The Care Act 2014 is nearly six months old. For many local authorities, itâ€™s time to take stock and test the temperature on how far they have come on this important set of reforms. Those conducting these internal reviews are seeking to reassure themselves that many of the practical and technical changes they need to deliver, for example, new IT systems or carerâ€™s assessments, are on track.
Equally, at a national level, much of the focus has been on making sure that staff have the confidence to deliver the Care Act and the government knows what technical support they require. Certainly, that is largely the focus of theÂ recent review by the Local Government Association, Department of Health and Association of Directors of Adult Social Services, the fourth of their â€œstocktakesâ€Â on progress with the act.
Less reported, at least from what I have read so far, is how local authorities feel they are doing on one of the guiding principles of the Care Act â€“ the duty to promote wellbeing (section 1 of the act). Putting it simply, do we know if we are making people happier, more resilient and more in control of their own lives? Are we promoting peopleâ€™s dignity and control by the individual over day-to-day life?
To remind ourselves, the â€˜wellbeing principleâ€™ places wellbeing at the heart of care and support. It is comprised of nine areas that local authorities must take into account in exercising their care and support functions, including personal dignity and protection from abuse and neglect. But how do we ensure this principle â€“ albeit broadly defined â€“ is not forgotten, or not seen as a bolt-on to other changes being rolled out?
Firstly, there is co-production. Co-production â€“ involving people who use services as equal partners in service design â€“ Â is one way to secure the wellbeing principle in how services are delivered. People know what brings them wellbeing, and good co-production can make sure services are shaped in ways that promote wellbeing, as thisÂ Think Local Act Personal resource argues.
The London Borough of Islington, for instance, have set up a board comprising people who use services to oversee all the work they are doing to personalise and improve care and support services.
Wellbeing can also be promoted by designing good person-centred assessment and care planning approaches. In Shropshire, for instance, when people have their needs assessed, a personal profile is completed. This covers what is really important to the service user or carer when it comes to â€˜having a good life, staying independent and living in the communityâ€™. In Cornwall and Greenwich, â€˜conversationsâ€™ are used as a technique during the assessment process to discover more about what a person wants and what will improve their wellbeing.
And we do need more effort to measure and report on progress on wellbeing. This is not an easy ask when money is tight. But expensive local evaluations are not always necessary. In Camden, local people are encouraged to complete simple online forms to report on their experiences of care and support and they are involved in co-producing anÂ annual account of progress. This provides a really powerful summary of the extent to which social care is improving wellbeing.
There is also a growing body of evidence of how toÂ measure more intangible areasÂ like wellbeing, integration and person-centred care, which can be drawn upon to design measurement tools.
Focusing on the overarching goals of the Care Act is far from straightforward, especially when money is so tight and when there are just so many substantive changes to oversee. But getting it right on wellbeing, and ensuring it remains at the heart of the reforms, is the only way to bring about lasting improvement. So next time we are conducting a review on the Care Act, we need to ask: are we increasing wellbeing?
Nearest tube: Elephant & Castle underground station (Northern and Bakerloo lines).
Nearest Railway Station: Elephant & Castle
Buses from Elephant and Castle: ask bus driver for Burgess Park. Bus numbers: 12, 171, 148, 176, 68, 484, 42, 40, 45