care act 2014 social work essay

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The Care Act 2014: Wellbeing in Practice, Suzy Braye Michael Preston-Shoot (eds)

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Helen Carr, The Care Act 2014: Wellbeing in Practice, Suzy Braye Michael Preston-Shoot (eds), The British Journal of Social Work , Volume 51, Issue 7, October 2021, Pages 2865–2866, https://doi.org/10.1093/bjsw/bcaa049

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The Care Act 2014 (the Act) promised to transform the landscape of adult social care. Instead of an outdated patchwork of provision, the law has been consolidated, modernised and informed by values, person-centred practice and statutorily articulated principles. Well-being, in particular, is at the heart of the legislation. Section 1 of the Act sets out a general duty on local authorities to promote the well-being of the adult when carrying out functions under the Act.

This edited collection, designed for social work students and practitioners, seeks to evaluate how far the promised transformation has been realised in practice and to assist professionals involved in adult social care to understand and deliver the potential of the law. Written by an impressive range of contributors, who combine practice, research and educational expertise, it draws on a wide range of evidence and multiple perspectives to interrogate emergent practices and to improve the legal literacy and professional judgement of those whose practice is shaped by the Act.

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• v.43(1); 2019 Feb

Adult safeguarding under the Care Act 2014

Katherine johnson.

1 Hertfordshire Partnership University NHS Foundation Trust

Billy Boland

Safeguarding adults is everybody's business, and it is now standard practice for clinicians to undertake safeguarding training as part of their mandatory training in the UK. Nevertheless, safeguarding work is complex and can involve significant dilemmas for professionals. The Care Act 2014 has introduced a number of differences in the way safeguarding is approached, emphasising the overall well-being and choice of the patient rather than merely focusing on their safety. This paper sets out to illustrate evolving safeguarding demand and practice, and aid clinicians in protecting people at risk by describing how they can approach challenging presentations.

Declaration of interest

Safeguarding adults in England and Wales is set out in the Care Act 2014. 1 The new law came in to being in April 2015 and superseded earlier documents that sought to protect vulnerable adults, 2 or ‘adults at risk of harm’, 3 from abuse. The Care Act itself brought together a wide range of social care concerns and activities, including personalisation, social care assessment and Mental Health Act 117 aftercare, as well as safeguarding, in a single statute. 4 This aimed to create ‘ a legal framework so key organizations and individuals with responsibilities for adult safeguarding can agree on how they must work together and what roles they must play to keep adults at risk safe’ . 5

In Scotland, the Support and Protection Act 2007 ‘seeks to protect and benefit adults at risk of being harmed’. The Act ‘requires councils and a range of public bodies to work together to support and protect adults who are unable to safeguard themselves, their property and their rights'. 6 In Northern Ireland, Adult Safeguarding Prevention and Protection in Partnership was published in July 2015. 7 It makes it clear that ‘safeguarding is everyone's business and that as good citizens we should all strive to prevent harm to adults from abuse, exploitation or neglect’.

Definitions

The term ‘vulnerable adult’ was a term used in No Secrets to describe those adults who may need to be subject to safeguarding. 2 However, in 2011, the Law commission recommended that this concept should no longer be used, as the label of vulnerability was not appropriate and could be ‘stigmatising, dated, negative and disempowering’. 3 The Care Act uses the term ‘adult at risk’ and also, at times, ‘adult with care and support needs’.

Most doctors will be used to definitions of abuse from statutory training in child protection and adult safeguarding, which is now a mandatory training requirement. Full details of forms of abuse under the Care Act are included in the Care Act statutory guidance. 8 It should be noted that services now have responsibilities to ensure that carers are also considered within the safeguarding context. Care Act statutory guidance note 14.45 recognises the circumstances in which a carer could be involved in a situation that may require a safeguarding response and provide information on how to manage these.

A ‘concern’ is used technically in the Act as the point at which the statutory authority is notified by someone that an adult at risk of harm is suspected to be the subject of abuse.

‘Enquiries’ are the investigations that the statutory authority makes in order to determine whether abuse has taken place, and whether the individual would benefit from safeguarding.

Safeguarding activity

Statistics gathered in the first 6 months following the implementation of the Care Act suggest that the number of adult safeguarding cases doubled during this period. 9 During the year following implementation of the Act, the Local Government Association undertook a series of six Care Act stocktakes to help them to understand the implications of the Act for local authorities. These stocktakes suggested that the rise in safeguarding referrals has continued, with 73% of councils involved in stocktake 6 reporting an increase in the levels of activity, and 34% stating that they had increased greatly. 10 By contrast, figures gathered by NHS Digital in their Safeguarding Adults: Annual Report for 2015–2016 11 indicate that 102 970 Section 42 enquiries were reported for the period 2015–2016, compared with 103 445 referrals during the period 2014–2015. It is difficult to directly compare statistics across these two reports in light of changes in terms of reference used within the safeguarding proceedings and therefore the reports. However, it should be noted that a total of 184 860 safeguarding concerns and 8365 ‘other enquiries’ were reported for the 2015–2016 period, suggesting that the rate of overall referral was greater than the recorded number of enquiries given above. When these are considered alongside the ‘referral’ rates from the previous year, it appears that the level of safeguarding concerns being raised has indeed increased. Statistics for 2016–2017 support this trend, showing 109 145 individuals under a safeguarding enquiry starting during the period measured, an increase of 6% from the previous year. 12

Guiding principles

As with all aspects of the Care Act, the concept of well-being underpins safeguarding practice, with ‘protection from abuse and neglect’ cited as one of the key elements of promoting individual well-being. 8 Within this, the Care Act guidance also outlines six fundamental principles for safeguarding ( Box 1 ).

Six Principles of Safeguarding 8

Empowerment

People being supported and encouraged to make their own decisions and informed consent

It is better to take action before harm occurs

Proportionality

The least intrusive response appropriate to the risk presented

Support and representation for those in greatest need

Partnership

Local solutions through services working with their communities; communities have a part to play in preventing, detecting and reporting neglect and abuse

Accountability

Accountability and transparency in safeguarding practice

In line with these principles, the Care Act focuses on early identification and prevention of potential abuse and neglect, rather than specifying thresholds for intervention. Any actions proposed should take into account the needs, goals and wishes of the patient, ensuring that their consent is gained before any action is taken. To support this aim, Making Safeguarding Personal (MSP), a sector-led safeguarding initiative, has also been introduced to help develop a more outcome-focused response. 13

The MSP ‘temperature check’ in 2016 14 recorded a number of positive outcomes in places where MSP was being implemented. Patients reported feeling more in control, with professional meetings declining but smaller patient meetings becoming more common. Overall, the results suggested that while MSP takes no longer than traditional approaches to implement, there is evidence to suggest that it leads to better outcomes and savings in time and resources.

Responsibilities

‘Effective safeguarding cannot be achieved without a large number of organizations and individuals working closely together, and there being an explicit recognition that safeguarding is everyone ' s concern.’ 15

The local authority is required under Section 42 of the Care Act to take a leading role in coordinating safeguarding enquiries, and may do this either through making enquiries themselves or by ensuring that others do so. Guidance for carrying out Section 42 enquiries is set out in paragraphs 14.63–14.67 of the Care Act Statutory Guidance. 8 Section 43 of the Care Act also requires local authorities to establish a Safeguarding Adults Board for its area, with the objective of helping and protecting adults that meet safeguarding eligibility criteria, through coordinating and ensuring the effectiveness of each of its members. A useful diagram showing the simplified responsibilities of key parties can be found in the Safeguarding Adults paper produced by the Care Quality Commission (CQC), the Association of Directors of Adult Social Services, NHS England, the Local Government Association and the Association of Chief Police Officers. 16

Alongside local authorities and other partner agencies, individual clinicians should seek to work with individuals at an early stage to promote well-being and independence, with the aim of preventing abuse and neglect from occurring. 15 Further to this, the focus should be upon identifying abuse or neglect early and raising a safeguarding concern. Care Act guidance states: ‘ No professional should assume that someone else will pass on information which they think may be critical to the safety and wellbeing of the adult. If a professional has concerns about the adult ' s welfare and believes they are suffering or likely to suffer abuse or neglect, then they should share the information with the local authority and, or, the police if they believe or suspect that a crime has been committed ’. 8 The safeguarding process can be time consuming, and it is important that clinicians continue to offer appropriate care and treatment to the patient. Where appropriate, clinicians should also attend safeguarding meetings in order to provide a more cohesive and robust plan of support.

Although not all concerns will be escalated to become Section 42 enquiries, this will be decided by the relevant safeguarding team, who will have overall responsibility for the decision on whether an enquiry is required. The team will consider the criteria as outlined in S.42(1) Care Act ( Box 2 ). They will also consider issues such as mental capacity 17 and consent, which will be explored in more detail in the case examples below.

Care Act Safeguarding eligibility criteria 1

• (1) This section applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there):
• (2) has needs for care and support (whether or not the authority is meeting any of those needs);
• (3) is experiencing, or is at risk of, abuse or neglect; and
• (4) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

Where clinicians have concerns that important factors are not being acknowledged, these can be raised with the enquiry officer and through initial strategy discussions and case conferences, which will be held during the safeguarding enquiry process. All individuals involved in the process will be included in determining whether allegations of abuse are substantiated and in developing an appropriate plan with the patient. Whereas under previous guidance, the emphasis was often on taking professionally proscribed measures to ensure patient safety, statutory Care Act guidance states that ‘professionals and staff should not be advocating “safety” measures that do not take account of individual well-being, as defined in Section 1 of the Care Act’. 8 As in the assessment of social care needs, practitioners should approach safeguarding concerns in an inclusive, outcomes-focused, person-centred manner, and the emphasis should be on ‘sensible risk appraisal, not risk avoidance’. 18 It should be made clear to the individual that they will be included at all stages of the enquiry and that factors such as their wishes, preferences, history and lifestyle will be taken into account throughout the process. Outcomes should be primarily patient determined. While there may be occasions when views of those involved in the process differ, decisions are made in a multidisciplinary manner with the patient's wishes at the forefront, with overall responsibility for reaching consensus falling to the safeguarding manager.

Safeguarding dilemmas

The case studies below highlight some of the factors and considerations which may be pertinent to safeguarding processes.

Case Example 1: Cheryl – Consent, Coercion and Domestic Violence

Cheryl is a 30-year-old woman with a diagnosis of severe anxiety and depression. She is living with her partner, Julian, and two children, both of whom are under a Child Protection Plan. There have been a number of concerns raised over recent months about Julian, who will often present as verbally aggressive towards professionals. Julian will also ensure that he is present at all of Cheryl's appointments. Cheryl comes to her out-patient appointment with a black eye which Julian states is due to walking into a door frame. Her psychiatrist manages to speak to Cheryl alone and Cheryl tells her that in fact Julian has hit her the evening before. Cheryl asks her psychiatrist not to tell anyone and says that she does not want police involved or for any action to be taken. Cheryl's psychiatrist feels that Cheryl has capacity to make this decision, but is concerned about the risks to Cheryl and her children. Cheryl's psychiatrist raises a Safeguarding Adults concern and also contacts Children's services to ensure they are aware of the incident.

Unlike previous guidance, which emphasised the duty to report and act on all allegations of abuse, the Care Act emphasises empowerment and the patient's right to choice and control over how and with whom information is shared. In this instance, Cheryl is refusing consent to contact police or for a safeguarding investigation to take place. Since Cheryl has capacity to refuse to report abuse to police or for a safeguarding enquiry to be undertaken, a risk assessment will need to be made in regards to whether others are at risk (public interest), a serious crime is taking place (public interest) or Cheryl's life is in danger (vital interest). In line with principles of protection and proportionality, if there is an identified risk in either of these areas, the investigating team may decide to overrule their consent and continue with the safeguarding investigation, involving only professionals and not friends or family members.

In light of Julian's behaviour, consideration should also be given to whether Cheryl's decision is being made under the influence of coercion and control, in which case Cheryl's consent may be overridden and a safeguarding investigation commenced. This new offence of ‘coercive and controlling behaviour in intimate and familial relationships’ was introduced into the Serious Crime Act 2015 as a way of providing better protection to victims experiencing continuous abuse. 8 In cases such as these, the individual may present as having capacity in relation to a decision but in fact be unable to make this decision owing to coercion or control. In these cases, the individual will not fall under the auspice of the Mental Capacity Act. This kind of enquiry is often complex and will require a range of professionals to work with the person to identify appropriate safeguarding options. In serious cases, the situation may ultimately require application to the inherent jurisdiction of the High Court, 15 who may legally be able to act against the wishes of the individual to safeguard them from further harm. Similarly, police now have the ability to use a Domestic Violence Protection Order under Sections 24–33 of the Crime and Security Act 2010 to remove an alleged perpetrator from the family home for a period of up to 28 days with or without consent from the person alleged to be experiencing abuse. 19

Should it be decided that safeguarding needs to proceed, with or without Cheryl's consent and involvement, there is a need to undertake ‘safe enquiry’, ensuring that any investigation does not increase risk to Cheryl. The Local Government Association guide to adult safeguarding and domestic abuse 20 provides a useful and comprehensive guide to dealing with these situations within the safeguarding context.

Finally, if Cheryl refuses consent and none of the above risk factors are present, this decision should be respected and Cheryl should be supported in considering other avenues outside the safeguarding agenda. Information may still need to be shared with children's services if there is a perceived risk to the children, which will need to be addressed under child safeguarding procedures.

Case Example 2: Layla – Unintentional Abuse, Carer Safeguarding and Mental Capacity

Layla is a 77-year-old woman with physical mobility difficulties and early symptoms of Alzheimer's disease. She is currently in a relationship with Giles, a 78-year-old man who also has physical mobility issues. Layla and Giles both attend Layla's Care Programme Approach meeting, during which Layla's psychiatrist notices that Layla's hair and clothes are unclean and she has lost weight. He asks Layla about this, who replies that Giles does not help her with her personal hygiene or give her food regularly. Giles explains that he is doing his best but is struggling to care for Layla at the moment owing to his physical health, and that he did not want to contact anyone for help as Layla does not want carers involved. He also discloses that he has found caring for Layla more difficult recently, as on a number of occasions she has lashed out at him and caused him minor injuries. Layla's psychiatrist is concerned that Layla is being neglected and raises a safeguarding concern.

This case study, while on the face of it simple, in fact outlines complex issues around unintentional abuse, carer safeguarding and mental capacity.

In this case study, a safeguarding alert has been raised owing to what appears to be unintentional neglect of Layla, which has arisen because Giles is struggling to care for her. Unintentional abuse is a recognised issue under the Care Act, and guidance is clear that the unintentional nature of this does not change the fact that it is a form of abuse or make the need for action any less important.

