The “full spirit of the Care Act” is not being met, the government has said as it plans to reintroduce performance assessments of council adult services.
The Department of Health and Social Care made the comment in its social care reform white paper, published this week, where it set out further details about how the “assurance framework” for councils would work.
The current Health and Care Bill would place a duty on the Care Quality Commission (CQC) to carry out and report on reviews of councils’ performance of their Care Act 2014 duties. A similar function was carried out by the CQC and its predecessors until 2010.
It would also give the Department of Health and Social Care the power to intervene and, if deemed necessary, direct improvements at authorities found to be failing, in a similar regime to that currently operating in children’s services.
Delivering on ‘letter and spirit of Care Act’
The white paper sets a 10-year vision for adult social care based on three objectives:
- People have choice, control and support to live independent lives.
- People can access outstanding quality and tailored care and support.
- People find adult social care fair and accessible.
The DHSC said the Care Act 2014, particularly with its focus on promoting wellbeing, provided a “strong foundation for our vision”.
But then, in a reference to the planned return of performance assessments, it said: “We recognise that the ambition of the Care Act has not consistently been achieved in the way we would have liked. New measures currently going through Parliament will strengthen how care and support is delivered and give us the tools to ensure we deliver on both the letter and the spirit of the Care Act.”
Lack of carer support
The white paper made one of two references to the Care Act’s full spirit not being met in a section on support for carers, though without explicitly setting out where councils were falling short.
A study published last year found the Care Act 2014’s strengthening of carers’ rights did not improve their access to support because of council budget pressures.
The legislation enhanced carers’ rights to an assessment and gave them, for the first time, an entitlement to support if they met new national eligibility criteria. However, the research found that volume of carer assessments, the numbers receiving support, council expenditure on carers and carer satisfaction with support all decreased after its implementation in 2015.
Citing a 2021 survey by Carers UK, the white paper said the availability and accessibility of services was “not always as easy or straightforward as it should be”.
Need to improve market shaping
In other areas, the white paper was more specific about Care Act failings.
Under section 5 of the act, councils must promote an efficient and effective care and support market that has a variety of providers, and high-quality services, with people having sufficient information to choose between them.
However, the white paper said there was “variability in the culture and strategic leadership across different localities, which impacts the quality and choice of services available for people”.
It said low fee rates paid by councils to providers, and uncertainty about future funding “can result in poor workforce conditions, inadequate quality care, market fragility and pose a threat to continuity of care”.
In relation to quality, it said that CQC provider ratings showed that some councils had 100% of services in their areas rated good or outstanding, but in other areas it was 65%.
“The government is committed to levelling up the country and addressing this geographical inequality so that everyone, everywhere receives outstanding quality and tailored care,” it added.
The paper also said that the sector was not doing enough to encourage the development of “innovative, community-based organisations that have the potential to give people greater choice, independence and wellbeing”.
Information and advice gaps
Under section 4 of the Care Act, councils must maintain an information and advice service that provides information on how the local care system works, available care and provision, how to access care and independent financial advice, and how to raise safeguarding concerns.
However, the white paper said: “People often do not know where to start when looking for information and advice, while others find that the volume of information available is overwhelming and poorly tailored to their own circumstances.”
It added: “Stakeholders have noted that some people do not know how to, or do not want to, go to their local authority, and may seek help or advice from family and friends, community groups, the voluntary sector, or doctors and nurses. This means that people end up seeking advice from multiple fragmented places, potentially receiving confusing or conflicting advice.”
It also said there was a need to “make prevention and early intervention a much stronger element of our model of support and of care pathways”. This is despite councils being under several prevention-related duties under the Care Act, including that under section 2, requiring authorities to contribute to preventing or delaying the development of needs, and also reduce existing needs.
Increasing sector-led improvement
The DHSC said that it would increase investment – by £70m over the next three years – in sector-led improvement to help achieve its white paper ambitions.
This would build on the existing DHSC-funded care and health improvement programme, delivered by the Association of Directors of Adult Social Services and Local Government Association.
The white paper said that councils and providers would have access to a “universal improvement offer”, including guidance on “the most up-to-date, evidence-based practice as it emerges”. Councils and their partners could also request bespoke support to tackle particular issues.
“By providing this tailored support early, local authorities and others will drive their own improvement, and reduce the risk of the need for more intensive support later,” it said.
Return of performance assessments
When performance assessments of adults’ services were scrapped in 2010, the then care minister, Paul Burstow, said sector-led improvement would take its place, providing a “more proportionate and constructive system”.
But, from April 2023 at the earliest, the two will go hand in hand with the reintroduction of CQC reviews of council adult services.
Under the Health and Care Bill, the CQC would assess councils against indicators it had developed, using methods it had devised and with a frequency it had set, all with the approval of the DHSC.
Secondary legislation will set out which council Care Act functions would be assessed, but the DHSC said its initial view was that it may cover some or all of:
- maintaining oversight of the social care workforce;
- managing transitions between services;
- preventing people from requiring social care ;
- carrying out their safeguarding duties
- ensuring good outcomes for people through effective leadership;
- managing their commissioning and contracting responsibilities;
- shaping the care market to meet people’s needs;
- meeting the needs of unpaid carers;
- assessing need and supporting people, including self-funders, to access care.
Where councils were found – through CQC assessments, data or intelligence from the DHSC’s regional officials – to be struggling, the white paper said the first step would be “directed support”.
Under this, the council would be required to produce and implement an improvement plan, success against which would see the directed support removed or tapered away.
In exceptional circumstances, the DHSC may intervene to either take over functions of the authority – which would likely be carried out by a commissioner – or direct the council to comply with the government or the commissioner’s instructions.
Councils would have the right to make representations before any statutory intervention was carried out.
“We expect that the Secretary of State for Health and Social Care would only use these powers in exceptional circumstances, where the CQC has identified a serious and persistent risk to people’s safety, and where other forms of support are insufficient to drive improvement,” the white paper said.
No plan to introduce appeals system
The DHSC onfirmed it had no current plan to implement the system, provided for in the Care Act, for people to appeal against decisions taken by councils in relation to care and support.
This was originally due to be implemented in 2016 but was subsequently dropped.
The DHSC said a strong feedback culture, including a right to redress, was important, but that this would be pursued through the current adult social services complaints system. Under this, where people are dissatisfied with the way complaints have been handled by councils or providers, they can refer their case to the Local Government and Social Care Ombudsman.
“While we do not intend to introduce [the appeals] system immediately, we are keeping it under ongoing review as the new reforms are implemented and will continue to gather evidence to inform future thinking,” it added.