The Care Act 2014 will not help vulnerable adults and their carers if the government persists in cutting local authority funding
The Care Act 2014 (CA) was supposed to usher in a new era of rights to protect vulnerable adults and their carers, but there is a mismatch between the legislation and the increasingly threadbare public services that are supposed to implement it.
Community care law specialists are familiar with having to navigate the opaque boundary between health services provided by the NHS and care services provided by local authorities (LAs). Disputes over whether a patient has health or care needs are commonplace. The CA was supposed to impose some order on the fragmented and confusing social care system. From April 2015, the Act introduced a duty on LAs to assess the care needs of vulnerable adults and the support needs of their carers. For many people, if they fall the other side of the medical needs boundary and are assessed as having care needs, this means they will have to pay. A recent report from the King’s Fund and the Nuffield Trust (Social care for older people: home truths
, September 2016) found that six consecutive years of cuts mean that 26 per cent fewer people are getting help from the state for care needs.
Fundamentally, the problem is that there is not enough cash in the system. Some LAs even struggle to meet their obligation to provide the assessments, as there is a shortage of social workers with the necessary skills. While central government has placed the assessments and other obligations on LAs, it is also pursuing a policy of draconian cuts to local government finance. The main income from central government to LAs, the revenue support grant, is being tapered out and this has led to over 40 per cent budget reductions for many councils. It is the poorest, mainly Labour-controlled ones that have been hit hardest, but the protests have cut across party lines.
Conservative councillor Cecilia Motley, chair of the Rural Services Network, an organisation representing around 150 LAs, denounced the financial settlement for local government announced at the end of last year as a ‘horrible miscalculation’. East Sussex County Council, which has always been Conservative-led, has been equally outspoken. Like a number of Tory authorities, it is arguing that the cuts imposed by the government are having a detrimental impact on its most vulnerable residents. In a letter to the prime minister earlier this year
, the leader of the council said that its services were feeling the strain due to an ageing population (the number of over 85s in the county is set to increase by 7.5 per cent over the next three years).
Ministers intended the CA to tackle the issue of care needs and the elderly by implementing the recommendations of the Commission on Funding of Care and Support (the Dilnot Commission), which centred on making more people eligible for public funding (Fairer care funding: the report of the Commission on Funding of Care and Support
, Department of Health, July 2011). The Act includes provisions for a lifetime cap on funding care costs, which the government has announced will be £72,000, and a more generous means test that raises the upper limit on savings to be eligible for councils to contribute to care costs, which the government has announced will be raised from £23,250 to £118,000.1The Dilnot Commission recommended a lifetime cap on contributions to social care of £35,000 and an upper limit on capital assets and savings of £100,000.
These measures were originally planned to be implemented this year, but have been delayed to April 2020.
Despite the 2011 census showing an increase of 11 per cent from 2001 in the number of over-65s in the UK, in England and Wales there was only a 0.3 per cent rise in the number of people residing in residential care homes in the same period. This could be due in part to improvements in health, but a greater part of the explanation, we believe, lies with the lack of affordable care.
In Leeds, campaigners are currently fighting the proposed closure of The Green, a home that provides care to vulnerable elderly people. What is happening in Leeds is typical of the sorts of local battles being fought up and down the country, often with the aid of lawyers bringing legal action, as councils look to save cash by closing residential homes. Services in the private sector are also being squeezed by spending cuts as LAs look to reduce what they pay for residents eligible for support. A two-tier system is emerging in which private care homes in richer areas concentrate on providing places for self-funding residents, while those in poorer areas are forced to close.
Due to economic policies pursued with wanton disregard for the human consequences, an army of carers is having to deal with the fallout of an ageing population and the state’s withdrawal from providing services to the most vulnerable. According to the census data, between 2001 and 2011 there was an increase in the number of unpaid carers in England and Wales of 600,000. The implementation of the CA provisions on the eligibility criteria for services paid for by councils would go a long way to providing the cash to assist elderly and other vulnerable adults. The problem is that by 2020 there might be precious few services left to take advantage of it.