Rarely can the government have acted so swiftly on a report into social care. The ink was barely dry on the Commission for Social Care Inspection investigation into eligibility criteria before care services minister Ivan Lewis had ordered a review into the growing number of people in need being denied council support. Local authorities throughout the land will be nervously awaiting the results.
The CSCI study found that the limits many councils are placing on the delivery of their adult services are causing an increasingly sharp divide between those people who qualify for social care and those who don’t. While there have been significant improvements in the standard of council services, a steady ramping up of the eligibility criteria means that fewer and fewer people actually qualify to use them. And, for those people who fall just short of the criteria, life can become pretty grim.
Between 2003 and 2006, at a time when the population of over-75s rose by 3%, the numbers of older people using council services fell by 27,000. Fewer households received supported homecare and the CSCI estimates that 6,000 disabled elderly people with high support needs received no services and no informal care last year.
“People who only five years ago qualified for council-arranged help are today excluded by the system,” says CSCI chair Dame Denise Platt, adding: “People who fall outside the system, including self-funders, have a poor quality experience that can leave them struggling to cope.”
No help at all
According to the CSCI, 73% of councils this year are expected to limit the services they provide to people whose needs, according to the Fair Access to Care Services (FACS) criteria, are judged as “substantial” or “critical”. Those with “low” or “moderate” needs may receive no help at all. Four councils currently supply services to “critical” cases only (see Four councils with ‘critical’ eligibility criteria).
There are, however, two councils who do seem to have found a way to buck the national trend on eligibility criteria. Both Calderdale and Sunderland continue to offer services to people in all four FACS bands.
According to Neil Revely, Sunderland’s director of health, housing and adult services, the key to maintaining (and expanding) the council’s provision has been a carefully planned reallocation of resources towards the services people need the most.
There is a strong emphasis on preventive services and providing care in people’s own homes. The council also has a good working relationship with the primary care trust. The result is a broad range of services that, crucially, do not cost the earth to provide.
“There’s been a nice squaring of the circle in that, although we have introduced these policies to help improve outcomes for our citizens, it has also turned out to be the most efficient way of doing things from a business point of view,” says Revely.
Low council tax
“We’ve got the lowest council tax in the North East so it’s not just a matter of throwing money at it. Nor are the population demographics particularly favourable in Sunderland, quite the opposite in fact.”
The services offered in Sunderland include 24/7 health and social care assistant teams who can respond to a call from anywhere in the city within 15 minutes. There is also a telecare service, currently available to 21,000 people in the city, which provides a range of equipment in people’s own homes and connects them to a specialist monitoring centre.
Revely emphasises that while people’s needs are assessed using the FACS criteria, this does not determine the level of service they receive. “It’s not the case that certain services are only available to people in certain FACS bands,” he says. “That’s not the way it works. It may be that some people with low level risk need quite a lot of support. The approach is driven by people’s wants as well as their needs.”
Sunderland clearly benefits from a good working relationship between health and social services. The health and social care assistant teams are provided “in loose partnership” with the PCT, although the staff are all council employees, and there are numerous examples of joint working.
“For instance, we operate the PCT’s wheelchair service and there are plans to appoint a new deputy director to cover community health services and drive social and health care integration,” says Revely. “It is a very joined-up approach.”
Revely says he cannot be sure whether investing in preventive and low level services helps avoid people’s needs drifting towards the more costly “critical” end of the scale. However, that is clearly his belief.
“We haven’t done a formal evaluation of this, but certainly that is our feeling. For example, admissions to residential homes are tumbling as a result of the services we provide to help people remain in their own homes, and we continue to free up budget for further investment in the new services.”
There seems to be no great secret to Sunderland’s success, so it is hard to see why other councils can’t follow suit. Indeed, in stark contrast to the national trend, Sunderland’s eligibility criteria appear to becoming ever more encompassing.
“In essence we are operating a fifth prevention FACS band for people who do not have assessed needs but may still require some level of service,” says Revely. “For example we have expanded the telecare service, which is free to those with assessed need, to the broader population for a charge of £3 per week.”
It is expected that Lewis’s review will clamp down on the use of strict eligibility criteria. In which case there may be several councils taking a good look at Sunderland.
This article appeared in the 6 March issue under the headline “How do they do that?”