The Care Act 2014 and unpaid carers: A handy summary

This handy summary is designed to support councils to prepare for Care Quality Commission (CQC) assessment as it relates to unpaid carers. CQC assessments will focus on how well councils are carrying out their statutory duties under the act, in line with new powers set out in Health and Care Act 2022 regulations.

Duties towards unpaid carers are woven through the Care Act 2014 legislation and associated statutory guidance (the guidance). This handy summary pulls together the key principles underpinning the Care Act and the statutory duties placed on councils regarding carers in one place.

Who is a carer? A carer is anyone, including children and adults, who provides care to a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction, and who could not cope without this ‘necessary care’. The care they give is unpaid. The guidance is clear that this support can be emotional as well as practical.

The Act was hailed as the most significant reform of care and support in more than 60 years. It is regarded as a major step forward in giving carers parity of esteem with those they care for, statutory entitlements to assessment and support in their own right, and removing requirements to be providing a set number of hours of care to be eligible for help from councils. The Act introduced a single, national set of eligibility criteria to be applied equally across the board. There is a clear focus on promoting carers’ wellbeing and taking account of the impact caring has on all aspects of their lives.

Carers in scope of the Care Act

The Act relates to adult carers – people over 18 who are caring for another adult. It also tasks councils with ensuring that young carers' needs are not overlooked when adults are being assessed for support. The act sets out how councils should work with young carers, and adult carers of disabled children (parent-carers), to plan an effective and timely move (or transition) to the adult care and support system using a whole family approach.

• Carers have parity of esteem (placed on an equal footing) with those they care for. They have entitlements to care and support in their own right and can be eligible for support, even if the person they care for has refused support or is not eligible.
• Councils can meet a carer’s needs for support by providing this to the person being cared for, even where the carer is not eligible (subject to their consent).
• Councils must provide and maintain an information and advice service for all carers about what can be done to help them (and those they care for) prevent, reduce or delay the development of longer-term needs for care and support, and to help them look after their own wellbeing.
• A carer’s eligibility for an assessment is based solely on them having the ‘appearance of need’ for care and support. Councils must offer an assessment on this basis.
• Councils have a duty to conduct a ‘transition assessment’ when a child, young carer or parent-carer is likely to have needs for support when they, or the person they care for, transitions to the adult care system.
• Eligibility for support is based solely on whether the carer’s role has (or is likely to have) a ‘significant impact’ on their wellbeing and as a result they are unable to achieve one or more of the wellbeing outcomes described in the Care Act; this is a lower threshold than the person being cared for, whose eligibility is based on being unable to achieve two or more of these outcomes.
• There are no requirements for carers to be providing substantial and regular amounts of care, or for a set number of hours, to be eligible for an assessment or support. This is important where carers may be providing care that fluctuates over time.
• Councils must arrange an independent advocate for any carer who would find it difficult to participate in their assessment and support planning where there is no-one else to help.
• Councils need a process in place for carers which effectively mirrors the requirements of assessment and care planning for people who draw on services - including offering carers who are “able, willing and [have] capacity to undertake it” what is called in Chapter 6.44 of the guidance a ‘supported self-assessment.’ Where a carer does not wish to self-assess, then councils must undertake another type of assessment.
• Carers must be given a written copy of a council’s decision about their eligibility for support.
• Carers eligible for support must get a support plan, including a personal budget “sufficient to meet their care and support needs” that can be spent in a number of ways. Carers must always be offered the option of taking some, or all, of their personal budget as a direct payment.

The wellbeing principle

The Care Act places “wellbeing at the heart of care and support”. Councils are directed to apply this wellbeing principle to adult carers, young carers, and parent-carers who fall within scope of the Care Act. They are also required to promote wellbeing when carrying out any of their care and support functions. Although ‘wellbeing’ is not defined, councils are directed to consider these domains of a person’s wellbeing as set out in the regulations and chapters 1.5 and 1.6 of the statutory guidance:

• personal dignity (including treatment with respect)
• physical and mental health and emotional wellbeing
• protection from abuse and neglect
• control by the individual over day-to-day life (including over care and support provided and the way it is provided)
• participation in work, education, training or recreation
• social and economic wellbeing
• domestic, family and personal well-being
• suitability of living accommodation
• the individual’s contribution to society
• independent living also is highlighted as core to the wellbeing principle.

