Government proposals for a national eligibility threshold for care are vague, under-funded and outdated, in so far as they base access to support on people’s deficits.
That was the message the Association of Directors of Adult Social Services (Adass), Local Government Association (LGA) and County Councils Network (CCN) in response to the government’s consultation on draft regulations under the Care Bill for a national eligibility threshold.
The threshold is supposed to be equivalent to the current ‘substantial’ threshold – used by 86% of councils – and the government has only allocated £23m in funding to implement it, mainly to help the three councils with a ‘critical’ threshold lower it (Northumberland, West Berkshire and Wokingham).
However, Adass, the LGA and CCN all said that the draft regulations implied a more generous threshold than ‘substantial’, meaning many more people would become eligible for care as a result.
For instance, the current ‘substantial’ threshold, under the Prioritising Need guidance, provides support to people unable to carry out the majority of personal care or domestic routines. However, the draft regulations state that people would meet criteria if they were “unable to carry out one or more basic personal care activities resulting in significant risk to any aspect of their well-being”.
While all three associations said they were not opposed to a more generous threshold in principle, they said this must be acknowledged by government and fully funded.
“Failure to do so would threaten the successful implementation of the reforms, the quality of existing services and add further pressures to an already strained system,” warned CCN in its response.
‘Subjective, vague and open to misinterpretation’
The network also warned that the proposed eligibility criteria were “subjective, vague and open to misinterpretation”, because they based access to support on “risk to well-being” without clarification of what this means.
Clause 1 of the Care Bill, which puts a duty on councils to promote well-being through their adult social care functions, implies a very broad definition of the concept. It states that well-being encompasses personal dignity, protection from harm, physical and mental health, emotional well-being, control over day-to-day life, contribution to society, suitability of accommodation, social and family relationships, social and economic well-being, and participation in work, training or leisure.
“The very broad drafting of ‘well-being’ will make it difficult for local authorities or individual professionals to be sure how widely eligibility should be interpreted,” warned CCN.
Without greater clarification, councils could be put at risk of legal challenges from people denied eligibility for care.
The three associations warned that the proposed criteria were based on an “deficit” model of care that provides support to people on the basis of what they cannot do, rather than an “asset” model that helps people make the most of their strengths and community networks.
They said this was in contrast to the government’s own objectives, and the rest of the Care Bill, which seek to move social care from a deficit to an asset-based approach, for example through duties on councils to help people prevent, delay or reduce their needs for care and support.
Adass and the LGA warned that the deficit-based nature of the eligibility threshold risked undermining the rest of the bill’s objectives.
Lack of training for social workers
The associations also warned that the government had not allocated enough funding for training social workers in applying the Care Bill reforms. The government’s impact assessment states that social workers should need four days’ training in year one (2015-16) and two days in year two (2016-17).
“We believe that this may not be adequate given the sheer scale (and complexity) of the reforms that the workforce will need to be absolutely familiar with,” said the LGA and Adass. “It will also be important to ensure that agency staff are adequately trained.”
This echoes concerns voiced by London Councils, which represents London boroughs, in its response to the government’s separate consultation on reforming care funding through the Care Bill.