7 Preventing needs for care and support

View notes on this clause

(1) A local authority must provide or arrange for the provision of services, facilities or resources, or take other steps, which it considers will—

(a) contribute towards preventing or delaying the development of needs for care and support by adults in its area, or
(b) reduce the needs for care and support of adults in its area who have such needs.

(2) In exercising that duty, a local authority must have regard to—

(a) the importance of identifying the services, facilities and resources already available in the authority’s area and the extent to which the authority could involve or make use of them in exercising that duty;
(b) the importance of identifying adults in the authority’s area with needs for care and support which are not being met (by the authority or otherwise).

(3) Regulations may make provision for enabling a local authority to impose a charge for providing or arranging for the provision of services, facilities or resources, or for taking other steps, under this section.

(4) A charge imposed under regulations made under subsection (3) may cover only the cost that the local authority incurs in providing or arranging for the provision of the service, facility or resource or for taking the other step.

(5) A local authority may exercise the duty under subsection (1) jointly with one or more other local authorities in relation to the authorities’ combined area; and where they do so—

(a) references in this section to a local authority are to be read as references to the authorities acting jointly, and
(b) references in this section to a local authority’s area are to be read as references to the combined area.

(6) Sections 20 (exception for persons subject to immigration control), 21 (exception for provision of health services) and 22 (exception for provision of housing etc.) apply in relation to the duty under subsection (1), but with the modifications set out in those sections.

22 Responses to 7 Preventing needs for care and support

  1. david roberts says:

    para 1 does not address the tricky issue of cost effectiveness, charging is not a sufficient consideration. Investment in prevention has to be balanced against other demands, so add a “be cost effective in” to the end of the sentence in para 1 before the sub-paras, and changing “contribute” to “contributing” etc

  2. Simon Stevens says:

    There must be something about affordability of charging and not charging people on low incomes.

  3. David Coldrick says:

    1 + 2 imply that the local authority should work actively with the three sectors: NHS, voluntary groups and also local private providers (all as part of ‘local services’) whether or not it has any contractual relationship with them. Currently the contractual relationship/funding of one sort or another often seems to dictate the possible level of involvement particularly with the private sector – thus many local providers are effectively excluded even if they wish to engage properly with the local authority because they have chosen not to seek contracts with them.

    This is vitally important because all three sectors must be properly engaged if the basic visibility of each rising cohort, which may eventually require step up local care, is to be achieved. That is because many people fall outside one or other sector in terms of eg eligibility and/or acceptability for/of services and the same applies within sectors eg as between those with assessed substantial needs and those with real but lesser needs which may well develop.

    Traditional task based care provision based on meeting substantial and critical needs which already exist must therefore be converted into a far more effective risk reducing continuum of engagement involving all the different service providers (including private ones) which includes those which can provide services/intervene at a lower level of need (whether or not substantial or critical at point of engagement) and probably at a lower overall cost.

    This appears to link in with earlier provisions in the draft which require more rounded information and signposting provision to enable people/their relatives and so on to truly appreciate all the options.

    It also emphasizes an underlying need for eg local forums to exist where service providers from all sectors, whether or not contracted to the local authority, can relate properly, start to operate suitable pilots, ensure peer accountability and so forth as part of genuine engagement across the board.

    It remains to be seen how this laudable objective is to be achieved as there is no clear structure apparent to achieve this end.

  4. Richard Judd says:

    I don’t think it’s a good idea to let the local authority make a charge for services that they are unable to source locally.Carers and service users want services to readily available,and are not interested in contracts between authorities and providers.Any charges for services should be taken in to account when sorting out a care plan and personal budget. Most carers I know,want down to earth practical solutions to problems they have.

    • ALAN TAYLOR says:

      Richard Judd makes some very sound suggestions – the use of personal budgets/direct payments is a useful tool but this suggestion makes it harder for the Carer Service User to seek something appropriate in their own locale. Some commissioning managers seem to be going along the line of ‘combine with others’ as it is easier for us to ‘manage you’ thus reducing the choice availble to service users – and making it easier for Local Authorities which is not what this legislation is about. Wider choice for service users may again mean the ‘big is not beautiful’ and a ‘basket of small quality services’ may be the answer. The contract then being between the service user and the provider.

  5. Pauline Dye says:

    The possibility of charging for carers’ support services needs to be weighed against the net contribution that carers make to health and social care. Support for carers should be seen as a good investment.

  6. Andrea Welch says:

    David Coldrick has hit the nail on the head by noting the problem of access criteria set to ‘critical and substantial’ in many areas. There will now exist a deep rooted culture in weeding out those who would benefit from preventative services, it will be like turning round the proverbial tanker. His suggestion for local forums would help and I believe should take place where most people’s care journey begins, in their local GP surgery. Proactive primary care joined with local authority services is key.

