Eight in 10 councils in England will not meet adult service users’ moderate care needs by next year on current trends, exclusive Community Care research reveals.
A survey, based on Freedom of Information requests, found three-quarters of councils now meet critical or substantial care needs only.
But this will rise to 80% by next year under plans to tighten thresholds by councils currently supporting people’s moderate care needs. This represents a sharp decline in provision from 2006, when 53% of councils supported moderate needs.
The situation is expected to become even worse for service users after the government’s comprehensive spending review (CSR) next month. Sector leaders are warning that impending cuts will lead many councils to raise thresholds to critical only.
Our survey, based on responses from 97 of the 152 English councils, found 3% of councils had a critical threshold, 72% substantial, 24% moderate and 1% low, under the Fair Access to Care Services (FACS) guidance.
However, five councils with a moderate threshold – Bolton, Derbyshire, Lancashire, Poole and Westminster – are proposing to tighten criteria to substantial this year. The Isle of Wight is proposing to raise its threshold from substantial to critical, while Wirral is considering a similar move, though it has not developed plans. Wigan has also not ruled out moving from substantial to critical this or next year “given the current financial situation”.
Sector leaders raised concerns about the impact of raised thresholds. “The danger is people who receive day services will find they are getting [less] and from this comes all the problems with [users'] mental health,” said Mencap’s head of campaigns and policy, David Congdon.
But with the CSR expected to unveil funding cuts to councils of 25% or more between 2011 and 2015, authorities have little room for manoeuvre, said Association of Directors of Adult Social Services president Richard Jones.
He said cuts of this scale presented councils with three options: “One is to reduce the numbers of people receiving a service; one is to reduce the costs of service; and the other is how you charge for a service. All those ways are going to play their way out as councils work harder to balance their budgets.”
Most councils will set budgets for 2011-12 early next year.
“You will see a lot of tough decisions made at that point [on eligibility],” said Local Government Association adult social care lead Andrew Cozens, who has already warned that councils were considering raising thresholds to critical.
Councils that are proposing to raise thresholds said they faced significant cost and demand pressures. Marian Harrington, Westminster Council’s adult social services director, said annual increases of 10% in the number eligible for support were not sustainable.
“Westminster has lost a lot of commercial income, which did shore up a lot of mainstream budgets,” she said. “We feel we are being hit a bit earlier than other authorities and we’ve still got the CSR.”
Harrington said Westminster had invested in reablement, early intervention and prevention services as well as information and advice to ensure those with moderate needs were catered for should they lose support.
Elaine Sherrington, Bolton Council’s executive member for adult services, said: “Adult social care is the single largest controllable spend across Bolton Council and it is necessary to make savings in this area in order to meet the council’s savings targets.”
However, former Department of Health social care finance chief John Bolton warned councils they might not save much by raising eligibility criteria.
Bolton, now interim director of adults’ services at Warwickshire Council, said social workers often tried to stretch the definition of FACS criteria to ensure clients had a service, and there were difficulties distinguishing between the critical and substantial bands.
All councils proposing to increase thresholds said they would reassess users at risk of losing support. Many people with moderate needs would retain a service as a result of having their needs reassessed as substantial, curbing the amount saved.
Service user independence
Bolton called for councils to invest in early intervention services, telecare and information and advice to prevent or delay people from developing higher-level care needs.
“Services should be in place to support those most in need,” said a DH spokesperson. “Local authorities set their own eligibility criteria to meet local demand, but their services must also address the need to help people be independent, where possible. This includes a strong emphasis on prevention, early intervention and support for carers.”
She said the government recognised the need for a sustainable solution to care funding, which was being considered by its Commission on the Funding of Care and Support, set up in July.
Councils set thresholds for support from adult social services at one of four levels of need:
● People are unable to carry out vital personal care tasks.
● Life is or will be threatened.
● Serious abuse or neglect has occurred or will occur.
● People are unable to carry out most personal care tasks.
● Abuse or neglect has occurred or will occur.
● Most family or social roles cannot be undertaken.
● People are unable to carry out several personal care tasks.
● Several work or educational roles cannot be maintained.
● Several family or social roles cannot be undertaken.
● People are unable to carry out one or two personal care tasks.
● One or two family or social roles cannot be undertaken.
Source: Fair Access to Care Services guidance, 2010
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