Care Bill (HC Bill 123)

A

BILL

TO

Make provision to reform the law relating to care and support for adults and
the law relating to support for carers; to make provision about safeguarding
adults from abuse or neglect; to make provision about care standards; to
establish and make provision about Health Education England; to establish
and make provision about the Health Research Authority; and for connected
purposes.

Be it enacted by the Queen’s most Excellent Majesty, by and with the advice and
consent of the Lords Spiritual and Temporal, and Commons, in this present
Parliament assembled, and by the authority of the same, as follows:—

Part 1 Care and support

General responsibilities of local authorities

1 Promoting individual well-being

(1) 5The general duty of a local authority, in exercising a function under this Part in
the case of an individual, is to promote that individual’s well-being.

(2) “Well-being”, in relation to an individual, means that individual’s well-being
so far as relating to any of the following—

(a) personal dignity (including treatment of the individual with respect);

(b) 10physical and mental health and emotional well-being;

(c) protection from abuse and neglect;

(d) control by the individual over day-to-day life (including over care and
support, or support, provided to the individual and the way in which
it is provided);

(e) 15participation in work, education, training or recreation;

(f) social and economic well-being;

(g) domestic, family and personal relationships;

(h) suitability of living accommodation;

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(i) the individual’s contribution to society.

(3) In exercising a function under this Part in the case of an individual, a local
authority must have regard to the following matters in particular—

(a) the importance of beginning with the assumption that the individual is
5best-placed to judge the individual’s well-being;

(b) the individual’s views, wishes, feelings and beliefs;

(c) the importance of preventing or delaying the development of needs for
care and support or needs for support and the importance of reducing
needs of either kind that already exist;

(d) 10the need to ensure that decisions about the individual are made having
regard to all the individual’s circumstances (and are not based only on
the individual’s age or appearance or any condition of the individual’s
or aspect of the individual’s behaviour which might lead others to
make unjustified assumptions about the individual’s well-being);

(e) 15the importance of the individual participating as fully as possible in
decisions relating to the exercise of the function concerned and being
provided with the information and support necessary to enable the
individual to participate;

(f) the importance of achieving a balance between the individual’s well-
20being and that of any friends or relatives who are involved in caring for
the individual;

(g) the need to protect people from abuse and neglect;

(h) the need to ensure that any restriction on the individual’s rights or
freedom of action that is involved in the exercise of the function is kept
25to the minimum necessary for achieving the purpose for which the
function is being exercised.

(4) “Local authority” means—

(a) a county council in England,

(b) a district council for an area in England for which there is no county
30council,

(c) a London borough council, or

(d) the Common Council of the City of London.

2 Preventing needs for care and support

(1) A local authority must provide or arrange for the provision of services,
35facilities or resources, or take other steps, which it considers will—

(a) contribute towards preventing or delaying the development by adults
in its area of needs for care and support;

(b) contribute towards preventing or delaying the development by carers
in its area of needs for support;

(c) 40reduce the needs for care and support of adults in its area;

(d) reduce the needs for support of carers in its area.

(2) In performing that duty, a local authority must have regard to—

(a) the importance of identifying services, facilities and resources already
available in the authority’s area and the extent to which the authority
45could involve or make use of them in performing that duty;

(b) the importance of identifying adults in the authority’s area with needs
for care and support which are not being met (by the authority or
otherwise);

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(c) the importance of identifying carers in the authority’s area with needs
for support which are not being met (by the authority or otherwise).

(3) Regulations may—

(a) permit a local authority to make a charge for providing or arranging for
5the provision of services, facilities or resources, or for taking other
steps, under this section;

(b) prohibit a local authority from making a charge it would otherwise be
permitted to make by virtue of paragraph (a).

(4) The regulations may in particular (in reliance on section 121(6)) make
10provision by reference to services, facilities or resources which—

(a) are of a specified type;

(b) are provided in specified circumstances;

(c) are provided to an adult of a specified description;

(d) are provided for a specified period only.

(5) 15A charge under the regulations may cover only the cost that the local authority
incurs in providing or arranging for the provision of the service, facility or
resource or for taking the other step.

(6) In cases where a local authority performs the duty under subsection (1) jointly
with one or more other local authorities in relation to the authorities’ combined
20area—

(a) references in this section to a local authority are to be read as references
to the authorities acting jointly, and

(b) references in this section to a local authority’s area are to be read as
references to the combined area.

