The Care Bill is undergoing Report Stage in the House of Commons, giving every MP a chance to address and challenge the historic reforms it lays out. This briefing outlines our position and the key facts on the issues of social care funding, Trust Special Administration and hospital ratings.
This briefing addresses the Care Bill as it goes before the House of Commons on Monday 10 March 2014, for scrutiny and proposed amendments at Report Stage. It provides background and key points on three of the most important changes laid out in the Bill.
The system of paying for social care for older people is under great pressure as local authority budgets shrink. It will be radically changed by the Bill, which introduces a headline cap on the amount spent by individuals with substantial needs.
These reforms represent key legal foundations of the Government’s response to the financial squeeze, and to the growing emphasis on how people are treated
In the NHS, meanwhile, clause 119 of the Bill provides for a controversial extension of powers over failing hospitals to other hospitals nearby. Across both health and social care, the Bill will lay the framework for a system of ratings for hospitals and other providers of care, based partially on the Nuffield Trust’s recent review of ratings commissioned by the Secretary of State.
These reforms give the Government the legal powers it needs to carry forward its response to the financial squeeze on health and social care, and the need to secure patient safety. They have been added since the Bill was first examined by a joint committee of both houses, and close examination now is crucial.
Key points include:
- Councils struggling to pay for social care under austerity are raising eligibility thresholds for help. This has removed government support from many older people who need assistance with everyday tasks. We need to find out what is happening to these people and what the implications might be for them, their families and the NHS;
- The new cap and a higher upper means test threshold for social care are a major step forwards. However, MPs should look closely at whether the Care Bill addresses the implications of the squeeze on eligibility according to need. Although it centralises the power to set the threshold, the Government have indicated that they will keep requirements high;
- The new powers in Clause 119 will allow Trust Special Administrators and the Secretary of State to downgrade or close wards at financially healthy hospitals. It is true that the underlying problems in hospital finances often need to be tackled regionally. However, the use of the fast-track Special Administration process does not seem appropriate for change to successful trusts;
- These changes should continue to use established slower processes, embraced by successive governments, which fully engage staff and patients;
- The new system of ratings takes on board many of our findings. However, there are serious challenges around giving one meaningful rating to hospital trusts, which contain many different wards and sites. The Care Quality Commission must be given plenty of time and space to make sure ratings are not misleading.
Find out more about our in-depth work on the issues of NHS reform and social care funding.
Nuffield Trust (2014) Care Bill: Report Stage, House of Commons. Briefing.