In this case example, professionals will need to consider Layla's capacity in relation to a range of safeguarding-related decisions, for example, whether she has capacity to decide whether to allow carers into the home, and whether she can consent to information being shared as part of a safeguarding enquiry. 15 The Care Act works together with the Mental Capacity Act 2005, and if Layla is found to lack capacity, an Independent Mental Capacity Advocate (IMCA) must be made available to her. Unlike most best-interests decision situations, an IMCA may be required even if there is an appropriate friend or family member who could support Layla.

If Layla is found to have capacity in these areas but also appears to have substantial difficulty in engaging with safeguarding processes, it may be appropriate for a Care Act Advocate to be involved. This is a new role under the Care Act which is used where a person with capacity demonstrates substantial difficulty in being involved in decision-making and does not have an appropriate friend or family member to support them. Where there is no appropriate individual, the local authority must provide an independent advocate. 21

Also pertinent in this case is that one of the major changes to safeguarding processes introduced by the Care Act is the need to provide safeguarding responses for carers who may be experiencing abuse due to their caring role. Since it has been identified that Giles is experiencing physical abuse from Layla in the course of his caring role, this avenue will need to be considered as a framework for providing him with appropriate support. Although the primary focus is likely to remain on safeguarding Layla, consideration will also need to be given to providing a more appropriate package for Giles as carer to help prevent further abuse to both parties. 8 In this instance, there is no indication that Giles lacks capacity; however, it should be remembered that where an alleged perpetrator lacks mental capacity, they are entitled to support from an IMCA throughout the safeguarding proceedings. 8

Case Study 3: Alexis – Organisational Abuse

Alexis is a 42-year-old Black British man living in a residential placement owing to his moderate learning disability and physical mobility issues. Alexis attends a routine out-patient appointment, during which he discloses that one of the staff members at the placement has left him sitting in the bath for an extended period of time on a number of occasions. Alexis also shares some racially derogatory names which he says the staff member has been calling him when he asks for help. Alexis's psychiatrist decides to raise a safeguarding concern.

This case example allows us to consider issues round organisational abuse, including neglect and poor practice within an institution or specific care setting, and action which will need to be taken in these instances, as set out in the Care Act statutory guidance. 8

In situations such as this, the safeguarding investigation will need to include Alexis's residential placement. The placement should be made aware that, as instructed by Care Act guidance, where a complaint or allegation has been made against a member of staff, they ‘should be made aware of their rights under employment legislation and any internal disciplinary procedures’. 8

The local authority does not have the right to direct Alexis' care home as to what actions to take against their staff; however, they should report concerns to the CQC and continue to monitor the situation. Since this is a care setting, the local authority must also advise other placing authorities of the concerns so that appropriate measures can be taken to safeguard all other residents as well as Alexis. Since Section 44 of the Mental Capacity Act makes wilful neglect or mistreatment of an adult who lacks capacity a criminal offence, should Alexis be deemed to lack capacity, police involvement may be required in the safeguarding process. 15

Conclusion: implications for patients and carers

The introduction of the Care Act 2014 has had a number of implications for patients and carers requiring support under the safeguarding framework. One of the positive developments in regards to individual empowerment is that the Act places a greater emphasis on individual self-determination and desired outcomes. Patients now have a more robust framework protecting their rights to make decisions about their lives, with new advocacy requirements ensuring that their voices are heard. Prevention principles have removed some of the previous thresholds which would have prevented those in the early stages of abuse or neglect from being overlooked, and require services to be more proactive in preventing the escalation of abuse.

However, it could be argued that the Care Act's emphasis on patient outcomes and goals could come at the price of leaving some individuals unsafeguarded who would previously have been supported under a less flexible framework. Services may need to develop new ways of responding to these concerns, ensuring that front-line staff across the multidisciplinary team work together to ensure that needs are met and risks are mitigated as far as possible. There are also questions over where this leaves family members, friends and other members of social networks who will continue to worry about the well-being of the vulnerable person. There is scope under Care Act legislation for support to be offered to carers under the safeguarding framework, and it may be that support can be offered to carers in this situation. For example a carer's assessment may be considered to discuss the effects of the caring role, including worry caused by these concerns.

About the authors

Katherine Johnson is a Think Ahead consultant social worker, Hertfordshire Partnership University NHS Foundation Trust, UK; Billy Boland is a consultant psychiatrist in community psychiatry, Hertfordshire Partnership University NHS Foundation Trust and vice chair (elected), Faculty of General Adult Psychiatry, Royal College of Psychiatrists, UK

The Care Act 2014: a new legal framework for safeguarding adults in civil society

The Journal of Adult Protection

ISSN : 1466-8203

Article publication date: 14 August 2017

Penhale, B. , Brammer, A. , Morgan, P. , Kingston, P. and Preston-Shoot, M. (2017), "The Care Act 2014: a new legal framework for safeguarding adults in civil society", The Journal of Adult Protection , Vol. 19 No. 4, pp. 169-174. https://doi.org/10.1108/JAP-06-2017-0024

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

Many of us may be able to remember the general air of excitement that surrounded the writing and publishing of “No Secrets” ( Department of Health, 2000 ) and “In Safe Hands” ( Welsh Assembly Government, 2000 ), although we might wish we were young enough not to! At the time, the documents generated mixed feelings amongst service users/customers and carers as well as professionals/practitioners. To some they were a major step forward on the road to raise the status of “vulnerable adult protection” (as it was then known) closer to that already enjoyed by child protection and domestic violence; to others it was a missed opportunity to go even further along that road; and to a small number it was a step too far when the perception was that existing legislation provided sufficient protection and any increased powers amounted to state intrusion into the private lives of adults.

The constitutional situation across the four countries of the UK meant that England and Wales had slightly different structures put in place to respond to situations of abuse and neglect, while Scotland and Northern Ireland were responsible for their own processes and took different approaches. Even within England and Wales, “No Secrets” and “In Safe Hands” were issued as guidance to Local Authorities under existing legislation and, as such, did not place any requirements on any other agencies or organisations to cooperate with the Local Authority. In fact, it could be argued that Local Authorities did not have to act in accordance with guidance if they could see good reason why not. Indicative of the anomalous position of the guidance is the situation in England regarding the requirement of Local Authorities to produce multi-agency policies and procedures to protect vulnerable adults – it is interesting to note how they had to produce multi-agency policies and procedures, but no other agency was required to work with them to do so!

“No Secrets” was published in March 2000 and required the above-mentioned policies and procedures to be forwarded to the Department of Health by October 2001. When one of us (PM) took up the post of Vulnerable Adult Protection Coordinator with Coventry City Council in mid-2003, he discovered that the Council had not submitted its policy and procedure to the Department and that in fact the Council had not even finalised them. When he advised the Department of Health of this, they did not seem unduly surprised or bothered and when he did submit them later that year their receipt was not acknowledged; when he chased the Department six months later to confirm that they had received them and to ask for feedback on them, he was told they had received them, and, if they have had any negative comments to make, they would have been in contact. Not really what you would want or expect if the Department and the government were really committed to making vulnerable adult protection a reality and to have a real impact on the lives of vulnerable adults and the services designed and intended to protect them. However, given that both “No Secrets” and “In Safe Hands” were launched with no key performance indicators and were announced as being “cost-neutral” perhaps we should not have been surprised.

the terminology of “vulnerable adults” was considered by some if not many to be discriminatory and labelling of the very people it was trying to empower by making it appear that they were some way the cause of their being abused and neglected;

the definition of “a vulnerable adult” was interpreted by some Local Authorities to require the adult to be in receipt of community care services to meet it;

the definition of “abuse” was seen as too vague and open to interpretation, being based as it was on the violation of the individual’s human rights rather than specific acts;

a definition of “abuse” that is based on the violation of someone’s human rights by another person or persons does not enable the protection of those who self-neglect, a particular issue before and subsequent to the implementation of the Mental Capacity Act 2005;

there was no duty on anybody to act under the multi-agency policies and procedures – there was not even a date when they had to be implemented, only returned to the Department of Health, a date that was not enforced;

not only was there no duty to act, but if the Local Authority, which invariably meant the local Adult Social Services Department, wanted to do so, it had no or few powers under which it could intervene; and

“Vulnerable adult protection” was seen by other agencies, particularly health organisations and, to a lesser extent, the Police, as the task of Social Services and, having made a referral, they would often withdraw involvement.

We are not saying that the above are all true or correct, but they are accurate reflections of perceptions and criticisms of “No Secrets” in the early 2000s. There was a groundswell amongst professionals directly involved with “vulnerable adults” and the organisations and agencies established to support and campaign on their behalf that was lobbying Ministers and the Department of Health to review “No Secrets” with a view to revising it to make it more effective. What followed was not a review of “No Secrets” but a consultation on a review of “No Secrets”, perhaps reflective of the lack of political will at that time to tackle the issue.

The Consultation on a Review of “No Secrets” was held in 2008/2009, with a response from the government in early 2010 that said it would establish an Inter-Departmental Ministerial Group, introduce legislation to put Safeguarding Adults Boards (SABs) on a statutory basis and issue multi-agency practice guidance. Before this could all happen, a General Election led to a change of government, with the newly-elected Coalition deciding to scrap its predecessor’s proposals in favour of a review of the chaotic plethora of legislation supporting – or not – adult social care that would propose a simplified legislative structure that would incorporate safeguarding within it. While frustrating in many ways, from a purely safeguarding perspective, which would otherwise continue to be under-valued, under-resourced and under-powered, this did make a lot of sense and was seen as likely to produce a more coherent base for work in safeguarding adults in the long run.

The Care and Support Bill was published in 2011, based very much on the recommendations of the Law Commission’s review of adult social care legislation, which took place between 2008 and 2011. This proceeded through a consultation process of its own, in the process of which it became the Care Bill and then the Care Act, receiving Royal Assent in May 2014 and coming into effect, in part, in April 2015. Statutory guidance was developed to support the implementation of the Act. The first edition of this was published in October 2014 by the Department of Health, barely six months after the Royal Assent; perhaps not surprisingly, the second edition was published in March 2016. The second edition was necessary to cover some aspects of the Care Act, which appeared to have been “shelved” by the government, some that were decided to be unwise and some that were considered necessary to be added. All of this is somewhat redolent of a piece of statutory guidance that was rushed and not properly thought through.

The Act, of course, only applies to England; Scotland already had its own legislation relating to adult protection, Wales had developed its own, which had important similarities as well as differences to the Care Act 2014 and Northern Ireland had not decided whether to introduce new legislation or not. This seemingly anarchic situation across the UK did, and still does, provide an opportunity for a research project that examines the processes by which the Care Act came to take the form it did and to compare it, and how it is implemented, with the legislation, or lack of it, in the other three countries.

In terms of adult safeguarding, the Care Act 2014 did contain framework legislation that placed SABs on a statutory footing. It required SABs to publish annual reports and strategic plans. Under certain circumstances it placed a duty on SABs to commission Safeguarding Adults Reviews (SARs), which replaced Serious Case Reviews (SCRs), with discretion to commission SARs in other circumstances. SABs were to have three statutory members, the Local Authority, Clinical Commissioning Group and Police, with discretion then as to how wide and inclusive the remaining Board membership was drawn. SABs were given the power to request information and Local Authorities the duty to conduct safeguarding enquiries. The adult safeguarding provisions were part of a general requirement in the Care Act 2014 to promote people’s wellbeing, with agencies being under a statutory duty to cooperate both at strategic and operational levels.

The Care Act 2014 did not follow Scottish legislation (the Adult Support and Protection (Scotland) Act 2007) in that no new protection orders were created; nor, despite strong advocacy, was an adult safeguarding power of entry created. Wales has similarly eschewed protection orders but has created an adult safeguarding power of entry in their Social Services and Well-being (Wales) Act 2014. Perhaps less well known, but nonetheless significant, is the fact that the Care Act 2014 has not given SABs the power to require statutory and other partners to contribute to resourcing its activities; nor do SABs have effective sanctions if agencies do not cooperate in terms of its adult safeguarding responsibilities at local level.

Subsequent developments have also shown some equivocation. Self-neglect was included in adult safeguarding arrangements for the first time in England in the Care Act 2014, but in key respects the second edition of the statutory guidance ( Department of Health, 2016 ) demonstrates some unease by appearing to limit the occasions when a safeguarding enquiry might be triggered in self-neglect cases. This example, and the failure to legislate for either an adult safeguarding power of entry or protection orders, arguably demonstrates ongoing unease with giving the state powers to intervene, despite evidence of the effectiveness of the Scottish adult protection system (see e.g. Preston-Shoot and Cornish, 2014 ). It is therefore important to recognise that the Care Act 2014 was a compromise, that there is nothing inevitable about the legal rules that were developed, and that they are the result of how competing perspectives, and arguably interests, are ultimately in some form reconciled.

Going forward, it becomes imperative to evaluate the different legislative and policy arrangements, and the four nations of the UK provide a perfect case study for research in that respect. It becomes equally imperative to look at outcomes from the perspectives of practitioners, service users and carers, especially because the statutory guidance ( Department of Health, 2016 ) places great emphasis on Making Safeguarding Personal, which requires a major culture shift in how health and social care agencies in particular have historically delivered adult safeguarding services. Some legislation is hard for practitioners and their organisations to understand, whilst some is experienced as hard to implement. The Data Protection Act 1998 and the Mental Capacity Act 2005 are two cases in point. What, one wonders, might practitioners and managers, across health and social care agencies and beyond, say about the Care Act 2014? SARs, and their predecessor SCRs, also highlight that legal literacy and safeguarding literacy across professions and agencies is variable ( Braye et al. , 2015 ), reinforcing again the need to track the experience of implementation of the provision of the Care Act 2014.

In 2015, a multi-disciplinary research team obtained funding from the Economic and Social Research Council to run a seminar series to consolidate and advance knowledge around safeguarding adults under the new legislative and policy framework. The research team comprises the following people: Alison Brammer, Keele University (Principal Investigator); Pete Morgan, Independent Consultant and the University of Warwick; Paul Kingston, University of Chester; Jonathan Parker, Bournemouth University; Bridget Penhale, University of East Anglia (Norwich), Michael Preston-Shoot, University of Bedfordshire and Alex Ruck-Keene, Barrister (39 Essex Chambers, London) and the University of Manchester.

The series aims to explore how the new law emerged through a policy process, the challenges of interpretation that emerge and how practitioners and their organisations can be supported to deliver the intentions and requirements of the Care Act 2014 and to keep people safe from abuse and harm.

theorise the process of law reform, exploring the interplay in making law between research and practice evidence, policy advocacy and political debate;

evaluate the new landscape for adult safeguarding, for example, the contested inclusion of self-neglect and the omission in England of a power of entry, and to appreciate the challenges in interpreting and implementing the new powers and duties;

examine accountability and responsibility to and for safeguarding adults in civil society;

develop the evidence-base for learning adult safeguarding law that instils an ethical, social justice commitment alongside technical legal knowledge;

establish an inter-disciplinary network uniting academic and practitioner perspectives, health and adult social care providers with civil society organisations providing welfare services, to assist with interpreting, learning and evaluating the new provisions; and

effectively disseminate work undertaken in seminars to academic, practitioner, service user and carer audiences.

