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Published 30 May 2014
The Care Act 2014 came onto the statute books on 14 May 2014. It contains a number of provisions which will have a very significant impact on NHS bodies, as well as overhauling the legal duties on arrangement and funding of social care.
For NHS bodies, key provisions in the Act include:
The Act reflects the new focus on standards of care, transparency and effective regulation of care in light of the Francis Report, the Winterbourne View scandal and other events of public concern. There is a strong impetus to ensure that the same minimum standards of care and transparency apply regardless of the nature of the provider delivering services: so all providers of health and social care services, in the public, private and third sectors, face the same need to effect a significant change in culture and policy.
The Act reveals the intention to place the CQC at the heart of regulatory 'bite', with the express duty to consider and refer NHS Trust providers to Monitor where concerns continue despite enforcement action. If referred, there is a requirement upon Monitor to take action – a conscious shift in emphasis between the two regulators.
The introduction of a new social care framework might seem to have limited relevance for NHS bodies. However it is likely to impact them directly in a number of ways. The volume of assessments of care needs to be carried out by local authorities will increase significantly, potentially leading to greater pressure of demand for joint assessments of health and social care need. The combination of a new test of eligibility for social care provision and continuing financial pressures may further increase the pressure on the boundaries between social care and continuing healthcare. At an operational level, NHS Trusts will need to ensure understanding of these changes to avoid increased delayed discharges in the period of change. Overall, the Act continues the push towards greater integration of services in the context of limited resources, meaning that the NHS has a greater need than ever before to understand the basis on which local authorities commission and fund social care.
There is a need for "Board to ward" understanding of the duty of candour and the new regulatory regime. This needs to balance understanding of the specific legal duties with clear leadership towards the more general cultural change required for NHS organisations to secure the confidence of the regulators and the public.
You will need to consider how to support staff at the health and social care interface in understanding the forthcoming changes to the social care structure and the potential implications for your organisation's work. This will require engagement with the new framework, and developing expectations of integration, at both a practical and a strategic level.
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