'Independence, Well-being and Choice' is a consultation paper setting out proposals for the future direction of social care for all adults of all age groups in England. The Department of Health (DoH) consulted with a wide range of stakeholders after announcing in April 2004 that there would be a new 'vision' for adult social care. This briefing is a summary of the key points. The NAS will be submitting a full response by the deadline - 28 July 2005.

Key proposals

  • Wider use of direct payments and the piloting of individual budgets to stimulate development of modern services delivered in the way people want.
  • Greater focus on preventative services to allow for early, targeted interventions, and the use of local authority well-being agenda to ensure greater social inclusion and improved quality of life.
  • A strong strategic and leadership role for local government, working in partnership with other agencies, particularly the NHS, to ensure a wide range of effective and well-targeted provision, which meets the needs of diverse communities.
  • Encouraging the development of new and exciting models of service delivery and harnessing technology to deliver the right outcomes for adult social care.

Transform lives by:

  • Ensuring they have more control.
  • Giving people more choices and helping them decide how their needs can best be met.
  • Giving people the chance to do the things that others take for granted.
  • Giving the best quality of support and protection to those with the highest levels of need.

Achieve this by:

  • Changing the way social care services are designed. Giving people more control over services through self-assessment and through planning and management of their own services.
  • Developing new and innovative ways of supporting individuals.
  • Building and harnessing the capacity of the whole community to make sure that everyone has access to the full range of universal services.
  • Improving the skills and status of the social care workforce.

Key points

Direct payments

Extending the benefits of direct payments to those currently excluded, by using an agent for those without the capacity to consent, or unable to manage even with assistance. This means, for example, that a child who currently has directly payments managed by a parent could continue to receive direct payments after the age of 18, even if they have a disability so severe that they cannot give consent themselves.

  • 12,585 individuals in receipt of direct payments (2003) by contrast 1.68 million adults using community care services in 2002/03

Individual budgets

The purpose of an individual budget would be to promote independent living. The budget would be held by the local authority on behalf of the person using services or their carer. People could have individual support to identify the services they wish to use, which might be outside the range of services traditionally offered by social care. Envisaged that these could be introduced (after initial pilot schemes) for people with a disability by 2012.

It is believed that the needs assessment and the estimate of an individual budget should be done before a financial assessment is undertaken. Only after the needs have been assessed should there be a discussion about the level of private contribution to be made to the cost of provision.

Right to request

Part of the consultation on the Green Paper is the merits of a 'right to request' not to live in a residential or nursing care setting, taking full account of the particular issues faced by the individual, and considering the financial, organizational and legal implications of both the status quo and alternative options. This 'right to request' would require service providers to make explicit the reasons behind their decision to recommend residential care, including cost considerations. This information would support the individual to make informed choices about options available to them.

Fair Access to Care Services (FACS)

FACS provides guidance from DH to assist in deciding who should receive social care services from statutory agencies. FACS provides a framework that determines how councils should carry out assessment and reviews, and provide or commission services to meet needs, subject to available resources.

It is believed that local authorities must retain the right to set local priorities and manage their budget and that those who approach the local authority should know that funding decisions are made on the basis of clearly understood criteria. Asking for views on FACS specifically and how eligibility criteria can be set up to encompass both higher levels of need and early intervention.

Director of Adult Social Services (DASS)

The introduction of the post of DASS alongside the Director of Children's Services will ensure that all the social care needs of local communities are given equal emphasis and are managed in a co-ordinated way. The relationship between these two posts will be crucial to ensuring that the needs of both adults and children in families are met and that services work well together. Simultaneously publishing best practice guidance on the role of DASS for consultation.

DoH suggests that DASS and local authority should undertake regular strategic needs assessments to plan ahead for the next ten to 15 years.  The local needs assessment should be linked with the wider assessment of housing need in the area, which must encompass the housing needs of older people and those with disabilities and which underpins the local or sub-regional housing strategy.

The DASS should play a key role in ensuring that arrangements are in place to support individuals during the transition between different services, to ensure multi-agency coordination and a seamless pathway. Young people approaching the age of 18 should also be involved in planning the services that they will receive as adults in order to ensure that adult services are genuinely responsive to their needs. 

Effective interventions earlier

Changing the focus to a preventative model of care by targeting people with low-level needs today could prevent them from becoming part of the group of people with 'greatest needs' in the future. In future, greater focus should be placed on preventative services through the wider well-being agenda and through better targeted, early interventions that prevent or defer the need for more costly intensive support.

The DoH will seek to improve the early identification and response to people's needs through better assessment and information sharing between local councils and NHS services; eg a process of single assessment for older people.

Information sharing

Explore the extent to which the need for people to provide broadly the same information to more than one agency could be minimized. Seek to experiment with more streamlined assessments including self-assessment.

Putting people at the centre of assessment

The Green Paper explores situations where individuals and carers will be able to self-assess so that they have more autonomy in the care services they receive. Suggestions include self-assessment online which would enable people to interact with social services staff, and select the level of service which best fits their needs. Anyone assessed as eligible for help will be offered the choice of using direct payments to arrange services themselves and control the whole process.

Where an individual is unable to access the support they require or their needs are more complex, social services will be involved in their assessment. For everyone undergoing an assessment, whether the person using services or their carer, the starting assumption should be that they have the capacity to express their views and wishes.

The individual's own assessment of their needs might conflict with those of their professional assessor. At present, this is too often hidden. The need for skilled social work is NOT to replace the views of the person who needs car; the skill is to find out what people themselves want.

What next?

There will be more consultations connected to the Green Paper in the coming months. Best Practice Guidance on the role of Director of Social Services is currently open for consultation (deadline: 28 July 2005).

The NAS will be submitting responses to both consultations and will keep you informed of any further developments.