To achieve the objectives, the seminar structure was devised to develop three distinct themes. The focus in year one was on how law is made, reflecting on contributions of researchers, civil society organisations, pressure and advocacy groups, statutory health and welfare agencies, and judicial decision making, including a comparative perspective. The focus in second year, currently underway, is on interpreting the law, including new concepts, such as Making Safeguarding Personal, dignity and wellbeing, and new accountabilities. The third and final year of the series will focus on learning law. How might new adult safeguarding powers and duties be taught and what can be learned from SARs, case law and investigations by the Local Government and the Health Services Ombudsman. Each theme is examined from academic, service user, statutory and third-sector organisation perspectives.

Seminar participants

The series aims to create a strong network of individuals and organisations concerned with adult safeguarding and with the capacity to engage in further collaborative research, policy and practice development, and conferences. Over the first year, seminars were held at Keele University, Bournemouth University and the University of Bedfordshire. Each seminar has been well attended with in the region of 40-60 delegates. The series to date has been truly multi-disciplinary with an impressive range of organisations and disciplines represented including the Department of Health, Local Authorities, Police authorities, health authorities, Association of Directors of Adult Social Services, Care Quality Commission, Civil society and third-sector organisations concerned with social and welfare services including Action on Elder Abuse, ASIST and Alternative Futures, Social Care Institute for Excellence, academics and educators, training and consultancy organisations and solicitors and barristers.

An open access dedicated website has been developed to support the series and can be found at: https://safeguardingadults.wordpress.com

The site includes presentations from the seminars, in video and print form, a discussion forum, and a live Twitter feed. Summaries of key issues from each of the seminars, links to publication outputs from the seminars and to other key works in the field of safeguarding and suggested pre-reading also appear on the site. Contact information about the seminar network and announcements about the seminar programme and other related events are also posted. The website also provides a forum for collating views expressed by members on any consultation documents of relevance to adult safeguarding. In addition the site hosts blogs during the life of the seminar series, and these are likely to continue beyond the series completion date.

Places at seminars may be reserved by e-mail to [email protected]. Any queries about the series should also be directed to this e-mail address. At the seminars themselves and in between seminars, there is an active Twitter feed @SALLY2016_18 #SafeguardingAdults.

We are delighted that this special issue of the journal provides a compilation of four papers based on presentations given at one of the seminars that took place in 2016, together with an additional legal paper (more on that later). The theme for the seminar was safeguarding in the devolved nations, so we are delighted to have papers from each of the devolved nations; the papers are as follows.

Our first paper is by John Williams, of Aberystwyth University and the focus is on Wales. The paper explores recent changes to adult safeguarding in Wales (including background information) that have been introduced as part of the Social Services and Well-being (Wales) Act 2014 and discusses their potential impact. Although the Act introduced a number of changes in adult safeguarding in Wales, not least the duty to make enquiries, statutory powers of barring and removal were not included. As a recently implemented statute, the legislation is still in the process of becoming established and care and health practitioners are becoming used to the changes required by the legislation. Although no official data on the impact of the new legislation are available yet, it is likely that the lower threshold that has been set for referrals will mean an increase in caseloads and the need for practitioners to react to both low- and high-risk cases. The paper provides a detailed examination of the provisions of the Act that are related to safeguarding and identifies that more research and evaluation of the different approaches to safeguarding across the UK are needed.

The second paper in the issue is from Scotland, which has had legislation in the form of the Adult Support and Protection (Scotland) Act since 2007, implemented from 2008. In this paper, Kathryn Mackay of the University of Stirling, together with colleague Mary Notman explore the potential value of having a specific, separate statue on adult safeguarding. The paper details the powers and duties mandated by the Act and relate these to the overall context of the broader Scottish legislative framework in relation to adult protection. The authors utilise a case study of one specific Local Authority in Scotland to explore the merits of and issues raised by the Act; this is achieved through consideration of the different forms of data contained in the annual reports on adult protection activity produced by the authority. From the data obtained, the use of Protection Orders is quite limited – as intended within the Act. It also appears that effective identification; investigations and interventions require staff to be skilled, knowledgeable and well supported. However, a lack of reports and data at national level means that comparison between the local and national data is quite limited. The paper provides an appraisal of the implementation of the legislation in recent years and considers developments that have taken place in both England and Wales. A need for comparative research across the different nations of the UK is highlighted.

The following paper in the issue is by Lorna Montgomery of Queen’s University, Belfast and her colleague Joyce McKee. The paper examines the current model of adult safeguarding in Northern Ireland. The distinctive features of Northern Irish society have shaped its adult safeguarding policy and practice in ways which differ from those in England, Scotland and Wales and the paper provides an analysis of adult safeguarding, legislation, policy and practice in this context. Usefully, the paper also includes insights from the Regional Adult Safeguarding Officer for Northern Ireland (McKee). A number of strengths, limitations and challenges of Northern Irish legal and policy frameworks, and practice systems in relation to safeguarding are discussed. This includes an emphasis on changes in the way that adult safeguarding has been conceptualised, together with a focus on prevention and early intervention activities. It appears that organisations from community, voluntary and faith sectors have important roles in the continuing development of policy and practice in Northern Ireland.

The fourth paper in this issue is by Adi Cooper and Claire Bruin from England. It is now two years since the implementation of the Care Act (2014) in April 2015, and this paper explores the impacts of the Act on adult safeguarding partnerships and practice. The paper considers a range of areas, including wellbeing and safety, safeguarding activity and process, changing criteria and definitions, Making Safeguarding Personal, SABs, SARs, and advocacy. The authors, an Independent Chair of two SABs, and a Senior Manager in adult social care in a Local Authority, present information from published sources, experience and networks in the professional sphere. The paper argues that the impact on adult safeguarding and SABs has been greater than originally envisaged in a range of areas. This appears to be as a result of aspects of adult safeguarding having been given statutory status in the Act, and a new framework put in place. The authors consider that this provision has resulted in added impetus to cultural change in adult safeguarding practice.

The final paper in this issue is by Tim Spencer-Lane of the Law Commission. Some readers of the journal of long-standing will be aware that there have been previous papers from Tim (on behalf of the Law Commission) in the journal in relation to legal and regulatory reforms that have a bearing on safeguarding. Examples of these are the Regulation of Health and Care Professions ( Spencer-Lane, 2012 ) and the reform of the law relating to Adult Social Care ( Spencer-Lane, 2010, 2011 ), which culminated in the Care Act 2014. This current paper, written following the recent consultation exercise and work by the Law Commission on potential reform of the Deprivation of Liberty Safeguards, provides an overview of the Law Commission’s final report and recommendations on the reform of the Deprivation of Liberty Safeguards under the Mental Capacity Act, together with some discussion of implications.

We hope that this issue has provided information and food for thought for readers and will stimulate both discussion and potentially, practice development. We also hope that it will stimulate some interest in the seminar series and that some readers will be able to attend future seminars and join in the ongoing discussion and debates relating to safeguarding and legal literacy.

Braye , S. , Preston-Shoot , M. and Cornish , S. ( 2015 ), “ Learning lessons about self-neglect? An analysis of serious case reviews ”, The Journal of Adult Protection , Vol. 17 No. 1 , pp. 3 - 18 .

Department of Health ( 2000 ), No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse , The Stationery Office (TSO) , London .

Department of Health ( 2016 ), Care and Support Statutory Guidance Issued Under the Care Act 2014 , 2nd ed. , TSO , London .

Preston-Shoot , M. and Cornish , S. ( 2014 ), “ Paternalism or proportionality? Experiences and outcomes of the Adult Support and Protection (Scotland) Act 2007 ”, The Journal of Adult Protection , Vol. 16 No. 1 , pp. 5 - 16 .

Spencer-Lane , T. ( 2010 ), “ A statutory framework for safeguarding adults? The law commission’s consultation paper on adult social care ”, The Journal of Adult Protection , Vol. 12 No. 1 , pp. 43 - 9 .

Spencer-Lane , T. ( 2011 ), “ Reforming the legal framework for adult safeguarding: the law commission’s final recommendations on adult social care ”, The Journal of Adult Protection , Vol. 13 No. 5 , pp. 275 - 84 .

Spencer-Lane , T. ( 2012 ), “ Reforming the professional regulatory bodies: the law commission’s review of health and social care professional regulation ”, The Journal of Adult Protection , Vol. 14 No. 5 , pp. 237 - 43 .

Welsh Assembly Government ( 2000 ), In Safe Hands: Implementing adult Protection Procedures in Wales , National Assembly for Wales and the Home Office , Cardiff .

Further reading

Department of Health ( 2005 ), “ Mental Capacity Act ”, TSO, London .

Department of Health ( 2009 ), “ Safeguarding adults report on the consultation on the review of ‘No Secrets’ ”, TSO, London .

Department of Health ( 2012 ), “ Draft Care and Support Bill ”, TSO, London .

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Home — Essay Samples — Psychology — Adult — The Care Act 2014 – The Major Changes In Safeguarding Adults

The Care Act 2014 – The Major Changes in Safeguarding Adults

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What the Care Act 2014 means for social workers

The draft statutory guidance puts flesh on the bone on how social workers will be required to practice under the legislation that comes into force in april 2015.

The draft statutory guidance for the Care Act 2014 provides a blueprint for how councils should implement the legislation in April 2015 and how they should deploy social workers and other staff in doing so.

Below we set out some of the key provisions for social workers and what the draft guidance has to say about their role.

The Act places a duty on local authorities to provide or arrange services that reduce needs for support among people and their carers in the local area, and contributes towards preventing or delaying the development of such needs ( section 2 ).

The draft statutory guidance states  that preventive services should operate at three levels: primary prevention to stop care and support needs from developing among those who do not have them,, for example through health promotion or action to reduce isolation; secondary prevention, for people at increased risk of developing needs, which could involve housing adaptations or telecare that prevent deterioration; and tertiary prevention for people with established needs to help improve independence, for example through reablement.

Assessments should seek to promote independence and resilience by identifying people’s strengths and informal support networks, as well as their needs and the risks they face, and asking what a good life means to them and how they think it can be achieved in partnership with professionals.

Information and advice

Section 4 of the Act places a duty on councils to establish and maintain a service providing information and advice to local people on care and support.

The draft statutory guidance sets out what topics councils should provide – or commission – information and advice on, and specifies that they must ensure that this is accessible and open to all who would benefit from it. It also sets out a clear role for social workers in supporting staff providing information and advice so that people with more complex needs can be identified as soon as possible.

“To help ensure that information and advice is proportionate to the needs of those for whom it is provided, a local authority should enable those providing information and advice to people contacting the local authority to have access to the support of registered social work advice when it is required,” it says. “This can help ensure that the potential for complexity is recognised early on and the person receives help to access non-statutory services and/or initial statutory sector support proportionate to their needs.”

Sections 9-13 sets out the Act’s provisions on assessing adults and carers , including duties to assess adults if they appear to have needs for care and support, and carers if they appear to have needs for support. These are fleshed out in the draft statutory guidance .

Who can do an assessment? The guidance says assessments can be carried out by a range of professionals including registered social workers, occupational therapists, rehabilitation officers and those with relevant NVQs. It adds: “Registered social workers and occupational therapists are considered to be two of the key professions in adult care and support. Local authorities should consider how adults who need care, carers, and assessors have access to registered social care practitioners, such as social workers or occupational therapists.”

Specialist assessments and complex needs

The guidance says registered social workers are “uniquely placed to be involved in complex assessments which indicate a wide range of needs, risks and strengths that may require a co-ordinated response from a variety of statutory and community services”. They can also advise and support assessors when assessing someone who may lack capacity to carry out relevant decisions.

Assessors who do not have knowledge of a condition must consult someone with knowledge of it through training or experience. The expert can be either external or in-house. Councils must ensure an expert is involved in the assessment for adults who are deafblind.

Training of assessors

It says assessors must have suitable and up to date training, maintained throughout their career, including knowledge of the conditions they are being asked to assess such as autism, learning disabilities, mental health problems or dementia. It adds that social workers have to demonstrate their continuing professional development in order to maintain their professional registration with the Health and Care Professions Council.

Assessments by phone

Where the individual’s needs are easily recognisable the assessment can be done by phone but councils should be aware of the risks of doing so, the guidance says. For example staff should have training in recognising issues around mental capacity. Where a person may lack to carry out relevant decisions, the assessment must be carried out face-to-face.

Supporting people through the care and support planning process Social workers may provide one-to-one support to help people develop their care plans if they wish although they may prefer to develop it themselves with their family, friends or others. The level of involvement should be agreed with the individual and anyone else they choose to involve. Social workers should talk to the person about their confidence to take a lead in the process and what support they feel they need to be meaningfully involved. Social workers may need additional skills, which councils should help them acquire, on how community-based and unpaid support can contribute to parts of the plan, such as support that builds emotional wellbeing and social connections.

If the person has substantial difficulty in being involved in the planning process and has no family or friends to support them, the local authority must commission an independent advocate to represent them and facilitate their involvement. This includes cases where the person lacks the capacity to decide to be fully involved in their care plan or consent to it.

Planning for people who lack capacity If a councils thinks a person may lack capacity to make a decision or plan, even after being offered support, then a social worker or other suitably qualified professional needs to assess their capacity in relation to the decision being made (for example whether the person has the capacity to decide whether family members should be involved in their care planning).

Minimising and authorising deprivation of liberty for people who lack capacity

In line with the Mental Capacity Act (MCA), care and support plans must minimise planned restrictions and restraints on the person as much as possible. These planned restrictions and restraints must be documented and reported to a social worker to agree. Significant restraints and restrictions that amount to a deprivation of liberty must be authorised under the Deprivation of Liberty Safeguards (Dols). But the guidance says that in most cases a deprivation of liberty would be avoided with proper person-centred planning. Planned reviews During the planning process the individual and their social worker, or another professional, may have recorded a date for review of the plan. The guidance says this can help to personalise care and support and assist councils in planning their workloads. But the authority should still keep the plan under review outside these dates, the guidance says.

The first review

The first planned review should be a ‘light-touch’ look at the planning arrangements six to eight weeks after sign-off of the personal budget and plan, and should be combined with an initial review of direct payment arrangements where relevant.

Reviewing several plans simultaneously If the care and support plan is combined with other plans that are reviewed annually, like education, health and care plans, then the council should try to conduct reviews together. Review options including face to face and peer-led reviews Review options could include self-review, peer-led review, reviews conducted remotely, or face-to-face reviews with a social worker. The planned review should be proportionate to the circumstances and to the value of the personal budget, the guidance says. The method of review should be agreed with the person and involve them and other people they identify where possible.

Reviews for people lacking capacity

If someone has a mental impairment and lacks capacity to make some decisions then the council should carefully consider when the next review should take place and is encouraged to make use of a social worker as the lead professional.

