The Care Bill 2013 and adult social care

The Care Bill 2013 will have a major impact on the work of local authorities and health bodies. Susan Thompson considers the reforms to adult social care law.

Due to become law by 2016, the Care Bill addresses three key areas of health and social care: Part 1: the major reform of adult social care law; Part 2 health reforms in response to the Francis Inquiry; Part 3, arrangements for Health Education and Health Research. This article looks at Part 1.

Until now adult social care support has been seen as only relevant to the most vulnerable in our society. With an ever increasing elderly population, growing old and supporting those in need of care and support, becomes everyone’s business on the basis that most of us will at some point in our lives need care and support, know someone in need of care or provide care for someone in need.

The Bill recognises the importance of promoting well being, preventing or postponing the need for care and support where possible, and when care is needed, putting in place a transparent and flexible personal care package which is portable and providing financial protection to individuals for the cost of care where this exceeds prescribed financial limits.

Wellbeing, prevention and information and advice


For local authorities there will be a duty to promote wellbeing (clause 1), take steps to put in place strategies which it considers will support prevention or delay in a person’s need for care (clause 2) and provide a system of information and advice that is universally accessible so that individuals understand what is on offer, help them plan for the future and know where to go for help (clause 4).

Current “signposting services” will not be enough and it is likely local authorities will need to commission a range of services from basic online information to advocacy services for individuals.

The Bill contains a charging provision where regulations can prescribe what must be delivered free and what can be charged (clause 2(3)).

How this works in practice will be important to ensure charging does not act as a barrier to obtaining information and advice.

There will be opportunities for a range of providers to provide these services as it is unlikely local authorities will deliver much of this themselves. To be effective there will need to be sufficient resource and funding allocated.

Adult Social Care Framework

Charging


Knowing what to expect from a service and what will be charged for is key. With local authorities able to charge for services (clause 14) and a financial cap on an individual’s liability for care costs (clause 15), transparency is essential.

Needs assessment and eligibility


Clauses 9-13 is described as the first part of a person’s journey through the system. Clause 9 places a duty on the local authority to carry out a needs assessment where it appears to the local authority that there is a need for care and support (similar to the current section 47 NHSCCA 1990). Where a need is identified then a national eligibility framework will apply to avoid the current postcode lottery for services. Where the threshold for eligibility for services will lie is a matter for debate but is placed at “significant” in the Bill with many campaigning for a lower threshold or access to services in certain circumstances where the threshold is not met.

Duty and power to meet needs


Clauses 18-20 sets out the duties and powers to meet needs under a reformed system. Needs must be met where an individual is eligible if the person resides in the area or has no settled residence but is in the area: the financial cap on care is exceeded or the person meets the funding threshold.

Integration and diversity of provider


Local authorities will have a duty to promote integration with the NHS and other health-related services (clause 3), but does not specify how other services, such as housing, should support integration. This is perhaps a deficit in the Bill given the well-being principle relates in part to the “suitability of living accommodation” (clause 1(2)(g).

A local authority must also promote diversity by promoting and building an effective market by shaping services which people use. This will include not just care and support but shaping services to enable individuals to undertake work, training and education (clause 5). Partners need to be involved and clause 6 requires local authorities to co-operate with relevant partners in exercising functions under the Act, working alongside Health and others in the joint strategic needs assessment (JSNA) of communities and the Health and Wellbeing Boards (HWBs). It will be important to understand how this will be played out to ensure choice by promoting competition while at the same time promoting integration.

Susan Thompson is a partner at DAC Beachcroft. She can be contacted on 0117 918 2737 or by This email address is being protected from spambots. You need JavaScript enabled to view it..