(7) 25Sections 21 (exception for persons subject to immigration control), 22
(exception for provision of health services) and 23 (exception for provision of
housing etc.) apply in relation to the duty under subsection (1), but with the
modifications set out in those sections.

(8) “Adult” means a person aged 18 or over.

3 30Promoting integration of care and support with health services etc.

(1) A local authority must exercise its functions under this Part with a view to
ensuring the integration of care and support provision with health provision
and health-related provision where it considers that this would—

(a) promote the well-being of adults in its area with needs for care and
35support and the well-being of carers in its area,

(b) contribute to the prevention or delay of the development by adults in
its area of needs for care and support or the development by carers in
its area of needs for support, or

(c) improve the quality of care and support for adults, and of support for
40carers, provided in its area (including the outcomes that are achieved
from such provision).

(2) “Care and support provision” means—

(a) provision to meet adults’ needs for care and support,

(b) provision to meet carers’ needs for support, and

(c) 45provision of services, facilities or resources, or the taking of other steps,
under section 2.

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(3) “Health provision” means provision of health services as part of the health
service.

(4) “Health-related provision” means provision of services which may have an
effect on the health of individuals but which are not—

(a) 5health services provided as part of the health service, or

(b) services provided in the exercise of social services functions (as defined
by section 1A of the Local Authority Social Services Act 1970).

(5) For the purposes of this section, the provision of housing is health-related
provision.

(6) 10In section 13N of the National Health Service Act 2006 (duty of NHS
Commissioning Board to promote integration), at the end insert—

(5) For the purposes of this section, the provision of housing
accommodation is a health-related service.

(7) In section 14Z1 of that Act (duty of clinical commissioning groups to promote
15integration), at the end insert—

(4) For the purposes of this section, the provision of housing
accommodation is a health-related service.

4 Providing information and advice

(1) A local authority must establish and maintain a service for providing people in
20its area with information and advice relating to care and support for adults and
support for carers.

(2) The service must provide information and advice on the following matters in
particular—

(a) the system provided for by this Part and how the system operates in the
25authority’s area,

(b) the choice of types of care and support, and the choice of providers,
available to those who are in the authority’s area,

(c) how to access the care and support that is available,

(d) how to access independent financial advice on matters relevant to the
30meeting of needs for care and support, and

(e) how to raise concerns about the safety or well-being of an adult who
has needs for care and support.

(3) In providing information and advice under this section, a local authority must
in particular—

(a) 35have regard to the importance of identifying adults in the authority’s
area who would be likely to benefit from financial advice on matters
relevant to the meeting of needs for care and support, and

(b) seek to ensure that what it provides is sufficient to enable adults—

(i) to identify matters that are or might be relevant to their personal
40financial position that could be affected by the system provided
for by this Part,

(ii) to make plans for meeting needs for care and support that might
arise, and

(iii) to understand the different ways in which they may access
45independent financial advice on matters relevant to the meeting
of needs for care and support.

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(4) Information and advice provided under this section must be accessible to, and
proportionate to the needs of, those for whom it is being provided.

(5) “Independent financial advice” means financial advice provided by a person
who is independent of the local authority in question.

(6) 5In cases where a local authority performs the duty under subsection (1) jointly
with one or more other local authorities by establishing and maintaining a
service for their combined area—

(a) references in this section to a local authority are to be read as references
to the authorities acting jointly, and

(b) 10references in this section to a local authority’s area are to be read as
references to the combined area.

5 Promoting diversity and quality in provision of services

(1) A local authority must promote the efficient and effective operation of a market
in services for meeting care and support needs with a view to ensuring that any
15person in its area wishing to access services in the market—

(a) has a variety of providers to choose from who (taken together) provide
a variety of services;

(b) has a variety of high quality services to choose from;

(c) has sufficient information to make an informed decision about how to
20meet the needs in question.

(2) In performing that duty, a local authority must have regard to the following
matters in particular—

(a) the need to ensure that the authority has, and makes available,
information about the providers of services for meeting care and
25support needs and the types of services they provide;

(b) the need to ensure that it is aware of current and likely future demand
for such services and to consider how providers might meet that
demand;

(c) the importance of enabling adults with needs for care and support, and
30carers with needs for support, who wish to do so to participate in work,
education or training;

(d) the importance of ensuring the sustainability of the market (in
circumstances where it is operating effectively as well as in
circumstances where it is not);

(e) 35the importance of fostering continuous improvement in the quality of
such services and the efficiency and effectiveness with which such
services are provided and of encouraging innovation in their provision;

(f) the importance of fostering a workforce whose members are able to
ensure the delivery of high quality services (because, for example, they
40have relevant skills and appropriate working conditions).

