Care Act 2014 Principles

Many of us may need care and support at some point in our lives and most people will be required to pay something towards the cost of this care. In order to give people who receive care and support, or people who look after someone as a carer, an opportunity to have a bigger say about what sort of care is best for them and their family, the Care Act 2014 was introduced.

The Act places a series of duties and responsibilities on local authorities about care and support for adults. It also created a consistent route to establishing an entitlement to public care and support for all adults with needs for care and support. In addition, it produced the first ever entitlement to support for carers, on a similar basis.

Why was the Care Act 2014 introduced?

The Care Act 2014 came into effect in 2015 and was the most significant reform of care and support for more than 60 years. It set out to put people and their carers in control of their care and support. The Act changed many aspects of how support is arranged and aimed to give those in need of support greater control and influence about how that care is delivered. The Act also put a limit for the first time on the amount anyone has to pay towards the costs of their care.

The intention was that the Care Act 2014 would make it easier for people who needed to access care and support to understand why things happen in a particular way. Following the first year of implementation of the Act in 2015 the Department of Health commissioned a survey to explore the impact of the Act on the lives of people with care and support needs. The survey comprised 1,181 people aged 18 and over; of these, 391 were people who need care and support themselves, and 643 were carers.

Some of the findings were:

• 25% felt that councils always or frequently listened to their wants and needs.
• 49% reported that their choices are always or frequently respected.
• 69% overall said their care and support made a positive difference to health.
• 48% said their care and support helped in them feeling safe or secure.
• 58% overall said support made daily living better.
• 42% of carers said that support made their daily living activities better, compared to 74% of people who need care or support.
• 29% said quality had improved over the last year.
• 21% wanted better quality, more flexibility or less complexity in arranging support.

The results of this survey showed a marked difference between councils’ perceptions of the Care Act 2014 implementation, which were more positive, and the experiences of the people who need care and the carers directly themselves. The information gathered was used to inform improvements in the Act’s implementation. The Care Act 2014 governs the care and support provided and commissioned by local authorities.

The Office for National Statistics (ONS) and the National Audit Office (NAO) state that:

• At some point during 2019-20, 839,000 adults were receiving long-term support arranged by local authorities.
• There are 25,800 estimated regulated adult social care locations as at March 2020.
• The estimated number of people working in adult social care in 2019-20 is 1.5 million.
• There are almost seven million carers in the UK.
• In 2019-20, 316,000 carers received direct support from local authorities under the Care Act. Of these, 66% of carers received information, advice and signposting to other services rather than money, and 34% of carers received support in the form of direct or part-direct payments, local authority-commissioned support, or a local authority-managed personal budget.
• There are 151 local authorities with responsibilities for providing or arranging care services as set out in the Care Act 2014.
• In 2019-20, local authority expenditure on adult social care was £16.5bn net.

Current demographic trends suggest a greater demand for care and increasingly complex care needs in the future, resulting in care forming an ever-increasing proportion of public expenditure.

The Care Act 2014 requires local authorities to ensure the provision or arrangement of services, facilities or resources to help prevent, delay or reduce the development of needs for care and support. Expenditure on prevention initiatives is often more cost effective than the expenditure required for avoidable future care needs.

What did the Care Act 2014 replace?

The Care Act 2014 combined various existing pieces of legislation which previously shaped how social care was arranged.

These included:

• The National Assistance Act 1948.
• Health Services and Public Health Act 1968.
• Chronically Sick and Disabled Persons Act 1970 (but only for adults).
• Health & Social Services and Social Security Adjudications Act 1983.
• Disabled Persons (Services, Consultation and Representation) Act 1986.
• Parts of the NHS and Community Care Act 1990.
• Parts of the Health and Social Care Act 2001.
• The Delayed Discharge Act 2003.

These laws were confusing and complex. They tended to focus on what service should be provided, rather than on what the person actually needs or wants. The Care Act 2014 was designed to be a simpler, modern law for 21st century care and support focussing on the individual needs of people.

The aim was to make the law fair and more consistent, removing certain anomalies that treated particular groups of people differently; the notion was to create a single route for determining entitlement, which works for all groups of people in all circumstances. The Act was therefore intended to remove the chance of discrimination and unfair treatment taking place when assessing care needs and provision.

