Homelessness, Adult Social Care and the Care Act, 2014
Homelessness, Adult Social Care and the Care Act, 2014
Study Group 1 – How is the Care Act, 2014 working for Homeless People? Homeless Practitioner Perspectives
Tue 26th July - 12.30-3.30pm
Room BSQ 1-05, Royal Holloway (Bedford Square Building), 11 Bedford Square, London, WC1B 3RA
Study Group 2 – How is the Care Act, 2014 working for Homeless People? Local Authority Social Work Perspective
Tue 9th August 2016 12.30-3.30pm
Virginia Wolf Building, KCL Kings College London (22 Kings Way) near Holborn for Tuesday 9th August (1-4pm).
Briefing Note:
Karl Mason (RHUL) with Dr. Michelle Cornes (KCL) and Dr. Martin Whiteford (Liverpool)
Homeless People’s access to adult social care services has often been described as problematic for a range of reasons (Manthorpe et al, 2015; Cornes et al, 2011; Whiteford and Simpson, 2011; Cameron et al, 2016). However, the winding down of ‘Supporting People’ funding and the overhaul of adult social care legislation through the Care Act, 2014 highlights a critical social policy juncture, which may afford some change in terms of this access. This briefing outlines some of the changes relevant to homeless people’s access to adult social care and then sets out plans for an exploratory piece of work to examine this issue, which will hopefully lead to a full research study.
The Care Act, 2014 (henceforth ‘the Act’) is the most significant overhaul of adult social care legislation since 1948 and its provisions set out a new regime for adults and their carers to access care and support, based on a wellbeing principle (Whittington, 2016). Prior to the Act’s implementation, social work roles in adult social care were performed through the lens of a neoliberal and managerial ‘care management’ system, which has often been cited as having a negative impact on professional social work practice (eg: McDonald et al, 2008). In this context, the Act was heralded as an opportunity for the ‘liberation’ of the social work profession from the constraints of earlier policy, with its emphasis on a strengths based approach, prevention, person-centred care and safeguarding (Whittington, 2016).
The cuts to ‘Supporting People’ funding for support services mean that care and support for homeless people must now be channeled through adult social care and the framework of the Act (Cornes et al, 2016) so it is important to examine how the Act might afford opportunities for improved access to care and support for homeless people. Whilst the Act does not reference homeless people explicitly, it does remove reference to ‘eligible groups’ as per previous community care laws. Its wellbeing principle is defined broadly to include aspects, which homeless people might struggle to achieve, including ‘maintaining a habitable home environment’ and ‘dignity’ and this is linked to a new national eligibility test (Cornes et al, 2016). Although eligibility is tied to physical or mental impairment, there is an accepted evidence base for combined physical health, mental health and substance misuse issues or ‘tri-morbidity’ and significant health inequalities and a shorter life expectancy (Cornes et al, 2016). This, of course, means that many homeless adults in need of care and support are likelyto meet the threshold for this eligibility test. The Act also simplifies Ordinary Residence rules, which have been a thorny issue for highly mobile or transient homeless people or those with difficulty proving a local connection. Its emphasis on personalisationappears to fit well with emerging evidence for the use of personal budgets with homeless people (Prestidge, 2014; Cornes et al, 2016). Additionally, the first piece of caselaw under the Act (R v LB Harringey) specifically critiqued a Local Authority for failing to consider ‘accommodation-related support’ in it’s assessment of an asylum seeker with mental health issues. The Act therefore appears to offer opportunities to both social workers in the delivery of person-centred services and homeless people in terms of access.
In spite of these prospects, Cornes et al (2016)express concern as to whether these opportunities will be realised in the implementation and day-to-day practice of Local Authority social workers. They point to the historical separation of housing and social care within Local Authorities and the likelihood that over-stretched adult social care services will resist extending their reach to this ‘difficult’ population. This builds on evidence that homeless people are an ‘invisible’ group in adult social care (Tinker et al, 2014) and that social workers in the UK tend to consider homelessness to be a housing problem (for the Local Authority’s housing department to intervene with) rather than a welfare or social concern (Maseele et al, 2014). If this were true, this would appear to support Hart’s (1971) ‘inverse care law’ where those in the most need receive the least care. Additionally, in terms of the opportunities for social work’s development under the Act, Whittington (2016) notes that social work is at risk in view of partial authorisation for the social worker role in the Statutory Guidance and the context of austerity in which the Act is being implemented.
