The Care Act and me: Ten years and counting

It is approximately ten years since the Care Act 2014 placed higher importance on wellbeing, choice, and impact on informal carers.

I still remember the day, sitting in the chamber of the House of Lords having an out of body experience.

It was November 2013 and I had been summoned from a career break to join the civil service team taking the Care Bill through Parliament – so I went from working in one of the poorest neighbourhoods in Santiago de Chile to working in the original heart of colonialism in the space of four days.

I was in what’s called the Officials’ Box in the Lords, supporting Earl Howe in a debate about the eligibility criteria at the heart of the Care Bill. I still remember the thoughtfulness and passion of the debate around the Care Bill’s definition of wellbeing and how it played into eligibility – the time and care spent on the difference between ‘belief’ and ‘religious view’ for example.

If I’m honest, it all seems charmingly innocent now.

I had been working on the policy groundwork of the Bill since 2011, with a sustained and growing excitement. It felt like not only was adult social care legislation self-evidently ripe for reform (I still have yet to meet anyone that defends what we had previously) – but that we had a truly special level of consensus on the policy vision we want new law to bring about.   

Of course there were differences, but (uniquely in my civil services career) all the main political parties, different parts of Whitehall, local government, practitioners, civil society and people using services were all fundamentally pulling in the same direction.

When the Care Bill became the Care Act in May 2014, the focus shifted to implementation with a real sense that the people we had met up and down the country who were let down by a broken system were genuinely going to see something different.

What we all forgot about was the public - if the general voting public doesn’t understand something, it is always the easiest thing for politicians of all stripes to cut.

In the 2015 spending review that followed the election of that year, local government grant was cut drastically. Although the Care Act funding we’d negotiated so hard for was still in there, it looked to me like a little raft in the maelstrom of local government finance. It wasn’t ring-fenced so it was obviously never going to be funded to the extent we had envisaged and this pulled the rug out from under the vision overall.

None of which is to say the Care Act has not changed anything. It has definitely driven increased focus on informal carers – although not to the extent envisaged and still less to the extent that we need to see. The debate on social care funding reform is still by-and-large framed by the Dilnot Commission recommendations that were codified by the Care Act but famously/infamously never switched on.

I also think the legislation was an example of genuine collaboration with civil society and experts by experience leading to a better product, which has been a template for other initiatives since. Last, it was an example of truly structuring legislation around wellbeing that has been followed in other spheres (for example a recent Pro Bono Economics report called for a wellbeing measure for children along similar lines).

In a new Research in Practice podcast, I had a fascinating conversation with my colleague Geraldine Nosowska reflecting on our different experiences of implementation and the longer-term legacy of the Care Act following its very difficult beginning. She pointed out that perhaps the major change was in the focus and narrative in delivering social care.

From risk management and very procedural responses to needs, the Care Act stimulated a more strengths-based approach, with a more intentional focus on co-producing better outcomes. That is certainly a legacy.

It is also positive to see a recent ADASS roadmap for social care noting that:

With that said, it was also interesting to reflect with Geraldine on how practice thinking has changed over ten years and what we might look at if we were to reopen the Care Act. The top of my list would have been a stronger prevention duty and making the legal age of transition to adult social care 25 rather than 18, which I think is more reflective of young people’s lives.

Overall I think the vision of the Care Act is battered but not beaten – councils have simply never had the stability and funding to have a realistic chance to deliver it.

This is disheartening in some ways, but also a source of hope. We don’t have to wait five years for a Law Commission report, White Paper, and Bill – what we need is simpler but also in some ways more difficult.

I think we must go back to that key constituency we forgot about all those years ago when we first brought the Care Act in – the public.

We must keep finding new ways to tell the story of what an incredible difference good social care can make, challenging ourselves to go further as allies of people who have experienced both the good and the bad of the current system, and working together to get these stories heard.

I’m really looking forward to participating in the Research in Practice Adults Annual Partnership Conference, a full day conference event 27 February. The conference theme will be practice in the context of ten years of the Care Act and I think it will be an important opportunity not only to look back but forward as well – maybe even to a time when the promise of the Care Act finally comes good.