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The draft Bill represents a major reform of the legal framework governing the provision of adult care and support in England. It goes further than just a consolidation by establishing in law, for the first time, that well-being is the guiding principle of decision-making in care and support. It significantly extends the rights of adult carers, and it places greater emphasis on prevention.
Less than a month before this report was agreed, the Government announced that the main recommendations of the Dilnot Commission's report Fairer Care Funding would be implemented through amendments and additions to this draft Bill. They will come too late for us to be able to consider them. The likely implications of this announcement are discussed in Chapter 2 of this report.
The draft Bill has been widely welcomed. That does not mean that it cannot be improved. There are gaps, risks of unintended consequences and further opportunities to realise the Government's White Paper vision.
Key among these is the need for the Government to work with interested parties to launch a campaign that raises awareness of what the national care and support offer is, how people can plan and prepare for their care needs, and what their rights to care and support are. The scope and limitations of care and support are very poorly understood, and it is clear that without such a national campaign the benefits of reform and of any capped cost system will be significantly diminished. We are concerned that the Government have not yet fully assessed the scale of the change the Bill will bring about.
The eligibility criteria will determine who obtains state funded care and support. Currently, every local authority operates its own interpretation of Government guidance on assessing what constitute eligible needs. To implement Dilnot, the Government intend for the first time to set a national minimum eligibility threshold. We heard evidence that for disabled working-age adults the restrictions placed on eligibility can make a huge difference to their quality of life and their independence. We recommend that, just as local authorities are bound by the Bill's well-being principle when they make decisions, the Secretary of State should be bound to take this guiding principle into account when designing and setting a national eligibility threshold.
Care and support are not free; there has always been means testing and charging. It is therefore not surprising that the boundary marking the divide between free NHS services and means-tested care and support is contested. The draft Bill offers new language to describe this boundary. We believe the altered wording shifts the boundary, and may result in more people in residential care falling into the means tested system. This is a serious drafting issue that must be put right.
The introduction of a capped cost system will lead to a large influx of people with needs into the local authority assessment system. This will provide an opportunity for offering information, advice and assistance that can prevent and postpone the onset of greater care needs. The advice made available to those navigating their way through the system should include advice on housing options and on personal finances.
Evidence heard by the Committee has highlighted the crucial role that housing can play in relation to an individual's well-being, leading to effective and successful hospital discharge arrangements, and safeguarding from abuse and neglect. We make recommendations to improve both the impact and the reach of the reform by recognising housing as a key partner of adult care and support.
A consistent message from our witnesses was that the key to successful integration is the relationships between different organisations, and their cultures. However, the rules should be made less onerous to make it easier for local authorities and the NHS to pool budgets and to commission together. We also believe that the draft Bill should be amended to allow the Secretary of State to mandate joint budgets and joint commissioning in certain circumstances.
The draft Bill marks a welcome extension of the rights of adult carers. However, the consequence is that young carers are left with their rights defined in "rump legislation" that sets a higher threshold for recognition and support. This is a serious omission which the Government must address.
While the draft Bill gives local authorities a new role in "market shaping" it does not directly address how services are commissioned. The Government in their White Paper criticise contracting care by the minute as an unacceptable commissioning practice. They should issue guidance to local authorities that explicitly rules out such practices.
The draft Bill for the first time places the safeguarding of adults on a statutory basis; however we believe there is a need to go further. The responsibilities of local authorities to prevent the abuse and neglect of those at risk must be made explicit, while steps must be taken to ensure that any provider of care and support services—whether from the private or voluntary sector—is subject to the same legal obligations as the local authority itself, including the Human Rights Act 1998. We also recommend that where abuses have taken place there must be corporate criminal responsibility, with organisations and key individuals held to account.
The draft Bill is predominantly about adult care and support, but also contains important provisions relating to the education and training of NHS workers, and health research. Mostly these have been welcomed by those giving evidence to our inquiry. We make a number of recommendations to improve the functions and objectives of Health Education England and of the Health Research Authority. In particular, we consider that the duties of HEE should be strengthened to facilitate integration of health and social care by ensuring more common training of care staff who switch between the two sectors. We also recommend making the promotion of research a key objective of the HRA, and we propose giving it the responsibility of protecting public safety by ensuring full disclosure of research data.
Finally, in much of the written and oral evidence we have received during the course of our inquiry we heard a consistent message about the inadequacy of funding for adult care and support. As a result care and support have increasingly been rationed and restricted to those with the highest levels of need. This is ultimately self-defeating—shunting costs and reinforcing the dominance of crisis and acute care over approaches that prevent and postpone the need for formal care and support.
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