This backdrop demonstrates that although there are opportunities in the Act for homeless people to attain improved access to adult social care and for social work to develop its professional approach to delivering adult social care, there are also notes of caution around whether this will actually be achieved.
It is therefore proposed to scope this issue in preparation for a larger research bid. This will involve two exploratory ‘study groups’ being convened, building on the potential to develop ‘communities of practice’ for those working with multiple exclusion homelessness (Clark et al, 2015).
The first study group (26th July 2016 – 12.30-3.30pm)will consist of homeless practitioners from a range of services across the country discussing their experience of access to adult social care for homeless people that they work with. It is hoped that this will lead to the generation of a number of vignettes illustrating perceived obstacles and will potentially develop a range of questions to provoke discussion at the second study group.
The second study group (9th August 2016 – 12.30-3.30pm) will convene a group of Local Authority social workers to consider the issues they face in assessing and supporting homeless people using the Act, which will include consideration of the vignettes and questions built up in the earlier study group. As well as contributing to the preparation of a research funding bid, this exercise will also facilitate the development of a community of practice for social workers and homeless practitionersinterested in the impact of the Care Act, 2014 . It may also be used as a precursor to a Making Research Count conference.
References:
Cameron, A., Abrahams, H., Morgan, K., Williamson, E. and Henry, L. (2016), From pillar to post: homeless women’s experiences of social care, Health and Social Care in the Community. Vol. 24 Issue 3 pp. 345-352.
Clark, M., Cornes, M, Manthorpe, J., Hennessey, C. and Anderson, S. (2015) Releasing the grip of managerial domination: The role of communities of practice in tackling multiple exclusion homelessness, Journal of Integrated Care, Vol. 23 Issue 5, pp.287 – 301.
Cornes, M., Mathie, H., Whiteford, M., Manthorpe, J., and Clark, M. (2016) The Care Act, Personalisation and the new Eligibility Regulations: Implications for Homeless People. Research Policy and Planning 31(3) 211-223.
Cornes, M., Joly, L, Manthorpe, J., O’Halloran, S., and Smythe, R. (2011) Working Together to Address Multiple Exclusion Homelessness, Social Policy and Society, 10(4), 513-522
Hart, JT (1971) The Inverse Care Law, The Lancet, Volume 297, Issue 7696, 27 February 1971, Pages 405-412
Manthorpe, J., Cornes, M., O’Halloran, S. and Joly, L. (2015) Multiple Exclusion Homelessness: The Preventative Role of Social Work, Vol. 45, pp 587-599
Maseele, T., Roose, R., Bouverne-De Bie, M. and Roets, G. (2014) From Vagrancy to Homelessness: The Value of a Welfare Approach to Homelessness, British Journal of Social Work, 44: 1717-1734
McDonald, A., Postle, K. and Dawson, C. (2008) Barriers to Retaining and Using Professional Knowledge in Local Authority Practice with Adults in the UK, British Journal of Social Work, 38: 1370-1387
Prestidge, J. (2014) Pan London Personalised Budgets for Rough Sleepers, Journal of Integrated Care, Vol. 22, Issue 1 pp 23-26
Tinker, A., Gilani, N., Luthra, I., Richardson, O., Howells, A., Kureeman, Z. and Oshunniyi, O. (2014) Why is it important to consider so-called “invisible” older people in UK healthcare?, Quality in Ageing and Older Adults, Vol. 15, Issue 4 pp 187-196
Whiteford, M. and Simpson, G. (2011) Who is left standing when the tide retreats? Negotiating hospital discharge and pathways of care for homeless people, Housing, Care and Support, Vol. 18, Issue 3-4 pp 125-135
Whittington, C. (2016) The Promised Liberation of Adult Social Work under England’s 2014 Care Act: Genuine Prospect or False Prospectus?, British Journal of Social Work, advance access online: doi: 10.1093/bjsw/bcw008