Care Act 2014

The Care Act 2014 received royal assent on 14 May 2014, after the Lords had considered the House of Commons' amendments to the bill on 8 May 2014.

The Act brought together previous care and support legislative provisions into one statute. It also introduced provisions that had been built on the recommendations made by the Law Commission, the Dilnot Commission and the government's response to the Francis inquiry.

Responsibilities of local authorities

The Act placed a statutory duty of wellbeing on local authorities, obliging them to give consideration to promoting the wellbeing of adults when making decisions. Local authorities would also be required to promote the integration of care with health services when undertaking their social services functions. There were also new provisions regarding the promotion of advice and the promotion of provider diversity and market oversight.

Under the Act, carers were afforded the same rights to support and services from local authorities. For the first time, carers could receive assessments of their needs and receive support on a par with those they cared for. Corresponding rights to assessment and support for young carers were included in the Children and Families Act 2014.

The Act also introduced a minimum eligibility threshold that would apply nationally, making clear when local authorities would provide support to people.

The statute furthered the ends of personalisation, by legislating for the right to personal budgets for service users to allow for each individual to receive tailored packages of care.

The Department of Health introduced the changes to duties on local authorities from April 2015 in 'phase 1' of its implementation of the Act.

Reform of the funding system

The Act also legislated for reform of the funding system for adult social care. Significantly, this included legislation for a maximum cap on the amount someone would have to pay towards their care and support, and for an increase in the threshold above which people start to contribute to their residential care costs.

Initially, the government planned to implement the funding reforms from April 2016 in 'phase 2', but it later delayed their introduction.

Care standards

While the Care Act 2014 focused predominately on social care, part 2 of the Act focused on care standards following the Mid Staffordshire public inquiry. It included:

• Increased powers for the Care Quality Commission: the Act established the statutory roles of the Chief Inspector of Hospitals, the Chief Inspector of Adult Social Care and the Chief Inspector of General Practice. The Act returned the Care Quality Commission's (CQC) powers to conduct period reviews, assess performance and publish reports.
• The creation of a new offence: providers of health and adult social care services in England could be subject to criminal sanctions if they supplied, published or otherwise made available false or misleading information.
• Duty of candour: the act required the secretary of state to include a new duty of candour on providers of health care and adult social services registered with the CQC. In practice, this would require providers to tell patient and service users if something unintended or unexpected occurs.
• Single failure regime: the Act amended the powers of the CQC and Monitor to create a more coherent approach to dealing with quality failures in NHS trusts and NHS foundation trusts.
• Warning notices: new provisions would allow the CQC to issue warning notices to trusts requiring significant improvement and to specify a time frame for delivering improvements. The CQC would not prescribe the action to be taken. The Act gave Monitor additional powers to impose licence conditions on a foundation trust following the issue of a warning notice by the CQC. Previously, Monitor was only able to make use of such powers where there had been governance (as opposed to quality) failings.

Role of the Trust Special Administrator

Part 4 of the Care Act 2014 clarified the role of the Trust Special Administrator (TSA), first introduced by the Health Act 2009, with amendments following the Health and Social Care Act 2012. The appointment of a TSA occured in response to provider failure (of either an NHS trust or NHS foundation trust).

The 2014 Act widened the powers of the TSA, Monitor and the secretary of state to make recommendations and take actions that had implications for organisations other than the trust under administration. The change in legislation followed the Court of Appeal ruling that the secretary of state had overstepped his power in relation to proposed changes to University Hospital Lewisham.

As a consequence, the Act also required the TSA to seek agreement from commissioners of all NHS trusts or NHS foundation trusts affected by the recommendations (and not just the commissioners of the trust under administration).

The Act clarified that specific consultation requirements on NHS bodies that apply during normal service reconfiguration did not apply with respect to the special administration procedure.