Care Act 2014: Government tightens national minimum threshold plans

Department of Health says threshold based on inability to meet 'two or more outcomes' best reflects current practice

Care worker helping an elderly woman with her medication
Credit: Voisin/Phanie/Rex (posed by models)

The government has tightened its plans for a national minimum threshold that adults will be required to meet to be entitled to social care support under reforms introduced from April next year as part of the Care Act.

The Act will introduce a national minimum threshold for social care for the first time rather than eligibility being set locally by councils. Most local authorities currently restrict care to people with at least ‘substantial’ needs, although application of the threshold varies locally.

Final regulations for the proposed national threshold published today mark a tightening of the criteria outlined in previous draft versions but the government insists the criteria it has chosen reflect current practice by being broadly similar to the ‘substantial’ threshold used by most local authorities.

Campaigners have criticised the government for failing to take the chance to broaden the entitlement to social care support.

Under the final regulations, adults will be entitled to care and support if their needs are related to a physical or mental impairment and their wellbeing is significantly impacted by their inability to achieve two or more outcomes. Ten outcomes are listed (see box below) including: maintaining personal hygiene, developing and maintaining relationships and managing toilet needs.

The government said it had set the minimum level at a person’s inability to meet ‘two or more outcomes’ after the Personal Social Services Research Unit from the London School of Economics concluded that the model came closest to current practice. The PSSRU tested three versions of the threshold – including one where people only had to be unable to meet one outcome – with 27 local authorities on 1,865 cases.

The final version marks a tightening of the entitlement for care around non-personal care needs.

National eligibility threshold: What the regulations say

An adult’s needs meet the eligibility criteria if—

(a) the adult’s needs arise from or are related to a physical or mental impairment or illness;
(b) as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified in paragraph (2); and
(c) as a consequence there is, or is likely to be, a significant impact on the adult’s well-being.

The specified outcomes are—
(a) managing and maintaining nutrition;
(b) maintaining personal hygiene;
(c) managing toilet needs;
(d) being appropriately clothed;
(e) being able to make use of the adult’s home safely;
(f)  maintaining a habitable home environment;
(g) developing and maintaining family or other personal relationships;
(h) accessing and engaging in work, training, education or volunteering;
(i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
(j) carrying out any caring responsibilities the adult has for a child.

Under the draft plans an adult was eligible if they were unable to achieve one outcome as a result of their needs, though the set of outcomes listed was different.

One of the draft outcomes was an inability to carry out ‘some or all’ basic care activities – meaning the person would have to be unable to carry out at least two personal care tasks such as toileting, getting dressed and maintaining your home. The draft plans would also have also seen a person entitled to care if they were unable to meet just one from a list of non-personal care related-outcomes such as accessing employment and training or carrying out childcare responsibilities.

In a marked shift from the draft plans, the final threshold means an adult will only qualify for support if they are unable to meet ‘two or more outcomes’ from a list of 10 that includes personal care and non-personal care related issues. This means that a person that is only unable to meet one outcome – for example access to support and employment – would have met the draft threshold but will not be entitled to support under the final version.

David Pearson, president of the Association of Directors of Adult Social Services (Adass), said that the final threshold more accurately reflected ‘substantial’ levels of need used by most councils.

‘We are also pleased to see that the threshold takes a more outcomes-based approach to eligibility than previous approaches. Our view has always been that the previous regulations did not mirror the current ‘substantial’ level and the work by the LSE, which we collaborated with, did demonstrate that the draft regulations were more inclusive,” he said.

“Of course, for the people that do not meet the eligibility threshold there’s also the new statutory responsibility for prevention and early intervention. That’s very encouraging but for that to have meaning there has to be sufficient funding in the system.”

Pearson said a wider debate on the level of public funding for social care was needed: “The critique of this [the eligibility threshold] is really a different issue which is whether ‘substantial’ as a nation is where we ought to be aiming for. That is a legitimate debate that goes back to the issue of how much funding the nation wants to put in to helping people who have increasing social care needs to be supported by the state.”

Richard Hawkes, chair of charity coalition the Care and Support Alliance, said that the threshold had been set too high and argued that the “only long-term solution to the crisis in care” was an increase in funding.

“[The Care Act] will only live up to its promise of a genuinely preventative system that promotes wellbeing, if the government re-thinks its plans to exclude so many older and disabled people from the system,” he said.

“Setting a high threshold for the care system is a bit like going to the doctor with a chest infection and being told to come back with pneumonia.”

A Department of Health spokesperson said: “Helping people to live independently and prevent them from becoming ill is what people want and is a better use of our resources. The Care Act and our £3.8 billion Better Care Fund will focus on keeping people well, which can save money and prevent people needing more support.

“We are clear that people, whatever their level of need, will receive help from their council to get support and information.”

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2 Responses to Care Act 2014: Government tightens national minimum threshold plans

  1. Sallyann Baxter October 23, 2014 at 4:44 pm #

    I think that the first line in section 14.22 is not written clearly as it implies that the OPG are abusing adults and children!!

    • Andy McNicoll October 23, 2014 at 4:49 pm #

      It is a bit unfortunately worded (I’m sure they meant to say ‘recorded by the Office of the Public Guardian)…

      “14.22. Financial abuse is the main form of abuse by the Office of the Public Guardian both
      amongst adults and children at risk. Financial recorded abuse can occur in isolation, but
      as research has shown, where there are other forms of abuse, there is likely to be financial
      abuse occurring. Although this is not always the case, everyone should also be aware of this
      possibility.”