Other principles councils must follow include:

• a starting assumption that a carer is best placed to judge their own wellbeing and support is not based on professional preconceptions about needs or how they should be met
• a carer’s views, wishes, feelings and beliefs are central to person-centred care and support planning
• preventing or delaying a carer’s needs for support, or reducing needs that already exist
• enabling carers to fully participate in decisions about their support, and providing the information necessary, including advocacy if required, to achieve this
• considering the impacts that a caring role has, not just on the individual carer, but on their wider social, family and community networks.

Universal services are those which councils have a duty to provide to all people in their local population, irrespective of current or future needs for care and support.

Councils must consider how they are promoting and providing these universal services to carers in their area, not just to those who may be eligible for assessment or support from them. This would include carers who pay for their own services, or who get NHS-funded support through Continuing Health Care (CHC), for example.

It’s important that frontline staff in councils (first contact staff and those assessing, planning, and reviewing care and support) are clear about where carers have statutory entitlements under the Care Act. These include a single eligibility threshold for assessment, and for care and support, advocacy, information, (including financial information), advice, personal budgets, direct payments, and assessment as they transition to the adult care system.

• Applying the wellbeing principle every time a council carries out any aspect of its statutory care and support functions.
• Taking a proactive approach to promoting carer wellbeing (not just offering crisis support).
• Recognising that carers are best placed to judge their own wellbeing and decisions about support recognise all of the carer’s individual circumstances.
• Maintaining a focus on the wellbeing outcomes for carers which are set out in Care Act and eligibility regulations.

• Setting out how councils will prevent, reduce or delay the development of carers needs based on analysis of current and future demand, and highlighting any gaps in support.
• Describing how future demand and gaps will be both met and resourced, encouraging innovation and flexibility on the part of carers’ support providers.
• Taking a co-produced approach to prevention that involves local carers in the design, commissioning and provision of preventative wellbeing support. Actively identifying and targeting carers who may benefit from early information about looking after their health and wellbeing.

Establishing and maintaining an information and advice service, which is distinct from the duty to meet eligible needs

• Establishing an information and advice service which takes account of the council’s local carer population and is accessible, inclusive, transparent, up-to-date, and is not limited to web-based information.
• Ensuring that regardless of eligibility, information includes advice about what can be done to prevent, delay, or reduce the development of a carer’s needs for support.
• Developing an information and advice strategy that is inclusive of the needs of unpaid carers and aligned to the content outlined in Chapter 3 of the guidance.
• Aligning information strategies with other council strategies, including Market Position Statements, Carers Strategies and Health and Wellbeing Strategies.
• Working with partners to provide targeted information and advice at key ‘trigger points’ in carer’s lives. Examples are given in Chapter 3.26 of the guidance.
• Early identification of carers who will benefit from financial advice or information, including how care and support can be funded.
• Offering independent advocacy where a carer will experience substantial difficulty in understanding, retaining or using information, and where there is no-one else to fulfil this role.

Market shaping and commissioning that focuses on outcomes, promotes wellbeing, quality, choice, diversity and sustainability in local markets, and is co-produced with carers

• Facilitating the personalisation of carers services, including local, specialised services that enable carers to make meaningful choices and take control of their support arrangements.
• Helping carers who receive direct payments to ‘micro-commission’ support where helpful.
• Encouraging flexible support which enables carers to participate in work, education, training or volunteering, and which is appropriate to the local carer population’s culture, beliefs and demography.
• Involving carers in commissioning processes and keeping the wellbeing principle and a focus on outcomes central to market-shaping and commissioning strategies for carers.
• Regularly updating Market Position Statements, including evidence and analysis underpinning council commissioning intentions for carers support and services. Using quality definitions for services which are based on standards such as NICE NG150, and seeking evidence of continuous improvement in the quality of carers services.

There are two eligibility decisions a council has to make: whether a carer is eligible for an assessment, and whether, having had an assessment, they are eligible for care and support. The Care Act introduced a single national threshold for both of these decisions.

