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Greater focus on prevention and integration essential to improve Care & Support Bill, warn Peers and MPs

19 March 2013

A cross party group of MPs and Peers warns today that the Government has not fully thought through the implications of its social care reforms and may leave local authorities open to a deluge of disputes and legal challenges. In a unanimous report, MPs and Peers also warn that without greater integration with health and housing, and a focus on prevention and early intervention, the care and support system will be unsustainable

The Committee also calls for a nationwide campaign to educate people about the need to pay for their own care, saying that adult care and support are poorly understood.

Launching the report today, Rt Hon Paul Burstow MP, Chair of the Joint Committee on the Draft Care & Support Bill, said:

"We need care and support to be more focused on prevention and more joined up with health and housing. There is much in the government’s draft Bill to welcome; it cuts through a complex web of arcane legislation that people struggle with. But there is room for improvement.

The government must take stock of its funding for adult care and support and think seriously about whether the transformation we all want to see can truly be delivered without greater resources.

There is a growing imperative to join-up services so they fit around people's lives and make the best use of resources. The whole system must shift its emphasis away from crises and towards prevention and early intervention.  The draft Bill helps, but we believe it could do more."

Among its key recommendations the Committee calls for:

  • A national campaign to raises awareness of what the national care and support offer is, how people can plan and prepare for their own care needs, and what rights they have to care and support.
  • Information and advice for all (including self funders) about support, care planning and housing options.
  • Provision of independent financial advice about the different options available to pay for care, including deferred payment arrangements.
  • A new power to mandate joint budgets and commissioning across health, care and housing, such as support for the frail elderly, making it simpler for NHS and local Councils to pool budgets.
  • A greater emphasis on assisting people to prevent and postpone the need for care and support.
  • Fast-tracking of care and support assessments for terminally-ill people
  • An end to ‘contracting by the minute’ whereby care workers sometimes spend just fifteen minutes with the person being cared for.
  • New legal rights for young carers to protect them from inappropriate caring responsibilities and ensure they get the support they need.
  • An obligation on the Secretary of State to take into account the draft Bill’s well-being principle when designing and setting a national eligibility threshold.
  • Stronger measures on safeguarding, including explicit responsibilities for local authorities to prevent the abuse and neglect.
  • Independent resolution of disputes over decisions about care and support - and costs that count towards the cap – through a Care and Support Tribunal.

In addition, the Committee makes a number of recommendations to improve health research and the education and training of NHS workers, including:

  • Strengthening the Health Research Authority responsibilities by ensuring full disclosure of research data
  • Supporting greater integration of health and social care by ensuring more common training of care staff who often switch between the two sectors
  • Strengthening the duties of Health Education England to give clinical experience to managers.

The Committee also warns that restricting support and care to those with the highest levels of need will become entirely self-defeating, because it shunts costs into acute NHS care and undermines interventions to prevent and postpone the need for formal care and support.

Further information

The Committee makes over 100 recommendations for improvements in the draft Bill, including calls for:

  • Greater clarity on the boundary between NHS continuing care which is free and means-tested social care, which is not. The Committee warns that the current wording of the Bill is likely to lead to the unintended consequence that more people in residential care will fall into the means-tested system.
  • A statutory duty of candour – echoing the duty recently called for by Robert Francis QC in his report into failings at Mid Staffordshire hospital – to provide stronger protection for recipients of care or support services.
  • Organisations – Not just employees – who are found to have contributed to abuse or neglect in a care setting, should be liable to criminal prosecution for breach of corporate responsibility.

The report also highlights that the timing of the announcement on establishing a capped-cost model – along the lines of that recommended by Andrew Dilnot in his report on the future funding of care last year – came too late for the Committee to consider its implications on the draft Bill in detail. However, the Committee calls for changes to be made to strengthen Parliamentary accountability for the operation of the new funding model, including the workings of care accounts and arrangements for means testing.