FIRSTLY, THE REFORMS are ground-breaking and long overdue. The Care Act introduces new rights for carers to get the support they need; duties upon councils to support shaping a vibrant market giving individuals real choice and control; a universal right to a deferred payment for residential care; greater reassurances and continuity through the introduction of a national eligibility threshold (to be set at Substantial); new duties to provide information and advice; the introduction of a care cap and threshold, and rights to personalisation. All these are underpinned by a duty to integrate and promote wellbeing. A very good summary of the main clauses of the care act can be found at care and support reform webpage
Secondly, these reforms are very much welcomed and while superficially they may seem relatively straightforward to introduce, this is far cry from reality. Adult social care is a complicated multi-billion pound industry, serving 1.3 million people and 6.5 million carers and employing 1.5 million workers, all arranged over 152 localised systems. This variety, and the organic way adult social care has evolved, makes it adaptable and creatively responsive to new ideas but also, at times, challenging to align and synergise.
This variety manifests itself in many ways, with councils all having different levels and areas of expertise. For example, some councils have already well-developed deferred payments schemes, whereas others do not. This variation does not, however, hinder but creates opportunities to share good practice and test approaches. ADASS, in conjunction with the Care and Support Reform Programme, has been instrumental in seeking and supporting a collaborative approach across councils at a local, regional and national context.
Thirdly, the Care and Support Reform Programme (a partnership between DH, LGA and ADASS) has set in motion a programme to implement these reforms up to 2016/17. This programme is highly detailed and has many inter-connected workstreams and groups. All, however, depend on the goodwill and commitment of adult social care staff across every council. While we cannot name and thank every participant, (as they are too numerous), this is a good opportunity to thank the following colleagues who have taken the lead to represent ADASS in the various workstreams (see below). This list also provides a helpful aide memoir of who is who from the perspective of local government, and the range of workstreams themselves:
- Assessment and Eligibility: Martin Farran (Barnsley), Matt Bowsher (Dudley) and John Powell (Redbridge); ADASS Associate – Bill Hodson
- Carers: Grainne Siggins (Newham) and Luke Addams (Greenwich): Michael Hake
- Safeguarding and Quality: Adi Cooper (Sutton); ADASS Associates- Mike Briggs, Cathie Williams and Jane Ashman
- Advice and Information: Aileen Buckton (Lewisham); ADASS Associates Cathie Williams and Caroline Marsh
- Advocacy: Tony Jobling (Newham) and Howard Tomlin (Newham); ADASS Associate – Ian Winter
- Prevention: Dawn Warwick (Wandsworth), Dwayne Johnson (Halton and Sefton), Rosemary Westbrook (Camden) and Neil Revely (Sunderland); Jeremy Porteus
- Paying and Charging for Care and Paying for the Reforms: Simon Williams (Merton), John Jackson (Oxfordshire) and Jane West (Hammersmith and Fulham); ADASS Phil Harding
- Care Markets: Ray James (Enfield), Peter Fahy (Coventry), Wendy Fabbro (Warwickshire); ADASS Associates Derek Law and Joan Beck
- Prisons: Mick Connell (Leicestershire); ADASS Associate – Ian Anderson
- Workforce: Phil Porter (Brent); ADASS Associates- Joan Beck and Derek Law
- Informatics: Terry Dafter (Stockport); Richard Pantlin and Ian Swanson
- Communications: Dawn Wakeling (Barnet) and Simon Galczynski (Islington): Richard Pantlin
Fourthly, aside from the Care Act, which received Royal Assent in May this year, the real detail lies buried in the underpinning secondary guidance and regulations. These create the rules and parameters through which the primary legislation is to be enacted, and consequently the extent to which councils need to change and adapt. The first wave of guidance and regulations connected to phrase 1 of the reforms being introduced in 2015/16 have just been published following an extensive consultation, and a second set of regulations and guidance is expected in November/December on funding reform (16/17), alongside a revised impact assessment.
