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Prevention is better than cure. So why are councils dragging their feet?

Source: PSE - Apr/May 16

Chloë Carter, policy and advocacy manager at the British Red Cross, considers the Care Act one year on and asks why progress toward prevention remains slow and confused.

Celebrated as the most significant reform of care and support in more than 60 years, it’s a year since the Care Act 2014 came into force in England. Replacing the confusing and often incoherent patchwork of legislation with a single statute, the Act was intended to make social care law clearer to councils and more accessible to the public. 

The Act clarifies the duties placed on councils in relation to adult social care. Some duties were new, but most consolidated existing law, or they were new in law, but not new in policy – like the prevention duty (Section 2). 

The prevention duty requires councils to ensure the provision of preventative services within their area. The British Red Cross recently undertook research to find out the extent to which councils understand and are implementing this duty. We sent FoI requests to all 152 English councils and received responses from 149 of them. 

Vision not being fully realised 

The results demonstrated that one year on, the Care Act’s vision for prevention is not being fully realised. There were some positive signs, such as the fact that more than 80% of councils had developed or were in the process of developing a local approach to prevention. But significant setbacks remained. 

One of the more concerning revelations was that over half of councils identified ‘providing information and advice’ as an action they’re taking to comply with the prevention duty – despite the Act placing a separate duty on them to do so (Section 4).

The Act’s statutory guidance recognises information and advice as a vital component of preventing or delaying people’s need for care and support. But while providing good-quality information and advice may be necessary for effective prevention, it is certainly not sufficient to fulfil the prevention duty. It’s legitimate to recognise the interdependency of the two duties, but councils must not conflate them. Nor can they cite their information and advice service as an example of meeting their prevention duty. 

Putting People First agenda 

If you look back a few years to 2008, then this misunderstanding and conflation of duties becomes all the more frustrating. Delivering universal information and advice and preventative services were two of the five goals that councils were set under the Putting People First agenda.

Each goal had three milestones against which councils were expected to deliver. By April 2011 – a full five years ago – all councils were expected to have information and advice services available to everyone in their area, irrespective of eligibility for public funding. 

With regards to prevention, all councils were expected to have a clear strategy (jointly with health) for how they would shift some investment from reactive services to preventative ones by April 2010. They then had a year to implement these and evidence cashable savings.  

Not only did Putting People First give impetus to these issues, but councils were given funding to support their delivery. Allocations from the Social Care Reform Grant had to be stretched across the five milestones, but they were sufficient to establish universal information and advice services and to begin shifting towards prevention. 

We’re seven or eight years on from the policy drive of Putting People First. There’s no excuse for conflating the Care Act duty to provide information and advice with the duty to ensure the provision of preventative services. Universal information and advice services should long be in place. 

Moving from reactive to preventative provision is a shift that will take longer to realise. Putting People First laid the groundwork, but prevention has needed the fresh impetus of the Care Act. According to the Association of Directors of Adult Social Services Budget Survey, spend on prevention is only around 6% of total budgets. 

Year one of Care Act implementation has seen focus given to those duties that were new to councils. Year two is an opportunity to look afresh at those duties that were new in law, but not in policy. This includes the enshrining in law of the long-held ambition that it is better to prevent, reduce and delay needs than to wait for a person to fall into crisis.

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