The Care Act 2014 is rightly widely admired. It not only consolidated the law on adult social care, it also made progressive ideas like the importance of 'wellbeing' central. The Act was brought forward by the Coalition Government and owes much to the then Liberal Democrat Social Care Minister Paul Burstow, whose commitment to improving the lives of people in need of social care is in no doubt.
But is the Care Act dream now over as a result of the funding crisis affecting social care? I think that is a question we now need to ask in the light of some of the responses by social workers to the online survey posted by Community Care magazine, with the support of the Care and Support Alliance.
As most readers will know, the Care Act 2014 requires local authorities to assess people who are in need of social care by reference to set criteria and come to an objective judgement based on what they then find. They have discretion over 'how' to meet the needs which have become evident through this process and regular reviews should assess whether any changes are needed. But reviews should not reduce a person's provision unless their needs have also diminished and/or they can demonstrate that there are other less expensive ways in which those needs can still be met.
Whether or not someone is eligible for social care hinges on how many outcomes they are unable to achieve in their day-to-day life and the impact on their wellbeing. These outcomes include being able to wash and dress, as well as being able to take part in leisure and social activities like other members of the community. What constitutes wellbeing is individual and the Act does not create a hierarchy of those needs i.e.in the criteria personal care needs are given the same level of priority as support to access the community.
However, many of the comments made by respondents suggest that this objective, needs-based approach that takes a person's wellbeing into account is being overshadowed by demands to cut costs within their local authorities. In some cases people are being denied their rights. For example:
"The view within the council is that is that only 20% of all those assessed should be receiving formalised care packages from the local authority and that 80% should only receive information and advice."
"I was moved off a case because the cost of a home package was too high (care and wellbeing principle ignored) and I refused to put the client in a care home against his (prior) wishes. The case was removed from me while I was on leave...... I left not long after."
"There has been a reduction in calls from 45 to 30 minutes so the call is now rushed and the basic needs are met but it's not very personal and there isn't enough time to check how the person is emotionally - managers need to remember that wellbeing isn't just about meeting basic needs, it's about the whole person! They are not just bodies, they are people."
"Reducing support for someone with mental health difficulties is very unhelpful. In essence, it usually has a negative impact on any progression that individual might achieve in terms of their wellbeing and personal development, hence producing a revolving door syndrome which I have personally seen in practice. There really is no such thing any more as a person-centred approach."
"Funding for quality of life activities such as to promote wellbeing and social inclusion is seen as a luxury we can no longer afford.....higher cost providers who will focus on quality skills development are shunned in favour of a need to fund just enough to pay the cheapest provider to ensure people are washed and fed, with little else to ensure a decent, dignified life with hope...."
It is important to make clear that other respondents to the survey talked about how the Care Act principles had been correctly applied. In these cases, reductions in packages were made when on review, needs were found to have genuinely decreased following a period of reablement or a change in circumstances.
Social workers have to navigate the grey area between 'good' reductions in care packages and 'bad' ones. Our findings demonstrate the complexity social workers face in making these decisions. As a number of respondents commented, this is more difficult now than ever. It feels as if the integrity of the profession itself is put into question in this climate, where managers and panels too often override social workers' decisions about the care people need in order to keep costs down.
There is a need for an honest debate about what it means to promote independence in this climate. But over and above this, I think the survey responses demonstrate just how incredibly hard it is to sustain the good intentions of the Care Act at a time of such acute funding distress in many local areas. And that is something we all need to worry about.
By Caroline Abrahams, Charity Director of Age UK and co-Chair of the Care and Support Alliance. The CSA represent 80 of Britain's leading charities including Age UK, Scope, Mind, Leonard Cheshire Disability, Alzheimer's Society and The Royal British Legion, campaigning for a properly funded care system alongside the millions of older people, disabled people and their carers who deserve decent care.