(3) In having regard to the matters mentioned in subsection (2)(b), a local
authority must also have regard to the need to ensure that sufficient services
are available for meeting the needs for care and support of adults in its area and
the needs for support of carers in its area.

(4) 45In arranging for the provision by persons other than it of services for meeting
care and support needs, a local authority must have regard to the importance
of promoting the well-being of adults in its area with needs for care and
support and the well-being of carers in its area.

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(5) In meeting an adult’s needs for care and support or a carer’s needs for support,
a local authority must have regard to its duty under subsection (1).

(6) In cases where a local authority performs the duty under subsection (1) jointly
with one or more other local authorities in relation to persons who are in the
5authorities’ combined area—

(a) references in this section to a local authority are to be read as references
to the authorities acting jointly, and

(b) references in this section to a local authority’s area are to be read as
references to the combined area.

(7) 10“Services for meeting care and support needs” means—

(a) services for meeting adults’ needs for care and support, and

(b) services for meeting carers’ needs for support.

(8) The references in subsection (7) to services for meeting needs include a
reference to services, facilities or resources the purpose of which is to
15contribute towards preventing or delaying the development of those needs.

6 Co-operating generally

(1) A local authority must co-operate with each of its relevant partners, and each
relevant partner must co-operate with the authority, in the exercise of—

(a) their respective functions relating to adults with needs for care and
20support,

(b) their respective functions relating to carers, and

(c) functions of theirs the exercise of which is relevant to functions referred
to in paragraph (a) or (b).

(2) A local authority must co-operate, in the exercise of its functions under this
25Part, with such other persons as it considers appropriate who exercise
functions, or are engaged in activities, in the authority’s area relating to adults
with needs for care and support or relating to carers.

(3) The following are examples of persons with whom a local authority may
consider it appropriate to co-operate for the purposes of subsection (2)

(a) 30a person who provides services to meet adults’ needs for care and
support, services to meet carers’ needs for support or services, facilities
or resources of the kind referred to in section 2(1);

(b) a person who provides primary medical services, primary dental
services, primary ophthalmic services, pharmaceutical services or local
35pharmaceutical services under the National Health Service Act 2006;

(c) a person in whom a hospital in England is vested which is not a health
service hospital as defined by that Act;

(d) a private registered provider of social housing.

(4) A local authority must make arrangements for ensuring co-operation
40between—

(a) the officers of the authority who exercise the authority’s functions
relating to adults with needs for care and support or its functions
relating to carers,

(b) the officers of the authority who exercise the authority’s functions
45relating to housing (in so far as the exercise of those functions is
relevant to functions referred to in paragraph (a)),

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(c) the Director of Children’s Services at the authority (in so far as the
exercise of functions by that officer is relevant to the functions referred
to in paragraph (a)), and

(d) the authority’s director of public health (see section 73A of the National
5Health Service Act 2006).

(5) The references in subsections (1) and (4)(a) to a local authority’s functions
include a reference to the authority’s functions under sections 59 to 66
(transition for children with needs etc.).

(6) The duties under subsections (1) to (4) are to be performed for the following
10purposes in particular—

(a) promoting the well-being of adults with needs for care and support and
of carers in the authority’s area,

(b) improving the quality of care and support for adults and support for
carers provided in the authority’s area (including the outcomes that are
15achieved from such provision),

(c) smoothing the transition to the system provided for by this Part for
persons in relation to whom functions under sections 59 to 66 are
exercisable,

(d) protecting adults with needs for care and support who are
20experiencing, or are at risk of, abuse or neglect, and

(e) identifying lessons to be learned from cases where adults with needs
for care and support have experienced serious abuse or neglect and
applying those lessons to future cases.

(7) Each of the following is a relevant partner of a local authority—

(a) 25where the authority is a county council for an area for which there are
district councils, each district council;

(b) any local authority, or district council for an area in England for which
there is a county council, with which the authority agrees it would be
appropriate to co-operate under this section;

(c) 30each NHS body in the authority’s area;

(d) the Minister of the Crown exercising functions in relation to social
security, employment and training, so far as those functions are
exercisable in relation to England;

(e) the chief officer of police for a police area the whole or part of which is
35in the authority’s area;

(f) the Minister of the Crown exercising functions in relation to prisons, so
far as those functions are exercisable in relation to England;

(g) a relevant provider of probation services in the authority’s area;

(h) such person, or a person of such description, as regulations may
40specify.

