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The Care Act 20 years on – Has it fulfilled expectations for carers or is it still a work in progress?
Writing in 2014, Dame Philippa Russell said, “The Care Act in many respects marks a quiet revolution in our attitudes towards and our expectations of carers. At last carers will be given the same recognition, respect and parity of esteem as those they support. Historically carers have felt that their roles and their own well-being have been under-valued and under-appreciated. Now we have a once in a lifetime opportunity to truly recognise and value us as expert partners in care.”
Ten years on, it remains true that the Care Act 2014 was a significant piece of legislation for us within the carers’ movement. Most of our rights have been hard won, through Private Members’ Bills and not in mainstream legislation brought forward by Government. Consolidating the rights of 4 million carers in England within a major piece of primary legislation, giving carers’ parity of esteem, was significant both symbolically and practically.
Key provisions in the Act have helped to recognise carers’ role and their own needs, new areas such as employment and digital have broadened potential support, but the Act’s potential has been severely limited by funding restrictions."
More carers than ever before are providing over 50 hours of care per week – say they feel exhausted and that their own physical and mental health and wellbeing are significantly affected. We need sustainable funding for social care and gaps in the law to be plugged to improve carers’ lives and fulfil the real aims of the Care Act 2014.
Care Act introduces fundamental changes in the way that carers are regarded and involved.
Several of the Act’s provisions fit unpaid carers’ aspirations, to be in more positive health for longer, to manage care and aspects of their lives with the right support and to be seen as a partner in care. Carers are included in Section 1, the principle of wellbeing, Section 2 the duty to prevent, reduce or delay needs and the many provisions which embed involvement, consultation and engagement. Taken together, for the first time, these provisions recognised that unpaid carers are fundamental; that in providing £154 billion worth of care a year, they have a right to be engaged, involved, considered and supported.
Carers and work has become better recognised and will continue to grow
The last 10 years has seen a growth in visibility of working carers; vital given our ageing population. Local carers’ strategies often have sections looking at working carers’ needs and many councils now have carers’ networks and leave provisions to support their own workforce who are unpaid carers. If 1 in 3 workers in the NHS is an unpaid carer, we’d expect similarly high rates in local government and social care.
A staggering 600 people a day give up work to care and when they do so, it impacts their financial outlook significantly in the short and longer term. For some, an understanding employer, flexibility, Carer’s Leave and good service connections could make a difference between staying in and giving up work to care."
There is more potential for this area. Increasing numbers of council are members of the forum Employers for Carers and are undertaking the Carer Confident benchmark to measure their practice. Councils could continue to grow and develop support for their own workforce, encourage positive employment practice from care providers and key contractors. This approach would meet carers’ wishes to stay in work as long as possible. As well delivering on the core principles of the Care Act 2014, it makes economic sense as well.
The potential for data, technology and digital to deliver Care Act outcomes
Data, technology and digital have a bigger role in councils’ delivery of Care Act duties. Records integration can reduce the number of times that carers have to tell their story and accessing services at a time that suits them is important to ensure that they don’t miss out. Tech which gives people with care needs increased independence and choice can also give carers’ peace of mind. Whilst it’s vital to retain a mix of in-person services, technology has a greater role to play.
Four key areas need to be tackled to refresh, revitalise and fulfil the potential of the Care Act 2014
These four areas include the underfunding of social care, the lack of focus on the economic value of social care, the ongoing invisibility of unpaid carers and the lack of duties on the NHS towards carers.
The chronic underfunding and lack of sustainable funding for social care is placing ever increasing and intolerable pressure on families to provide frequently escalating levels of care, with disastrous consequences for their health, wellbeing, work and relationships. This runs counter to the whole basis of the Care Act 2014 meaning that the real potential of the law has not been realised.
Despite the increase in the numbers of unpaid carers providing very significant amounts of care, councils are finding more carers with complex and pressing needs requiring support, reductions in assessments and essential services for unpaid carers. Inflationary pressures on councils are being passed on to local services, which, in turn affects carers.
The underfunding of social care means that it is unable to work optimally and a service under pressure does not always have the space to learn, consider, reshape and innovate.
The economic value of social care and the Care Act needs to be counted
We need public policy and the Treasury to shift to a position where the economic value of social care is properly recognised. Care is fundamental for many carers and disabled people to be able to work. With a shrinking UK workforce, this makes economic sense as well as supporting families with vital services and creating jobs locally.
Section 5 of the Act sets out that councils have a responsibility to encourage sufficiency of supply for current and future demand for care services, and the importance of enabling people who need care services and carers to work if they wish to. Given the numbers of disabled people out of work and carers having to give up work every year, there is a real economic imperative for Treasury and government to act quickly.
Increasing the visibility of caring – by making it a protected characteristic
We need to also make unpaid caring better understood and valued in broader society; often small things can make a difference. Making caring a protected characteristic could help to create wider recognition and support for unpaid carers, by placing a duty on all public bodies to promote equality between carers and other groups, making sure that equality and diversity plans across the board consider caring.
Improving NHS legislation and responsibilities towards carers
We need the NHS to work better for carers.
When we look at the provisions within the Care Act 2014, the parity of esteem, the understanding of carers’ needs and wellbeing and the requirement for support to meet needs, we see how far the NHS falls short.
All carers have interaction with the NHS, and yet there is a patchwork of involvement and responsibilities which are poorly understood. If the NHS recognised and supported carers’ better as valued partners in care and improved their health and wellbeing, pressure on local authorities would be reduced and carers would have better outcomes.
