The potential of adult social care under the Care Act is not always realised. The ambition for a collaborative approach to personalised care and support designed by the individual, and the potential for social work as a means of addressing discrimination and challenging societal attitudes, is often a missed opportunity.
The universal nature of Care Act duties, in particular the power of advising guiding safeguarding and connecting people with solutions was never given sufficient prominence. There was always a strong perception that social care was only for ‘some people’. This, combined with the changing landscape of health and social care, means the sector has had to adapt to many challenges and changes.
Enacted during a time of national public spending constraint, achieving the aims of this progressive legislation was always going to rely on innovation.
The fundamentals of our regulatory approach remain unchanged since the Act’s introduction; it was, and still is, about people receiving care and support personalised to their individual needs, provided and funded in a range of ways.
As the independent regulator of health and social care, we are here to ensure people have safe, high-quality care. Our single assessment framework illustrates what ‘good’ looks like, encouraging care services to improve and holding them to account."
Our annual State of Care reports continue to highlight the challenges for people drawing on support, family carers, care providers and care leaders which threaten the stability and quality of services. We have spoken of the opportunities lost through a lack of preventative approaches and the need to tackle health inequalities that continue to persist, particularly for people with protected characteristics.
Through our work, we have been able to show the relative failure to integrate health and care services, with care services in many cases remaining an unequal partner. Here, the impact is felt most acutely by people receiving care, including people with mental health needs, a learning disability and autistic people, and people living with dementia.
The Care Act envisaged a functioning care market, with regular market position statements that outline what is needed for a healthy, diverse, sustainable market to deliver good quality, person-centred care. We’ve seen some great examples of innovative models of support that are highly personalised and bespoke, but these appear in pockets, with traditional forms of support still appearing to remain dominant. We continue to see greater fragility in adult social care, with greater inequality around access.
Against these challenging conditions, councils are trying to tackle workforce problems including recruitment and retention challenges, and some adult social care providers struggling to pay their staff a wage in line with inflation. All while planning for increased demand for services for people whose needs are more complex to meet, addressing gaps and planning for the future.
Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need. Family carers, including many unpaid carers, are a critical part of all local care systems but are not always getting their needs assessed and provided with support they need.
Councils need to demonstrate an understanding and preparedness for the changing and complex needs of local populations, to ensure they are delivering on the aspirations in the Care Act both now and in the future.
The NHS and social care are two halves of a whole, often providing support for the same person trying to navigate their way through a complicated system. Over the last 10 years we’ve seen some improvement in the priority and value given to adult social care, on a hopeful trajectory toward parity of esteem with health care, but there is still a long way to go.
The enactment of the Care Act coincided with the cessation of inspection and annual review of adult social services. Since then, sector led improvement has been a valuable tool for councils to lead their own improvement. Our assessments of council’s delivery of their Care Act duties will provide the evidence base to further drive improvement in the way care is funded, commissioned and delivered. Together with our assessments of integrated care systems and providers, we’ll showcase opportunities for the whole sector to improve, encourage collaboration across all parts of the system to address issues, and promote the need for national reform.
With council budgets failing to keep pace with rising costs and increases in numbers of people needing care, risks of ‘unfair care’ are elevated. Investment and reform must work effectively hand-in-hand to transform adult social care so that it can carry out its essential role of enhancing the health, wellbeing and experiences of people using services in their communities. Planning care for people with increasingly complex needs will require significant market investment to provide extra care housing, supported living and suitable community housing, as well as homecare services. Social work, alongside social care, needs to have enhanced status within integrated systems. Systems need to think about improved housing and technology as equal solutions to promoting independence.
For future social care funding to have a long-lasting impact, it must tackle the systemic problems that all social care partners are faced with. This includes stronger workforce planning where social care is an equal partner, offering staff better pay, rewards and training linked to career progression. All this must be rooted in the belief that social care is a respected and sustainable career. We see through our regulation how services that successfully develop career progression and training for staff have higher retention rates.
Under our Market Oversight scheme, introduced under the Care Act, we monitor a snapshot of a section of the adult social care market. In the last year, we have seen a greater proportion of care home fees have been privately funded. When there is less access to state-funded care, there’s a greater risk of inequality and people could become more reliant on friends, family and voluntary organisations for support.
Since commencing the scheme in 2015, the way that adult social care providers operate has continued to change. Whilst the largest operators are captured within the entry criteria for the scheme, we would support updates to the scheme that, along with our assessments of councils and ICSs, will allow us to offer a more joined up view of the market across health and social care.
There are of course many other areas in need of reform which impact on the delivery of the Care Act, such as important reforms to the Mental Health Act. Problems with the current Deprivation of Liberty Safeguards (DoLS) system have left many people who are in vulnerable circumstances without legal protection for extended periods, and delays in implementing the Liberty Protection Safeguards mean these challenges will continue.
As the independent regulator we’ll continue to ensure our regulation is driven by what matters to people, and to local communities, when they access, use and move between services. Importantly, we’ll use our unique position to spotlight priority areas and help drive improvements across individual services and systems of care.
