Service Provision – Social Care

The Care Bill 2014

Photo credit: John Curtis/Rex Features The Care Bill is currently passing through Parliament. You will find on overview of the Bill’s content on our webpage Service Provision – For Carers (together with a consideration of its implications for carers). The Bill, when enacted later this year, will be referred to as The Care Act 2014. We are pleased to note (27th Feb 2014) that an eminent specialist in the law and  learning disability will now be writing a series of  pieces on the new legislation in Community Care Online. We will publish them all here. In a series of pieces, legal trainer Belinda Schwehr will set out how the Care Act 2014 will affect practice. The first focuses on assessment and support planning. The first piece begins: The Care Bill has the potential to do some very interesting things to the customer’s journey within adult social care. Assessment is divided into three distinct stages. Firstly, identifying the needs; then deciding whether they are eligible social care needs, and lastly, the care planning stage, where the impact of one’s carer’s willing and able support will be deducted, the remainder of unmet needs costed and put into one’s personal budget for a commissioned package or a direct payment, or one’s individual care account (for self-funders over the savings threshold for funding subsidy). En route, the carer may well be provided with council funds to meet their own needs, related to the caring that they are going to continue, or start, to do. Reviews need only be done if the council thinks that the circumstances of the person have changed, or on reasonable request from service users, or their advocates. Advocates will play an increased role as sounding boards, given that a duty is imposed on councils to fund it for those who would struggle with the processes without such help – unless, that is, the person has someone else appropriate, and unpaid, to do it for them. Service users will be entitled to a copy of their assessment and care plan, with written reasons for any finding of ineligibility, regarding any item or service contended for. Comment The existing judicial review case law, which has shaped users’ rights and councils’ obligations to date, was supposed to be consolidated in the Care Bill. That that was the mission of the Law Commission’s 2008-11 review, after public consultation established that nobody wanted fewer rights for people with disabilities, or more discretion, if the legal framework was going to be modernised – the public just wanted it to be simpler and more accessible… Continued here.

Direct payments, personal budgets and individual budgets

A comprehensive, expert guide to direct payments, personal budgets and individual budgets was published in Community Care online on 6th August 2013. This offers a ‘good’ introduction to the ‘personalisation agenda’ which most carers, including family carers, will encounter. It explains phrases such as person centred planning, resource allocation system (RAS), and considers the intentions of the Care Bill 2013/14 and the Social Care (Self-Directed Support) Act 2013, including their implications for people in residential care. The guide contains a mass of factual information, data from recent surveys and and reports, and links to several other online articles and resources. The publication of this guide coincides with the publication of Community Care’s annual report ‘The state of personalisation 2013‘, based on interviews and surveys of social work professionals. The social workers’ own verdict on how well councils are equipping them to deliver personal budgets in ‘the age of austerity’ is not very encouraging for service users, with a majority seeing a widening gap between aspiration and reality: 84% agree that service users’ choice and control has been reduced in the last two years; 75% think the resource allocation systems are difficult for service users to understand; just 2% reported that service users and their families actually take the lead in support planning…

Winterbourne View

“… we have already found strong evidence that the health and care system is not meeting the needs of people with learning disabilities or autism and behaviour that challenges. There is a vast gap between policy and practice. This report sets out the actions that we are taking now to address the serious issues we have already identified” On 25th June 2012 the Department of Health published its Interim Report into the Winterbourne View Hospital case. The report, and it is safe to assume the final report when published, will have major implications for the families and carers of people with a learning disability, for how services are delivered and for how they are supervised and regulated. The full Interim Report is available here: The following is an extract from the report’s Executive Summary: 1. At any one time around 15,000 people in England have learning disabilities or autism and behaviour that challenges. Most of these people are supported by their family carers or live independently in the community, often with complex packages of support. But at any one time, around 1,200 of these people may be in hospital services for assessment and treatment. This review is about the quality of health and care services they receive. 2. This report does not cover what happened at Winterbourne View hospital as criminal proceedings are ongoing. We will publish a full report, including what happened at Winterbourne View, when criminal proceedings have concluded. However, we have already found strong evidence that the health and care system is not meeting the needs of people with learning disabilities or autism and behaviour that challenges. There is a vast gap between policy and practice. This report sets out the actions that we are taking now to address the serious issues we have already identified. 3. This report is based on:
  • the reports of the Care Quality Commission’s (CQC) focussed inspection of 150 hospitals and care homes for people with learning disabilities and the national summary report, published alongside this report;
  • widespread engagement with people with learning disabilities, people with autism, family carers voluntary groups, with health and care commissioners, providers and professionals, as well as the regulators; and other evidence submitted to the review team.
4. While only local action brings best practice, this report identifies 14 actions we will take at a national level so that the focus is on improving the lives of people with learning disabilities or autism and behaviour which challenges. 5. The main initial findings are:
  • Too many people are placed in in-patient services for assessment and treatment (A&T) and are staying there for too long.
  • This model of care goes against government policy and has no place in the 21st century. People should have access to the support and services they need locally – near to family and friends – so they can live fulfilling lives within the community.
  • Winterbourne View was an extreme example of abuse, but we have found evidence of poor quality of care, poor care planning, lack of meaningful activities to do in the day, and too much reliance on restraining people.
  • All parts of the system – those who commission care, those who provide care and individual staff, the regulators and government – have a duty to drive up standards. There should be zero tolerance of abuse.