(8) The reference to an NHS body in a local authority’s area is a reference to—

(a) the National Health Service Commissioning Board, so far as its
functions are exercisable in relation to the authority’s area,

(b) a clinical commissioning group the whole or part of whose area is in the
45authority’s area, or

(c) an NHS trust or NHS foundation trust which provides services in the
authority’s area.

(9) “Prison” has the same meaning as in the Prison Act 1952 (see section 53(1) of
that Act).

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(10) “Relevant provider of probation services” has the meaning given by section 325
of the Criminal Justice Act 2003.

7 Co-operating in specific cases

(1) Where a local authority requests the co-operation of a relevant partner, or of a
5local authority which is not one of its relevant partners, in the exercise of a
function under this Part in the case of an individual with needs for care and
support or in the case of a carer, a carer of a child or a young carer, the partner
or authority must comply with the request unless it considers that doing so—

(a) would be incompatible with its own duties, or

(b) 10would otherwise have an adverse effect on the exercise of its functions.

(2) Where a relevant partner of a local authority, or a local authority which is not
one of its relevant partners, requests the co-operation of the local authority in
its exercise of a function in the case of an individual with needs for care and
support or in the case of a carer, a carer of a child or a young carer, the local
15authority must comply with the request unless it considers that doing so—

(a) would be incompatible with its own duties, or

(b) would otherwise have an adverse effect on the exercise of its functions.

(3) A person who decides not to comply with a request under subsection (1) or (2)
must give the person who made the request written reasons for the decision.

(4) 20“Relevant partner”, in relation to a local authority, has the same meaning as in
section 6.

(5) “Carer of a child” means a person who is a carer for the purposes of section 61.

(6) “Young carer” has the same meaning as in section 64.

Meeting needs for care etc.

8 25How to meet needs

(1) The following are examples of what may be provided to meet needs under
sections 18 to 20—

(a) accommodation in a care home or in premises of some other type;

(b) care and support at home or in the community;

(c) 30counselling and other types of social work;

(d) goods and facilities;

(e) information, advice and advocacy.

(2) The following are examples of the ways in which a local authority may meet
needs under sections 18 to 20—

(a) 35by arranging for a person other than it to provide a service;

(b) by itself providing a service;

(c) by making direct payments.

(3) “Care home” has the meaning given by section 3 of the Care Standards Act
2000.

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Assessing needs

9 Assessment of an adult’s needs for care and support

(1) Where it appears to a local authority that an adult may have needs for care and
support, the authority must assess—

(a) 5whether the adult does have needs for care and support, and

(b) if the adult does, what those needs are.

(2) An assessment under subsection (1) is referred to in this Part as a “needs
assessment”.

(3) The duty to carry out a needs assessment applies regardless of the authority’s
10view of—

(a) the level of the adult’s needs for care and support, or

(b) the level of the adult’s financial resources.

(4) A needs assessment must include an assessment of—

(a) the impact of the adult’s needs for care and support on the matters
15specified in section 1(2),

(b) the outcomes that the adult wishes to achieve in day-to-day life, and

(c) whether, and if so to what extent, the provision of care and support
could contribute to the achievement of those outcomes.

(5) A local authority, in carrying out a needs assessment, must involve—

(a) 20the adult,

(b) any carer that the adult has, and

(c) any person whom the adult asks the authority to involve or, where the
adult lacks capacity to ask the authority to do that, any person who
appears to the authority to be interested in the adult’s welfare.

(6) 25When carrying out a needs assessment, a local authority must also consider—

(a) whether, and if so to what extent, matters other than the provision of
care and support could contribute to the achievement of the outcomes
that the adult wishes to achieve in day-to-day life, and

(b) whether the adult would benefit from the provision of anything under
30section 2 or 4 or of anything which might be available in the
community.

(7) This section is subject to section 11(1) to (4) (refusal by adult of assessment).

10 Assessment of a carer’s needs for support

(1) Where it appears to a local authority that a carer may have needs for support
35(whether currently or in the future), the authority must assess—

(a) whether the carer does have needs for support (or is likely to do so in
the future), and

(b) if the carer does, what those needs are (or are likely to be in the future).

(2) An assessment under subsection (1) is referred to in this Part as a “carer’s
40assessment”.

(3) “Carer” means an adult who provides or intends to provide care for another
adult (an “adult needing care”); but see subsections (9) and (10).