Care managers assess older and disabled people more generously in councils with tighter eligibility thresholds, suggests government-commissioned research.
Practitioners asked to assign 24 service user case studies to Fair Access to Care Services bands gave significantly different answers depending on the council they worked for, found the research produced by the Personal Social Services Research Unit (PSSRU) at the London School of Economics.
Care managers in areas with tighter criteria were more likely to assign a case study to a higher of the four FACS bands (critical, substantial, moderate, low) than those with looser criteria. “This could indicate a propensity to up-rate client need ratings among care managers from authorities with more stringent policies,” said the report.
Responses to almost all of the vignettes covered the full range of FACS bands, “suggesting significant disparities in how individual cases are graded”.
Divergence was also identified in responses from care managers from the same authority but researchers said further investigation was necessary to assess how far this reflected different approaches among practitioners or the limitations of the vignettes.
There was significant divergence in responses to the case study below, with 15% assigning it to the ‘low’ FACS band, 42% to ‘moderate’, 27% to ‘substantial’ and 5% to ‘critical’.
Reasons for variations
The report suggested that the variations arose from the fact that FACS uses “a simple set of needs statements to cover a wide range of situations”, which made it difficult to apply the guidance systematically to cases.
Some care managers interviewed for the research said they found FACS difficult to apply. “Eligibility criteria are not clear and it often feels like a lottery as to
whether somebody is accepted for a care package or not,” said one.
The report said the fact that many councils set their thresholds using a sub-category – such as ‘upper substantial’ or ‘upper moderate’ – suggested authorities found FACS bands to be too broad. Also, councils tended to use FACS to manage entry into the system, rather than to between distinguish between levels of need above the eligibility threshold, making the distinction between ‘substantial’ and ‘critical’, say, less defined.
The research raised questions about FACS’ utility as a policy tool at local and national level, said the report. For instance, councils who raised their eligibility to save money may not achieve their goal if practitioners responded by “uprating” clients’ needs to help them get a service.
The research also raises questions for the government’s ambition, in its recent White Paper, to set a national minimum threshold for social care across England in order to increase consistency of access. Ministers plan to set up a working group to explore options for a new assessment and eligibility framework to underpin the national threshold by next March.
About the research
Survey of Fair Access to Care Services Assessment Criteria Among Local Authorities in England, by Jose-Luis Fernandez and Tom Snell, was commissioned by the Department of Health and the Economics of Social and Health Care Research Unit.
It was based on one survey of local authorities on their use of FACS criteria and a separate survey of care managers from participating authorities about their interpretation of 24 “vignettes”, each describing a service user and their needs. Eighty five councils took part in one or both parts of the survey and 343 care managers responded to at least one of the vignettes.
The report said that an “inherent limitation of the study” was that the vignettes could not capture all the elements of a real-life assessment because of the lack of personal contact between practitioner and client. Also, they were a snapshot of the client that did not allow for the possibility that risks to their independence could reduce due to the provision of reablement, equipment or other support before the determination of eligibility.Mithran Samuel is Community Care’s adults editor.