Promoting people’s right to choice and control under the Care Act 2014 – how are local authorities performing?

13 October 2015

The Independent Living Strategy Group has today published a report concerning the performance of local authorities in respect of people’s right to choice and control under the Care Act 2014.  The report draws on the findings of a survey of social care recipients regarding their perceptions of choice, control and well-being over the past year and of a survey of local authority guidance regarding the Care Act 2014.

The key findings are:

  • Despite the emphasis on wellbeing and choice and control in the Care Act 2014, almost half (45%) of respondents to our survey said that their quality of life had reduced and almost a third (30%) said that they had experienced a reduction of choice and control over the past year
  • Half said their need for support had increased and yet only 22% had experienced a corresponding increase in paid support over the past year. Most additional support came from family and friends. Where people did receive additional support it was most likely to come from family and friends if available.
  • Of the 57% of respondents who had their care package reassessed in the previous 12 months, 17% said that they had been told that there was a financial cap placed on certain types of expenditure
  • 29% of respondents reported restrictions being placed on their use of direct payments or personal budgets. 33% didn’t know whether they were subject to any restrictions. 
  • Of those reporting that their use of direct payments or personal budgets had been subject to restrictions, stipulations regarding the tasks of personal assistants/carers were most commonly reported (48%). 18% said that they had had their personal support plan declined. 14% reported they had been limited to choosing from a shortlist of providers. 11% said they had been limited to using a pre-payment card.
  • Of those survey respondents who are transitioning from Independent Living Fund to local authority support, 14% reported they had been told that they should expect less support in future, while the majority (56%) said they had not been told whether their support would increase, decrease or stay the same.

Our analysis of local authority guidance on the Care Act found that:

  • Local authorities are generally not yet meeting their duties to ensure the provision of clear, accessible, accurate and locally tailored information regarding care and support.   This means that those seeking or receiving care and support lack access to information regarding their rights and entitlements, sufficient to exercise choice and control.
  • Some local authorities have produced ‘quick guides’ explaining the key features of the Care Act. These rarely emphasize choice and control and the universal entitlement to a personal budget.
  • Local authorities are not defining personal budgets in a way that corresponds with their definition in the Care Act statutory guidance. Whereas the guidance describes personal budgets as a mechanism for choice and control, the guidance we reviewed typically describes personal budgets only as the sum of money allocated to meet care and support needs.
  • Some local authorities infer that if a person opts for their personal budget to be managed by the local authority that they should anticipate having less control over how it is spent than if they choose a direct payment. Some say, in effect, that the person will need to accept that the council chooses to provide. This does not meet the requirements of the Care Act statutory guidance which says that the option chosen should have no bearing on the ability of individuals to direct their support.

Looking beyond local authority care and support:

  • In relation to NHS Continuing Care, some Clinical Commissioning Groups have adopted explicit policies which place financial limits on the amount that will be spent to support an individual to live in their own home as opposed to residential or nursing care. This is likely to have a particularly impact on people who would previously have accessed support from the Independent Living Fund

Alongside the report the Group has published a ‘key messages checklist’ to assist individuals in understanding their rights and local authorities to meet their duties to produce clear, accurate and accessible information about the Care Act 2014.

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