ADASS, alongside over 5,000 responses, commented upon the proposed guidance and regulations for 15/16, which in part was developed in partnership ahead of the consultation. ADASS views were highly supportive, although we questioned the extent of assurances of the affordability of implementing these reforms. Feedback from the DH suggests that, overall, there are unlikely to be substantive changes to the draft secondary legislation. This means that councils can be confident that the preparations they are putting in place based on the draft legislation will be fit for purpose and not subject to change.
In the area of assessment and eligibility – where around 24 councils tested the proposed criteria for the new national eligibility threshold in parallel with the consultation process – agreement has now been reached on the preferred model.
Fifthly, to help understand the level of preparedness amongst councils and to understand their support needs, the Care and Support Reform Board has introduced a series of stocktakes to which all councils contribute. To date there have been two stocktakes which build up a picture of strengths and challenges for individual councils as well as for the programme overall.
Results from the first stocktake have now been analysed and follow up conversations, by email and telephone, have taken place with those councils where there appeared to be a lack of confidence regarding their ability to be ready to implement the Act in April 2015.
Overarching issues include:
- Good progress being made by the majority of councils
- Limited resources and conflicting and competing demands between adult social care transformation programmes ( eg BCF and the Care Act) largely account for a lack of confidence about being ready in 2015
- There are particular pressures and priorities for those directors responsible for children's services as well as adults
It is anticipated that the information gained from the second stocktake will provide a much fuller picture of progress since the questions it contains are more detailed and, in many areas, also require supporting evidence. Follow up work by the four new Area Improvement Advisors, working with the TEASC programme director and the Joint Programme Office, alongside the ADASS regions is expected to identify and then provide the necessary support councils need.
Sixthly, to implement the reforms it takes more than just designing new systems and rulebooks. The success depends upon our biggest resource: our valued workforce. The Care and Support Reform Programme recognises these as a core ingredient and has commissioned Skills For Care to develop and produce learning and development materials due to be published at the same time as the secondary legislation for social care reform.
A series of national meetings taking place during September were due to provide an opportunity for councils to find out what the materials look like and inform future planning for how they will be rolled out to the workforce. These meetings have attracted strong interest, further underlining the fact that staff learning and development is widely seen as a key priority.
The materials, which comprise fact sheets, power point presentations and workbooks, will sit alongside best practice and guidance materials being produced by SCIE, which cover assessment and eligibility, safeguarding and information, advice and advocacy.
In addition, there will be good practice advice on universal deferred payments being developed by the National Association of Finance and Assessment Officers, and high level legal literacy materials. The specification for the legal materials is being scoped by a small group of adult social care lawyers and will be commissioned from specialist legal trainers during the autumn and will be available early in 2015.
Lastlyly, but not least, the most pressing question from all parties is the affordability of the reforms. The Government has made available £147.9 million to implement the social care reforms in 2015/16. These allocations are based upon impact assessments conducted by the DH drawing upon evidence and assumptions available at the time.
However, with greater clarification of the new duties as being set out in the secondary legislation, and raised awareness with councils, there are real concerns as to whether this allocation is sufficient. DH have engaged with ADASS and LGA to look into the allocations and to undertake further impact assessments.
This engagement has been welcomed by local government and in partnership with DH and LGA, ADASS has developed and launched a financial model to test the assumptions for the social care reforms for 15/16.
One hundred and twenty councils completed the financial model sent out in August, and analysis and detailed discussion with DH is now underway, but the emerging understanding is that the new rights for carers has long been recognised as the key area of risk for councils in terms of affordability. These discussions are now testing the returns as to understanding the scale of the risk involved, establishing total numbers and unit costs and then anticipating the future cost of support services for those additional Carers who decide to approach their council.
The outcome of these high level meetings between DH, LGA and ADASS, and ultimately the Treasury, will be forthcoming shortly, although exact timescales are yet to be set.
Alongside understanding the cost of implementing the social care reforms for 15/16, financial modelling to forecast the potential costs of the care cap and the assessment costs for self -funders is still underway This work will be important in informing the next impact assessment and the regulations and guidance for funding reform.
So, all in all, a busy time for everyone, and the contribution and engagement across the sector, and the collaborative approach taken by DH holds great promise that these urgent and welcomed reforms can be realised.