Is Fair Access to Care Services dying?

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The Fair Access to Care Services (FACS) guidance has formed the basis for deciding whether people are eligible for adult social care in England for the past seven years, but recent decisions by councils have sparked concerns over whether it remains valid.

FACS was intended to provide a common eligibility framework throughout the country while giving councils the freedom to set their threshold for services at one of four levels of need: low, moderate, substantial or critical (see below).

However, it has recently proved difficult to adhere to in the face of rising cost pressures and an increasing need to ration services. Earlier this month, Birmingham Council announced plans to limit directly funded care to only those with “critical personal care needs”, a higher category than the FACS critical threshold.

Before that, Thurrock Council consulted on plans to split its substantial threshold into higher and lower levels, and only fund services for those with critical and higher substantial needs.

These developments have led some commentators to proclaim the current eligibility banding system to be outdated.

“It’s dead,” says Ruth Cartwright, the British Association of Social Workers’ joint manager for England, “When it first came in it was all about supporting people and helping people to be independent and then of course it got turned into a rationing tool.”

“Birmingham’s and Thurrock’s proposals are an inevitable consequence of an under-funded system,” says Richard Humphries, senior fellow for social care at think-tank the King’s Fund.

Both Cartwright and Humphries, a former social services director, say FACS puts social workers increasingly in the position of ticking boxes rather than assessing needs and making professional decisions.

Andrew Cozens, group lead for adult social care at the Local Government Association, agrees there is a problem with FACS.

“FACS is falling apart as a concept if it gets more and more up to 152 varieties [of threshold], as councils interpret it in a variety of ways,” he says. “It makes it much more difficult for people to work out what they are entitled to in different authorities,” he says.

But Cozens doesn’t think the system is dead because it still provides a starting point from which councils can work.

Lorna Payne, director of community well-being in Thurrock, agrees. She says the council was trying to balance demand and manage resources by splitting the substantial band into two levels, but in the end it decided against the move.

She says now is not the time to change thresholds, given the level of change facing social care, including the government’s overhaul of the NHS, which will vest commissioning powers in GPs, abolishing primary care trusts.

“Criteria will need to be modified over time but, because we are not clear about how things will work in practice with GPs, now is not the time,” says Payne.

The sector’s former inspectorate, the Commission for Social Care Inspection (CSCI), investigated FACS in 2008 and concluded it should be replaced. Under CSCI’s proposal, councils would be unable to set a needs threshold below which they did not support service users. Instead, they would have to provide at least some support to people with lower-level needs who could deteriorate over time without support, as well as those with more pressing needs.

This was rejected by the Labour government, which simply revised the FACS guidance in line with the personalisation agenda, and Cartwright warns that the issues raised by CSCI’s investigation remain unresolved.

The debate on FACS’ future will likely see some form of resolution once the Commission on the Funding of Care and Support, chaired by Andrew Dilnot, and the Law Commission review of adult social care law publish their final reports next year.

This will be followed by a White Paper on social care reform in the autumn and legislation in 2012. The government has all but confirmed that it will introduce a system of portable their needs reassessed.

This points to the establishment of a national eligibility threshold, something that is already set to be introduced in Wales. However, Humphries points out that this sits uncomfortably with the UK government’s emphasis on devolving power to local councils and communities.

He says: “If you believe in localism and local councils working out their own needs, the logical conclusion of that is to ask, ‘Why do you need national eligibility criteria?’. That exposes an unresolved tension between localism and national entitlement in the context of care services and it needs to be worked through.”

Cozens and the LGA, however, back a national minimum threshold. However, he acknowledges this needs adequate funding and a sophisticated distribution formula to ensure all local authorities can deliver its promise.

When the time for a new system does arrive Cartwright social workers to be given more power to decide on what needs are meet and how best to meet them. Although she sees the need for a national framework, she says: “More should be left to the professional discretion of social workers, working with the personalisation agenda and a person-centred approach.”

She warns that this can only work if councils are given enough resources to manage people’s care, a remote prospect in the current financial climate.

Any reform to FACS is unlikely to be implemented until 2013 or 2014 at the earliest when the government’s legislation comes into force. Before then, councils with social services authorities face cuts in government grant of 11.6% and 7.7% respectively in 2011-12 and 2012-13, meaning they will have to struggle with a system buckling under the weight of demand with only scant resources to prop it up.

WHAT THE FACS BANDS MEAN

Critical needs

Life is or will be threatened.

Serious abuse has occurred or will occur.

Inability to carry out vital personal care tasks or family roles.

Substantial

Abuse or neglect has occurred or will occur.

Inability to carry out most personal care tasks or family roles.

Involvement in many aspects of work cannot be maintained.

Moderate

Inability to carry out several personal care tasks or family roles.

Involvement in several aspects of work cannot be sustained.

Low

Inability to carry out only one or two personal care tasks or family roles.

Involvement in one or two aspects of work cannot be sustained.

Related articles

Council plans to axe care for ‘isolated’ with new threshold

Council to outsource social workers and set tightest threshold

Councils eye Birmingham’s ‘super-critical’ care threshold

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