  7. Melissa Echalier, Action on Hearing Loss says:

    We support the introduction of this service; however, it is essential that such services are accessible to all groups, including those people with complex needs. For instance, in cases where someone has hearing loss, the delivery of early intervention in dementia will need to be delivered in an accessible way.

    We know that people do not take up social care where their need is already apparent because they cannot afford the charge. It is less likely that they will take up the offer of preventative services if they are charged for these. We believe that, for such prevention to be effective, it must be part of local authorities’ free universal offer. This approach could be further justified by related savings made to social and health services further down the line. Therefore, while we understand that the draft bill is only providing for the regulations to make provision around charging, we believe that clause 7 (3) should be removed from the draft bill.

  8. Belinda Schwehr says:

    This provision is all about securing universal services so as to ensure that the minimum possible number of people actually qualify for an individual care plan under the duties of the authority to meet eligible unmet need. It provides for contracting for services, as an authority, rather than putting the money in people’s budgets, which makes sense, if one is doing this strategically. What is interesting, legally, in my opinion, is that this allows for social care authorities to exercise a discretion whether or not to charge for universally available preventive services (that is not new, but is not done in practice at present), and for such charges to be levied on people who are merely signposted to services that are NOT even contracted for by councils, but which have merely been grant funded (this derives from the reference to ‘taking other steps’ – this means grant funding, in my view). I have no political problem with that, but I would say that it makes relationships with service users and the voluntary sector more complicated, in terms of obligations to consult about cuts or reductions to grants, once charges have been paid to the council for the provider’s grant-funded offering; and in terms of who is going to DO this charging (the council, directly, or the grant funded service provider, as agent for the council?). It also raises the issue of means assessment before such charges are levied; at the moment, universally offered services do not tend to be charged for by the council, for fear of putting people off using them, and because of the admin overload of applying a Fairer Charging assessment to all those people who don’t actually formally qualify for services in an individual care plan. As soon as there is a charge by the council under statutory powers, it will involve the means of persons need to be assessed, and this may be unworkable.

  9. Amanda Jayne Maclachlan says:

    psychiatrists since the 2007 mental heralth act can now lock up anybody who would refuse treatment for their own health and safety. These drugs they use on people are highly dangerous and dibilitating. I would like to propose that forcing treatment onh anybody is a severe infringement of human rights. If you removed the rights of psychiatrists to force treatment they would lose their incentive to keep depriving people of their liberty for petty reasons.

  10. Jan Kendall Dementia Advocacy Network says:

    Independent Advocacy plays a significant part in ‘preventing needs for care and support’ by providing support to plan ahead e.g. in the early stages of dementia. Information and advice have been clearly seen as vital preventative services. We would welcome all Local Authorities including Independent Advocacy as another service to be provided. Including it alongside Information and Advice would enable many people to act on the information and advice they have been given.

  11. Manar Matusiak, Living Autism says:

    It would be helpful if this general statement could be further qualified for adults who have an autistic spectrum condition where the Autism Act, 2009, and the Autism Strategy, Fulfilling and Rewarding Lives, clearly indicate that in order for effective identification of needs to take place, frontline staff must have appropriate information and training.

    The abilities of people with high-functioning autistic spectrum conditions or Asperger’s Syndrome often mask the anxieties and the experiences of the condition which can lead to personal neglect and mental health issues. Early detection by knowledgeable professionals and appropriate support are key to the prevention of additional and acute needs for care and support.

  12. Anne Barrett on behalf of the South Carers Network says:

    Clause 7
    Positive
    • Good preventative approach
    Negative
    • Need some sort of benchmarking, evidence, cost benefit nationally to be able to plan services locally
    • Charging needs clarification
    • Social care focused, what about health?
    • Need to make the wider economy responsible, ie housing, employers

  13. Rosemary Trustam says:

    These comments are from Preston’s Learning Disabilities Forum comprising service users, carers and provider reps as well as some specific local authority post-holders. All felt that a sufficiency of preventive services are needed to be assured by the local authority. (These could be funded via grants) and people referred to appropriate ones when they don’t reach the threshold for social care. If they are to prevent, then the local authority needs to invest in them – or find themselves picking up higher social care costs.
    We didn’t talk about the local authority charging but discussion did express concern about the deterrent effect of charges. Presumably local groups could make some small charges related to aspects of services which might enhance provision but not be prohibitive. People with personal budgets should also be able to purchase these services which would help the overall provision

  14. Peter Denton - for Tameside LINk says:

    We support the general principle of prevention and early intervention. We feel it is important to recognise the people will exercise choice about how they live their lives. Whilst we all have responsibilities to each other and to society, people’s level of access to health and care services must not be varied as a result of their lifestyle choices.

    It must also be recognised that for many people prevention is an unattainable goal – we will all die at some point and most people will require some health and care services at the end of their life.

  15. Sally Young says:

    We welcome the duty to take steps to focus on preventative support for adults not eligible for care and support services. Many voluntary sector providers already play a key part in prevention services and activities which should be recognised and included by commissioners. We would like to see a general duty to assess unmet need, not just have regard to it. We would also like to see a duty to ensure that prevention services include adults who are already receiving care and support such as people in residential homes, which may avoid an escalation of need and unnecessary hospital admissions.