The Act clearly states the steps that must be followed to work out this entitlement, to help people better understand the process. It follows the person’s “journey” in the care and support system.

The Care Act 2014 introduced:

• National care and support eligibility criteria for both adults and carers.
• Accessibility to information and advice that both adults and carers need to make good choices about care and support.
• Rights to independent advocacy in some circumstances.
• Personal budgets and rights to request a direct payment.
• New responsibilities about making the transition from children’s services to adult social care.
• New responsibilities about provider failure, for example if a care home closes.
• Support for people who move between local authority areas.

How many principles are there under the Care Act 2014?

There are six principles under the Care Act 2014, which are:

• Empowerment – You know best about the care and support you need; your views, wishes, feelings and beliefs should always be considered. To ensure that this is implemented in the right way, professionals must discuss all the possible outcomes of the patient’s decision, without enforcing their opinions too much. If the patient does not have capacity to give consent, then their decisions can be made for them. Whether the patient has capacity depends on a few factors that are specified in the the Mental Capacity Act 2005.
• Protection – Professionals should always work to protect you and other people from abuse and neglect. The Act clearly states how people can raise concerns about the safety or wellbeing of someone who has care needs. If a person is at risk of abuse or neglect, authorities must act immediately. An effective response must be in place to protect the person in need.
• Prevention – The main aim of professionals should be on the person’s wellbeing, on reducing the need for care and support, and on reducing the likelihood that the person will need care and support in the future. Local authorities have a legal duty to prevent, reduce and delay people’s needs from worsening. The aim is to have responsive local authorities that are able to support people at an early stage, to prevent and reduce the likelihood of people ending up in crisis situations.
• Proportionality – Appropriateness and proportionality are concepts that must apply to all assessments and are not themselves forms of carers’ or needs assessments. A proportionate assessment will be as extensive as required to establish the extent of a person’s needs and any decisions made will always be person-centred and based on their individual circumstances.
• Partnership – Any decisions should be made with the person’s involvement, and their wellbeing should be balanced with that of any involved family and friends. It also applies to multi-agency collaboration working in partnership to provide the appropriate care and support for the individual.
• Accountability – Professionals should ensure that any actions taken to support a person receiving care affect their rights and freedom as little as possible. The accountability principle also states that safeguarding is everybody’s duty, and everyone in contact with a vulnerable person should be responsible for noting any risks and taking action on any harm identified.

These six principles underpin the work of professionals and other staff who work with adults. They apply to all sectors and settings that work to care for and safeguard adults, including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

What is the main principle of the Care Act 2014?

The main principle of the Care Act 2014 is to help to improve people’s independence and wellbeing and for care providers and givers to promote a person-centred approach to the care and support they provide.

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. The Act requires local authorities to involve adults in their assessment, care and support planning and review. Considering the person’s views and wishes is critical to a person-centred system. Person-centred care and support planning mean that a person can receive part or all of their personal budget as a direct payment. Direct payments aim to enable a person to exercise the maximum possible choice over how they are supported, who they are supported by and where they are supported.

The Health Foundation has identified a framework that comprises four principles of person-centred care:

• Affording people dignity, compassion and respect.
• Offering coordinated care, support or treatment.
• Offering personalised care, support or treatment.
• Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

The Care Act 2014 holds the local authority responsible for ensuring that an individual receives the care and support they require and that their carers receive the support they require, as a result of an assessment of their individual needs.

Wellbeing principles in the Care Act 2014 

The Act highlights wellbeing as one of the key responsibilities for local authorities, with an inextricable link to the main principles, that is of prevention and protection.

The Statutory Guidance of the Care Act 2014 says at paragraph 1.21: “Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people’s needs for care and support and how meeting these can help them achieve the outcomes most important to them.”

The Care Act 2014 places a duty on local authorities to promote an individual’s “wellbeing”. This means that they should always have a person’s wellbeing in mind when making decisions about them or planning services.