Reviews for people with deteriorating conditions or few family or friends supporting them

More frequent reviews may be needed for people who have a progressive condition and their health is deteriorating and for people who have few family or friends supporting them. The guidance says it may be helpful to put a duty to request a review into commissioned services for these groups. So, for example, a domiciliary care worker should be required to ask for a review if they believe the person is in need of one. Reviews that propose increased restraints or restrictions on a person who has not got the capacity to agree them Councils should have policies for recognising and handling revisions to support plans that propose increased restraints or restrictions on a person who has not got the capacity to agree them. These changes could become a deprivation of liberty, which requires appropriate safeguards to be in place, the guidance says. The social worker, occupational therapist or other relevant social care qualified professional or mental capacity lead should be involved, as well as an advocate. Adult safeguarding Professionals and staff need to be able to handle adult safeguarding enquiries – for example suspected abuse or neglect – in a sensitive and skilled way to minimise distress to the individual. The guidance says it is likely that many enquiries will require the input and supervision of a social worker, particularly in more complex situations. For example, where abuse or neglect is suspected within a family or informal relationship it says it is likely that a social worker will be the most appropriate lead.

Who can carry out an enquiry into safeguarding concerns

Councils must make enquiries whenever abuse or neglect are suspected in relation to an adult with care and support needs or ensure another agency does so. The circumstances will often determine the right person to begin an enquiry. In many cases it will be a professional who already knows the individual, such as a social worker, a housing support worker, or health worker such as a community nurse.

Assessments of young people making the transition to adult care and support

Social workers will often be the most appropriate professionals to carry out assessments of young people with complex cases who are making the transition to adult services. The guidance says transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.

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• Introduction
• Stage 1: The development of legislation and the ISP
• Stage 2: Delay of Part 2 of the Care Act
• Stage 3: Ongoing implementation of the Care Act
• Stage 4: The revival of the care cap
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Implementing England’s Care Act 2014: was the Act a success and when will we know?

Many countries are reforming long-term care to deal with the social risks created by demographic and social change. However, the passage of legislation is often followed by a new set of challenges as policy is implemented. This article examines England’s Care Act 2014 through Compton and ‘t Hart’s criteria of policy endurance to demonstrate the importance of assessing effectiveness at multiple time points. Early success in ‘implementation readiness’ was followed by the abandonment or dilution of key commitments. Yet, the Act’s foundational principles – well-being, prevention and capping private spending – continue to shape care policy, much as its original supporters hoped.

Many countries are reforming their long-term care systems to deal with the new social risks created by demographic and social change. These large-scale reforms can be hard won, for example, Japan’s reform of aged care was ‘the culmination of some 30 years of deliberation’ ( Lai, 2002 : 5). They are often heralded by their advocates as the beginning of a new era: Australia’s National Disability Insurance Scheme was greeted as ‘a major paradigm shift’ ( Green and Mears, 2014 : 25). However, the passage of legislation is often only the beginning of a new set of challenges as policy goals are translated into practice. A vast literature attests to the wide variety of factors that can affect implementation and lead to unexpected outcomes as policy aspirations and ideas interact with the complexity of organisational settings (see, for example, Pressman and Wildavsky, 1973 ; Lipsky, 1980 ; Kingdon, 1984 ; Sabatier, 1986 ; O’Toole, 2000 ; Hupe and Hill, 2016 ). In this article, we discuss the Care Act 2014 in England – a wide-ranging piece of legislation that sought to improve adult social care provision – to highlight the importance of reassessing the success of policy reforms at multiple time points.

Adult social care refers to the personal care and support that is intended to promote the independence and well-being of older people, disabled people, people with mental health problems and unpaid carers. In England, the national government establishes the legislation and policy that informs social care. Local governments have responsibility for overseeing social care systems within their areas and for commissioning and monitoring the provision of care from a variety of providers ( Hudson, 2021 ; Humphries, 2022 ). The Care Act 2014 was an ambitious piece of legislation aimed at reforming the funding and provision of adult social care in England – a policy area known for its complexity (for an introduction to the Act, see Social Care Institute for Excellence, 2021 ). Implementation required stakeholder engagement at multiple levels: the macro (national), meso (regional) and micro (local government, service users, care providers and staff) ( Hunter et al, 2020 ). The Act was backed by an implementation support programme (ISP), a relatively new government initiative that aimed to create a conducive environment for effective implementation. This programme, which ran from 2013 to 2016, was found in a national evaluation to have achieved its aims ( Peckham et al, 2019 ). Yet, despite this preparatory work on implementation readiness, almost a decade on from the Act, it is clear that most of its goals have not been achieved. The Act’s funding reforms were abandoned, the number of carers’ assessments has fallen below expectations, individualised care funding has stalled and investment in prevention has been deprioritised ( House of Commons Library, 2017 ; Health and Social Care and Housing, Communities and Local Government Committees, 2018 ; Tew et al, 2019 ; Fernández et al, 2020 ; Health and Social Care Committee, 2020 ; Bottery and Ward, 2021 ).

This article considers the success of the Care Act through a temporal lens, using Compton and ‘t Hart’s criteria of policy endurance. It explores the apparent early success of the ISP, the later failings in key elements of implementation and the enduring symbolic importance of aspects of the Act (for example, its focus on well-being and prevention) to illustrate how assessments of success fluctuate over time. It draws primarily on three research projects that evaluated different aspects of the implementation of the Act. It highlights how an assessment of policy success can benefit from incorporating a temporal dimension, which can account for the contextual changes that may affect ongoing policy implementation. In other words, we should consider how the relative successes of a policy might vary over time in response to complex shifts within the wider policy environment. In doing so, the article also contributes to the understanding of implementation as an unfolding process, which cannot be captured through ‘snapshot’ evaluations.

The Care Act 2014

Adult social care services provide support with the activities of daily living for people who have a long-term illness or disability, or who provide unpaid care. Their delivery sits within a complex policy environment. In England, the national government sets the legislative context, while local governments undertake the needs and means assessments that assess eligibility for care, and arrange support for people who meet the assessment criteria. Most care is provided by the private sector, and a substantial proportion of people purchase their own care, as they have assets above the means-test threshold, that is, the level of assets at which a person is required to fund their own care and support ( Hudson, 2021 ). Discussions on the future of social care funding have been ongoing, with little resolution, across successive governments ( Kings Fund, 2021 ), and this uncertainty, along with wider funding pressures, has affected the sustainability of social care markets in England ( Humphries, 2022 ).

The Care Act 2014 was a significant and broad piece of legislation. It substantially reformed and consolidated existing social care statutes, placed a number of duties on local authorities and established new rights for people accessing services and carers. Local authorities in England were assigned a broad well-being duty (a principle to promote the quality of life of an individual who draws on support) and the responsibility to ensure the availability of a wide variety of good-quality social care services for people who need them. There was a shift in emphasis from commissioning services towards meeting local population needs. Local authorities were given a market-shaping duty (the responsibility to understand and stimulate local care markets) and new requirements to invest in prevention (that is, activity to reduce or delay future demand for long-term care), support unpaid carers and extend the take-up of personal budgets (a set amount of local authority funding that facilitates choice and control for individuals) (see Part 1 of the Care Act 2014 1 ). A limit on financial liability – sometimes called the ‘care cap’ – was introduced to set the amount that an individual who pays for their care can be expected to contribute over their lifetime. Four distinct stages can be identified within the evolution of the Care Act 2014. The stages indicate shifts and slippages in the implementation of the Act.

Between 2008 and 2011, the Law Commission – a statutory independent body that reviews legislation in England and Wales – assessed the confusing array of social care law in response to a government request. Following the publication of a scoping report, the Law Commission ( 2011 ) conducted a consultation of the sector to gather feedback on provisional proposals and established a series of recommendations that informed the development of the Care Act 2014. The drafting of the Act was seen to be an unusually inclusive process, bringing in key stakeholders to help shape an ambitious piece of legislation. Humphries ( 2022 : 49) notes that the Act was ‘widely acclaimed’ within the social care sector and offered ‘a ray of hope’.

There were two parts to the Care Act, each of which had a different implementation timetable. The first part came into force in April 2015 and included the main local authority duties around well-being, prevention, market shaping, support for carers and individualised funding ( National Audit Office, 2015 ). The second part, introducing the cap on care spending by private individuals, was scheduled for implementation in 2016. This staged approach to implementation stemmed from an explicit temporal rationale, namely, that there was a need to build capacity and readiness within the sector for the wide-ranging changes to the care market that the care cap would trigger.

To support the Act’s implementation, the Department of Health, the Local Government Association and the Association of Directors of Adult Social Services (ADASS) established the ISP to provide ‘the support necessary to carry out this challenging piece of legislation’ ( National Audit Office, 2015 : 7). The ISP aimed to clarify the requirements within the Act, as well as develop resources to support implementation. The programme was also designed to facilitate collaboration and provide a channel of communication between the local, regional and national levels ( Peckham et al, 2019 ).

An evaluation of the ISP, funded by the National Institute for Health and Care Research (NIHR), found that, overall, it had been successful ( Peckham et al, 2019 ; 2022 ). There were some limitations, for example, operational staff did not always receive information from senior managers and frequently had to rely on their own interpretation of policy, which had the potential to increase confusion and lead to inconsistencies in implementation ( Peckham et al, 2019 ). However, despite this limitation, the programme was assessed to have improved ‘implementation readiness’ ( Peckham et al, 2019 ), and local authorities were felt to be in a good position to implement the Act. A key strength of the programme was the facilitation of communication between local authorities and central government, and enhanced regional-level support.

While Part 1 of the legislation was introduced according to the planned timetable, Part 2 (the care cap) was not. The requirement of sector ‘readiness’ for the financial changes proved to be a difficult criterion to meet. Following concerns expressed by local governments about the viability of implementation, the cap was first delayed ( Prior, 2015 ) and then dropped in 2017 ( Doyle-Price, 2017 ; House of Commons Library, 2017 ).

Despite the abandonment of Part 2 of the Act (the care cap), the implementation of Part 1 continued. The NIHR commissioned three projects to consider the implementation of specific elements of the Act: one looked at market shaping and personalisation ( Needham et al, 2020 ); a second looked at prevention ( Tew et al, 2019 ); and a third focused on rights for carers ( Fernández et al, 2020 ). The broadly positive findings of the ISP evaluation (discussed earlier) were not matched by these subsequent studies. Findings from these projects underlined the challenges local authorities encountered when implementing the Care Act. The project on market shaping and personalisation found that local case sites had made limited progress. Working to develop a strategic approach to market shaping and personalisation was hindered by long-term funding uncertainty, recruitment challenges and local authority restructuring, which increased the instability of social care markets ( Needham et al, 2020 ). The prevention evaluation ( Tew et al, 2019 ) found that a range of initiatives had been undertaken; however, the challenging financial context inhibited sustained investment in preventative approaches. Fernández et al ( 2020 ) examined the support available to, and accessed by, carers. While the importance of carers’ well-being was recognised, the evaluation found that this was not converted into an increase in service access, as local authorities sought to manage demand within a challenging financial context. Instead, support was focused on carers who were providing the most intensive levels of care. The number of carers’ assessments, a key commitment in the Act, had gone down, rather than up, since 2015.

The fluctuating fortunes of the Care Act were again highlighted in 2021 when the government announced plans to finally implement the Care Act’s cap on care spending, subject to some modifications. The Health and Care Act 2022 legislated for an amended version of the cap, noting: ‘Legislation to allow a cap on care costs was already in place in the Care Act but implementation was postponed’ (Section 6.166 of the Heath and Care Act 2022). The government also proposed a health and social care levy, a separate, new tax, which would provide funding for the care cap, among other things ( HM Government, 2021 ). However, optimism about finally achieving a version of the care cap was dimmed later in 2022 when, first, the health and care levy was abolished and then it was announced in the Chancellor’s autumn statement that the care cap would be delayed until October 2025 ( HM Treasury, 2022 ). As in 2017, a key reason for delay was concern within local government about not being ready for ‘the financial and operational implementation challenges’ ( County Councils Network, 2022 ). The twists and turns in the Act’s implementation affirm that, as noted by Manthorpe ( 2021 ), despite the political consensus directed to the Care and Support Bill, the Care Act has not addressed the wide-ranging challenges facing adult social care in England.

The lack of achievement in key areas may suggest that the Care Act has failed in its aims. However, the three underpinning principles of the Act remain influential in contemporary policy debates and suggest that the Act continues to have resonance. These are: the commitment to well-being as the goal of social care rather than a narrow functional view of care; the investment in prevention rather than responding to crises; and the promise to place social care on a more secure and fair financial footing. Marczak et al ( 2022 : e1715) note that the Care Act ‘legitimised the definition of carers as clients’, or a group of people who should receive support, even if this ‘did not necessarily translate into more tangible assistance’. Well-being and prevention are key themes in the ‘Integration and innovation: working together to improve health and social care for all’ and ‘People at the heart of care: adult social care reform’ white papers ( Department of Health and Social Care, 2021a ; 2021b ). The care cap continues to be government policy – and indeed has now been legislated for twice , with planned implementation in 2025.

This brief summary of the Care Act timeline highlights the importance of considering policy implementation through a temporal lens. The apparent success of the ISP in Stage 1 did not translate into successful implementation in Stages 2–4, and yet the principles underpinning the Act continue to inform policy discussions and the funding proposals remain in place for 2025 (for now). This leaves us to question on what grounds and when we should assess the success of a policy.

The policy implementation literature has identified a number of approaches through which the success of implementation can be assessed. There are the ‘top-down’ versus ‘bottom-up’ accounts of implementation forces, as well as hybrids of these ( Howlett, 2019 ). There is the focus on the policy itself, most famously, its ambiguity and complexity ( Matland, 1995 ). There is a newer concern, emerging from implementation science, with system complexity ( Braithwaite et al, 2018 ), which requires public services to be analysed via a ‘processual and systemic’ frame ( Osborne and Radnor, 2016 : 56).

Here, we want to highlight the importance of also giving attention to the issue of when an assessment of implementation success is made. Moran ( 2001 : 179) makes the point that ‘judgements about success and failure are highly sensitive to the moment when we make the judgement’. Pollitt ( 2008 : 140), in his book about time in public policy, notes: ‘certain programmes which may appear highly problematic after a couple of years (when most evaluations tend to be done) bed in and move up the learning curve to become relatively successful a few years later’. In particular, as ‘t Hart and Bovens ( 1996 : 23) argue: ‘Short-term effects are also more easy to register than long-term effects which are likely to become intertwined with other phenomena in complex and often unintended ways. Moreover, short-term and long-term effects may in some cases be at odds with one another, the latter reversing or neutralising the former’.

