The care and support white paper and draft bill successfully set out a compelling vision for care and support in the 21st century. The draft bill provides a consolidated and modernised legal framework for adult social care replacing all existing legislation.
Personalisation and prevention which have been driven forward almost despite the legal framework will, in future, be supported and enabled by the legislation. The major themes of the white paper and the bill reflect well the major issues and themes that emerged during the engagement exercise, as well as during the debate in the run up to the Health and Social Care Act.
The proposed duty for local authorities to ensure people can access preventative services is welcome in principle. The embedding of wellbeing as a purpose within the bill provides a unifying purpose for the first time.
The current position is that the statutory duties of local authorities do not reflect the outcomes we all want to achieve. In fact, at present it seems it is no-one’s statutory duty to ensure that people are helped to be as well and as independent as they can be.
Rather, local authorities have duties to meet the needs of people above a certain threshold and the duties of health bodies tend to be concerned with access to services and availability of treatment free at the point of delivery.
What this can mean is that at times of budgetary constraint, local authorities looking at how to reduce spending can be forced to reduce areas of discretionary expenditure including preventative services. So the new duty should shift the balance of decision making, though, of course, there need to be sufficient resources to allow this to happen.
Focus on outcomes
Both the white paper and the draft billl are clear about the need to focus on the outcomes that people want: indeed the white paper is framed in a set of “I” statements. These statements set out clearly what everyone should have a right to expect in relation to their care and support from accessing information and advice through access to preventative services to choice and control in relation to care plans.
The reinforcement of the responsibility to integrate services where this will deliver better outcomes and/or better value for money sits well with the duty promote integration placed on various bodies, from health and wellbeing boards to Monitor, within the Health and Social Care Act.
Amongst the broad principles and expectations there are proposed solutions to a number of smaller yet significant issues. For example, there are proposals to amend the Ordinary Residence rules so that the responsibility for funding remains linked to the authority making the placement rather than potentially changing depending on the type of accommodation someone lives in.
So, while there is plenty of detail to analyse and much work to do to take forward some of the specific proposals, the framework is largely one we would sign up to. And then we have to consider the question of resources.
The funding question
ADASS was not expecting a full and final solution to either the proposals of the Dilnot Commission nor to the growing funding gap, knowing that the substance of the debate about this would have to take place as part of them next spending review.
We acknowledge the proposals to transfer some additional resources from the NHS to fund implementation costs and add to resources already being transferred. Yet in many places, savings that adult social care departments will have to achieve in the two years of the additional transfer will far outweigh the additional resources.
So the best hope again might be for fewer reductions or perhaps some investment in prevention if it can deliver reductions in on-going ependiture. Funding for extra care housing is acknowledged as well, yet will not go far relative the need for such investment.
Any additional resources are better than none but delivering against the ambitious vision in a meaningful way will need more than this. Our hope is that the government will now move swiftly to resolve the outstanding funding questions and we in the sector are more than ready to join them in taking this forward.