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This assignment will critically discuss the impact of the Social Services and Wellbeing (Wales) Act (SSWBWA) (2014) on adult social care. Looking at the drivers for change and why and how Welsh legislation and guidance has diverged since devolution. Focusing on what these changes mean for older people (over 65) and adult carers. Drawing upon examples of good practice in these areas to demonstrate the key principles of the Act.
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Fulfilled lives, Supportive Communities (2007) set out the Welsh Governments (WG) vision to modernise social services. The strategy highlighted the following drivers for change: an increased demand for services for people with high care needs, over longer periods of time; an increase in informal care; an increase in lone living and a high demand for services from individuals aged 85 and older (WG, 2007). Similarly, Sustainable Social Services for Wales: A Framework for Action (2011), further highlighted challenges to public services in Wales including the fragmentation of families and communities, demographic change and increased expectation. Alongside hard economic realities; the increasing rise in demand for social services and a difficult financial outlook. The white paper summarised the need to refocus on sustainable renewal as opposed to historical approaches of efficiency or cost cutting measures (WG, 2015).
Wales voted for devolution from the United Kingdom (UK) in 1997. The devolution process began with the passing of the Government of Wales Act (1998) which established the National Assembly for Wales. The Government of Wales Act (2006) led to the creation of a separate legislature, then in 2011 the UK Government implemented legislation enabling the Welsh Government (WG) to make laws in all 20 areas devolved to Wales (Gov.UK, 2018). It is evident since devolution Wales are establishing their own national identity and legislation has been diverging from England. Social care legislation and guidance in Wales now has a strong emphasis on the spirit of mutuality and collective ambition/action. Roots of such values can be seen in the work and ideologies of Aneurin Bevan, labour minister and architect of the NHS (IWA, 2018).
In 2011 the Law Commission reviewed all adult social care law in England and Wales. Concluding the legislative framework for adult residential care, community care, adult protection and support for carers was inadequate, incomprehensible and outdated. Making recommendations for a clearer, modern and more cohesive framework for adult social care which will make a difference not only to those who receive care and support, but also those who manage the system (Department of Health, 2012). The discussed divergence is prevalent in the implementation of the afore mentioned recommendations of Law Commission Report enacted in the Care Act (2014) in England and the SSWBWA (2014).
The SSWBWA (2014) repealed and replaced much English legislation such as: NHS & Community Care Act (1990); Health & Social Care Act (2001); Carers (Recognition& Services) Act (1995) and Carer and Carers (Equal Opportunities) Act (2004). Exceptions being the Children Act (1989); Mental Health Act (1983/2007); Mental Capacity Act (2005) and the Equality Act (2010). In brief the key principles of the SSWBWA (2014) are supporting people who have care and support needs to achieve well-being. Placing people at the heart of the new system by giving them an equal say in the support they receive. Achieved through partnership and co-operation which drives service delivery. Delivery of services which promote the prevention of escalating need and ensure the right help is available at the right time (WG, 2014). The six principles of the Care Act (2014) are: empowerment; protection; prevention; proportionality; partnership and accountability (Skills for Care, 2014).
One of the fundamental differences between the Acts is that the Care Act (2014) is adult specific with separate legislation for children and carers. Conversely the SSWBWA (2014) addresses the whole life course and social care generally. Similarly, both Acts contain legislation in relation to safeguarding vulnerable adults and the establishment of local safeguarding boards. However, in Wales the local safeguarding boards deal with both adults and children and are overseen by a national safeguarding board. Wales and Scotland have both included adult protection and support orders into their legislation, however there is no such provision in England (Mitchell, 2013). S.127 of the SSWBWA (2014) enables applications to the magistrates for such orders which allow authorised officers to speak in private to an adult suspected of being a risk (Law Wales, 2016).
The service user pathway is essentially the same under both Acts, beginning with an assessment, following which assessed needs are compared with needs identified in the eligibility criteria. Where there is an unmet need there is then a duty in both England and Wales to provide support and services. This can be provided by the LA itself, independent providers or via direct payments. Under the SSWBWA (2014) the duty to assess an adult who may have need for care and or support is outlined in part 3, section 19. The duty is triggered by an appearance of need as opposed to a request. Assessments include consideration as to whether the needs then meet the eligibility criteria outlined in part 4, section 32 and section 35 establishes the duty to meet these assessed needs. The process requires a comprehensive analysis of five elements and consideration of the eligibility criteria: the person’s circumstances; their personal outcomes; the barriers to achieving those outcomes; the risks to the person or to other persons if those outcomes are not achieved; and the person’s strengths and capabilities (Clements, 2017). This type of assessment has elements strengths-based theory/perspective, building upon a person’s existing strengths as opposed to deficits.
