Jacob Lant: Chief Executive, National Voices

Right reforms, wrong resource

The Care Act is a beautiful piece of law. Certainly from the point of view of those receiving care, it established in legislation some important principles which campaigners had been pushing on for many years. 

For example, putting the person at the centre of the care process was seen as the core idea behind the Act. Indeed, it was seen as a key way to drive reform of the sector by putting people in control. 

Delivering personalisation 

As part of this, the Act aimed to ensure people have good access to information and advice about their care options. It also guaranteed a social care assessment for anyone who needs it, regardless of their finances. And where care plans and packages are put in place by a council, there is a commitment to regularly reviewing and updating those plans to ensure people’s needs are properly met over time. 

The Act also extended the use of personal budgets and direct payments, giving in theory people receiving care ultimate control over how the resources available should be spent. 

Lastly, the Care Act also gave proper legislative recognition of the role unpaid family carers play. It acknowledged the need for carers to be involved in decisions, and for support to be made available to them as well as those they are caring for. 

These are all things that National Voices, as the largest coalition of health and care charities in England, wholeheartedly supports. In everything we do, we put people in the driving seat. Working with them, we come up with solutions together that can help improve the way policy makers and professionals design and deliver services. So, to have a social care system built on this same principle is a big step.

A lesson for the next Government 

I want to acknowledge for a moment the responsible Minister at the time, Norman Lamb, as well as the civil servants and the local government contributors who worked on the Act. They put in place the foundation for a much brighter future for social care. It certainly was a piece of legislation that felt like users, carers and the VCSE organisations supporting them were genuinely able to shape. It certainly felt like a more collaborative effort than either the 2012 or 2022 Health and Care Acts. Any incoming government should take note of how this approach to reform built such a broad consensus of support. 

Reality check 

But the fundamental problem with the Care Act is that since it was given Royal Assent it has been completely divorced from the reality of the resources. 

A “government spokesperson” is likely to overlook that last statement and say something like “we are spending more on social care than ever before”. In the case of social care, councils are actually spending £2.7 billion more in real terms than they spent in 2010/11. However, this is set against an 11 per cent rise in requests for support since 2015/16, with the unit cost of home care going up by 17 per cent in real terms in the same timeframe. 

In layman’s terms, we have more people seeking help and the help is costing more. Any budget increases have been swallowed by this. It’s therefore not surprising that the British Social Attitudes survey has recorded that satisfaction with social care support has fallen from 31 per cent very or quite satisfied in 2014, to just 14 per cent in 2023. 

Progress on the principles 

Let’s look again at the principles in the Act that were designed to improve personalisation, but where the lack of resource has limited progress. 

Providing good information and advice

A 2017 survey by TLAP showed that 51 per cent of people found it quite or very difficult to find information about social care support. And in 2022, research I led in my time at Healthwatch England showed 42 per cent of those in need of social care support approach their GP as the first port of call, with just 15 per cent saying they turned to their council. 

It is clear that resources have limited how much council can promote their role in providing information and advice about social care. This is in part because there is no resource for communication campaigns, but also because councils are already struggling to meet existing demand and are unlikely to be able to cope with the additional case work this would generate. 

Guaranteed assessments 

A survey by the Association of Directors of Adult Social Services in autumn 2023 suggested that there are nearly 250,000 people still on waiting lists for an assessment. However, clearing the waiting list is a challenge as social care is continually under pressure to prioritise assessments for those awaiting discharge from hospital because of the bed permacrisis in the NHS. 

This is not a new phenomenon created by the pandemic. A backlog of assessments was starting to grow before 2020, with average waits at the time sitting at about 2 months. However, the problem with any sort of time delay is that people are not proactive about seeking help, they often wait until they have hit a crisis. So, any delay in carrying out an assessment can have serious consequences.

Direct payments  

Extending this policy under the Act was a key pillar of putting people in control. However, the number of people using direct payments has actually fallen since 2015/16 by about 8 per cent. 

The King’s Fund venture some explanations for this in their Social Care 360 report. They suggest it may be because direct payments require more involvement and responsibility, and people need support to manage this. It may also be that the limited choice of services on which to spend direct payments, because of wider issues with the social care market, that people may wonder whether it is worth taking on the extra work. 

Whatever the reason, only a quarter of people in receipt of social care are accessing it through a direct payment. 

Some solutions

With politicians of all persuasions seemingly unwilling to address the resource challenge, over the near future we are going to have to look to each other to make progress in implementing the Care Act. 

This is where I see even more importance for the relationship between local councils and the VCSE sector. Through working even more closely together we can:

• continue to help councils understand how they work in coproduction with their local populations to design services that work for people.
• join up how we promote information and advice about social care and set up ways of referring people through to their local council more efficiently. 
• be more responsive to people awaiting assessments and make sure interim support is made available to help in the meantime. 
• provide support to help people understand the benefits of direct payments and how best to use them. 

This work doesn’t come free. And it requires councils and VCSE organisations to continue to understand our strategic and intertwined relationship in this space. But get this right and with modest investment we could create some flexible local responses that make the social care offer more proactive, easier to understand and simpler to navigate. Ultimately this would be a big step towards achieving the vision set out in the Care Act.