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The Care Act 2014 is as relevant today as it was back in 2014. Unfortunately, the experience of millions of people in need of social care, their unpaid carers and care workers, bears little resemblance to the vision set out in legislation. The Care and Support Alliance represents over 60 of England’s leading charities campaigning for a properly funded care system.
We’ve been working on a set of outcomes for social care which for us capture the gaps in implementing the Care Act. One of these speaks for itself, [that]:
National legislation (Care Act 2014) and guidance is properly adhered to, implemented and promoted throughout England, compliance is robustly monitored, people’s existing rights are upheld, and an effective system of recourse is in place for service users when the system fails to meet their needs.
There’s no need to reinvent the wheel. The Care Act was and remains a clear and compelling statement of what social care should look like today.
The other outcomes that follow are grounded in that legislation and need to become a reality.
Everyone, no matter who they are, gets the care and support they need, when they need it, so they can have the best quality of life possible and lead independent and fulfilling lives.
Millions of older and disabled people are unable to get the care they need because they are waiting for an assessment, they don’t meet increasingly high thresholds for getting support, or because they cannot find a paid carer to provide the care they need[1]. While requests for care have increased significantly, the number of people receiving long-term care has fallen to 835,000 in 2022/23, a 38,000 drop from 2015/16[2]. The voluntary, community and social enterprises sector have an important role to play in providing some lower level, but hugely impactful, support to people where there is such a high bar for state support.
All people who use social care have access to quality, accessible and clear information and barrier-free advocacy support that helps and empowers them to navigate the social care system.
People who need care, and their unpaid carers, should have genuine choice and control about their care so that it best meets their needs and aspirations. Social care should be person-centred.
These were principles established by the Care Act: a significant shift in the focus for councils from providing services to meeting people’s needs. ADASS have found[3] that two in five (39 per cent) directors report that there is limited availability of timely information, advice and support to help people to make choices about their care. Even for those of us working in the sector, navigating the system can be baffling.
We need to do better in giving people the tools they need to make decisions about their care, not only to uphold their dignity, but also to support better individual and system outcomes.
Working in social care is a valued career. People accessing care are supported by well-trained, compassionate and well-paid care staff whose skill and dedication is properly recognised and valued.
Care is a people business. There are currently 152,000 vacancies in social care and a vacancy rate of 9.9 per cent[4]. Many people leave a job they love to work in the NHS or the retail sector for better pay and terms and conditions. As a result, it is increasingly difficult for people to access the care they need and the quality of care for those who do receive it isn’t always as good as it should be, despite the best efforts of dedicated and skilled care workers. The workforce needs investment, recognition and value commensurate with the critical service it provides.
Funding for social care is sufficient, sustainable, and well planned to ensure all people – including older and working-age disabled adults – can access the support they need.
Without a sustainable income the system will continue to fail. The Health Foundation[4] estimates that in future spending on social care will need to rise by £8.3bn by 2032/33 just to keep pace with projected demand, based on current levels of provision. The Health and Social Care Levy proposed by the Government in 2021 would have gone a long way to providing appropriate and sustainable funding for the sector. We are now living with the consequences of the decision to abandon the levy which impacts not only people who need care, their carers and their friends and family, but also other public services, notably the NHS.
Those caring for a family member or friend are properly supported to undertake their unpaid caring responsibilities, ensuring they can access the breaks, assessments and support they need to live a life beyond caring, and juggle caring alongside paid employment.
According to the 2021 census, there are 5 million unpaid carers across the UK, although the actual figure is believed to be much higher. The number of carers receiving support has not increased since 2015/16 and fewer of them now receive paid support such as cash payments[5]. Many have no choice but to reduce or give up paid employment entirely. As well as being disastrous for families, it has a significant economic impact as employers shoulder the cost of lost productivity.
Social care is viewed as a valued part of the national infrastructure and has parity of esteem with the NHS to help deliver integrated care, including equal involvement in local funding decisions and priority-setting.
Social care remains poorly understood and the poor cousin of the NHS.
The recent Health and Care Act formalised membership of integrated care systems to include council and VCSE organisations in integrated care partnership. This is a good start, but the impact is limited by many of the formal accountabilities resting with the NHS-centric Integrated Care Boards. There is scope to give a real voice to social care through the partnerships but little evidence to date of this being realised.
The 2014 Care Act was heralded as the most significant reform of social care legislation for 60 years. The reality, ten years on, is that social care is still in desperate need of sustainable funding and significant reform. The legislation is an important starting point, but we all still have some way to go in turning legislation into a lived reality.
