Designing a social care system fit for the 21st century: strengths and weaknesses of the Care Act 2014

The first part of the Care Act 2014 drew heavily on the Law Commission’s review of adult social care. The review began in 2007 and its initial terms of reference did not even refer to carers or the notion of wellbeing but both came to feature heavily in the Act, illustrating that the Commission actively listened, particularly to carers’ voices. Placing informal carers on an equal footing with people drawing on care and the right to a carer assessment were significant breakthroughs in the Act.

Peter's blog is part of a series of blogs reflecting on the 75th anniversary of the National Assistance Act. To read more of these, please visit our project page.

The key requirement in the Act on local authorities to promote an individual’s wellbeing also represented overdue recognition of the value of a ‘social care’ approach, exemplified brilliantly by Clenton Farquharson when he says, ‘The NHS saved my life; social care made my life.’  We also forget now that adult safeguarding, direct payments and personal control of your budget were all put on a legal footing by the Act that ‘levelled up’ practice nationwide. The Act was less groundbreaking when it came to providers. Its focus was to limit the risk of another major provider crash like that of Southern Cross in 2011. From today’s perspective, the Act tries to ‘manage’ rather than create the dynamic capability needed to shape and influence rapidly changing markets. While it created a regime for provider failure, we still haven’t defined the relationship between public money and prices, profits and company structures.

The second part of the Act was a response to recommendations of Andrew Dilnot Commission on the Funding of Care and Support. It would have brought in changes to the social care means test and a cap on individuals’ lifetime social care costs. However, in 2015, the Local Government Association (LGA) successfully lobbied government to defer the implementation of these measures, hoping to divert funding into the wider social care system. The LGA secured deferral but not extra money.

The postponement highlighted a key gap between the aims of the Care Act and the resources to support it. The courts have determined that a lack of resources cannot justify failure to meet eligibility for care but, as local authority resources have become tighter, any provision that falls outside the legal assessment of daily needs has become exposed to the harsh climate of resource scarcity.

'Successful prevention improves lives and increases value for money, yet it is left to councils’ discretion.'

One area that has continued to be underfunded is prevention. The Act’s emphasis on prevention isn’t an optional extra that is ‘good to have’ in a system. People must pay serious attention to prevention, supported by evidence-creating practice and curiosity. Successful prevention improves lives and increases value for money, yet it is left to councils’ discretion.

After dramatic reductions in council funding, the government now sees the new Care Quality Commission assurance regime as introducing accountability for how councils meet their Care Act duties. Other countries are more ambitious: Australia’s system engages in an actuarial assessment of need and the effectiveness of community prevention on demand for higher-level services. This seems to offer an effective partnership dynamic between central and local government. We need co-ordination of which options guide effective local delivery that builds capacity.

For all the analysis of the troubled state of adult social care, the Care Act met the desire for legislation fit for 21st-century social care. Like many, I remain clear that the Care Act 2014 is a solid legal framework that has been let down by implementation. This has partly been about inadequate resourcing, but it’s also been about a failure to lead the system in new ways.

'If social care lacks definition, it’s because it’s dynamic.'

A passion for care and life has seen the vision of #socialcarefutures take root. If social care lacks definition, it’s because it’s dynamic. There is increasing agreement that social care will not be ‘fixed’ by one big policy and needs a programme of development that utilises its capability to deliver for our much-changed demography and expectations. Richard Humphries states that what is needed is not more top-down approaches to reform of care but a concerted attempt to work outwards and upwards from a community and personal level.

An invigorated partnership approach to how we want to use the capabilities of social care to reshape and redefine the social contract of today would bring people with lived experience to the table. Implementing the Care Act has shown the talents and imagination that stem from co-production. In Think Local, Act Personal, and local collaboration, we have seen how lived experience enhances policy. If we are serious about the Care Act principle of delivering for our wellbeing, then who better to judge delivery and inform the development of social care capability than those with direct experience?

It’s not time to walk away from the Care Act; instead, it’s time to invigorate it with the money and capabilities to deliver the modern social care system fit for the 21st century.