Compton and ‘t Hart ( 2019 : 4) acknowledge the complexity of establishing whether a policy has been successful, noting: ‘policy assessment is necessarily a multi-dimensional and multi-perspectivist, and political process’. To account for this complexity, they suggest a range of criteria of assessment, including the relatively neglected notion of ‘endurance assessment: the extent to which the achievements and success of a policy are maintained’. This dimension of Compton and ‘t Hart’s framework sensitises us to the timing element of any policy assessment. Policy success should be assessed not through a ‘one-off snapshot but as a multi-shot sequence … ascertaining how its performance and legitimacy develop over time’ ( Compton and ‘t Hart, 2019 : 5). They suggest that a temporal focus requires attention to:

• • the degree to which the policy confers legitimacy on the broader political system;
• • the degree to which the policy’s programmatic, process and political performance is maintained over time; and
• • the endurance of the policy’s value proposition (that is, the proposed ‘high-level’ ends–means relationships underpinning its rationale and design, combined with the flexible adaptation of its ‘on-the-ground’ and ‘programmatic’ features to changing circumstances and in relation to performance feedback).

We used these three criteria to consider the success of the Care Act over time, drawing on the available evaluations of the Care Act implementation and the broader policy context.

Assessing the endurance of the Care Act

As discussed earlier, the implementation of the Care Act was originally planned to be in two parts and the context in which the Act was implemented changed across time. Exploring these changes in context helps us to understand the seemingly shifting fortunes of the Act. By synthesising the findings from the NIHR-commissioned projects undertaken at different points in the Care Act’s implementation, we draw out the influence of the wider context in which the Act was implemented. In particular, we look at how different stages of implementation relate to Compton and ‘t Hart’s criteria outlined earlier.

The ISP that accompanied the Act can be seen as a key element of conferring legitimacy ( Hunter et al, 2020 ). Peckham et al ( 2019 ) found that the ISP facilitated close collaboration between key actors and generated broad consensus directed to the main aims of the Act. Stakeholders were found to broadly support the principles of the Care Act, and this fostered a sense of investment in the support programme that facilitated ‘productive conversations … that may have more commonly been adversarial’ ( Peckham et al, 2019 : 72). The programme helped to secure endorsement of the ‘value propositions’ ( Compton and ‘t Hart, 2019 : 6) within the Care Act and offered a mechanism by which the rationale and legislative means were accepted.

The ISP benefited from strong collaboration across three key national bodies heavily involved in the implementation of the Care Act: the Department of Health, the Local Government Association and ADASS. The partnership working embedded within the ISP prompted Peckham et al ( 2019 ) to classify the programme as an example of collaborative policy design ( Ansell et al, 2017 ). Ansell et al ( 2017 ) make a case for pursuing collaborative policy design in order to strengthen implementation. Policy design, or the development of ‘visions, goals, causal assumptions, rules, tools, strategies and organisations to address a particular policy problem’, should be built on ‘collaboration and deliberation between upstream and downstream actors’ ( Ansell et al, 2017 : 468–9). These collaborative and deliberative actions enable stakeholders to share knowledge and experience, which can also promote innovation and lead to more effective policy and subsequent implementation ( Sørensen and Torfing, 2011 ). Collaboration in policy design can also promote a sense of ‘joint ownership’ ( Ansell et al, 2017 : 476) and support for policy solutions. Collaborative policy design is a continuous process of ‘adaptive implementation’ ( Berman, 1980 , quoted in Ansell et al, 2017 ), where the new knowledge and data generated by implementation is fed back into the adaption (or further design) of policy. The communication facilitated within the ISP encouraged collaboration to address identified problems and concerns, and, as a result, developed stakeholder support for the legislation.

This spirit of collaboration was also found within the ISP’s facilitation of shared learning between national and local government. Peckham et al ( 2019 ) highlighted that within dispersed governance, effective implementation requires links to be forged between national and local levels. Within the ISP, regional coordinators fulfilled this function by facilitating communication and information exchange between central government and local agencies – a complex task that required regional co-ordinators to engender trust and project credibility. The connections between national and local levels facilitated feedback on the implementation of the Care Act and allowed elements of the ‘flexible adaptation’ of policy that contributes to the continued endorsement of a policy ( Compton and ‘t Hart, 2019 : 6).

The ISP provided a mechanism that facilitated collaboration on, and endorsement of, the value propositions of the policy. However, some elements of the legislation lacked definition. This lack of clarity may have meant that it was easier for key components of the legislation to be accepted. Peckham et al ( 2019 ) draw on Matland’s ( 1995 ) discussion of how the specific qualities of a policy can affect its implementation. With regards to the Care Act, there was a broad consensus over its principles; however, there were ‘some new and largely untested ideas that were always likely to be open to interpretation’ ( Peckham et al, 2019 : 115). Needham et al ( 2020 ) found a variety of interpretations of the key term ‘market shaping’ and a lack of benchmarks as to what constituted ‘good’ market shaping. This lack of clarity within the Care Act was found to have hindered its implementation, as the different interpretations of these concepts challenged the aim of the Care Act to increase consistency across the social care system. Peters’ ( 2015 : 12) exploration of policy coordination makes a distinction between policy development and its administration. The Care Act can be seen as representing Peters’ vertical dimension of policy coordination, where central government is dependent on local authorities to implement reforms to social care. Legislative ambiguity meant that local authorities were pursuing their own version of market shaping and challenged policy coordination. Furthermore, analysis of parliamentary debates on the Care Bill found that there was a lack of clear differentiation between services intended for carers and services for people with care needs ( Manthorpe et al, 2019 ; Fernández et al, 2020 ). This blurring had the potential to affect local authority charging policies, with carers potentially charged to access services in some areas and not others ( Fernández et al, 2020 : 14–15).

In summary, the ISP was found to have enhanced the legitimacy of the Care Act, though there remained a lack of clarity about key elements within the Act. As one of the first ISPs used by the government, the model was found to be an effective one for supporting implementation readiness ( Peckham et al, 2019 ) and for conferring legitimacy across the system ahead of full implementation.

A second dimension of the temporal assessment of policy identified by Compton and ‘t Hart ( 2019 ) is the extent to which the performance of the legislation is maintained over time. A series of projects, published five years after the Act, came to much less positive conclusions than the ISP evaluation. The care cap was postponed in 2015 and abandoned in 2017, contributing to widespread uncertainty about future funding ( House of Commons Library, 2019b ; Health and Social Care Committee, 2020 ). Needham et al ( 2020 ) identified that such uncertainty affected collaboration between local authorities and social care providers. Social care providers were hesitant to commit to long-term investment in their estates. Funding uncertainty was also found to contribute to a lack of coherence within local authorities’ approach to market shaping. For instance, self-funders were frequently treated as peripheral to market-shaping strategies, despite having a significant impact on the local care system ( Henwood et al, 2022 ).

The elements of the Act that remained in place were found to have been patchily implemented. Short-term austerity and the real-terms fall in social care spending from 2009 to 2016 ( House of Commons Library, 2019a ) severely limited the impact of the Act. Fernández et al ( 2020 : 20) found that carers’ access to support and information had increased but there was a drop in carer-specific services. Local authorities’ capacity to meet ‘policy ambitions with regard to carers therefore has been mediated by budgetary constraints as well as constant demographic pressures’ ( Fernández et al, 2020 : 22). Tew et al ( 2019 ) also found that the financial challenges presented by short-term austerity affected how local authorities responded to their Care Act duty to promote well-being and to prevent, reduce or delay the need to access social care services. While there were strong expressions of support for the principles of prevention, local authorities favoured short-termism and meeting existing demand. Furthermore, Tew et al ( 2019 : 17) found that there could be a lag of between one and five years from the introduction of a preventative approach and the accrual of eventual benefits. This lag, and the expectation of annual cost savings, had the potential to jeopardise the continual investment required by a preventative approach. The pressure of short-term austerity steered local authorities towards prioritising meeting existing demand, rather than making the necessary investment in prevention.

While Needham et al ( 2020 ) and Tew et al ( 2019 ) noted that austerity had the potential to encourage greater innovation within social care services, in practice, local authorities were engaging in risk-averse behaviours that were focused on compliance. An objective of the Care Act was to foster the development of a vibrant social care market and encourage diversity in service provision in order to facilitate choice and control ( Needham et al, 2018a ; 2018b ). In examining how local authorities have responded to duties placed on them to shape social care markets, Needham et al ( 2020 ) found that local authorities’ concern to secure the sufficiency of supply frequently precipitated a prescriptive approach that restricted individuals’ choice and control of services. Some local authorities had trialled practices like co-design that would respond to local variance and facilitate stakeholder learning; however, these attempts were hampered by uncertainty around funding and low levels of trust between commissioners and providers. Local authorities that were engaging most effectively with their local care systems had minimised the level of control and prescriptive rules in preference for provider- and community-led innovation. However, most were struggling to sustain this approach in a context of funding cuts. Trust can promote collaboration and sustain commitment to partnership working ( Ansell and Gash, 2007 ; Ansell et al, 2017 ). However, the pressures of operating within a challenging financial context led some social care providers to adopt a defensive stance that sought to protect their business interests and restricted their willingness to engage in market-shaping activities ( Needham et al, 2020 ). Furthermore, some local authority social care commissioners were wary of for-profit providers and expressed unease that providers expected to extract large profits when local authorities were operating within straitened financial circumstances.

Across the evaluations, the wider context of short-term austerity and uncertain long-term funding was found to affect internal and external stakeholder relations and local-level coalitions supporting the implementation of the Care Act. Particular difficulties within local authorities included the skill mix of staff, high workloads and a lack of staff continuity ( Needham et al, 2020 ). Market shaping not only requires the involvement of social care commissioning teams but also necessitates the support of others across the local authority, such as procurement and legal teams, as well as such services as housing and planning. It requires a shift in culture to one that is permissive of greater risk taking and iterative learning. Some case sites had worked with providers and other stakeholders to co-design models of care ‘but had to abandon this approach due to internal resistance from legal and procurement teams and an inclination to emphasise contract price’ ( Needham et al, 2020 : 33). The strong relational skills and the capacity to develop associations of trust and shared learning were not found to be present in local case sites, despite the efforts in the ISP phase to build relationships.

There was also evidence that the challenging financial circumstances affected external stakeholder relations, which, in turn, affected the implementation of the Care Act. Tew et al ( 2019 ) found that collaboration was challenged by partners being motivated by different incentives. Health partners were focused on reducing delayed transfers of care from hospital, which risked the ‘inappropriate provision of expensive packages of nursing and social care that may be hard to disentangle’ ( Tew et al, 2019 : 7) and obstructed the integration of preventative approaches. Fernández et al ( 2020 ) identified increased collaboration between local authorities and the voluntary sector, which could expand access to low-level services that aimed to build the resilience of carers. However, within some case sites, it was suggested that this collaboration ‘sometimes masked strategies aimed at diverting people from using core social care services’ ( Fernández et al, 2020 : 29–30). Consequently, while the ISP had facilitated collaboration, the challenging financial circumstances had negatively affected relationships between local authorities, social care providers and wider stakeholders.

The third element of Compton and ‘t Hart’s framework is the endurance of the significant ideas or principles that underpin a policy. In other words, whether a policy has an underlying symbolic value. The ISP generated broad agreement on the key principles of the Care Act that underlie a shared vision for social care. The three projects exploring local authorities’ response to the Care Act reveal its partial implementation, as discussed earlier. However, each project presents evidence for ongoing support for the key principles within the legislation. Fernández et al ( 2020 : 14) found that the Care Act had legitimised an increased focus on meeting carers’ health and well-being at the service level. Furthermore, within Tew et al’s ( 2019 ) project, case sites expressed a commitment to promote well-being and build capacity for prevention. Needham et al ( 2020 ) noted that commissioners within local case sites recognised and supported the focus on well-being and the shift away from more functional and needs-based accounts of social care. Across the projects, the challenges of implementation were attributed to ongoing funding uncertainty and short-term austerity rather than reservations directed to the principles of the Care Act. Engaging stakeholders in the design of the legislation may help to sustain the principles and ideas that have informed the Act. The endurance of the key principles of the Care Act are also reflected in the most recent white papers from the Department of Health and Social Care ( 2021a ; 2021b ) – ‘Integration and innovation: working together to improve health and social care for all’ and ‘People at the heart of care: adult social care reform’ – which continue to emphasise the principles of well-being and prevention. Hence, while elements of the Care Act were dropped, or only partially implemented, the Act’s ‘value propositions’ ( Compton and ‘t Hart, 2019 : 6) appear to have an ongoing influence on policy.

Applying Compton and ‘t Hart’s ‘multi-shot’ approach when assessing the success of the Care Act has conveyed the ‘policy content and situational variables’ ( Ansell et al, 2017 : 481) that affected the implementation of the Care Act and how these shifted across time. As discussed earlier, these variables can be broadly categorised as the effects of short-term austerity and long-term funding uncertainty, as well as the conditions of local care systems. Local authorities were operating within challenging financial circumstances that reduced trust between local authorities and social care providers, and limited collaboration. In an uncertain context, local authorities were risk averse and acted to retain tighter control over social care provision. Their scope to do so was limited by the complexity of care provision, involving multiple stakeholders. Crisis management was prioritised over the development of the longer-term strategic approach required to fully implement the Act.

Applying Compton and ‘t Hart’s temporal dimension when assessing policy success develops our understanding of how the wider context can affect implementation. As Howlett et al ( 2016a ; 2016b ) argue in their development of Kingdon’s ( 1984 ) multiple-streams approach, interactions between streams of ‘competing coalitions’ ( Howlett et al, 2016a : 75) of actors can produce unexpected and messy outcomes as different streams rise and fall in prominence throughout the policy cycle. Building a coalition to support the principles of legislation is likely to be easier at the start of the policy process, where actors are given the opportunity to contribute to policy design. Evaluation of the ISP showed that coalitions were developed with the aim of ensuring implementation readiness. However, across time, it proved hard to hold these coalitions together due to the effects of short-term austerity and long-term funding uncertainty, as well as the conditions of local social care systems.

These coalitions were more fragile for being multi-level, as well as within levels of government. Exworthy and Powell ( 2004 ) highlight three potential coalition patterns in building policy coalitions: central–local; central–central and local–local. The ISP built vertical coalitions between the central and the local. However, the conditions of austerity undermined the extent to which horizontal local–local coalitions (for example, between local authorities and providers, or between local authorities and health partners) could effectively implement the legislation and reduced trust between local authorities and central government partners.

The temporal focus of Compton and ‘t Hart reminds us that the assessment of policy success is always ongoing and incomplete. Here, we have considered the ISP and synthesised findings from projects considering implementation ‘on the ground’. Taking the multi-shot approach allows us to identify that the policy was effective at conferring legitimacy in the short term and has been effective at sustaining its value proposition in the long term. Where it has not been effective is in Compton and ‘t Hart’s criteria of programmatic, process and political performance. The ongoing discussions about the future implementation of the care cap, over ten years after the Act itself, highlights that even an assessment of programmatic performance is not static. We may yet see success for a part of the Act that was previously abandoned.

