The Care Bill is about to undergo detailed scrutiny by Members of Parliament. This briefing provides explanation and analysis of the Bill and the policies it will enable the Government to implement.
This briefing addresses the Care Bill in the form in which it will be read to the House of Commons on Monday 16 December 2013. It does not aim to be a comprehensive overview of the Bill, but instead provides a brief summary and analysis of the parts of the Bill where the Nuffield Trust has particular expertise.
These are reforms to the way in which adults receive financial support to pay for social care; the new single failure regime for hospital trusts; controversial new powers for Trust Special Administrators; and the introduction of a new system of care provider ratings, based in part on recommendations from the Nuffield Trust Ratings Review.
The Bill’s provisions represent the most significant reforms to social care funding in several decades. They also facilitate many of the key elements of the Government’s response to Robert Francis QC’s public inquiry into the failings at Mid Staffordshire hospital. Meanwhile, the new powers to change the operations of trusts neighbouring a failing trust could radically shorten and centralise the process of reconfiguring hospital services.
These elements were largely absent from the Draft Care and Support Bill put before a Joint Committee of both houses for consideration, which reported in March of this year. Careful consideration of these important changes will therefore be essential.
These key provisions were largely absent from the Draft Bill put before a Joint Committee − scrutiny by MPs will be essential
This briefing looks both at the specific provisions in the Bill, and the planned regulations, guidance and funding decisions which the Government has indicated will be implemented alongside them. It provides an interpretation of how these will fit together to form new systems and asks key questions in areas of potential concern.
Key points include:
- The new cap and a higher upper means test threshold for social care are a major step forwards. But the funding which will support the new cap and means test threshold will not fully bridge the growing gap between funding and demand for social care;
- The funding pressures facing the current system of social care are causing eligibility thresholds to rise, leaving out people whose needs may be serious but are not classed as ‘substantial’. Although we welcome the standardisation of eligibility, we are concerned that many of these people will continue to be excluded;
- The new powers for Trust Special Administrators have the potential to give Monitor and the Secretary of State the ability to undertake large-scale reconfigurations, including controversial closures, outside the established processes of commissioner and public consent. MPs should consider the implications of this carefully;
- We welcome the Duty of Candour, but it will only work if the NHS embraces a more open and less punitive culture. There are concerns that central bodies responsible for overseeing financial and waiting times targets may sometimes still encourage a culture which avoids confronting failure. Given this, we question the decision not to apply the Duty of Candour to these organisations;
- We are concerned as to whether the Care Quality Commission has the expertise to carry out its new duties overseeing the finances of certain social care providers;
- It is important that the Care Quality Commission should be given time and space to develop a system of ratings in which the public and professionals can have full confidence.
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