Care Act funding decision exposes the nonsense of eligibility criteria

The unpalatable truth is that resources - and resources alone - determine how councils see what is ‘need’, argues Colin Slasberg

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Photo: Gary Brigden

by Colin Slasberg

When Fair Access to Care Services was replaced with the Care Act Eligibility Regulations, the aim was to eliminate the ‘post code lottery’ of provision through the introduction national eligibility criteria.

The government view was that the postcode lottery was the product of councils being able to choose how many of the four FACS bands it would consider eligible. It had come to the view that the problem was by the time of the change a minor one.

The ‘vast majority’ of councils operated at the same level of ‘critical’ and ‘substantial’.  It expected the new national eligibility threshold to take effect at that level. The policy intention was that the new national criteria ‘describes a level that can maintain current practice’. A seamless transition was anticipated.

There was just one fly in the ointment. Three councils – West Berkshire, Northumberland and Wokingham – operated a ‘critical’ only policy under FACS. Surely this would mean they would require additional resources to climb up to the level of all the rest.

The government’s Impact Assessment looked at this. But it actually made the rather surprising finding that ‘spending is either close to or above the median of their statistical neighbours, and in some cases the proportion of services provided to over 65’s significantly above the median’.

This might have disturbed the government view of the post code lottery, but didn’t. It simply decided these councils would not receive any extra funding. But they objected, and began judicial proceedings. Government responded by agreeing to a piece of detailed research to explore the facts. Using the Freedom of Information Act, the result can now be made public.

The research focussed on what had actually changed since the transition to the national eligibility criteria. It found that ‘the case for a new burden on the councils has not been established’. And accordingly ‘no additional funding should be awarded’.

So the national eligibility had made no difference for these councils. This was, in fact, entirely predictable. It would apply to all councils. The Audit Commission identified as long ago as 2008 that eligibility criteria made no difference to spending levels.

This is a finding replicated in recent months by the Institute of Fiscal Studies who found very large differences in spending levels between councils, but which bore no discernible relation to need.

They did find large differences in how spending levels had changed amongst councils in recent years, some reducing much more than others. However, these changes bore no relationship to need or eligibility criteria.

The differences stemmed simply from differences in how much of each councils’ spending was supplemented by local taxes prior to the large cuts in government grants. Those with more local tax were cushioned and those with less more exposed to cuts.

How much longer can government and sector leaders maintain the pretence that eligibility criteria determine ‘need’, and hide the unpalatable truth that it is resources – and resources alone – that determine how councils see what is ‘need’.

Once the pretence has gone, they will perhaps be open to working with people and their real needs as previously outlined in these columns.

Colin Slasberg is an independent social care consultant

8 Responses to Care Act funding decision exposes the nonsense of eligibility criteria

  1. A Man Called Horse June 16, 2017 at 10:56 am #

    Absolutely correct analysis. Should we enter another recession with business rate income declining as businesses cease trading, the problem of funding via local taxation will be even more ruthlessly exposed. London with its tax base more diverse will suffer less. The fact is that the model of ending Government rate support grant will eventually mean all services will be funded via local taxation. Clearly a recession of any kind will lay waste to the idea that Local communities can fund their own care services. Raising business rates helps to close down business and raising Council Tax is unfair, regressive and hurts the poorest the most as they are still expected to pay some of their own Council Tax. We are probably very close to entering the next recession and this will just mean need is redefined further to fit the available resources to pay for services. The Care Act is a bad piece of Legislation. Local Authorities saddled with Direct payment legislation they can hardly afford.

  2. Craig Derry June 17, 2017 at 7:48 am #

    Spot on as usual Colin. When austerity hit and savings plans were developed, radical reductions in care spend were achieved almost overnight – clearly nothing to do with need. As those of us with experience across a number of councils know, spend was often based on meeting lower needs than FACS and facing austerity was initially more about moving the bar up to FACS level rather than depriving people of services that met their assessed needs. Of course there are limits in what this can achieve and the savings from this ran out in about 2 years. Since then we have seen real cuts and “community resilience” and similar become the watch words for “over to you – we can’t afford it any longer”

  3. Peter Feldon June 19, 2017 at 12:50 pm #

    I don’t think that the evidence from the Institute of Fiscal Studies explicitly supports Colin’s assertion “that it is resources – and resources alone – that determine how councils see what is ‘need’”. Resources are a significant contributory factor, but there are others – including the professional judgements of social workers and other assessors.

    The IFS report entitled National standards, local risks: the geography of local authority funded social care, 2009–10 to 2015–16 published in April examines “the extent to which the level of LA social care spending per adult varied around England in 2015–16, and the extent to which these spending differences correlated with local demographic and socio-economic characteristics, and assessed local relative spending needs for adult social care as of the last official assessment in 2013–14.”