The events of 2022 – the revival of the care cap followed by its delay – affirm the value of examining the question posed by this article (‘Was the Care Act 2014 a success, and when will we know?’). For as long as legislation is able to retain its value proposition, then it continues to be possible that its programmatic elements will be revived. This insight requires us to sustain the multi-shot approach advocated by Compton and ‘t Hart, revisiting at regular intervals the ongoing process of implementation.

The implementation of England’s Care Act 2014 has been examined here using a temporal framework to capture changing patterns over time. The analysis has contributed to our understanding of implementation within a complex, multi-level governance context, such as social care. Implementation is a long-term process and policymakers need to continue to engage with implementation in a reflexive way to identify shifts in context and consider how this may affect policy implementation. Although our focus here has been on England, we see the findings as having relevance to other jurisdictions as they attempt large-scale reform of their long-term care in complex and multi-level systems.

Applying the endurance dimension of Compton and ‘t Hart’s framework led us to consider the success of the policy across multiple time points. Social care policy implementation occurs in a complex system, necessitating vertical and horizontal coalitions, which shift over time. Writing about the Welsh legislation, which closely paralleled the English Care Act, Cooke et al ( 2019 : 79) note: ‘The implementation of the Social Services and Well-being (Wales) Act 2014 will take years, decades even, and change will only come about if those in the social care sector are supported to evaluate and understand what is important in social care delivery and how to take the best approaches’.

The multi-shot approach advanced by Compton and ‘t Hart draws attention to taking this long view of policy implementation. The fortunes of the Care Act have ebbed and flowed. Its ISP – one of the first of its kind – was found to have been effective in creating implementation readiness. Detailed analysis of its key themes – market shaping, personalisation, carers support and prevention – found that many of the Act’s duties remain unfulfilled. The repeated abandonment of its funding reforms was a clear failing, though one that may yet be reversed. The foundational principles of the Act – a commitment to well-being, prevention and reforming the funding of care – continue to shape care policy, though there is still uncertainty as to how the social care system will realise these foundational principles. Even a decade on from its passage, we cannot give a summative assessment of whether the Care Act has been successful, and the extent to which it will come to be seen as a key intervention in which crucial concepts (well-being, prevention) and mechanisms (the cap) were introduced remains unclear.

There are limitations to the analysis presented here. Our assessment of the success of the Care Act was restricted to the research questions and scope of the evaluations on which we have drawn. The commissioned studies explored the implementation of the Care Act across local case sites. While attempts were made to secure a mixed sample, it may be that the local authorities recruited were more amenable to discussing the implementation of the Care Act in their area.

A key contention of this article is that the timing of an assessment will influence whether a policy is judged to have been a success. The COVID-19 pandemic has had a great effect on the commissioning and delivery of social care ( Bottery, 2020 ; Dunn et al, 2020 ). The wider effects of this changing context are still emerging. Recent UK government announcements on care investment and the delay of the cap on spending by self-funders have added further turbulence and uncertainty. Again reflecting Compton and ‘t Hart’s endurance dimension, there is scope for further longitudinal analysis to assess the ongoing significance of the Act. While the Care Act was found to have been only partially implemented, the principles of the legislation continue to shape policymaking in the sector. This symbolic legitimacy could secure the continued influence of the Care Act on long-delayed reforms of social care funding.

See: www.legislation.gov.uk/ukpga/2014/23/contents/enacted

This project was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R14-1215-21004, ‘Shifting-Shapes: How Can Local Care Markets Support Quality and Choice for All?’, and PR-ST-1116-10001, ‘Shaping Personalised Outcomes – How Is the Care Act Promoting the Personalisation of Care and Support?’). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

The authors declare that there is no conflict of interest.

Ansell , C. and Gash , A. ( 2007 ) Collaborative governance in theory and practice , Journal of Public Administration Research and Theory , 18 ( 4 ): 543 – 71 . doi: 10.1093/jopart/mum032

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Ansell , C. , Sørensen , E. and Torfing , J. ( 2017 ) Improving policy implementation through collaborative policymaking , Policy & Politics , 45 ( 3 ): 467 – 86 . doi: 10.1332/030557317X14972799760260

Berman , P. ( 1980 ) Thinking about programmed and adaptive implementation , in H . Ingram and D. Mann (eds) Why Policies Succeed or Fail , Beverly Hills, CA : Sage , pp 205 – 28 .

Bottery , S. ( 2020 ) How COVID-19 has magnified some of social care’s key problems , The King’s Fund , www.kingsfund.org.uk/publications/covid-19-magnified-social-care-problems .

Bottery , S. and Ward , D. ( 2021 ) Social care 360, The King’s Fund, www.kingsfund.org.uk/publications/social-care-360 .

Braithwaite , J. , Churruca , K. , Long , J.C. , Ellis , L.A. and Herkes , J. ( 2018 ) When complexity science meets implementation science: a theoretical and empirical analysis of systems change , BMC Medicine , 16 : 63 . doi: 10.1186/s12916-018-1057-z

Compton , M.E. and ‘ t Hart , P. ( 2019 ) How to ‘see’ great policy successes. A field guide to spotting policy successes in the wild , in M.E. Compton and P. ‘t Hart (eds) Great Policy Successes , Oxford : Oxford University Press , pp 1 – 20 .

Cooke , K. , Iredale , R. , Williams , R. and Wooding N. ( 2019 ) Measuring the Mountain: What Really Matters in Social Care to Individuals in Wales , Pontypridd : University of South Wales .

County Councils Network ( 2022 ) Councils call for delay to flagship social care reforms , www.countycouncilsnetwork.org.uk/councils-call-for-delay-to-flagship-social-care-reforms-warning-services-face-a-perfect-storm-of-financial-and-workforce-pressures-over-the-next-12-months/ .

Department of Health and Social Care ( 2021a ) Integration and innovation: working together to improve health and social care for all , www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version .

Department of Health and Social Care ( 2021b ) People at the heart of care: adult social care reform , https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper .

Doyle-Price , J. ( 2017 ) Social care, Hansard House of Commons debates , 7 December, 632, c. 1235, https://hansard.parliament.uk/commons/2017-12-07/debates/F7AD5D1D-C8D6-411D-BF42-B432955B2A8E/SocialCare .

Dunn , P. , Allen , L. , Humphries , R. and Alderwick , H. ( 2020 ) Briefing: adult social care and COVID-19. Assessing the policy response, Health Foundation .xs doi: 10.37829/HF-2020-P06

Exworthy , M. and Powell , M. ( 2004 ) Big windows and little windows: implementation in the congested state , Public Administration , 82 ( 2 ): 263 – 81 . doi: 10.1111/j.0033-3298.2004.00394.x

Fernández , J.L. , Marczak , J. , Snell , T. , Brimblecombe , N. , Moriarty , J. , Damant , J. , Knapp , M. and Manthorpe , J. ( 2020 ) Supporting carers following the implementation of the Care Act 2014: eligibility, support and prevention , www.lse.ac.uk/cpec/assets/documents/cascfinalreport.pdf .

Green , J. and Mears , J. ( 2014 ) The implementation of the NDIS: who wins, who loses? , Cosmopolitan Civil Societies: An Interdisciplinary Journal , 6 ( 2 ): 25 – 39 , doi: 10.5130/ccs.v6i2.3915

Health and Social Care and Housing, Communities and Local Government Committees ( 2018 ) Long-term funding of adult social care: first joint report of the Health and Social Care and Housing, Communities and Local Government Committees of session 2017–19, House of Commons , https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/768/768.pdf .

Health and Social Care Committee ( 2020 ) Social care: funding and workforce. Third report of session 2019–21, House of Commons , https://committees.parliament.uk/publications/3120/documents/29193/default/ .

Henwood , M. , Glasby , J. , McKay , S. and Needham , C. ( 2022 ) Self-funders: still by-standers in the English social care system? , Social Policy and Society , 21 ( 2 ): 227 – 41 . doi: 10.1017/S1474746420000603

HM Government ( 2021 ) Building back better: our plan for health and social care , https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1015737/Build_Back_Better-_Our_Plan_for_Health_and_Social_Care_web_accessible.pdf .

HM Treasury ( 2022 ) Autumn statement 2022, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1118417/CCS1022065440-001_SECURE_HMT_Autumn_Statement_November_2022_Web_accessible__1_.pdf .

House of Commons Library ( 2017 ) Social care: government reviews and policy proposals for paying for care since 1997 (England) , https://researchbriefings.files.parliament.uk/documents/CBP-8000/CBP-8000.pdf .

House of Commons Library ( 2019a ) Adult social care funding (England) , https://commonslibrary.parliament.uk/research-briefings/cbp-7903/ .

House of Commons Library ( 2019b ) Adult social care: the government’s ongoing policy review and anticipated green paper (England) , https://researchbriefings.files.parliament.uk/documents/CBP-8002/CBP-8002.pdf .

Howlett , M. ( 2019 ) Moving policy implementation theory forward: a multiple streams/critical juncture approach , Public Policy and Administration , 34 ( 4 ): 405 – 30 . doi: 10.1177/0952076718775791

Howlett , M. , McConnell , A. and Perl , A. ( 2016a ) Moving policy theory forward: connecting multiple stream and advocacy coalition frameworks to policy cycle models of analysis , Australian Journal of Public Administration , 76 ( 1 ): 65 – 79 . doi: 10.1111/1467-8500.12191

Howlett , M. , McConnell , A. and Perl , A. ( 2016b ) Weaving the fabric of public policies: comparing and integrating contemporary frameworks for the study of policy processes , Journal of Comparative Policy Analysis: Research and Practice , 18 ( 3 ): 273 – 89 . doi: 10.1080/13876988.2015.1082261

Hudson , B. ( 2021 ) Clients, Consumers or Citizens? The Privatisation of Adult Social Care in England , Bristol : Policy Press .

Humphries , R. ( 2022 ) Ending the Social Care Crisis: A New Road to Reform , Bristol : Policy Press .

Hunter , D.J. , Redgate , S. , Hudson , B. and Peckham , S. ( 2020 ) Do policy implementation support programmes work? The case of the Care Act 2014 , Journal of Long-Term Care , 196 – 207 . doi: 10.31389/jltc.42

Hupe , P. and Hill , M. ( 2016 ) ‘And the rest is implementation’. Comparing approaches to what happens in policy processes beyond great expectations , Public Policy and Administration , 31 ( 2 ): 103 – 21 . doi: 10.1177/0952076715598828

Kingdon , J.W. ( 1984 ) Agendas, Alternatives, and Public Policies , Boston, MA : Little Brown and Company .

Kings Fund ( 2021 ) A short history of social care funding reform in England: 1997 to 2021 , www.kingsfund.org.uk/audio-video/short-history-social-care-funding .

Lai , O.K. ( 2002 ) Long-term care policy reform in Japan , Journal of Aging & Social Policy , 13 ( 2–3 ): 5 – 20 . doi: 10.1300/j031v13n02_02

Law Commission ( 2011 ) Adult social care, https://www.lawcom.gov.uk/app/uploads/2015/03/lc326_adult_social_care.pdf .

Lipsky , M. ( 1980 ) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services , New York : Russell Sage Foundation .

Manthorpe , J. ( 2021 ) The impact of the Care Act 2014: a summary of the research evidence, NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London , https://kclpure.kcl.ac.uk/portal/files/142511239/Care_Act_Research_Summary_2020.Pdf .

Manthorpe , J. , Fernández , J.L. , Brimblecombe , N. , Knapp , M. , Snell , T. and Moriarty , J. ( 2019 ) Great expectations: ambitions for family carers in UK parliamentary debates on the Care Bill , International Journal of Care and Caring , 3 ( 3 ): 359 – 74 , doi: 10.1332/239788218X15411706089442

Marczak , J. , Fernandez , J.L. , Manthorpe , J. , Brimblecombe , N. , Moriarty , J. , Knapp , M. and Snell , T. ( 2022 ) How have the Care Act 2014 ambitions to support carers translated into local practice? Findings from a process evaluation study of local stakeholders’ perceptions of Care Act implementation , Health & Social Care in the Community , 30 ( 5 ): e1711 – 20 .

Matland , R. ( 1995 ) Synthesising the implementation literature: the ambiguity–conflict model of policy implementation , Journal of Public Administration Research and Theory , 5 ( 2 ): 145 – 74 .

Moran , M. ( 2001 ) Managing reform: controlling the medical profession in an era of austerity , in M. Bovens , P. ‘t Hart and G.B. Peters (eds) Success and Failure in Public Governance: A Comparative Analysis , Cheltenham : Edward Elgar , pp 171 – 83 .

National Audit Office ( 2015 ) Care Act first-phase reforms , www.nao.org.uk/wp-content/uploads/2015/06/Care-Act-first-phase-reforms.pdf .

Needham , C. , Burn , E. , Hall , K. , McKay , S. , Mangan , C. , Allen , K. , Henwood , M. , Carr , S. and Glasby , J. ( 2018a ) Shifting shapes: report of work package 1 – national interviews, local authority survey and secondary data analysis , www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/Shifting-Shapes-WP1-Report-final-030718.pdf .

Needham , C. , Hall , K. , Allen , K. , Burn , E. , Mangan , C. and Henwood , M. ( 2018b ) Market shaping and personalisation in social care: a realist synthesis of the literature , www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/research/market-shaping-and-personalisation-social-care.pdf .

Needham , C. , Allen , K. , Burn , E. , Hall , K. , Mangan , C. , Al-Janabi , H. , Tahir , W. , Carr , S. , Glasby , J. , Henwood , M. et al. ( 2020 ) Shifting shapes: how can local care markets support personalised outcomes? , www.birmingham.ac.uk/documents/college-social-sciences/social-policy/publications/shifting-shapes.pdf .

O’Toole , L.J. ( 2000 ) Research on policy implementation: assessment and prospects , Journal of Public Administration Research and Theory , 10 ( 2 ): 263 – 88 , doi: 10.1093/oxfordjournals.jpart.a024270

Osborne , S.P. and Radnor , Z. ( 2016 ) The new public governance and innovation in public services: a public service-dominant approach , in J. Torfing and P. Triantafillou (eds) Enhancing Public Innovation by Transforming Public Governance , Cambridge : Cambridge University Press , pp 54 – 70 .

Peckham , S. , Hudson , B. , Hunter , D. and Redgate , S. ( 2022 ) Policy success: what is the role of implementation support programmes? , Social Policy & Administration , 56 ( 3 ): 378 – 93 . doi: 10.1111/spol.12771

Peckham , S. , Hudson , B. , Hunter , D. , Redgate , S. and White , G. ( 2019 ) Improving Choices for Care: A Strategic Research Initiative on the Implementation of the Care Act 2014 , National Institute for Health Research , https://kar.kent.ac.uk/81218/1/Revised%20final%20report%20Care%20ActS%20Implementation%20Support%20Programme.pdf .

