Data collection
The Bill allows the Secretary of State to require a provider of adult social care to provide the Secretary of State with information that relates to: the person on whom the requirement is imposed; their activities in connection with the provision of social care; any person to whom they have provided adult social care. The Bill sets out restrictions on the onward disclosure of information, directions to certain bodies to exercise these functions of the legislation, and arrangements with third parties.
LGA view
We support the intention of gathering high quality data so long as the data collection is proportionate, the data sharing is purposeful, and its prime purpose is seen as supporting effective local commissioning and delivery of care. The data should be jointly owned by the sector, and should flow not just to the DHSC but also back to authorities, for them to understand and support their residents better, understand the impact of different interventions and support and be able to benchmark their own performance. Equally, it is important that the NHS shares data with local government so that local partners have access to the same information. To this end, local government should be involved in discussions to agree what data is collected and how. Where the DHSC collects data directly from providers this should be shared with local government in support of councils’ market shaping duties.
Adult social care regulation
The Bill introduces a new duty for the Care Quality Commission to: conduct reviews of councils’ regulated adult social care functions (functions under Part One of the 2014 Care Act); assess the performance of councils following each review; and publish a report of its assessment. In addition, the Bill sets out the roles and responsibilities of the CQC and the Secretary of State. The latter will set objectives and priorities for the CQC in relation to the assessment process, and the former will determine the indicators of quality for the assessment process (which the Secretary of State needs to approve and can direct the CQC to revise). Wherever possible, this framework should use existing data sets and reporting rather than creating new ones. Similarly, the CQC must prepare a statement setting out the frequency with which the reviews are conducted, the period they relate to and the methodology to be used. This must be approved by the Secretary of State, who can also direct the CQC to revise the statement.
LGA view
We understand Government’s desire for greater transparency in social care. Councils need to continue to be an equal partner in the ongoing design of national oversight, which must build on existing sector led improvement work, recognise local democratic accountability and give a meaningful voice to people who draw on and work in social care.
Any new processes or structures for assurance and oversight need to be accompanied by a New Burdens assessment to fairly capture the capacity and resource implications for councils in meeting new regulatory approaches.
Any assurance process has the potential to highlight shortfalls in services and delivery of the intentions of the Care Act due to resource constraints. Any assessment of a council’s adult social care services would need to be contextualised in terms of available resources. It is unfortunate that added assurance and oversight is being introduced ahead of any clear proposals for reform and investment.
The assurance process must continue to be developed in partnership with local government and the CQC; we favour an approach looking at whole systems, based on a shared agreement of what good looks like (– in particular, the importance of person-centred and locally flexible care and support), based on councils’ own self assessments and improvement plans, and where targeted local reviews are needed, building on the successful model of Local Area Reviews which took place in 2017 and 2018.
An important aspect of the assurance process will be intervention in cases where, following CQC assessment, a council is considered to be failing in its duties. The criteria for such intervention, and what is considered “failure”, is under current discussion with DHSC civil servants. They indicate that the policy intention is for this to be very rare, but – as with many aspects of this section of the Bill – much will depend on the drafting of the policy and any further guidance or secondary legislation.
Direct payment to local providers
The Bill enables the Secretary of State to make direct payments to any bodies engaged in the provision of social care services. Currently, the Secretary of State can only make such direct payments to not-for-profit bodies.
LGA view
We recognise Government’s desire for a mechanism that gets funding to social care providers quickly. Local decision-making, local knowledge of the provider market, and local democratic accountability are important underpinnings of the system of social care funding and should not be bypassed; it is therefore helpful that the white paper stated that this power would only be used in exceptional circumstances. We urge the Government to consider how best to ensure the use of this power does not disrupt the important local foundations of social care funding.
Discharge to assess
The Bill updates the approach to hospital discharge by changing the legislative framework to enable a ‘discharge to assess’ model. This model includes enabling assessment to take place after an individual has been discharged from acute care. The Bill repeals existing requirements to assess for care needs before hospital discharge.
LGA view
We support the ‘discharge to assess’ model, and its underpinning philosophy of ‘Home First’, which advocates that home is the most appropriate place for resolving crises and recovery for nearly all people being discharged from hospital. We support the removal of the requirement for assessment and discharge notices. The model needs to be properly funded, and funding should be channelled through the Better Care Fund.
Better Care Fund
The Bill proposes to create a standalone legal basis for the Better Care Fund (BCF), separating it from the NHS Mandate setting process, which will no longer be on an annual basis.
LGA view
The LGA supports the proposal to separate BCF planning from the NHS Mandate.
Public health power of direction
The Bill introduces measures to make it easier for the Secretary of State to direct NHS England to take on specific public health functions. Under section 7A of the 2006 NHS Act, the Secretary of State for Health and Social Care can make arrangements for his public health functions to be exercised by NHS England, however the Secretary of State cannot require NHS England to take the delegated function.
LGA view
It is unclear whether the changes relate only to public health functions exercised by NHS England or equally to public health functions exercised by local government. Any new legislation needs to be clear on which requirements apply to which parts of the public health system. The LGA will be seeking clarity on the Secretary of State’s power of direction.
Obesity
The Bills introduces new strengthened food labelling requirements, including changes to front-of-pack nutrition labelling and mandatory alcohol calorie labelling. It also introduces restrictions to prohibit advertisements for products high in fat, sugar or salt being shown on TV and online before 9pm.
LGA view
We support proposals to strengthen front-of-pack nutrition labelling and calorie labelling on alcohol. We believe a single, standard and consistent system will help people make informed choices.
We also welcome plans to prohibit advertisements of products high in fat, sugar or salt being shown on TV and online before 9pm. It is disappointing that the Bill does not include plans to give councils powers to ban junk food advertising near schools, which is something that councils and the LGA have campaigned for.
Water Fluoridation
The Bill streamlines the process for the introduction, variation and termination of water fluoridation schemes in England by transferring the responsibilities for doing so, including consultation responsibilities, from local authorities to the Secretary of State for Health and Social Care.
LGA view
Whilst we welcome the shift to a more streamlined consultation process for water fluoridation schemes, water fluoridation must not be imposed on communities. It has been the long-standing policy that local decision-makers are best placed to take into account locally-expressed views and to balance the perceived benefits of fluoridation with the ethical arguments and any evidence of risks to health. Local authorities have encountered difficulties with the current consultation process, including the fact that local authority boundaries are not coterminous with water flows, which requires the involvement of several authorities in these schemes.