    They found that these variables “can only explain a minority of the variation in adult social care spending.” The report suggests that other reasons to explain the difference in spending include the following:
    • differences in the local priority placed on adult social care;
    • differences in the availability of funding;
    • the government methodology for allocating funding “fails to reflect the ‘true’ need for social care spending in a local area”.

    In addressing the third point, the report states that “spending needs are inherently difficult to estimate because they depend on such a wide range of factors and, in any case, are to some extent subjective” and the “somewhat subjective nature of these criteria (especially that related to the effects on well-being) means that, in practice, different LAs may interpret these national rules in somewhat different ways.” Part of this this subjectivity reflects the fact social workers and other assessors are making professional judgements about eligibility determination, and also about what is considered to be a sufficient personal budget to meet an individual’s care and support needs.

    In the first year of the implementation of the Care Act there are indications (from the IFS analysis) that variations in the local resources available could be influencing decisions about eligibility and sufficiency. The local authority has to take its resources into account, but let’s not just be resigned to these pressures – we must exercise our professional muscle to ensure that decisions about sufficiency are strongly influenced by a social work perspective.

    • Colin Slasberg June 20, 2017 at 1:10 pm #

      Pete

      If you are saying that assessments of need should be shaped by person centred thinking delivered through skilled practice. I agree with you entirely. But I think you would have to agree that the use of ‘professional muscle’ to make that happen has yet to make scarcely a dent over the past several decades. Why else have we had so much turmoil in the search for transformations? None of them has worked. We must stand back and ask why, not limp along in the hope we can somehow make it work.

      In terms of your review of the evidence, its essential to look at it the whole of the evidence base to form the soundest view, not just a narrow selection. It wasn’t just the IFS evidence that brought me to the conclusion that its resources alone that determines need. There is also the Audit Commission in 2008, and the range of PSSRU studies for DH and, finally, the evidence from the FoI in the article. And you shouldn’t forget that the IFS started from the premise that all the received wisdoms – such as the post code lottery having been addressed by the Care Act Eligibility Regulations – are true. The IFS are very much in learning mode themselves about what the evidence of their own eyes is telling them.

      To come back to what I think is our agreed position I would urge you to support the case to create a system of resource allocation that will enable skilled practice to flourish. Without it, practitioners will have only the hopelessly unequal task of pitting their ‘muscle’ against the might of a system that does not want that.

  4. Peter Beresford June 20, 2017 at 7:28 am #

    We have to hope that the key organisations whose responsibility it is to make the social care system workable for the millions of people who need it, take careful note of this well evidenced argument. Central government for years has shown the low priority it gives social care. But organisations like the ADASS, LGA, CQC etc etc, must now play their key parts in bringing about positive and sustainable change. They have yet to demonstrate their willingness to do this. It really is put up or shut up. They talked about launching a movement for social care. They did this without involving service user movements, but better late than never. Now really is judgement day.

  5. julian spurr June 21, 2017 at 9:58 pm #

    Social work is a political entity and rightly has a focus on the people who are poorest and most vulnerable. This is primarily a battle between the left and the right.
    Funding has been cut and people suffer. The Care Act was hailed as being a massive change in the way things would be done.
    Well it has not and funding cuts to local authoritiy budgets cannot possibly lead to better social work or better outcomes.
    I have never known a so called profession do so much naval gazing.How many more times do I have to listen to statements about relaunching social work, re-imagining social work or reinventing social work.
    Social workers have become politically irrelevant and this is in my experience demonstrated in the absolute lack of interest in politics by many social workers.
    Get angry about the way things are and so something about it rather than try and intellectualise a situation that is bleeding obvious.Professional muscle ? Are you serious ? Social workers cannot even protect themselves let alone the most vulnerable !

  6. Angie June 21, 2017 at 10:30 pm #

    I’m a locum doing the above SW role and fully agree with the article….I seem to be requesting funding and resources for every case allocated to me as I always base my assessments on need and then link it to the criteria of the Care Act. Strangely the local council I am working for have saved over 2 million last year because they have cut all resources and reduced services because people do not meet the criteria. Finally the impact of this practice results in more crisis work for staff who are on and off with sickness issues more than they are at work…..The domino effect hits again!!

  7. Blair McPherson June 22, 2017 at 12:13 am #

    Assessment of need has become assessment to determine eligibility. Social workers may have thought they knew what “need ” was but successive government have redefined “need” to fit with the available funds. The gap between need and eligibility has widened year on year as budgets have been cut. The government only see this as a problem if the gap is bigger in some authorities than others.