Patterns of Demand and Provision in English Adult Social Care Services

This article reports on a quantitative study of the national datasets for adult social care in England. Building on recent analysis of trends in demand and expenditure, the aim of the study was to investigate the relationship between local authority (LA) characteristics, levels of demand for state-funded services and rates of short- and long-term provision. Publicly available data on short- and long-term activity and finances were collected for all LAs in England from 2016 to 2019 and combined with other indicators including population demographics and the Index of Multiple Deprivation. Correlation analysis was undertaken to investigate patterns of demand and provision and their link to contextual factors. Findings showed that variation between LAs was to some extent shaped by contextual factors such as deprivation and demographics, but was also subject to the effects of rationing and the impact of the self-funded market on levels of demand. Implications are discussed for efforts to reform the adult social system and address longstanding inequalities that have been both highlighted and exacerbated by the COVID-19 pandemic.

Changing English Local Authority Duties by the Adoption of Easements in the COVID-19 Pandemic;Findings from an Interview-Based Study

As part of the government's response to the Coronavirus pandemic, temporary changes were made to the 2014 Care Act. These changes-called 'easements'-reduced the requirement on English local authorities (LAs) to meet some of their usual duties where they were not able to do so either as a result of increased demand or where a large proportion of their workforce was absent. Only eight LAs chose to adopt easements. In the five LAs we studied the decision had been taken in the early stage of the pandemic when there was a considerable degree of uncertainty about how society would be able to respond. LAs were required to provide reasons for the decisions although it appeared that most of the five LAs studied had not faced overwhelming demand and had decided to adopt easements as a precaution. By the end of June 2020, no LA was still using easements. The five LAs in this study concluded they could manage without them, as the majority of LAs were doing. They had dealt with considerable opposition in the press and social media as well as Freedom of Information requests in the face of accusations that by using easements they were denying entitlements to care. With the benefit of hindsight, it is unlikely that they did anything very different from LAs that had not used easements. This article reports findings from a study on the effect of the adjustments or 'easements' that were made to the 2014 Care Act when measures to manage the impact of COVID-19 were introduced in England in 2020. Only eight local authorities (LAs) implemented the changes permitted. The experiences of five are explored in this article. Data were collected in 2021 through interviews with Directors of Adult Social Services and other senior managers in these LAs and analysed using a thematic approach. Participants referred to the challenges under which they were working pre-pandemic, including resource pressures and problems recruiting and retaining staff. Despite the conditions attached to adopting easements these LAs had done so because of the uncertainties they were facing. All ceased to use them within a short time because they could manage without them. They had been shocked by the concerted opposition to easements and the time necessitated in responding to this. They contrasted their experiences with the apparent ease with which NHS colleagues had been able to change their practices. The experiences of these LAs may contribute to planning for the continuity of social care in any future emergency.

The Impact of Austerity Measures on People with Intellectual Disabilities in England

Context: UK austerity measures following the 2008 financial crisis included budget reductions for health and social care. We aimed to investigate the extent to which austerity-measures had impacted the lives of people with intellectual disabilities in England, and whether their support costs were associated with their characteristics, needs and outcomes. Objectives: We report on what services people with intellectual disabilities were using, whether they had lost care, the costs of their support, and what impact any loss of benefits and services had on individuals’ lives. Methods: 150 participants with intellectual disabilities across England were interviewed about their services and their well-being. Service and individual support costs were calculated. Statistical and thematic analyses were employed. Results: The largest proportion (42%) of our sample had lost care. 14% had experienced changed care, and care had remained the same for 36%. Only 7% said their care had improved. No associations were found between costs and characteristics and needs except for whether the person had mild or severe intellectual disabilities. Those who had lost care engaged in fewer activities and had significantly lower self-esteem and quality-of-life scores compared with those who had not lost care. Loss of care impacted on individuals’ independence and future aspirations. Limitations: A comparative study of austerity impacts across the whole of England was not possible. Our costs data may be underestimated because full information on support from home, key, or support workers was unavailable. Implications: In attempting to mitigate against COVID-19 impacts on people with intellectual disabilities, policy-decisions will need to consider the backlog of a decade of cuts. © 2021 The Author(s). cial-NoDerivs 3.0 Unpor.

"It's about how much we can do, and not how little we can get away with": Coronavirus-related legislative changes for social care in the United Kingdom.

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services.