Caring for our future; shared ambitions for care and support

Last month the Department of Health announced that it intended to ‘co-produce’ the proposed social care reform white paper. This month, on the 15th of September it has launched an ‘engagement’, entitled ‘Caring for our future; shared ambitions for care and support’ which is intended as the first step toward making good on this commitment.

The content of the engagement reveals that the scope of reform is meant to go well beyond responding to the proposals of the Dilnot Commission on long term care funding or the Law Commission review of adult social care law.  However the government does ask for people’s views on the recommendations of the Law Commission and the Dilnot Commission ‘and on ‘how we should assess these proposals, including in relation to other potential priorities for improvement’.  So the DH is still thinking about the extent to which they intend to implement the proposals of the two commissions.

The engagement focuses on six key areas. These are;

  • quality – including improving quality and developing the future workforce;
  • personalisation – giving people more choice and control and helping them to make informed decisions;
  • shaping local care services in order to ensure a wide range of innovative and responsive services;
  • prevention and early intervention;
  • integration, in particular better connections between the NHS and local services; and
  • the role of financial services.

The engagement runs for three months. There will be a series of events and meetings which will be attended by six ‘discussion leaders’ drawn from the ‘care and support community’ – one for each of the six key areas. The discussion leaders come from a variety of backgrounds representing service providers, local authorities and the NHS. Jeremy Hughes from the Alzheimer’s Society and Imelda Redmond from Carers UK represent service users and carers. There will also be a web based feedback form that people can use to respond directly. This can be found at Written comments must be sent to the Department of Health by December 2nd.

Find out more about our Care in Crisis campaign

Care Quality Commission Annual Report

The Care Quality Commission has published its annual report on the state of health and adult social care in England. This report is different in format from it’s two predecessors as a result of being  produced under the  new regulatory system brought in by the 2008 Health and Social Care Act.

It therefore looks at whether services comply with the essential standards of safety and quality bought in by the act, rather than the old minimum standards.  Introduction of the new system means that CQC has only been compiling data on compliance by social care providers for 6 months.

Also, as the Health Select Committee report published yesterday points out, there has been a dramatic drop in the number of inspections of social care services carried out.

Some of CQC’s findings are alarming and show low rates of compliance with the essential standards, particularly by nursing homes and by NHS hospitals. Under outcome 4 – which requires that people experience ‘effective, safe and appropriate care, treatment and support that meets their needs and protects their rights’, only 51% of nursing homes an NHS hospitals are compliant.

They  also lag behind  on outcome 9, management of medicines,  where they both achieve just over 60% compliance, on outcome 16, management of risks to health, welfare and safety, and outcome 7, safeguarding.

The CQC is also planning to launch a new website which will make it easy for people who are looking for a service to see why services have been rated as non compliant.

Find out more about care on the Age UK website



Care Quality Commission under-resourced

The publication of the Health Select Committee report today backs up our belief that that Care Quality Commission needs more resources to undertake inspections. The committee reported that the focus on registering providers had taken away resources from its core function of inspection. This led to a huge 70% fall in the number of inspections in the second half of 2010-2011. MPs stated that the priorities and objectives of the health and social care regulator were not clear and the system for registering new providers was not thoroughly tested before being rolled out.

The role of the Care Quality Commission is to support the most vulnerable; the significant drop in inspections is therefore of grave concern. In 2010/11 just 3,805 inspections took place in adult care homes comparison to 10,856 in 2009/10. MPs highlighted that these failings were not adequately brought to the attention of ministers.

The only way the health regulator can provide better monitoring and regulation is to have more resources, yet their budget has been reduced by 30%. We are calling for yearly inspections to safeguard the quality of care for of older people in hospitals and care homes across the country. The challenge now for the Government and the Care Quality Commission is to work together to ensure this takes place and that they have the funding to do so.

Find out more about our Care in Crisis campaign


When is a care review an assessment?

Last Thursday four disability groups demonstrated at Kensington Town Hall in support of Elaine MacDonald. Ms MacDonald has recently, following a Supreme Court judgment, been told that the local authority is entitled to withdraw her night time care and to require her to wear incontinence pads even though she is not incontinent.

The four groups have raised some important concerns about the review process that led to the withdrawal of Ms. MacDonald’s services. A leaflet for the demonstration says ‘the ruling has accepted that reviewing care plans can be treated as a reassessment of need. Therefore any contact with social services, even a phone call, could lead to detrimental changes to a disabled person’s care package’.

This is indeed an issue. One of the five Supreme Court judges, Lord Kerr, concluded that, even though although two reviews of Ms MacDonald’s care were not intended to be reassessments, they yielded sufficient information to enable the council to legitimately change the way that it met her needs.

Obviously if this was correct it would have a knock-on effect in that if the local authority was not intending to assess the person’s needs they would not tell the person that they were being assessed. The fears expressed by the four disability groups therefore seem well justified.

Age UK was also concerned about the review process in this case, as it falls short of being a decent assessment of need in one crucial respect. Ms MacDonald’s original assessment follows the guidance (Fair Access to Care Services as it was then) by setting out risks to independence and what services are needed to reduce these risks.

However the subsequent review just recorded that Ms MacDonald’s needs continued to be critical and substantial but did not analyse why. The local authority subsequently reached the conclusion that the ‘underlying need’ was to keep Ms. MacDonald safe – which resulted in other needs identified by the initial assessment – such as psychological wellbeing – being seen as of secondary importance.

