The Care Act
In May 2015, the Care Act passed into English law, and fundamentally changed the way in which social care is to be delivered. It replaces and amends a number of existing Acts, and enshrines the new statutory principle of wellbeing: a move away from providing specific services according to eligibility criteria, to a broader approach designed to meet an individual’s needs based their own circumstances. The wellbeing principle is rooted in keeping people independent for as long as possible, and in control of their own care pathway where it is appropriate for them to do so.
The Act is very much geared towards preventative services, and is clear that housing and housing related support is a key element of this.
Key changes include:
- The principle of wellbeing: that a person’s needs may be influenced by a number of factors including their housing situation, financial arrangements, or links to their community. Local Authorities have a duty to promote wellbeing when carrying out their assessments, and there is an assumption that people know best what they need in order to live well. There are eight elements listed as contributing to a person’s wellbeing, all of which can be assisted through appropriate housing services: personal dignity, including respect; physical and mental health, and emotional wellbeing; protection from abuse and neglect; control over day to day life; participation in work, education, training or recreation; social and economic wellbeing; domestic, family and personal relationships; and suitability of living accommodation.
- Assessment, including carers’ assessments: local authorities have a duty to assess any person who appears to have any level of need for care and support. This is irrespective of whether the authority considers that the person may be eligible for help from them, and must assess their needs regardless of any assistance provided by an existing care arrangement (whether informal or paid for). A significant change is that this duty now also extends to carers, many of whom have needs of their own which have not been recognised previously. Reducing the mental stress and physical demands of caring for someone in their own home can have significant benefits to the carer’s ability to maintain their own wellbeing. Housing needs, therefore, including the need for repairs, adaptations, overcrowding, safety (including hoarding and cleanliness) and other aspects of the home environment, should be included in the assessment process.
- National eligibility criteria: a new eligibility criteria, which applies across the country, replaces the Fairer Access to Care Services (FACS) criteria under which care services were allocated previously. These are arranged around the person’s ability to meet a range of defined outcomes. Many of these outcomes are linked to the home environment. Some of these, such as maintaining personal hygiene, managing toilet needs, being able to make use of the home safely and maintaining a habitable home environment are clearly linked to Disabled Facilities Grants and adaptations, but others could also be improved through home based interventions: ensuring a kitchen is safe and hygienic for example, can help with preparing and eating nutritious food, and encourage improved relationships as people can cook for friends and family and will be less anxious about inviting people into their home.
- Care planning and review: where a local authority has a duty to meet eligible needs, then a care and support plan must be put in place (or a support plan for carers). This may include housing support or adaptations, and authorities are not expected to hold lists of ‘prescribed providers’. Everyone should have a personal budget as part of their care plan, some of which may be paid through direct payment, and people should be allowed to choose their own forms of support as they wish. This could allow local providers to develop new ways of meeting people’s needs outside the traditional routes funded through social care.
Care plan reviews must take place within 12 months, but can be carried out by the person themselves, their carer, a provider or another authorised professional. They are then signed off by the local authority. Caseworkers, for example, could be well placed to undertake this role if suitably trained. The review should be person-centred, should be used as an opportunity to ensure outcomes, needs and aspirations are being achieved, and to make adjustment where they are not.
- Deferred payments: this scheme allows people to move into residential care, without having to sell their home to contribute to the cost of the care they receive. The costs will, instead, be recouped when they decide to sell their home themselves, or will be realised from their estate when they die. The local authority will need to satisfy itself that there is sufficient equity in the home when the deferment agreement is made, so maintenance and repairs could be an important aspect of this calculation. If there is a spouse or partner remaining in the home, they may also find maintaining the home more difficult on their own, and Handyperson services in particular could offer a lifeline in these circumstances.
- Funding reforms: The Act outlines a radical reform of the way social care will be paid for in the future. The most important of these are the changes to the way people contribute to their care costs, including local authorities being able to charge self-funders going into care homes for their care costs (although this cannot be more than the local authority would pay), a strengthening of ‘top-up’ fees rules so that these must be arranged through the local authority, and from 2016/17, increasing the upper capital limit for care cost to £118,000, and imposing a cap on the amount someone has to pay towards their care costs of £72,000 (for people over retirement age). The second phase of the reforms has, however, currently been delayed due to concerns about the ability to implement them while the overall condition of the social care system is unstable.
Aids and minor adaptions up to the value of £1,000 should continue to be arranged and paid for by social care for eligible people.
The Care Act requires that local welfare authorities (County or Unitary authorities) co-operate and work with local housing authorities (district councils in two tier authorities), housing providers, third sector providers and private companies to produce a range of services to meet their obligations and help people stay well and independent in their own homes. Market shaping and commissioning is a major part of this duty. Promotion of innovation, quality and value for money are key to developing services which provide choice for customers while emphasising prevention, reducing isolation and enabling independence.
Commissioners should be aware of the market in their local area, and the business challenges faced by their providers. They must have an understanding of the financial implications of delivering quality services, and legislative demands on providers (for example, the introduction of the new Living Wage and pension reforms) taking care not to set fee regimes that are not sustainable for long term service provision, and which can lead to disruptive and costly reprovisioning and disruption to services.
For further information, read the Foundations Care Act Briefing paper or download a Briefing from Care & Repair England