How eligibility for adult services should be changed

Community Care and VODG’s adult services eligibility conference on 24 June will feature a keynote address by care services minister Ivan Lewis. Here, John Adams explains what he would like Lewis to change about eligibility for services

The problem of ever-tightening eligibility criteria for social care and the rising numbers of people in need excluded from services is rapidly turning into a crisis. Shortcomings in the Fair Access to Care Services system (FACS), used by councils to decide who should be helped, and the “no help here” culture were highlighted by the Commission for Social Care Inspection’s report published in January, Lost to the System? Our conference, on 24 June, in partnership with Community Care will focus on how to solve the problem.

On the day the CSCI report was published, care services minister Ivan Lewis asked the commission to review FACS and make recommendations for change in line with the government’s vision of more personalised services. It’s a tough task given demographic projections and increasing resource constraints, but change is necessary. The question is, what would an improved system look like?

The growing clamour for services will be accompanied by continuing pressures on public spending over the next few years. Workable solutions have to be found which actually reduce demand, but in a fair way. And in trying to square the eligibility circle it’s easier to reach agreement about underpinning principles, such as fairness, consistency and transparency, than it is to get agreement about their implementation at a local level.

To move beyond FACS, greater sensitivity is required. Critically the system should monitor at regular intervals outcomes for those determined as eligible for help to ensure value for money and to maintain control of public funds. But the system should also monitor those judged as not eligible for help because only in this way will we begin to fully appreciate the long-term consequences of our decisions. This calls for the systematic follow-up of individuals who have been diverted out of the system, a suggestion likely to fill resource managers with dismay, but how else can we know whether our political and strategic choices are effective or not?

Wider context

Additionally there is a need for councils to operate their eligibility systems within the wider context of corporate well-being strategies, including community, voluntary sector and NHS engagement. Crucially this depends on effective local leadership and directors of adult social care services are well placed to demonstrate this, given that many of them hold cross-cutting portfolios.

In the context of the forthcoming green paper about funding social care, instead of locally applied FACS why not design a system that ensures a guaranteed level of support for people with similar needs, whether they live in Cornwall or Cumbria? It’s not an original idea, but we already have a national system for determining eligibility to benefits, an established national principle of NHS treatment being free at the point of delivery, and a universal approach to education, so why not a guaranteed minimum level of social care support also, delivered via a system that’s not dependent on decisions made in town halls? The new emphasis on personalisation certainly suggests that the current approach is outdated.

Ultimately, any approach to rationing social care is likely to succeed or fail on the balance of the overall level of funding available in relation to demand. According to the Local Government Association an extra £2.7bn is needed over the next three years for social care to keep pace with projected demand. It seems unlikely that any government will have such deep pockets, so a revised eligibility system seems not only inevitable, but desirable. But first of all we need to understand how rigid systems that block access to short-term, frequently low-cost support create a false economy – and ultimately undermine communities.

John Adams is general secretary of the Voluntary Organisations Disability Group (VODG), an umbrella group of leading voluntary organisations providing support to disabled people

This article appeared in the 8 May issue under the headline “‘Town halls should not decide level of social care'”

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