News analysis on new guidelines on fair access to care

On 7 April, a new era of consistency will begin in local
authorities in England. The postcode lottery, where one person will
receive a full package of community care support while someone in
the next street with the same needs will be offered nothing, will
come to an end. At least, that’s the theory, writes
Ruth Winchester.

The introduction of Fair Access to Care Services (Facs) this
month has been a long time coming. It was first mooted in the 1998
white paper Modernising Social Services, in response to widespread
confusion over who should be providing what, to whom, and to what
standard.

Facs introduces for the first time a non-negotiable eligibility
framework of “bands of need”. A person’s needs will be categorised
as “critical, substantial, moderate or low” based on the risk to
their independence should services not be provided.

The idea is that, whereas in the past some groups of people have
found it more difficult than others to access services, every adult
should in future be treated in a consistent way by their local
authority. So living with a partner, or having a “developing need”
rather than an acute need, should no longer prevent someone from
receiving services.

But, although the wording which defines these bands is
nationally set and cannot be altered to suit local priorities,
local authorities will retain the autonomy to set the eligibility
criteria wherever they like, according to the resources
available.

In practice, then, it is still unlikely that two adults with the
same needs will receive the same level of service in neighbouring
councils, even if two people with the same needs within an
authority should now receive a consistent level of service.

Local authorities in England and Wales have been told in no
uncertain terms that the criteria, and the start date for using
them, are not a moveable feast. The guidance states: “Given that a
consultation draft of the guidance was issued in the summer of
2001, the final guidance issued in May 2002 and this practice
guidance first issued in August 2002, councils have had plenty of
time to deliver.” Any case already open when Facs comes in will
have to be reviewed between now and April 2004 using the new
criteria.

There have been many wrangles about the introduction of Facs and
some questions remain. While most people support the concept of
consistency and standardisation, no new money has been identified
to go with the new guidance.

While some people might receive services they could not obtain
before, others will no longer be entitled. Some older people’s
charities have suggested that the re-targeting of services will see
older people miss out more than other groups.

Liz Railton, deputy chief executive of Essex Council, says
councils have been gearing up to the change for some time, and says
that the principle of ensuring a consistent approach to eligibility
is welcome. But she adds: “It is still going to be a decision which
is made locally about where the thresholds should be.

“A council could decide to set their criteria so that they
provide services to almost everyone, but they’d have to set their
level of council tax accordingly. To be honest, I think most
councils are really feeling the pinch – there simply aren’t going
to be a lot more services provided to a lot more people as a result
of this.”

This seems to make the Facs guidance’s emphasis on improving
access to preventive and low-level services meaningless. “Most
councils will tell you there isn’t money to put into any sort of
preventive, low level services, and they will tell you that it
really worries them,” Railton says.

“Unfortunately, the reality is that these days, only those
people with very high needs are receiving any services – and I
can’t see the Facs guidance changing that.” CC