Peters , B.G. ( 2015 ) Pursuing Horizontal Management , Lawrence, KS : University Press of Kansas .

Pollitt , C. ( 2008 ) Time, Policy, Management: Governing with the Past , Oxford : Oxford University Press .

Pressman , J.L. and Wildavsky , A.B. ( 1973 ) Implementation: How Great Expectations in Washington Are Dashed in Oakland , Berkeley, CA : University of California Press .

Prior , D. ( 2015 ) Cap on care costs, Hansard: House of Commons written ministerial statements, 20 July, HCWS145 , https://hansard.parliament.uk/commons/2015-07-20/debates/1507207000018/CapOnCareCosts .

Sabatier , P.A. ( 1986 ) Top-down and bottom-up approaches to implementation research: a critical analysis and suggested synthesis , Journal of Public Policy , 6 ( 1 ): 21 – 48 . doi: 10.1017/S0143814X00003846

Social Care Institute for Excellence ( 2021 ) Care Act 2014, www.scie.org.uk/care-act-2014/video#:~:text=The%20Act%20begins%20by%20defining,qualifying%20for%20care%20and%20support

Sørensen , E. and Torfing , J. ( 2011 ) Enhancing collaborative innovation in the public sector , Administration & Society , 43 ( 8 ): 842 – 68 . doi: 10.1177/0095399711418768

Tew , J. , Duggal , S. , Carr , S. , Ercolani , M. , Glasby , J. , Kinghorn , P. , Miller , R. , Newbigging , K. , Tanner , D. and Afentou , N. ( 2019 ) Building social resources to prevent, reduce or delay needs for care and support in adult social care in England , www.birmingham.ac.ukDocuments/college-social-sciences/social-policy/publications/prp-prevention-pdf-121219-acc.pdf .

t Hart , P. and Bovens . M. ( 1996 ) Understanding Policy Fiascoes , New York : Routledge .

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Care Act 2014 Principles

Last updated on 19th April 2023

In this article

Many of us may need care and support at some point in our lives and most people will be required to pay something towards the cost of this care. In order to give people who receive care and support, or people who look after someone as a carer, an opportunity to have a bigger say about what sort of care is best for them and their family, the Care Act 2014 was introduced.

The Act places a series of duties and responsibilities on local authorities about care and support for adults. It also created a consistent route to establishing an entitlement to public care and support for all adults with needs for care and support. In addition, it produced the first ever entitlement to support for carers, on a similar basis.

Why was the Care Act 2014 introduced?

The Care Act 2014 came into effect in 2015 and was the most significant reform of care and support for more than 60 years. It set out to put people and their carers in control of their care and support. The Act changed many aspects of how support is arranged and aimed to give those in need of support greater control and influence about how that care is delivered. The Act also put a limit for the first time on the amount anyone has to pay towards the costs of their care.

The intention was that the Care Act 2014 would make it easier for people who needed to access care and support to understand why things happen in a particular way. Following the first year of implementation of the Act in 2015 the Department of Health commissioned a survey to explore the impact of the Act on the lives of people with care and support needs. The survey comprised 1,181 people aged 18 and over; of these, 391 were people who need care and support themselves, and 643 were carers.

Some of the findings were:

• 25% felt that councils always or frequently listened to their wants and needs.
• 49% reported that their choices are always or frequently respected.
• 69% overall said their care and support made a positive difference to health.
• 48% said their care and support helped in them feeling safe or secure.
• 58% overall said support made daily living better.
• 42% of carers said that support made their daily living activities better, compared to 74% of people who need care or support.
• 29% said quality had improved over the last year.
• 21% wanted better quality, more flexibility or less complexity in arranging support.

The results of this survey showed a marked difference between councils’ perceptions of the Care Act 2014 implementation, which were more positive, and the experiences of the people who need care and the carers directly themselves. The information gathered was used to inform improvements in the Act’s implementation. The Care Act 2014 governs the care and support provided and commissioned by local authorities.

The Office for National Statistics ( ONS ) and the National Audit Office ( NAO ) state that:

• At some point during 2019-20, 839,000 adults were receiving long-term support arranged by local authorities.
• There are 25,800 estimated regulated adult social care locations as at March 2020.
• The estimated number of people working in adult social care in 2019-20 is 1.5 million.
• There are almost seven million carers in the UK.
• In 2019-20, 316,000 carers received direct support from local authorities under the Care Act. Of these, 66% of carers received information, advice and signposting to other services rather than money, and 34% of carers received support in the form of direct or part-direct payments, local authority-commissioned support, or a local authority-managed personal budget.
• There are 151 local authorities with responsibilities for providing or arranging care services as set out in the Care Act 2014.
• In 2019-20, local authority expenditure on adult social care was £16.5bn net.

Current demographic trends suggest a greater demand for care and increasingly complex care needs in the future, resulting in care forming an ever-increasing proportion of public expenditure.

The Care Act 2014 requires local authorities to ensure the provision or arrangement of services, facilities or resources to help prevent, delay or reduce the development of needs for care and support. Expenditure on prevention initiatives is often more cost effective than the expenditure required for avoidable future care needs.

What did the Care Act 2014 replace?

The Care Act 2014 combined various existing pieces of legislation which previously shaped how social care was arranged.

These included:

• The National Assistance Act 1948.
• Health Services and Public Health Act 1968.
• Chronically Sick and Disabled Persons Act 1970 (but only for adults).
• Health & Social Services and Social Security Adjudications Act 1983.
• Disabled Persons (Services, Consultation and Representation) Act 1986.
• Parts of the NHS and Community Care Act 1990.
• Parts of the Health and Social Care Act 2001.
• The Delayed Discharge Act 2003.

These laws were confusing and complex. They tended to focus on what service should be provided, rather than on what the person actually needs or wants. The Care Act 2014 was designed to be a simpler, modern law for 21st century care and support focussing on the individual needs of people.

The aim was to make the law fair and more consistent, removing certain anomalies that treated particular groups of people differently; the notion was to create a single route for determining entitlement, which works for all groups of people in all circumstances. The Act was therefore intended to remove the chance of discrimination and unfair treatment taking place when assessing care needs and provision.

The Act clearly states the steps that must be followed to work out this entitlement, to help people better understand the process. It follows the person’s “journey” in the care and support system.

The Care Act 2014 introduced:

• National care and support eligibility criteria for both adults and carers.
• Accessibility to information and advice that both adults and carers need to make good choices about care and support.
• Rights to independent advocacy in some circumstances.
• Personal budgets and rights to request a direct payment.
• New responsibilities about making the transition from children’s services to adult social care.
• New responsibilities about provider failure, for example if a care home closes.
• Support for people who move between local authority areas.

How many principles are there under the Care Act 2014?

There are six principles under the Care Act 2014, which are:

• Empowerment – You know best about the care and support you need; your views, wishes, feelings and beliefs should always be considered. To ensure that this is implemented in the right way, professionals must discuss all the possible outcomes of the patient’s decision, without enforcing their opinions too much. If the patient does not have capacity to give consent, then their decisions can be made for them. Whether the patient has capacity depends on a few factors that are specified in the the Mental Capacity Act 2005 .
• Protection – Professionals should always work to protect you and other people from abuse and neglect. The Act clearly states how people can raise concerns about the safety or wellbeing of someone who has care needs. If a person is at risk of abuse or neglect, authorities must act immediately. An effective response must be in place to protect the person in need.
• Prevention – The main aim of professionals should be on the person’s wellbeing, on reducing the need for care and support, and on reducing the likelihood that the person will need care and support in the future. Local authorities have a legal duty to prevent, reduce and delay people’s needs from worsening. The aim is to have responsive local authorities that are able to support people at an early stage, to prevent and reduce the likelihood of people ending up in crisis situations.
• Proportionality – Appropriateness and proportionality are concepts that must apply to all assessments and are not themselves forms of carers’ or needs assessments. A proportionate assessment will be as extensive as required to establish the extent of a person’s needs and any decisions made will always be person-centred and based on their individual circumstances.
• Partnership – Any decisions should be made with the person’s involvement, and their wellbeing should be balanced with that of any involved family and friends. It also applies to multi-agency collaboration working in partnership to provide the appropriate care and support for the individual.
• Accountability – Professionals should ensure that any actions taken to support a person receiving care affect their rights and freedom as little as possible. The accountability principle also states that safeguarding is everybody’s duty, and everyone in contact with a vulnerable person should be responsible for noting any risks and taking action on any harm identified.

These six principles underpin the work of professionals and other staff who work with adults. They apply to all sectors and settings that work to care for and safeguard adults, including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

What is the main principle of the Care Act 2014?

The main principle of the Care Act 2014 is to help to improve people’s independence and wellbeing and for care providers and givers to promote a person-centred approach to the care and support they provide.

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. The Act requires local authorities to involve adults in their assessment, care and support planning and review. Considering the person’s views and wishes is critical to a person-centred system. Person-centred care and support planning mean that a person can receive part or all of their personal budget as a direct payment. Direct payments aim to enable a person to exercise the maximum possible choice over how they are supported, who they are supported by and where they are supported.

The Health Foundation has identified a framework that comprises four principles of person-centred care:

• Affording people dignity, compassion and respect.
• Offering coordinated care, support or treatment.
• Offering personalised care, support or treatment.
• Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

The Care Act 2014 holds the local authority responsible for ensuring that an individual receives the care and support they require and that their carers receive the support they require, as a result of an assessment of their individual needs.

Wellbeing principles in the Care Act 2014 

The Act highlights wellbeing as one of the key responsibilities for local authorities, with an inextricable link to the main principles, that is of prevention and protection.

The Statutory Guidance of the Care Act 2014 says at paragraph 1.21: “Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people’s needs for care and support and how meeting these can help them achieve the outcomes most important to them.”

The Care Act 2014 places a duty on local authorities to promote an individual’s “wellbeing”. This means that they should always have a person’s wellbeing in mind when making decisions about them or planning services.

Wellbeing can relate to:

• Personal dignity, including treating the individual with respect.
• Physical and mental health and emotional wellbeing.
• Protection from abuse and neglect.
• Control by the individual over day-to-day life including over care and support.
• Participation in work, education, training or recreation.
• Social and economic wellbeing.
• Domestic, family and personal relationships.
• Suitability of living accommodation.
• The individual’s contribution to society.

Wellbeing is a broad concept and there is no hierarchy in the areas of wellbeing listed above – all are equally important. There is also no single definition of wellbeing, as how this is interpreted will depend on the individual, their circumstances and their priorities. Wellbeing encompasses several areas of life. Therefore, using a holistic approach to ensure a clear understanding of the individual’s views is vital to identifying and defining wellbeing in each case.

The wellbeing principles are part of the Care Act 2014 eligibility criteria and as such local authorities also have to consider carers and the impact of their role on their wellbeing. Similarly, they have to consider the impact of a cared for person’s needs on their carer’s wellbeing. If the impact is significant then the eligibility criteria under the Care Act 2014 are likely to be met.

Safeguarding principles of the Care Act 2014

The Commission for Social Care Inspection stated that before the Care Act 2014, the legal framework for adult protection was neither systematic nor coordinated, reflecting sporadic development of safeguarding policy over the last 25 years.

Sections 42 to 47 of the Care Act 2014 seek to place safeguarding on a statutory footing.

Under the Act safeguarding duties apply to an adult who:

• Has a need for care and support, whether or not the local authority is meeting any of those needs.
• Is experiencing, or at risk of, abuse or neglect.
• As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.

The view of what constitutes abuse or neglect should not be limited, as abuse or neglect can take many forms and the circumstances of the individual case should always be considered. Domestic abuse is specifically listed in the Care Act 2014, and it is clear in the Act that the abuse or neglect can be inflicted intentionally or unintentionally.

The aims of adult safeguarding are to:

• Stop abuse or neglect wherever possible.
• Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs.
• Safeguard adults in a way that supports them in making choices and having control about how they want to live.
• Promote an approach that concentrates on improving life for the adults concerned.
• Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect.
• Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or wellbeing of an adult.
• Address what has caused the abuse or neglect.

The Care Act 2014 requires local authorities to set up a Safeguarding Adults Board (SAB) in their area, giving these boards a clear basis in law for the first time.

The Act says that the SAB must:

• Include the local authority, the NHS and the police, who should meet regularly to discuss and act upon local safeguarding issues.
• Develop shared plans for safeguarding, working with local people to decide how best to protect adults in vulnerable situations.
• Publish this safeguarding plan and report to the public annually on its progress, so that different organisations can make sure they are working together in the best way.

The Act also requires local authorities to make enquires, or ask others to make enquiries, when they think an adult with care and support needs may be at risk of abuse or neglect in their area and to find out what, if any, action may be needed. This applies whether or not the authority is actually providing any care and support services to that adult.

In conclusion

The Care Act 2014 was designed to help to improve people’s independence and wellbeing; it strengthens the rights of people with a need for care and their family carers. It promotes fairer, more personalised care and moves the focus of local authorities from providing services for specific groups, to supporting individuals to achieve the outcomes that matter to them.

Postscript 

The Coronavirus Act 2020 which came into force on 25 March 2020 is extensive and amends many duties and responsibilities of public bodies in existing legislation across the board including the Care Act 2014. The Coronavirus Act enables local authorities to ease the relevant Care Act 2014 duties.

However the Care Act Easements Guidance makes it clear that a local authority should only take a decision to begin “exercising the easements”, that is relaxing the rules, when it is no longer reasonably practicable for it to comply with its Care Act 2014 duties and where to continue to try to do so is likely to result in urgent or acute needs not being met, potentially risking life.

The Care Act Easements Guidance states that any easements to the Care Act 2014 duties made by a local authority should be proportionate to the circumstances and suggests that a local authority could consider easements when, for example, the workforce is ‘significantly’ depleted, or there is increased demand. The Care Act Easements Guidance sets out a clear process to be used by a local authority when deciding if it should exercise any easements.

If, at any time, the Government suspends provisions contained within the Coronavirus Act, public bodies will need to revert to their duties under the Care Act 2014. The Care Act Easements Guidance makes clear that the emergency legislation is temporary.

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• > Journals
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Article contents

Why was the care act 2014 developed, what are the international comparisons, assessment under the care act, responsibilities of professionals, implications for service users and carers, dilemmas and challenges, personalisation and social care assessment – the care act 2014.

Published online by Cambridge University Press:  02 January 2018

The Care Act 2014 represents a significant change in legislation in England. For the first time it brings together various aspects of adult social care into a single statute succeeding earlier acts and policy. Given its importance to the lives of service users and carers, clinicians need to have a clear understanding of its implications. We provide an overview of why it was developed, its underlying principles and international comparisons, as well as implications for assessments, interventions and outcomes. The impact on the lives of patients and carers is discussed, as well as dilemmas and challenges the Act presents. While it addresses other important aspects of social care, including safeguarding, Mental Health Act section 117 aftercare and duty of candour, we focus on personalisation because of the opportunities it provides to enhance management plans for people experiencing mental health problems.

