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Prof Jon Glasby: Professor of Health and Social Care, University of Birmingham and Director of IMPACT Centre and Dr Laura Griffith: Deputy Head of National Embedding, University of Birmingham and IMPACT Centre

It is hard to think of an Act whose principles seems so promising on paper, but which simply has not been implemented in practice.

Care Act 10 years on banner

In late 2022, The House of Lords Adult Social Care Committee published its report A ‘Gloriously Ordinary Life’. In reflecting on the legacy of the Care Act, the Committee concluded that:

“The tragedy of the situation facing adult social care is that the right prescription for many changes have been nearly to hand for eight [now ten] years in the shape of the Care Act 2014… In principle, …the Act enshrines in law many of the principles that we endorse for adult social care, including the right for individuals to determine the relationships they wish to have with their families and friends, and the right for unpaid carers to be appropriately supported when they wish to provide unpaid care and support. 

One witness told us: “What you have is policy and law rooted in a lot of the right stuff. It is rooted in wellbeing, community, choice and control; it puts people in control and at the heart of their care and support.” There is consensus, however, that the Act has never been implemented in practice and has resulted in little change on the ground” (para 212-216). 

Indeed, it is hard to think of an Act whose principles seems so promising on paper, but which simply has not been implemented in practice. In the view of the Committee, this extremely sad state of affairs is due to:

  • The extreme financial pressures facing local government – for the Committee, “the tangible explanations for the shortcomings of the Act start and finish with funding” (para. 223)
  • A failure to take some of the more fundamental actions that might be needed to change the underlying culture of adult social care.

Our own analysis agrees, and the University of Birmingham’s broader work (with Matthew Bennett, Yanan Zhang and Patrick Hall) on the ‘lost decade’ of 2010-20 highlights the terrible impact of under-funding on people’s lives; the strain experienced by carers; threats to quality and access; and the pressures faced by service providers and partner agencies. 

Unfortunately, adult social care is too often seen as ‘dead money’ that has to be spent to provide a basic safety net. 

In our view, this is completely wrong, and adult social care should be a form of social and economic investment we make in ourselves as a society. At IMPACT, the UK centre for implementing evidence in adult social care, we believe that “good care isn’t about ‘services’, it’s about having a life” – a mission that ought to be consistent with the Care Act (if it had ever really been implemented in practice).

Our work with IMPACT also sheds light on the second of the Committee’s observations. Historically, adult social care services have been episodic, crisis-orientated and ‘deficits-based’ (essentially identifying what’s ‘wrong’ with someone and what might need ‘putting right’). This is inherently negative, and makes people concentrate on what they’d can’t do, rather than on what they can do, and what makes for a good day and a good life. Worse, it ignores (and can sometimes even ride roughshod over) the way in which we live other aspects of our life – the everyday support we gain from the connections we all draw on in our families, friendship groups and communities to lead the lives we choose.

And yet – despite such significant pressures – all is not lost. IMPACT is working across the UK with all kinds of partners - from user-led organisations to councils and from individual providers to whole regions. 

In spite of the barriers, these partners are trying really hard – often in exceptionally difficult circumstances – to make a difference. 

Usually, they find ways to be as close as possible to the people and communities they’re trying to support, they try to share power, and they’re keen to get whatever support they can to move forwards (which is where IMPACT comes in).

Just to give a flavour from other nations, through our Network on choice and control we met Friends United Together, a group of people with learning disabilities in Swansea who pooled their direct payments, formed a co-operative and now control their own support – enabling them to stay together as a group even after local commissioning arrangements changed. They want to share their story with others and to tell it their way – so made a video with us to help others learn from their journey. 

We also met Una, Owen’s Mum, who told us about the band that Owen formed with friends and with the support of a personal assistant. This is an everyday innovation that probably costs a fraction of a formal service, and that anyone could have thought of – but no one did (except Owen and those who really know and care about him). Their short documentary of ‘The High End Dead’ is on YouTube and is a joy to behold.

We’ve worked in Antrim, on an asset-based approaches Demonstrator project, where a community organisation called MEAPP / IMPACTAgewell® brings together integrated locality hubs around local GP practices to identify older people at risk of isolation and signpost them to local community resources. When this happens, a small sum changes hand from the system to the community, recognising that we don’t get community resources by accident, but because we all choose to invest in them in different ways (whether through our time, our passion and creativity, and indeed our money). Every £1 spent generates a saving of £2.38 through reduced demand for formal services[1] – and the group has been working to further develop the support it provides to people from minority ethnic communities, reach additional GP practices, and share this way of working with others across Northern Ireland and beyond. This year, it made Sir Chris Whitty’s annual report on health in an ageing society and won the ‘best health creating population health management approach’ at the 2022 Health Creation Alliance Awards.

These are just three small examples of what’s possible. Even though the Care Act, as a whole, failed to deliver on its own very laudable principles, lots of people are still trying.

Laura and Jon work at the University of Birmingham as part of IMPACT, the UK centre for implementing evidence in adult social care.

The House of Lords report on A ‘Gloriously Ordinary Life’ is available here.  Jon Glasby was a special adviser to the Committee.

Jon is a co-author of ‘A lost decade’ available here.