local authority’s adult social care functions by the Care Quality Commission, with councils being potentially subject to government intervention for failings, it announced last week.
In its NHS reform White Paper, the government proposed to introduce a duty through a planned Health and Care Bill, in which the CQC would be responsible for assessing local authorities’ delivery of their adult social care duties.
CQC annual assessments of local authorities were scrapped by the government in 2010, at the same time as the CQC stopped carrying out inspections of local authorities, which then focused on adult safeguarding.
Since then, councils have worked together to support their own performance through “sector-led improvement”, typically on a regional basis and involving sharing information and data, and teams of council practitioners and managers conducting peer reviews of other authorities.
New power of intervention for government
Running alongside the CQC assessment proposal are plans to introduce a new power for the health and social care secretary to intervene where it’s considered that a local authority is failing to meet its duties.
“Any intervention by the Secretary of State would be proportionate to the issues identified and taken as a final step in exceptional circumstances when help and support options have been exhausted,” the White Paper said.
It plans to “secure these provisions in primary legislation at a high-level”, prior to working with government partners and the sector on detailed system design and practice, to provide consistent oversight and reduce the variation in the quality of care.
The system would put adults’ services on a similar basis to children’s services, in which local authorities are subject to regular inspection by Ofsted and government intervention if they are deemed ‘inadequate’.
Proposals ‘do not address wider social care challenge’
In response to the proposals, Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said: “We understand the desire for greater transparency in social care, but councils need to be an equal partner in the design of any national oversight.
“This must build on existing sector led improvement work, recognise local democratic accountability and give a voice to people who use and work in social care. It is helpful the white paper recognises the pressures facing social care and makes clear the government remains committed to reform, but action is needed and proposals must be brought forward as a matter of urgency.
“These proposals do not address the need to put social care on a sustainable, long-term footing, nor the wider changes needed to ensure care and support can best enable people to live the lives they want to lead.”
Changes to NHS bodies
The biggest part of the government’s proposals is to scrap clinical commissioning groups (CCGs) and set up integrated care systems (ICS) on a statutory basis to plan health services in their areas. ICSs, which currently exist on a voluntary basis, cover larger areas than CCGs, typically encompassing multiple local authorities, who would have representation on ICS boards.
Separate ICS Health and Care Partnerships, on which councils would also be represented, would plan health, social care and public health services in their areas,
The proposals would see NHS bodies and local authorities placed under a new duty to collaborate, replacing existing duties to co-operate.
The government is “exploring ways to enhance the role of CQC in reviewing system working”, the White Paper said.
Hopsital discharge fines to be scrapped
Meanwhile, measures are due to be brought forward to facilitate smoother discharge by putting in place a legal framework for a ‘discharge to assess’ model.
This would allow NHS continuing healthcare (CHC), NHS-funded nursing care (FNC) assessments and Care Act assessments to take place after an individual has been discharged from acute care, replacing the existing legal requirement for all assessments to take place prior to discharge.
As a result, the system of councils being fined for delayed discharges that they are responsible for – introduced in 2004 – would be scrapped.
Government to make direct payments to providers
Additionally, the White Paper sets out plans that would allow the government to make direct payments to adult social care providers rather than having to give grants to local authorities to then distribute to services.
This is based on the experience of the challenge of getting funds to providers as required during the pandemic.
The paper also proposes a new data collection system across health and social care, which would include the collection of information on people who self-fund their care and the hours and costs of care per person.
“We need to make changes to the data we collect and the frequency with which we collect it; not just for central government assurance and oversight, but so that local authorities, providers and consumers can access the data they need, while minimising the burden on data providers,” the White Paper said.
This social care data will be linked up to people’s health data to improve understanding of the lifetime costs of care, it added.
White Paper should be seen as ‘first step’
Association of Directors of Adult Social Services president James Bullion welcomed the White Paper, but said it should be seen as the “first step in an important journey over the coming months”.
“We note that the white paper reaffirms that proposals to reform social care will be published later this year, these must incorporate all outstanding issues, including a workforce plan to put social care staff on an equal footing with workers in the NHS, greatly improved support for family carers and a commitment to long-term funding to develop the kind of care and support that will enable us all to live the lives we want in the place we want to be.”
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