SSWBWA (2014) Part 3 Code of Practice (assessing the needs of individuals) section 17, states that assessment starts from the presumption that an adult is best placed to judge their own wellbeing; this resonates with voice and control key principles of the Act. Tanner (2010) suggested the process of assessment should increase intrinsic worth as a way of helping individuals maintain or change their ongoing story of self and situation, as well as being a route to determining service provision. The Delivery of the personalisation agenda in both the Care Act (2014) and SSWBWA (2014) places an emphasis on self-assessment which if undertaken correctly would be person centred in all senses. A criticism of this self-assessment is that it removes the opportunity for individuals to benefit from the ideas and opportunities that a professional assessment may evoke (Tanner, 2010). Luke Clements (2017) supporting this suggested that 2016 research on the implementation of the SSWBWA Act found the assessment process ‘felt like a ‘tick box’ exercise, fitting people into ‘neat administrative boxes’ which meant it was unlikely to provide a bespoke outcome’. Furthermore, the research found that person-led assessments ‘placed too much onus on the individual and their ability to communicate what support they needed’: that ‘many felt they would have benefitted from knowing what services were available in advance and how those services might help them’.
In a statement in 2005 the Department of Health warned that for too long social work has been perceived as the gatekeeper of services. Suggesting radical change is needed which reinforce social work values and hand back control and choice to individuals as opposed to professionals. Clements (2008) agrees that although the government and legislation wishes to move away from the perception of ‘gatekeeping services’ it is a core function of a social workers role. Social care resources are scarce and access to them must be regulated by a state agent. SSWBWA (2014) Part 3 Code of Practice (assessing the needs of individuals) section 18, describes the principle of coproduction and the need to form a relationship where practitioners and individuals share power to plan and deliver support together. Recognising that all partners have vital contributions to make in helping meet identified personal outcomes. Furthermore, under section 23, an individual must feel they are an equal partner in their relationship with professionals (SCW, 2014). This principle is further embedded into the Code of Professional Practice for Social Care (2017), section 1 whereby practitioners must work in person centred ways and support individuals to maximise their decision making (SCW, 2017).
The Raglan Project illustrates how the following key principles of the SSWBWA (2014): voice and control and coproduction look and work in practice. The Project provides homecare for adults within a small rural community living with dementia. Moving away from the tradition model of task lead care which is focused on meeting physical needs within a specific time to relationship-based care, by also focusing on social and emotional needs. Staff work alongside individuals and those important to them such as family and carers to decide how time is spent and how tasks or activities are carried out. This is agreed daily to form personalised plans which then form the basis of provision, as opposed to a prescribed list of tasks (SCW, 2018). Giving individuals voice and control of their care and support as they are treated as active participants in coproducing plans and the delivery of truly person-centred care. This also reflects sections 1 and 2 of Code of Professional Practice for Social Care Workers (SCW, 2017).
Staff also worked hard to re-establish links within the local community. Evans (2009) argued that a sense of community is a crucial factor in quality of life for many older people, with less geographic mobility individuals are more likely to have lived in areas for longer and spend have spent more time in their community. Therefore, are more likely to have derived a stronger emotional attachment to their home and surroundings. The project established a group ‘friends of Raglan’, which is independent of social services and sustainable in terms of financing and commitment from members of the local community. Individuals are supported and encouraged to attend these social events and as a result some are now able to attend independently and self-sustain access. Community is also linked to wellbeing as individuals have rights and under the Act to belong to good strong communities (SCW, 2018).
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Both Acts create powers to charge for such services, however, income and capital assessment, caps and disregards differ in England and Wales (Mitchell, 2013). Both Acts acknowledge that individuals must be left with a basic level of income, charges should be reasonable and provide regulations on how means testing individuals and thresholds. The Dilnot Commission (2011) found that individuals faced uninsured risk of large scale expenditure on care and support. Furthermore, the current system was inadequate, unfair and unstainable. Proposing a lifetime cap and higher means tested threshold (Age Uk, 2018). Although reviewing funding in England, WG welcomed the report and agreed that Wales faces similar issues with variations across the country. Wales set out their own programme for renewal and in 2011 introduced a £80 per week limit on the amount a LA can charge for care in the community, furthermore in 2016 they made a commitment to increase the amount of capital a person can keep without having to pay for residential care from £24,000 to £50,000 (WG, 2018). Clements (2017) criticised the £80 cap suggesting it exacerbates disadvantage, by subsidising the care needs of the wealthy with expendable income, by paying the same as those with little or no money. No such measures are in place currently in England and Dilnot’s proposals were due to come into force in April 2016, however have been delayed until April 2020.
Smith (2017) criticised the current system central government use to fund adult social care. Suggesting that if the government wished to ensure those in equal need in different parts of the country received equal care, then they need to remove LA discretion. Which would subsequently make eligibility assessment more consistent in both practice and principle. With the increased emphasis on active participation and personalisation both England and Wales have both favoured ‘cash for care models’. In England Personal Budget are an allocation of money calculated by a LA as being necessary to meet a person’s eligible needs. The LA then provides a statement with the available amount to the individual. Welsh Ministers opposed the introduction of Personal Budgets and instead opted for Direct Payments and the Care and Support (Direct Payment) (Wales) Regulations (2015) outline the governance.
