Welsh social care bill: people to get a say in the services they receive

The recently unveiled social care bill could transform services in Wales, but how it is implemented will depend on the detail, by Ruth Crowder

The new social services and wellbeing bill for Wales looks set to transform social care services. It will introduce, among other things, a duty to provide support for carers, a national eligibility criteria and a duty to provide “preventive” services. All these are welcomed by the Welsh Reablement Alliance, a group of third-sector and professional organisations campaigning for consistent and high quality reablement services.

The preventive services are intended to delay or prevent people developing need for care; reduce those care needs and you minimise the effect on people of their disabilities. There is clear evidence that effective reablement services can do all of these things. Reablement is a personalised programme that helps people improve their ability to do the things they want and need to live independently.

The new bill requires local authority assessments to seek to identify the outcomes a person wishes to achieve and the extent to which services can help achieve those. The alliance welcomes that as a powerful means of giving people real voice and control over what services they receive and how.

The bill will also require health and local authorities to work together. These duties have the potential to deliver transformational change in enabling people to live independent lives. Greater integration between health and social care is essential if Wales is to deliver effective services which reduce the impact of high levels of chronic ill-health in the population.

What isn’t yet clear to the organisations is how that will work for people who have care and support needs and yet would still benefit from access to enabling services.

The examples of what can be provided lists already existing services, but not more modern enabling approaches. There is also no mention of the impact equipment and adaptation can have as part of a package of services to minimise the effect of disability for people.

The bill also identifies the power to charge for services when people have care and support needs. This could lead to a situation where someone accesses reablement as a preventive service without charge and someone who has passed the eligibility assessment and has greater need for care and support could be charged. This has the potential to be highly ineffective at minimising the effect of disability and reducing people’s need for care.

The bill will also give Welsh ministers powers to set a national eligibility criteria. This is intended to reduce the current variability and postcode lottery that exists in service provision in different local authorities. How this level will be set is not detailed but will be revealed in future regulations. Without this detail, it is difficult to see how the bill will affect service provision in practice.

The current variability means that local authorities may set the level at which they provide services to match the resources available to them. If the new national level is set too high, many people who receive services may no longer do so; set too low and the costs of providing care could rise significantly.

Carers will also benefit. Currently they have a right to an assessment of need but not to any particular action from that. This bill creates a new duty to provide support to help them care, including taking into account their wishes to work or have leisure time. This is an excellent development, however there is potential that this could generate significant increases in cost, just at a time when social care budgets are being squeezed.

The principles, aspirations and intentions of the bill are excellent. As ever, the devil will be in the detail of further regulation and how it is implemented in the real world.

Ruth Crowder is chair of the Welsh Reablement Alliance and policy officer for the College of Occupational Therapists.