Adult Social Care 2017 LocalGovernmentLawyer 8 Respondents were then asked what, in those areas where compliance with the Care Act was proving difficult, were the primary reasons why. Funding and available resources, unsurprisingly, were cited most frequently in the top three reasons at 98%, although by only a handful of respondents (9%) as the number one reason. “The main issues facing social care are not to do with compliance per se – the principles of the Act are not significantly different from prior to the Act,” argued one respondent. Instead, “the main issues are related to lack of resources to meet eligible needs and demand for care, in controlling the costs of providers and availability of workforce.” Another suggested that the key problem was managing expectations with a limited budget. A lack of understanding of the provisions of the Act amongst client departments and a lack of experience within those departments were more likely to be named as the number one reason (27% first-place mentions for both), although in both cases only 60% of respondents put these in their top three. Other reasons given were the difficulty in ensuring that third party contractors are aware of and complying with the legislation (42% of respondents mentioning this in the top three) and a lack of clarity in the drafting of the Act (24%) – a finding that implies that one of the key aims of the Act, to address confusing areas of social care law, has not been entirely successful. Integrating health and social care, breaking down barriers One of the Government’s key aims – and something widely accepted as good in theory – is greatly to improve the integration of social care with health. However, the picture has been decidedly mixed and so we asked respondents to state what they considered to be the barriers. The survey found that the most frequently cited barrier was the cultural differences or lack of trust between the various types of organisation (with 70% putting it in their top three). “It is not just a lack of trust - but a lack of willingness to participate and work together,” claimed one lawyer. Another reported that there were “no clear routes of communication between departments and it is too easy to shift the responsibility on provisioning care support onto the client and their carers as no one is willing/able to communicate with all parties.” The next major barriers were a lack of resources to explore new approaches and produce new commissioning designs/invest in preventative services or other services (put by 59% in the top three), the complexity of legal issues and agreements (43%) and a lack of established relationships with health commissioners (30%). Difficulties with sharing information about services users was the fifth most cited barrier (25%), followed by limits on ability to delegate or share functions (18%). In their comments, one respondent cited “different priorities”, “buck passing” and the perception that “health appears to have no incentive to work in partnership and it is more a passing the cost exercise”. Another accused health of “failing to recognise their legal duties”, while one respondent suggested there was “a significant challenge resulting from the funding, governance and measurement regimes in the NHS as opposed to local government - NHS England expectations in particular drive behaviours within health that are counter-productive to true integration locally”. Reaching formal agreements We asked respondents whether their local authority had reached an agreement under s.75 of the National Health Services Act 2006 with NHS bodies for pooled budgets and integrated working. Three quarters said their councils had, while a further 8% reported it to be something that was “in progress”. A small but significant minority of respondents (16%) said their councils did not have formal working Fig 4 Fig 4