How will the new Health and Care Bill impact the provision of adult social care in England?
The Covid pandemic has brought social care to the forefront of political awareness. The Prime Minister has now announced his plans to reform what the state provides and a plan for how to fund this.
The proposals in the Bill mean social care provision in the UK will be fundamentally altered. The Bill will place an obligation on the health and care systems to align and work together more closely to deliver combined health and social care for the increasing number of our population aged over 65, and those who require support earlier in their lives.
The Bill will change the commissioning and delivery of care and it has specific measures on system assurance and data to guarantee appropriate provision and commission of social care.
Will the Bill improve the integration between the NHS, local authorities and care providers?
The Bill should be the mechanism to secure the oft promised integration of health and care systems. In the Bill there is an obligation on the NHS and local authorities to work even more closely together.
This duty to collaborate is put into law by this Bill. Furthermore, every region of England will be covered by an Integrated Care System within which the Integrated Health and Care Partnership will align systems and produce a plan to integrate health, public health, and social care needs. The Bill will also introduce the ability to bring in a joint appointment of executive directors. All of these measures are aimed directly at improving integration.
Will the Health Secretary’s new power to intervene in social care provision undermine the ability of local authorities to manage services effectively?
The new powers for the Secretary of State relating to care will allow the Government to make emergency payments directly to all social care providers. This power recognises that there are circumstances where speed of action and flexibility in provision are sometimes needed.
The Covid pandemic has brought social care to the forefront of political awareness
As this payment power is to be determined solely on a case-by-case basis and is not intended to replace the existing system of funding via local authorities, I see no basis to suggest Local Authorities are being side lined.
What lessons has the social care sector learned from the pandemic and how does the Bill reflect these?
There is an explicit recognition that this Bill is not intended to address all the challenges. The pandemic has highlighted that the demand pattern for care is likely to change, and that those changes are likely to result in a rise in costs.
Firstly, the social care industry is extremely fragile with several large monopolistic providers and a very long tail of small and medium size providers, whose financial strength is weak.
Secondly, the number of deaths in social care will result in demands for assurances of quality. It is likely that the way the regulatory regime provides that assurance is likely to come under scrutiny.
Finally, any concern about residential care is likely to lead to an increase in domiciliary care. Although this reduces the accommodation cost it will lead to increased support costs as the need for more and better qualified carers rises.
Will the Bill help to reduce or increase the bureaucracy and red-tape faced by the adult social care sector?
The NHS and the care system have complained that the existing legislation is too detailed and prescriptive with barriers that prevent joint working. Moreover, the system of procurement under the 2012 Act has attracted criticism due to the involvement of the Competition and Markets Authority. The Government’s intention was that the measures in the Bill will remove these bureaucratic barriers. The changes to the procurement regime are likely to be beneficial. However, only when the Bill has been enacted and measures in place will a reasoned judgement on their effectiveness be possible.