Clements (2008) highlighted that ‘cash for care’ models such as Personal Budgets (England) and Direct Payments (Wales) can be costly as LA’s can no longer operate cost ceilings on care and support nor negotiate with providers. Which as a result would cost individuals more in top up’s. Drakeford (1999) suggested the approach is underpinned by the perception of responsibility and a shift in emphasis moving away from state responsibility. Likewise, Beresford & Jones (2008) warned of the dangers of passing on this responsibility; individuals in need of care and support could ultimately be held to account if they fail to manage their budget or payments. Arguing the model merely is a shift of responsibility and risk, particularly with less money coming from central government into social are and rising need.
Similarly, both Acts contain provisions to promote the integration of services, however the SSWBWA (2014) creates stronger powers to intervene and enforce this integration. Subsequently in Wales there is a requirement for LA’s and NHS bodies to enter into formal partnership agreements (Mitchell, 2013). This is prevalent when looking at adult carers in Wales, an example of good practice of multiagency working, which is a key principle of SSWBWA (2014) and outlined in s.3 of Code of Professional Practice for Social Care Workers (2017) is Neath Port Talbots Carers Service. The service is a registered charity that works closely with partners in Neath Port Talbot County Brough Council and ABMU health board to ensure adult carers are identified early and provided with the right information at the right time (NPT Carers Service, 2018). This links into another key principle of the Act which relates to preventative services and early intervention. The Carers Centre offer a range of information and advice including: support with benefits and entitlements; information on carers rights; promoting the health and wellbeing of carers; signposting to services and undertaking carers assessments in partnership with the LA.
The SSWBWA (2014) consolidates three existing carers acts and removes the requirement to establish that the carer is providing ‘a substantial amount of care, on a regular basis’. Under part 3 section 24 of the Act there is a duty to assess carers for support. Pre-act the onus would be on carers to request this assessment, however now assessment is triggered by the appearance of need. Carers must be fully involved in their assessments and the duty to assess applies regardless of the LA’s view of the level of the carer’s need for support or their financial situation. Specific consideration should also be given to: the extent to which the carer is able, and will continue to be able, to provide care; the extent to which the carer is willing, and will continue to be willing, to do so ; whether the carer works or wishes to do so and whether the carer is participating in or wishes to participate in education, training or any leisure activity. Section 28 allows LA where appropriate to combine, with consent, the assessments of the individual in need and the carer (Clements, 2017). Carers Wales undertake research in relation to the implementation of the SSWBWA (2014). Their findings from 2018, state despite some examples of good practice such as the above-mentioned Neath Port Talbots Carers Service, there are still systematic failures. Processes differ throughout the 22 LA’s and highlighted a trend in carers not receiving or are unaware that they’ve had a carers assessment. The figures for 2016/2017 showed only 3.5% had received the assessment (Carers Wales, 2018).
Part 3 Code of Practice (assessing the needs of individuals) states that when undertaking an assessment, the LA must identify all presenting needs, including those which would be deemed as eligible if a carer was not meeting those needs. Therefore, care provided by a ‘willing carer’ is not ignored for eligibility purposes. Once a LA has gathered the relevant information the Act and The Care and Support (Eligibility) (Wales) Regulations 2015 require that it decides if the person’s ‘needs’ are such that they meet the eligibility criteria and if so, care and support is made available to address those needs. The eligibility criteria regulations create a process with four stages: the need arises for a specified reason (caring), the need relates to certain key activities/outcome; the person is unable to meet that need even with the available support from others / the community; and the need cannot be met without the LA providing assistance. This was initially described by the WG as the ‘can and can only’ test, however this was criticised, suggesting it places an onus on individuals to prove they had tried and failed accessing community support services, prior to accessing personalised support (Clements, 2017).
In conclusion since devolution Welsh legislation and guidance is diverging as Wales assumes its own national identify and values. The SSWBWA (2014) aimed to simplify and update social care legislation, repealing and replacing English legislation in an Act which was unique and innovative as it covered the life course. For practitioners the key principles of the Act are built into the Code of Professional Practice for Social Care Workers therefore should underpin all practice (SCW, 2018). This essay has discussed how the Act can and should work with examples of good practice which embed and interpret the key principles. Carers Wales (2018) suggest although there are many examples of good practice occurring under the Act there has been a systematic failure to provide a services and support to carers which is enshrined in a much-heralded piece of legislation. Clements (2017) argues the Act is a broadly positive development with some innovative provisions. Since devolution, however, many authorities have not been equipped nor supported to implement such major organisational changes. Furthermore, some provisions of the Act are complex for both individuals and professionals to interpret, such as eligibility criterias. Suggesting that although, flawed these issues are remedial.
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