How have the Care Act 2014 ambitions to support carers translated into local practice? Findings from a process evaluation study of local stakeholders' perceptions of Care Act implementation

Abstract

The Care Act 2014 imposed new statutory duties on English local authorities in relation to family or informal carers and it broadened carers' statutory entitlements to assessment, care and support, irrespective of eligibility for local authority funding of the person they care for. Despite this legislative framework, local authorities appear to be translating the new legal obligation into practice in different ways. This paper draws on evidence from in-depth interviews held during 2017-2018 with key stakeholders in three English local authorities to investigate whether and how local efforts meet the Act's intention of supporting carers. We explored local goals associated with supporting carers, local authorities' approaches to needs assessment and service provision as well as barriers and facilitators to adoption of the new legal obligations towards carers. The paper draws on Twigg, J., & Atkin, K. (1995), typology to explore perceptions of local stakeholders of the interaction between formal care system and carers post-Care Act. The findings indicate that despite a clear Care Act emphasis on meeting carers' needs, when faced with financial constraints the formal care system approaches carers mainly as a resource and often supports carers to keep cared-for people away from health and social care systems. Although replacement care is a vital element in the Care Act's ambitions to support carers, in sampled authorities, it was often newly being subject to needs thresholds and financial assessment of people they care for, leading to reported conflicts of interests between carers' needs and those of cared-for-people. The Care Act is nonetheless seen as having made progress in legitimising carers' needs as clients. Social care professionals increasingly emphasise the importance of meeting carers' needs and well-being as valued and desirable outcomes.

What is the evidence behind cancer care reviews, a primary care cancer support tool? A scoping review

“…Further studies should identify the role that primary care practitioners believe they have in CCRs, their perceived usefulness for patients as well as the process for undertaking CCRs (see Table 2 ). The Care Act 2014 (UK) does highlight the need for primary care providers to support carers, and whilst this is not included formally in CCRs it could be considered for future iterations provided it was accompanied by adequate resourcing [ 65 ]. Other work could focus on improving care coordination between secondary care and primary care such as treatment summaries.…”

Applying a dyadic outcomes approach to supporting older carers and care‐recipients: A qualitative study of social care professionals in England

“…Issues were also raised with regard to confidentiality, data protection and ensuring carers' needs are not eclipsed by the needs of the care‐recipient. Finally, there were challenges related to underinvestment and the fragmented nature of the adult social care system (Marczak et al, 2021 ) and commissioning models that encourage inter‐agency competition, rather than collaboration focussed on supporting people's QoL.…”

“…The Care and Support (Eligibility Criteria) Regulations 2015 formally define carers' ‘eligibility for support’ in terms of needs related to their QoL outcomes, for example ability to maintain nutrition, sustain personal relationships and engage in leisure activities. The importance of supporting carers to sustain health and wellbeing, as envisaged by the Care Act, has been affirmed in the 2021 adult social care white paper, ‘People at the Heart of Care’ (Department of Health and Social Care, 2021 ; Marczak et al, 2021 ).…”

“…Carers occupy an ambiguous status in relationship to legislation, policy and practice. Carers have been variously conceptualised as providers of care ( co‐workers alongside formal services), recipients of care ( co‐clients , who are eligible for support in their own right) and as free resources (carers willingly providing support to their relative on an unpaid basis) (Marczak et al, 2021 ; Rand & Malley, 2014 ; Twigg & Atkins, 1994 ). The Care Act explicitly seeks to reinforce carers' status as co‐clients , entitled to support and to be treated on an equal footing to care‐recipients.…”

Young Adult Carers Services in England: Facilitating Choice over Future Caring?

“…UK social care policy recognises the importance of supporting adult and young carers, but the needs of young adult carers have received less attention [2,15]. Tese young people occupy a liminal space between young carers who require protection due to their vulnerability as children, and adults who are the main providers of social care [16]. In particular, the Carers Action Plan emphasised the need to provide better support to adult carers [2].…”