The document to discuss this week on 1/8/13 is the Draft National Minimum Eligibility Threshold for Adults. While the government isn’t necessarily known for creating snappy titles for policy documents, eligibility criteria for access to Adult Social Care are at the heart of services and how they are and will be provided so the fundamental importance of this consultation can’t be underestimated – to those who use and work in adult social care.
Eligibility Criteria – a background
Fair Access to Care Services (FACS) were introduced in 2003 as a way of trying to ‘standardise’ and clarify decisions across local authorities in England and Wales when decisions were made as to who would receive social care services. There are four ‘bands’ of services and there are descriptions of what each ‘level’ consists of. The bands are ‘low’, ‘moderate’, ‘substantial’, ‘critical’.
Gradually as money has been squeezed, there has been a tendency for the band which is provisioned by local authorities has edged higher. There’s a useful introduction to FACS here (PDF) which explains the system as it currently is succinctly.
Why Draft New Thresholds?
There has been much criticism of FACS and that will be an issue we can explore more as a part of the chat – why has FACS failed? I have a lot of ideas myself. Part of the issue the government has identified to be ‘solved’ in the new Care and Support Bill is the ‘postcode lottery’ issue. Each local authority can which criteria it will provide support for. This has been seen as unsatisfactory as people in neighbouring authorities can be entitled to vastly different levels of service.
So we are looking at new national thresholds which will not be reliant on the judgement of local authorities. The idea is that this will create more clarity about who can and can’t receive services funded by local authorities. This is a crucial draft document which will have enormous repercussions.
Where will be national eligibility criteria sit?
The first chapter of the document explains the need for change. The document dwells on the inequity and lack of clarity about people knowing what they may be entitled to in terms of care services and how different this can be in different local authorities. The paper explains that from April 2015, the government is committed to introduce national eligibility criteria at least as a minimum (LAs will be free to provide more than the national minimum if they wish/are able to afford to). The ‘postcode lottery’ will not disappear. There is a thinking that the national minimum threshold will be at the ‘substantial’ level which is currently pretty much where most local authorities have their threshold at the moment. The immediate difference might, then, be very little. But there have been difficulties in definitions through the lifespan of FACS. ‘Substantial’ to me could be interpreted differently to ‘substantial’ by another social worker in the same team as me. This is where some of the difficulties lie.
What will the new Care and Support system look like?
There’s an interesting part of the paper which pushes to how the ‘new’ support system will work and uses the lovely government language of adjusting the way that they envisage this system will be delivered. ‘Assessments’? They won’t be primarily used to gatekeep to services (or not) but will be used to ‘supporting people to identify needs’ and look at where support will come from. Well, to be honest, I don’t see how this is different from what happens now – except the language but perhaps that’s the key.
The govt do envisage people accessing assessments from local authorities ‘earlier’ when they have lower needs so that support which might take place outside that which is funded can be provided earlier. The difficulty is that there has to be support available to be signposted to and if people are not assisted with funding for low level needs, those who are able to self-fund will have an obvious advantage. Mind, money, in itself, creates advantages which may or may not be fair (not but I’m a bit of a closet socialist at times!).
What will an assessment look like?
I was interested that the paper looks at what an ‘assessment’ is and emphasises that it should not be deficit-led. This will be a real change if it is what happens but I have doubt and the reason for my doubt is that it is not the way that systems have and are built. If I look at my experiences in mental health social work over the last few years, we have been increasingly moving away from ‘needs-led’ ‘strengths-based’ models of assessment and running towards ‘deficit models’. Clustering means we are being asked to look at the greater impairments people have and not at their strength. That is what the system asks us to do. I wonder if the people writing this draft guidance are actually aware of that the move has been far and away from the strengths-based models that they claim to embrace. This is an example of the Department of Health not having a clue what is actually happening in social work currently.
The paper also looks at the need to work across health and social care for assessments. Again, I sniggered. Seriously. Do the people writing the document know what work we did with the Single Assessment Framework – trying to simplify assessments across health and social care so they could be jointly undertaken – and do they know or have they properly evaluated what happened there and why it didn’t work?
It’s easy to make broad statements of ‘assessments will take place across health and social care’ but there needs to be an understanding of all the times this has been attempted in the past and what the barriers have been because those barriers (mostly about different pots of funding) have not been removed.
The govt have presented some draft regulations to be used. They are in the paper and I won’t go into them in detail but the paper asked a few questions specifically about these draft regulations. They want feedback and I think it’s something we could have quite a focussed discussion on. The question the paper asks are
Whether the draft regulations have any holes in terms of groups who may not be covered by them?
Nothing sprang out at me specifically but thats something that might need someone with a more detailed knowledge of Community Care Law than me to establish.
Are the regulations equivalent to current ‘substantial’ threshold?
This made me chuckle because ‘substantial’ is so hard to define. The draft regulations are sufficiently woolly and unclear to ensure that interpretation will continue to be the key. That’s no shock really.
What are the practical implications for implementing the regulations?
Here the government ask about how easy they will be to implement and what statutory guidance should be included. The definitions within the regulations are vague enough to be useless but what would be better? I am going to have a ponder about whether better regulations could be written by people who actually use, know and understand the system. I’m interested that the government talk about having focus groups with users, carers and local authorities? I’d ask how they choose the people who sit on these focus groups. I hope there are people who have cognitive impairments included and social workers who work in the teams that implement these criteria and that the representations from ‘local authorities’ are not simply at the management level (which is what I fear!).
What’s the impact of the Draft Regulations
The paper presents rough cost estimates for implementing the new draft regulations. There is a rough costs between £18-25million given. I wonder how much of this will come from central government – and these costs don’t include additional services provided to carers which increase those potential costs exponentially.
In the discussion on Thursday I’d like to look at the following questions (and please do feel free to add your own)
Have FACS failed?
What would be the implications of new national criteria?
Is the government plan to move from defining needs to identifying support realistic?
Experiences/examples from practice?
New regulations – are they clear enough?
will they make a difference to anyone?
Can they be improved?
Is ‘substantial’ the only realistic place to draw the line?
How do you define ‘substantial’ – do these regulations make it clearer?
I hope at the end of the discussion we’ll have enough to submit a response to the consultation which I’ll post here if I can work out how to do that!
So join me on Thursday 1 August at 8pm to discuss the draft document about adult eligibility criteria – I know there’s no better way to spend an August evening!