Our ability to improve the lives of people in the community has become routinely bureaucratised. It’s no wonder social work professionals are demoralised, and our workforce retention crisis persists.
Since its enactment, we’ve heard the Care Act referred to as probably the biggest change in social care since the welfare reform. To some extent, the statement has an element of truth, but sadly not the whole truth. In revisiting the Act’s ambitions and provisions at its ten-year anniversary, we have a unique opportunity to reflect on its overall impact, especially how much we’ve achieved and what remains unfinished business for future reforms.
The reflections here represent the individual views of a policy researcher (DR) and social care improvement lead (CC) from the Social Care Institute for Excellence (SCIE). Our thoughts traverse two worlds, that of policymakers seeking to create the framework and conditions for better care and the practical world of care delivery. Each vantage point offers different complexities and priorities. Both of us believe the lived experiences of people drawing on care and their carers remain the best lenses for evaluating the Act’s achievements.
In that respect, rarely does a piece of legislation disrupt the construct of public services like the Care Act of 2014.
The radical ambition deeply ingrained in the Act set out the concept of personal wellbeing. This shifted the ambition for social care away from fulfilling needs with services to supporting people to lead independent lives by enabling personal choices and control. As a laudable ambition, the concept remains a cornerstone for both recent and future policy reforms and standards for good practice.
The spirit and ethos of the Care Act uniquely combined years of experience and good practice in social care and established the clear objective of embedding person-centred and strengths-based practice. The Act set out this ambition for all areas of social care, including children’s services, and like the best Swiss clock, defined how they should work to deliver better outcomes for people in the community.
Through adopting good practice in social care, the bar was set high for what good looks like. This did not limit the Act’s scope to service provision but extended to ‘meeting needs in a way that considers personal outcomes’. A holistic approach was also applied to unpaid carers. Not only was their vital role to the care system acknowledged, but the Care Act established a statutory requirement to assess and meet their needs as well.
The Care Act 2014 included the concept of co-production in its statutory guidance and suggested that co-production should be a key part of its implementation. Consequently, one of the most significant changes over the past ten years has been the adoption of co-production principles and practices across the social care sector. Despite growth in understanding of co-production, the care system still struggles to support and promote individual wellbeing.
Findings from SCIE’s survey research in 2023, ‘Experiences and Understandings of Co-production in Adult Social Care’, suggest one reason may be that senior leaders with the least exposure to frontline working had a much better knowledge of co-production (95 per cent familiarity) than those working in direct care delivery (41 per cent familiarity). We also found that the way social care is organised and delivered present barriers to co-production. Social care staff in our survey reported co-production was hindered by time (reported by 47 per cent), organisational culture (31 per cent), cost (26 per cent) and communication (25 per cent). Survey respondents expressed concerns about the inclusiveness and representativeness of current co-production and stressed the importance of extending participation in co-production beyond the ‘familiar voices’.
We recognise that the Care Act did not lead to the structural reforms required to achieve its ambitions. Other contributors to this compendium will no doubt comment in detail on the failure of successive governments since the Care Act – and even before – to tackle the fundamental societal problem of rising demand for social care and support and insufficient resources to meet people’s needs. We simply cannot ignore the effects of our ageing society, especially as people’s care needs are expected to continue rising (Chief Medical Officer’s Annual Report 2023).
From our perspective, the lack of political will to tackle how social care is funded and describe what people can expect as support remains the biggest disappointment. Practically speaking, these circumstances meant implementation of the Care Act’s provisions was unfeasible. The timescales were also unrealistic. The response from local government illustrates well the conundrum of mandating changes without sufficient time and resources to deliver them.
Through supporting the Care Act’s implementation, we observed many councils dividing the responsibilities across different departments, rather than aligning to the Act ethos and bringing together all areas of social care. This approach contributed further to the system’s fragmentation and navigation problems. Losing the benefit of holistic, whole system thinking limited the strengths-based ways of working that underpin the Act.
Years of austerity and budget pressures have reduced councils’ ability to comply with the ethos and spirit of the law, and increasingly to its letter.
Recent experiences of people who draw on care illustrate increasing frustration with accessing services, ongoing inequalities in care experiences and unfulfilled promises for personalised choices and leading independent lives. The reality of struggles with budgets and workforce mean some provisions of the Care Act have evolved into lesser versions. For examples, “accessible information and advice and guidance” has become “signposting”; “prevention” has become “signposting, provision of equipment and assistive technology”; and the duty to carry out a care assessment has led to self-assessment, screening and signposting.
These compromises suggest our progress is stuck.
Our ability to improve the lives of people in the community has become routinely bureaucratised. It’s no wonder social work professionals are demoralised, and our workforce retention crisis persists.
Hearkening back to the original concepts of the Care Act, we propose a strong case for reclaiming and promoting social work as the powerful and important profession that it is, trusting and empowering staff to use their judgement rather than complete tasks. In addition, we support working with sector partners to shape a new narrative for social care, one that promotes the values of caring and its assets to society at large (for example the Time to Act and Social Care Future campaigns).
Thinking about how people wish to lead their lives, we also believe how we conceptualise social care in the future ought to include the role of housing in care and support, particularly in regards prevention. Housing is one area overlooked by the Care Act, and the Act’s prevention provisions have been largely unrealised. We recognised this, and during 2021, SCIE led a commission on the role of housing and the future of care and support. The commission made recommendations for how better housing and different housing options could help people both live safely at home as long as possible and stay connected with their family, friends and communities. Many of these recommendations included preventative interventions and innovations in early support.
“Housing with care” policies hold great potential for developing new models of care and introducing digital innovation. In some respects, the UK government has enthusiastically grasped these opportunities. The SCIE commission’s research findings and recommendations have contributed to the government’s Task Force on Older People’s Housing, which will report its own recommendations later this year. The government also recently launched a £42.6 million investment programme in social care innovation, which includes several innovations involving housing.
The focus on housing is not unique. Our colleagues in the Netherlands are pursuing a similar vision as official government policy, and they recently launched a campaign aimed at preparing people for living longer and age in place. Their approach re-balances the rights and responsibilities for care between individuals, their families and the state: “self if you can, at home if you can, and digitally if you can” (the Dutch WOZO programme). Considerable public dialogue would be required were the UK to move in a similar direction.
From people’s varied experiences and our own research evidence, we know the Care Act wasn’t perfect. Neither would we throw the proverbial baby out with the bathwater. The Act’s ambitious provisions continue to provide a useful framework for social care policymakers and practitioners. Emerging policy ideas, innovation and grassroots campaigns keep us optimistic for a better future. Building on the Care Act’s core ethos, the pursuit of a fair and equitable social care system remains our North Star at SCIE.
About the authors: Carmen Colomina is a social worker and social care improvement lead who has supported local leaders to implement the Care Act 2014 since October 2013, starting in local government and more recently at SCIE. Deborah Rozansky is SCIE’s director of policy, research and information since 2021, and previously she worked as a consultant focused on improving health and social care policy and practice, including the Better Care Fund.