Wellbeing can relate to:

• Personal dignity, including treating the individual with respect.
• Physical and mental health and emotional wellbeing.
• Protection from abuse and neglect.
• Control by the individual over day-to-day life including over care and support.
• Participation in work, education, training or recreation.
• Social and economic wellbeing.
• Domestic, family and personal relationships.
• Suitability of living accommodation.
• The individual’s contribution to society.

Wellbeing is a broad concept and there is no hierarchy in the areas of wellbeing listed above – all are equally important. There is also no single definition of wellbeing, as how this is interpreted will depend on the individual, their circumstances and their priorities. Wellbeing encompasses several areas of life. Therefore, using a holistic approach to ensure a clear understanding of the individual’s views is vital to identifying and defining wellbeing in each case.

The wellbeing principles are part of the Care Act 2014 eligibility criteria and as such local authorities also have to consider carers and the impact of their role on their wellbeing. Similarly, they have to consider the impact of a cared for person’s needs on their carer’s wellbeing. If the impact is significant then the eligibility criteria under the Care Act 2014 are likely to be met.

Safeguarding principles of the Care Act 2014

The Commission for Social Care Inspection stated that before the Care Act 2014, the legal framework for adult protection was neither systematic nor coordinated, reflecting sporadic development of safeguarding policy over the last 25 years.

Sections 42 to 47 of the Care Act 2014 seek to place safeguarding on a statutory footing.

Under the Act safeguarding duties apply to an adult who:

• Has a need for care and support, whether or not the local authority is meeting any of those needs.
• Is experiencing, or at risk of, abuse or neglect.
• As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.

The view of what constitutes abuse or neglect should not be limited, as abuse or neglect can take many forms and the circumstances of the individual case should always be considered. Domestic abuse is specifically listed in the Care Act 2014, and it is clear in the Act that the abuse or neglect can be inflicted intentionally or unintentionally.

The aims of adult safeguarding are to:

• Stop abuse or neglect wherever possible.
• Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs.
• Safeguard adults in a way that supports them in making choices and having control about how they want to live.
• Promote an approach that concentrates on improving life for the adults concerned.
• Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect.
• Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or wellbeing of an adult.
• Address what has caused the abuse or neglect.

The Care Act 2014 requires local authorities to set up a Safeguarding Adults Board (SAB) in their area, giving these boards a clear basis in law for the first time.

The Act says that the SAB must:

• Include the local authority, the NHS and the police, who should meet regularly to discuss and act upon local safeguarding issues.
• Develop shared plans for safeguarding, working with local people to decide how best to protect adults in vulnerable situations.
• Publish this safeguarding plan and report to the public annually on its progress, so that different organisations can make sure they are working together in the best way.

The Act also requires local authorities to make enquires, or ask others to make enquiries, when they think an adult with care and support needs may be at risk of abuse or neglect in their area and to find out what, if any, action may be needed. This applies whether or not the authority is actually providing any care and support services to that adult.

In conclusion

The Care Act 2014 was designed to help to improve people’s independence and wellbeing; it strengthens the rights of people with a need for care and their family carers. It promotes fairer, more personalised care and moves the focus of local authorities from providing services for specific groups, to supporting individuals to achieve the outcomes that matter to them.

Postscript 

The Coronavirus Act 2020 which came into force on 25 March 2020 is extensive and amends many duties and responsibilities of public bodies in existing legislation across the board including the Care Act 2014. The Coronavirus Act enables local authorities to ease the relevant Care Act 2014 duties.

However the Care Act Easements Guidance makes it clear that a local authority should only take a decision to begin “exercising the easements”, that is relaxing the rules, when it is no longer reasonably practicable for it to comply with its Care Act 2014 duties and where to continue to try to do so is likely to result in urgent or acute needs not being met, potentially risking life.

The Care Act Easements Guidance states that any easements to the Care Act 2014 duties made by a local authority should be proportionate to the circumstances and suggests that a local authority could consider easements when, for example, the workforce is ‘significantly’ depleted, or there is increased demand. The Care Act Easements Guidance sets out a clear process to be used by a local authority when deciding if it should exercise any easements.

If, at any time, the Government suspends provisions contained within the Coronavirus Act, public bodies will need to revert to their duties under the Care Act 2014. The Care Act Easements Guidance makes clear that the emergency legislation is temporary.