The Care Act 2014 represents the latest evolution in current attitudes to care. It was asserted by Norman Lamb MP, Care and Support Minister in the UK coalition government, as ‘the most significant reform of care and support in more than 60 years’. Reference Lamb 1 Think Local Act Personal (TLAP, a partnership of more than 50 organisations, including the National Health Service (NHS), ‘committed to transforming health and care through personalisation and community-based support’( www.thinklocalactpersonal.org.uk/About-us/ )) sees it as representing a significant change in legislation, of importance to service users and carers in England and Wales because ‘for the first time it puts them in control of their care and support. It also makes clear what kind of care they should expect’ ( www.thinklocalactpersonal.org.uk/Browse/careact2014/ ).

Social care law can be seen to have begun with the National Assistance Act in 1948 that contained provisions for the basis of the modern welfare state. Direct payments as a method of personalisation were introduced in 1996 by the Community Care Act. More recent updates, such as the Carers and Disabled Children Act 2000 and the Health and Social Care Act 2001, broadened and refreshed these approaches. Separately, safeguarding of adults from abuse was dealt with by the Department of Health in No Secrets . 2 The Care Act 2014 succeeds earlier acts with a single statute. The golden thread running through the Act is the promotion of individual well-being ( Box 1 ):

‘The 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.’ (Care Act 2014 section 1(1))

‘As a service user who has in the past been a carer to a diverse group of individuals, I feel that had a lot of these changes been made in the past, many people's lives would have transformed sooner rather than later. That being said, we are now moving forward to enable individual lives to be more fulfilled.’ (Deb Barnes)

Box 1 Scope: purpose of the Care Act (adapted from the Care Act 2014)

a To reform the law relating to care and support for adults

b To reform the law relating to support for carers

c To make provision about safeguarding adults from abuse or neglect

d To make provision about care standards

e To establish and make provision about Health Education England

f To establish and make provision about the Health Research Authority

g To make provision about integrating care and support with health services

Box 2 Care Act specified outcomes

The specified outcomes as defined in the Act are:

a managing and maintaining nutrition

b maintaining personal hygiene

c managing toilet needs

d being appropriately clothed

e being able to make use of the adult's home safely

f maintaining a habitable home environment

g developing and maintaining family or other personal relationships

h accessing and engaging in work, training, education or volunteering

i making use of necessary facilities or services in the local community including public transport and recreational facilities or services, and

j carrying out any caring responsibilities the adult has for a child.

In establishing the Care Act, a cap on spending for long-term social care was originally proposed to be introduced in April 2016. However, this has now been postponed until at least 2020. In 2014, The King's Fund reviewed international comparisons for health and social care provision. Reference Robertson, Gregory and Jabbal 3 It highlights that The Netherlands introduced a ‘universal’ (i.e. available to all) system of insurance for long-term care in 1968. In the 1990s it introduced caps in response to rising costs, but this led to long waiting lists and the caps were abolished. Latterly, they have raised the threshold to access social care and outlined aspects of care that are expected to be delivered by families. Sweden established the right to tax-funded legislation in 1982/1983, whereas countries including Germany, France, Japan and South Korea all have mandatory long-term care insurance schemes.

Assessment of needs, both for service users and their carers, is a core aspect of the Care Act. The process is divided into three stages: identifying needs, assessing eligibility and care planning. Reference Schwer 4 Each of these should be viewed not only as a gateway to support but as an intervention in itself.

Stage 1: identifying needs

The Act places a statutory duty on local authorities to provide assessments for any adult, including carers, appearing to have a need for care or support, regardless of the local authority's view of the level of that need or the individual's financial resources (section 9–10). It is important to note that in some areas this responsibility may be delegated by the local authority to partner organisations, such as NHS foundation trusts, and that assessment may be carried out by a range of professionals, including healthcare professionals. This assessment should address the person's needs in relation to the specified outcomes as defined in the Care Act ( Box 2 ). It aims to identify the impact of these needs, the person's desired outcomes, and whether the provision of care and support services will be effective in contributing to the achievement of these outcomes (section 9(4), 10(5)). For clarity, we have used the term ‘specified outcome’ as a technical definition to refer to those outcomes specified in the Care Act ( Box 2 ) and ‘personal outcome’ to describe all possible outcomes individuals may see as important.

It is crucial that the individual, their carer and any other person the individual requests be fully involved in the assessment process. Consideration should also be given to the most appropriate kind of assessment. Options for supported self-assessment, telephone assessment, joint assessment with other agencies or a combined assessment of the needs of, for example, the individual and their carer, may be appropriate (Care Act section 6(3)). In addition, in cases where the individual has significant difficulty in representing themselves at assessment and has no suitable advocate, the local authority is required to provide an independent advocate regardless of the individual's capacity under the Mental Capacity Act 2005. 5

Stage 2: assessing eligibility

At the eligibility stage, the Care Act replaces previous Fair Access to Care (FACS) guidance on eligibility criteria 6 , 7 with a national eligibility threshold based on the causes, extent and impact of the individual's needs (~ Box 3 ). It should however be noted that local authorities are able, where considered appropriate, to meet non-eligible needs and may choose to do so, for example, in order to prevent further deterioration.

Well-being, individual personal outcomes and eligibility

In order to judge eligibility, impacts and contexts of needs are relevant: individual needs must be considered against the specified outcomes to determine whether or not they can be met, and reasons for this should be understood. Some social needs are not addressed by the Care Act, for example housing and debt. A homeless person would not be eligible purely by virtue of their homelessness, but the reasons for homelessness may make them eligible. For example, becoming homeless solely through relationship breakdown would not be considered potentially eligible. However, homelessness through an inability to manage a tenancy due to the impact of severe mental illness (i.e. impaired ‘ability to maintain a habitable home’ as defined in the specified outcomes) may well be eligible.

Furthermore, the impact on well-being is a personalised assessment and an individual perception, so that two people with the same needs in relation to specific outcomes could end up with a different assessment of eligibility. For example, obsessive-compulsive disorder could manifest in repetitive behaviours which affect an individual's ability to maintain family relationships and employment. These two specified outcomes may be fundamental for one person and significantly affect their well-being. Another person may have very different priorities or personal outcomes that they want to achieve; their well-being is not significantly affected and they would not be eligible.

The word ‘significant’ is not defined in the legislation, rather it is a judgement made by the local authority after considering the person's needs and what is important to them. However, well-being is a broadly defined and holistically assessed concept, relating to areas such as: personal dignity; physical and mental health and emotional well-being; protection from abuse and neglect; control by the individual over day-to-day life; participation in work, education, training or recreation; social and economic well-being; domestic, family and personal relationships; suitability of living accommodation; and the individual's contribution to society. 5

Box 3 The National Eligibility Threshold (Regulation 2(1)14) 11

An adult's needs meet the eligibility criteria if –

a the adult's needs arise from or are related to a physical or mental impairment or illness;

b as a result of the adult's needs the adult is unable to achieve two or more of the outcomes […] and

c as a consequence there is, or is likely to be, a significant impact on the adult's well-being.

The key to assessment under the Care Act is understanding what personal outcome (personal aim, wish or goal) the individual is looking for and what their needs are, before considering how these needs can be met. Person-centred assessment focuses on the individual and the difficulty they have in achieving personal outcomes, balanced with their strengths and support network; it does not start with service provision. For example, the assessment does not begin with ‘the person needs residential care’, but rather may find that ‘the person is unable to wash, dress and feed themselves. This is having an impact on their personal dignity and their ability to continue to live safely in their own home’.

The local authority must consider what strengths, resources and capabilities the person has themselves and within their support networks and wider community. This strengths-based approach to assessment and care planning can maximise opportunities for utilising assets found within communities and normative support networks, thereby reducing dependence on service provision by meeting people's needs in more innovative and creative ways.

Stage 3: care planning

In developing and delivering preventive approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services, but are actively encouraged and supported to participate and are able to design care and support based around achievement of their goals. All assessments and subsequent care and support plans should be person-centred and genuinely engage the person and people involved in their care throughout.

Support plans should consider the broader needs identified by the assessment as well as the personal outcomes associated with the specified outcomes the individual is looking to achieve to maintain or improve their well-being. The person's own capabilities, assets and strengths and the potential for improving their skills, as well as the role of any support from family, friends or others that could help them to achieve what they wish for, should be incorporated into the plan. A person's independence should be maximised across these networks before any statutory service provision is considered to meet the desired personal outcomes.

Any person who requires ongoing support and has eligible needs is entitled to have these needs met through a personal budget. The Care Act 2014 has given parity to carers, who are now entitled to have their own eligible needs met through a carer's personal budget. A personal budget is an amount of money allocated for a person's support; this can be managed with or on behalf of the individual by the local authority or a broker, or can be paid to the individual as a direct payment. Person-centred care and support planning means that a person can receive part or all of their personal budget as a direct payment. Direct payments aim to enable a person to exercise the maximum possible choice over how they are supported, who they are supported by and where they are supported. The person must understand how much money is likely to be required to meet their eligible needs and have clear and realistic expectations of what is available locally. People who self-fund are entitled to receive necessary information, advice and support with support planning.

The third national TLAP survey Reference Waters and Hatton 8 demonstrated that over three-quarters of personal budget holders reported a positive impact of personal budgets on their lives. People with mental health difficulties were more likely than other groups to report a positive impact on relationships with carers, family and friends. However, older people were less likely than other cohorts to report a positive impact on mental health.

Plans may be revised as a scheduled review or in response to changing needs or circumstances. The review should be a positive opportunity to consider whether the plan is enabling the person to meet their needs and achieve their desired personal outcomes. At this point it can be considered whether the support provided is working (be this through a carer, the community, through a direct payment or a commissioned service through a personal budget), whether new personal outcomes need to be defined, or whether any changes need to be made to care and support to achieve improvement.

The Care Act places a responsibility on the local authority to inform the individual of their eligibility determination and produce a written record of whether any of their needs meet the eligibility criteria, and the reasons for this decision. Where an individual does not have eligible needs, the local authority must also provide information on what support may be available in the wider community, or what preventive measures might be taken to prevent or delay the condition progressing. This will require professionals responsible for eligibility decision-making to clearly evidence the reasons for their decisions and present these in an accessible format for the person concerned.

The Care Act 2014 has changed the ability that a service user or carer has to influence assessment of their own needs and eligibility. Whereas the FACS criteria 7 considered the needs of the individual, they did not consider their whole well-being and how this fits into their everyday lives, meaning that some service users may not have completely fitted into the specified categories. The criteria that the Care Act 2014 looks at focus on the individual in context, so that the impact on their well-being cannot now be overlooked or misjudged.

This holistic approach is mirrored by the TLAP ‘I’ statements, which make their markers for change much simpler to understand across a diverse range of individuals ( Box 4 ). These statements complement the Care Act in allowing the individual service user to take control of everything that supports their specific needs and requirements. ‘I’ statements are presented in the form of first-person statements, for instance, ‘I have the information and support I need in order to remain as independent as possible’.

‘A service user or carer can automatically feel comfortable in all the statements as they are very clear and acknowledging. They allow you to take control of everything that supports your needs and requirements. The implications are quite dramatic; you feel worthwhile and not a burden to anyone and it allows you to take greater control of your own personal needs.’ (Deb Barnes)

Box 4 Think Local, Act Personal ‘I’ statements 9

• Information and advice: having the information I need, when I need it

• active and supportive communities: keeping friends, family and place

• flexible integrated care and support: my support my own way

• workforce: my support staff

• risk enablement: feeling in control and safe

• personal budgets and self-funding: my money.

The Care Act 2014 has introduced some major statutory changes to the way social care is delivered nationally, and as such presents a number of dilemmas and challenges to service users, carers and service providers.

Assessment as intervention

Assessment under the Care Act should be an intervention in itself rather than merely a process by which individuals are granted or denied access to funded services. This presents challenges both for local authorities as a whole and for individual professionals in a number of areas, including the necessary provision of reliable and up-to-date information about local services, and management of the time and resources required to ensure that assessments can be completed in a full and holistic manner.

Provision of appropriate and proportionate assessment

Assessment under the Care Act 2014 requires local authorities to become more flexible in administering assessments and to develop assessment processes which allow for this both internally and in collaboration with other organisations.

Measurement of efficacy

Whereas the Care Act 2014 defines specified outcomes for service users and carers, the way in which these are met will be highly specific to each individual service user and may create challenges in the ways local authorities monitor and measure the efficacy of service delivery.

Provision of services

Local authorities are expected under the Care Act to promote and shape the local market so as to achieve diverse provision of care and support in their area. This carries with it budgetary implications with regards to commissioning, funding and fee-setting, which must be considered not only in terms of local authority budgets but also in relation to providers' sustainability. 10

Carer support

The Care Act broadens previous definitions of the carer role and requires assessment of support needs for anyone who feels that they fulfil this role. 6 The challenge for local authorities is to provide sufficient information to all potential carers on their rights to assessment and possible financial support, while managing the potentially increased demand for these assessments and provisions.

Time will tell whether the aspirations of the Care Act are achieved. The emphasis is clear that care should be holistic and empowering; promotion of well-being is at its core. It is hoped that it will develop services that are inclusive, work in a person-centred way, and achieve specific outcomes. The introduction of the Care Act makes this way of working a statutory duty that public services will be measured by. It will be through individual lives and stories that success will be realised.

Declaration of interest

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• Volume 41, Issue 3
• Deb Barnes (a1) , Billy Boland (a1) , Kathryn Linhart (a1) and Katherine Wilson (a1)
• DOI: https://doi.org/10.1192/pb.bp.116.053660

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Care Act: assessment and eligibility

The Care Act 2014 sets out local authorities’ duties when assessing people’s care and support needs.

This resource, updated December 2022, supports care practitioners and answers their questions about assessment and determination of eligibility under the Care Act. It also provides practical guidance over what they should do when applying the letter and spirit of this law.

Care Act 2014: the assessment and eligibility process

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This chart explains how each stage of this journey relates to different needs, outcomes and forms.

A guide to the Care Act duties that Local Authorities have towards individuals in their area, including duties relating to assessment of needs for care and support for adults and carers and determination of eligibility.

Key principles

The Care Act covers eight fundamental principles, which social care practitioners should be able to see in their practice.

Important concepts

A look at key concepts such as ‘outcomes’, ‘needs’ and ‘interventions’.

Assessment of needs

A guide to assessments of needs for care and support for adults and carers, how to prepare and how to undertake them as a social care practitioner.

Determination of eligibility

A look at what determination of eligibility is, what evidence is needed, and how to make a determination.

Practice examples

Selection of examples that have been taken direct from the frontline to support practitioners to carry out assessments and eligibility determination.

Enquire about CPD accredited training or consultancy

Put the Care Act into practice with our CPD-accredited training