The tightening of eligibility criteria – special report

The annual Association of Directors of Social Services and Local Government Association social care finance survey, published in March, said 77 per cent of councils planned to tighten eligibility criteria for older people’s services.

This week, Counsel and Care’s survey of local authority care charging and eligibility criteria shows that many councils have gone ahead with their threats to tighten access to care as they fight funding shortfalls.

One-third of the 33 councils in England that responded to Counsel and Care’s survey had tightened eligibility criteria in the past year and two-thirds now only offer care to older people with critical and substantial needs.

In recent weeks Community Care has reported that tighter criteria are being implemented by several councils, including:

– Wiltshire, where 150 older people will lose access to day services under changes to eligibility criteria. Wiltshire now only offers services to people with substantial or critical needs and whose wellbeing would be at risk if they did not receive services

– Northamptonshire, where 1,500 people could be affected by plans to restrict adults’ services to people with critical and “greater substantial” needs

– Hampshire, where services will only be available to those with critical needs

– Cornwall, which plans to remove services from people with low-level needs ;

– and Bradford, which plans to restrict eligibility criteria for adult care to people with substantial or critical needs .

The Department of Health’s Fair Access to Care Services guidance out the four levels of eligibility criteria – critical, substantial, moderate and low needs – and says that councils must not only identify immediate needs but also those that could worsen without “timely” care.

Counsel and Care chief executive Stephen Burke says councils could be storing up problems for the future by tightening eligibility criteria so older people with low-level needs do not receive services.

Burke also says that the tightening of eligibility criteria is just one part of a “triple lottery” for services for older people, alongside where people live and councils’ care charging policies.

As well as highlighting the level of charges – the survey found councils’ maximum charges ranged from £3.91 to £315.90 per week – the report also points out that two-fifths of councils that responded to the survey did not cap charges, meaning they could charge service users as much as they wanted to.

This can be a potential “drain” on pensioners’ incomes that policy-makers must address, the report warns, and Burke calls for councils that do not have a maximum charge to introduce one.

He adds: “The contradiction in care is that while older people are paying higher charges, fewer are getting services.

“The dignity and well-being of older people depends on them being able to access adequate support to help them live independently for as long as possible. Currently, older people are being denied this right.”

It is also ironic that Counsel and Care’s survey was published just days after the government revealed that councils had made bigger savings last year in adult social care  than in any other service as they implement the recommendations of the Gershon efficiency review.

Of the £1.2 billion of efficiency gains made by councils in England in 2005-6, just over £200 million came from adult social services, compared with £76 million from children’s services, £52 million from Supporting People, and £16 million from homelessness services.

It also seems like councils will have to wait for any extra support from the government.

A Department of Health spokesperson says the government has provided £11.5 billion to councils in 2005-6 for adult personal social services, plus an extra £200 million for older people’s projects over the next two years, and says next year’s comprehensive spending review will give it “the opportunity to examine the changing health and social care needs of our population”.

Social services departments are, however, only going to face more pressure to provide services as the population continues to age, which was illustrated by the report by Sir Derek Wanless on the future of social care funding .

Anne Williams, joint chair of the Association of Directors of Social Services resources committee, says councils have been “desperately trying” to deal with changing demographics but these are now working against them.

“More and more councils are withdrawing from low-level services and concentrating on substantial and critical needs,” she says. “But this is the exact opposite of the way we want to work, we’re always fire fighting.”

Although she thinks the Treasury and Department of Health are aware of this issue and are doing a lot of work to understand it, the government is also saying that there is not a lot of money around and it is looking for councils to make more efficiencies.

Williams says social care’s “hugely impressive track record” in managing change and making efficiencies is working to its detriment now.

“If you look at local authority budgets, education is ring-fenced,” she says. “After that social care is the next biggest tranche.

“Because we have a good track record we have been the people who have had to deliver a lot of the savings. But everyone is saying we can’t do much more.”