If the review had done what the initial assessment had done and set out the reasons that care was being provided it is quite possible Ms. MacDonald would have been able to use this to challenge the idea that her need was simply to be kept safe. Continue reading “When is a care review an assessment?”

After Southern Cross, what next?

Britain’s largest care home provider, Southern Cross, finally appears to have reached the end of the road. This should not, we hope, result in many home closures, as the landlords from whom Southern Cross rents its properties are taking possession of the homes. They should in most cases continue to run them.

In many cases residents might be better off than before since new owners may have better access to funds to invest in the homes.

For anyone who is worried about the future of one of these homes, we have some helpful information and advice. You can also call Age UK’s free information line on 0800 169 65 65.

So how on earth did we get into this mess, and how will we stop it happening again? Continue reading “After Southern Cross, what next?”

A new legal framework for social care; the Law Commission reports

The Law Commission review of adult social care law has completed its work and has published proposals for comprehensive new social care legislation. It would be an understatement to call these proposals ‘long awaited’. The Law Commission has been working on them since 2008, but on a longer timescale it has been apparent for many years that community care law,  made up of over sixty years’ worth of legislation and case law, is a complete shambles. The Law Commission notes that ‘piecemeal’, ‘exceptionally tortuous’, ‘labyrinthine’, and ‘the worst drafted subordinate legislation ever encountered’ are just some of the descriptions that Judges have used in referring to various components of the legal system.

The brief of the Law Commission has been to consolidate, rather than radically reform the law. This was always going to be a challenge. Decisions have to be made about what to do where current law is confused, contradictory or fudged, and there are differing views of how social care law should develop in the future. Even basic definitions such as ‘social care’ and  ‘adults at risk of abuse’ can be hotly contested. On top of this, in the current political climate the very idea that the work of local authorities should be constrained by legislation is under challenge.

The Law Commission has taken the view that its role is not to take sides but to make recommendations for a new statute which will be robust and flexible enough to accommodate different policies. The Law Commission has not, as is usually the case with reviews of this kind, produced draft legislation, so the new report marks the conclusion of the review. This  is attributed mainly to the fact that, in response to a request from the government, the review has had to conclude a year earlier than expected. This is so that its conclusions can be brought together with those of the Dilnot Commission on long term care funding in order to inform a single parliamentary bill in 2012.

In practice the Law Commission is proposing some significant changes, so  the importance of the commission’s proposals  should not, be underestimated.

Really significant new proposals include;

  • The legislation would set out overall principles which should be used to interpret more detailed legislation
  • A national framework for eligibility would (unlike current guidance) ‘stipulate basic minimum entitlements to services’
  • Local Authorities would have a duty to asses the needs of carers and would have a duty (rather than, as at present, a power) to meet carers’ eligible needs.
  • People should be able to use direct payments to purchase residential care;
  • Local authorities will be able to delegate aspects of the assessment process to other organisations – but the local authority must ‘retain overall control of the process’
  • Local Authorities should be required to do more to enable people with care needs to move from one local authority to another
  • The role of social services in leading and co-ordinating safeguarding of adults who are at risk of abuse or neglect should be set out in legislation rather than, as at present, left to guidance

Perhaps as significant as the new legislation, however, would be measures to make existing rights and entitlements clearer. The overall structure of the law would be simpler, with different roles allocated to legislation, regulations and guidance. Guidance in particular would be simplified. At the moment, as the Commission points out, there is a ‘range of disparate and unconnected pieces of statutory and practice guidance’. These should ideally all be consolidated into a single document, and if multiple documents are issued they should at least be available in a single location and presented as a coherent whole. The Commission notes that at present there is considerable confusion about the status of guidance and of policy documents such as ‘Putting People First’. The purpose of guidance, the commission notes, should be ‘to guide social services authorities on the exercise of their functions under the statute’. Guidance should ‘not extend to policy exhortations or vague statements about the ‘direction of travel’ of social services functions’. Continue reading “A new legal framework for social care; the Law Commission reports”

Changing the social care landscape

It would probably be fair to describe the current crisis in social care as cataclysmic. Local authorities throughout the country are proposing unprecedented cuts to services, along with tightening of eligibility criteria and increasing charges. On top of this two separate commissions are due to report back this year with proposals for wholesale change to the social care system. These are the ‘Dilnot’ Commission, set up to recommend new ways of paying for adult social care system, and the Law Commission review of Adult Social Care Law.

At first sight the Law Commission would seem to be the least radical of these forces for change. Its brief is to consolidate existing legislation rather than to change it, and the consultation proposals published last year were mainly about retaining the existing rights of people who need care and support. The proposals do however involve significant changes in order to ensure that the legislative framework supports personalisation. They also include a substantial section on the role of local authorities in safeguarding adults who are at risk of abuse – something which has hitherto been left mainly to guidance.

The Dilnot Commission, in contrast, has been told to explore all options and to come up with radical proposals. The commission will however be constrained in how radical it can be by the need to comply with the present legal framework. The Government could, of course, sweep the entire body of current legislation away, but at the moment the Department of Health appears to be broadly supportive of the Law Commission’s proposals.

So is the relationship between the two commissions one in which the radicalism of the Dilnot Commission will be limited by the Law Commission’s dogged defence of something like the status quo? Well, I don’t think so, for two reasons. Continue reading “Changing the social care landscape”