Last year the Department of Health issued its Fair Access to Care
Services guidance requiring all local authorities to implement new
eligibility criteria by April. They apply to anyone older than 18
and affect all service user groups.
The guidance requires local authorities to adopt a prescribed set
of eligibility criteria. Although councils cannot change the
wording they can determine the eligibility “threshold” applied
The aims of the guidance are to increase consistency, reduce the
postcode lottery, promote those needs which have been given a low
priority and give prevention a higher profile. These aims are to be
applauded. But I find the prescribed criteria confusing and
The process of deciding eligibility is one of balancing risk and
resources. Effective criteria ensure that the risk to a person’s
independence is linked closely with the opportunity for support.
The guidance recognises this and the four bands within the criteria
clearly relate to risk. But the wording within the criteria,
especially around the moderate and low bands, fails to make the
link clearly enough.
An assumption within the criteria is that the number of needs a
person has is a key determinant of their level of risk. For
example, within the substantial band the criteria state: “There is,
or will be, an inability to carry out the majority of personal care
or domestic routines.”
Within the moderate band “majority” is replaced by “several” and in
the low band by “one or two”. Although there may be links between
the number of needs and the level of risk the key determinant is
surely the level of risk associated with each need. I don’t believe
the criteria reflect this. In addition, the rolling together of
personal care and domestic routines as if they were the same seems
Having spoken to colleagues and service users I have found they
share my concerns. Given that the DoH issued a second set of good
practice guidance as recently as March I assume that concerns must
But the rewritten guidance fails to address the real problems and
seems to distance itself from the wording in the original. The
assessor’s role is promoted and an overly mechanistic
interpretation discouraged. All very fair but missing the point. If
the aims of the guidance are to be achieved the wording within the
criteria should be rethought.
Mark Walker is a planning and project manager for a local
authority in the north of England.