This section sets out the specific duties and expectations of councils as they relate to carers who are eligible for assessment, and for care and support.

Eligibility for assessment

This is based solely on a carer’s ‘appearance of need’. The national threshold for eligibility for assessment (as opposed to services and support) is “where it appears to the local authority that a carer may have needs for support (whether currently or in the future) a carer’s assessment must always be offered.” Using this criterion, the vast majority of carers would be eligible for an assessment.

• This duty is independent of the eligibility for support or otherwise of the person being cared for.
• Assessments are ‘proportionate’ but sufficient to accurately identify the level of need carers might have.
• Ensuring that on first contact with the council, or a service commissioned by the council to provide support or a carer's assessment, a carer’s eligibility for assessment, as well as any communication and advocacy needs, is established, and full information is provided about what to expect from an assessment.
• Offering independent advocacy where a carer would have difficulty expressing their needs without support and there is no-one else to provide this (see advocacy duty).
• Ensuring carers understand they can be assessed separately, or jointly with the adult(s) they support, where both agree; if there is no agreement on this, the assessment must be carried out separately.
• Offering advice and information about other services or prevention support which may be available to carers who are not eligible for assessment.

Carers UK have a helpful summary of types of carers’ assessments including assessments that are:

• carried out solely by the council
• delegated to local carers’ organisations
• delegated to a carers’ organisation, but the council carries out complex assessments
• pre-screened by a carers’ organisation, but the main statutory assessments are carried out by the council
• carried out by multi-disciplinary team members (for example, occupational therapist, physiotherapist or nurse)
• a combination, including complex assessments carried out by the council.

Eligibility for support

Eligibility for support is based on the impact of providing necessary care on one or more wellbeing outcomes defined in Care Act regulations. The national threshold for eligibility for services and support (as opposed to assessment) is whether providing care has ‘significant impact’ on a carer achieving one or more of the wellbeing outcomes as set out in the regulations.

Staff in councils and carers support organisations who are likely to have ‘first contact’ with carers should always establish whether a carer would have ‘substantial difficulty’ in engaging with any assessment and support planning process. Where there is no-one else (such as a family member or friend) able to provide independent support, councils have a duty to arrange independent advocacy (Chapter 7 of the guidance).

Support planning ensures carers remian in control of their own support, with the help they need to enhance their wellbeing and improve their connections to family, friends and community.

The Care Act places a carer’s entitlement to a personal budget (PB) into law for the first time. Personal budgets and direct payments are often confused or conflated. A personal budget is a clear statement of the cost to the council of meeting all an eligible carer’s needs. A direct payment (DP) is where a carer chooses to take their personal budget as a direct payment (in full or in part) and they or a third party manages their own support arrangements.

Councils must provide information about direct payments, and ensure that carers are offered the opportunity of a direct payment every time assessment, support planning or reviews take place

The guidance says a carer’s support plan should be reviewed at least annually, with a light-touch review considered six to eight weeks after sign-off of the initial support plan and agreed personal budget

Councils have a duty to undertake transition assessments for children, young carers and parent-carers as they transition between the children’s and adults social care system.

Councils should consider a carer’s wellbeing, which includes protection from abuse and neglect, in any assessment of carers, as well as the adult they care for.

This guide summarises the key duties to be undertaken by councils under the Care Act as they relate to unpaid carers. It is intended as an aide-memoire or prompt for councils preparing for CQC assessment.

Nothing in this paper seeks to amend or replace statutory guidance. Whilst every attempt has been made to ensure accuracy and promote best practice, this resource does not represent a formal statement of the law or government policy. Directors should obtain further information or legal advice, as necessary.

You may also find useful:

• Unpaid carers and Care Quality Commission assurance
• Top tips for CQC assurance preparation
• Ten things to do now to prepare for CQC assurance around unpaid carers is a quick checklist focussing on local authority duties towards unpaid carers
• Carers and safeguarding briefing
• Integrated Care Systems (ICS) PowerPoint template for councils to use when briefing and raising the profile of unpaid carers with integrated care system colleagues.
• What's the story? Using National Carer Data to develop your narrative for Care Quality Commission Assurance, 8 November 2023 presentation slides