  16. Jacqui Cuff: Advocacy Manager- Cats Protection says:

    Ensuring that a budget is available to maintain or obtain an animal such as a cat should be expressed as a valid payment under the provisions of this Bill. As mentioned under the wellbeing clause the benefits of a companion animal such as a pet can lift mood and prevent conditions deteriorating. Research by Manchester University (Creature Comforts) of patients with diabetes and chronic heart disease showed interactions and relationships with pets helped people with long term conditions. Cats Protection research of over adults over 55 shows that cats are especially popular with this age group – 79% of people prefer to share their feelings with a cat rather than a human and that 50% said their cat has helped them in times of crisis.

  17. Dr Helen Brown says:

    West Anglia Crossroads strongly support the aims of this section. We support carers having the right to carers assessments and the right to services as a result of this. We are concerned that these might be means tested, as this will make identifying more carers at an earlier stage will be made more complex.
    Young carers should also have the rights to carers assessments and the right to services as a result of this.

  18. Janice Clark says:

    How can charging Carers for services or assessment be viewed as “preventative”? This is most likely to deter Carers coming forward for help when they really need it – thus jeopardising the caring situation. Should the caring situation then break down a Local Authority could end up funding full time alternative care – when support to a Carers at no charge might have been a few pounds! There would also be an additional cost to the whole system to heal my broken back or medicate my stress and depression.

    Also there is something not right in the thinking behind this.

    Why should I – a carer – pay for support to help me go on caring – carers save the state £119 billion a year! If I use my savings – what do I use for my own care which, as I am 67, could be sooner rather than later. This seems to me to be exploitation. If I am unable to support my own health and care needs because I have been exploited – is this not an abuse of my Human Rights? Think about it. It’s the State that should be paying us!

  19. Emma Stone, Director of Policy & Research, Joseph Rowntree Foundation says:

    Prevention and ‘that bit of help’

    1. JRF is delighted that the White Paper will place a clear duty on local authorities to incorporate preventive practice and early intervention into care commissioning and planning.

    2. JRF research has shown that the availability of low-level assistance and support – which older people themselves have described as ‘that bit of help’ – is highly valued by many older people, improves quality of life, supports people to live well in their own communities for longer, and may also delay or prevent the need for more acute support services (Raynes et al 2006).

    3. As always, if commissioners are to have regard for investing in this assistance and low-level, community-based support, then it is important to identify what people actually want and need.

    4. JRF has a substantial body of evidence on this subject, including the collation of several local example of good practice (Raynes et al 2006; Centre for Policy on Ageing 2011).

    5. We have concluded that the evidence demonstrating the effectiveness of these schemes does exist, but it tends to be widely dispersed among small scale evaluations. We therefore welcome the commitment in the White Paper to create a single bank of evidence regarding preventive interventions in care and support, in order to support and inform national and local investment, commissioning and provision.

    6. We would, however, sound a note of caution: a duty to commission services offering ‘that bit of help’ will not be successful without sufficient investment to stimulate their local provision. The White Paper suggests Social Impact Bonds might be one funding solution. These are a promising development, but remain relatively untested in this policy field. We do not know if the standard of evidence required by social investors will be within the reach of some of the small local charitable organisations providing some of the most innovative schemes, and therefore may not be commissioned.

    7. Given the uncertainties of SIBs, JRF would have liked to have seen some commitment from the government for initial statutory funding to encourage the initial commissioning of such schemes, to boost confidence in their efficacy among potential social investors. Evidence will also start to emerge from initiatives like TLAP (Think Local Act Personal) and from communities participating in the Dementia Challenge (e.g. see recent JRF work in York on dementia-friendly places by Crampton, Dean and Eley 2012).

    (Research referred to above can be found at http://www.jrf.org.uk)

  20. Mrs Ann Leask says:

    Prevention should occur before the service User deteriorates. If care was the responsibility of the Health Authority, then prevention could be built into each health issue at the point of first contact with the GP.

  21. Jill Manthorpe says:

    The potential for charging for universal services risks a two tier system of basic and tailored advice, information and support. Our research with Carers Workers (NIHR SSCR funded) shows that many of them run out reach services for carers who do not self-identify as such or who are hard to reach or to hear. Charging for preventive services seems to be counter cultural in that many people who are in need of care and support are disadvantaged in socio-economic terms and the indication of means testing will be a further disinclination to seek support. After all we do not charge for immunisations and so on. Work done on the cost effectiveness of social care by PSSRU has begun to quantify the social gain and gains to NHS from preventive services – not just individual well-being- of services such as debt advice.

    Prevention of harm or the risk of harm is also a key feature of adult safeguarding and this subject should be included in any Guidance. This would include prevention of re-offending and of repeat vicimisation,