The government has rejected Commission for Social Care Inspection proposals to replace the current system for determining eligibility for adult care on the grounds of cost and potential upheaval to councils.
Draft revised guidance issued last week would retain the Fair Access to Care Services system introduced in 2003, under which councils are able to set eligibility thresholds at one of four levels of need: critical, substantial, moderate or low.
The CSCI, which was replaced by the Care Quality Commission in April, had proposed a system under which councils allocated resources to people with immediate high needs and those likely to develop needs over the medium and longer-term (see box).
A government-commissioned report last year found councils applied FACS in different ways, neither professionals nor service users were confident in their understanding of it and preventive services were marginalised.
However, it said there were also systemic problems with FACS, including tensions with the personalisation agenda, given FACS’s emphasis on standardised assessments of need as opposed to individual choice and control.
It said while some in social care thought “FACS could be made fit for purpose, the bulk of opinion calls for a radical reappraisal of arrangements”.
The Department of Health accepted a number of the CSCI’s recommendations, including placing much greater emphasis on preventive services in the proposed guidance, so those who did not meet eligibility thresholds received support in other ways.
However, it said the CSCI’s proposed bands were untested and introducing them would carry significant training costs and could cause greater upheaval to councils at a time of “fundamental change” with the roll-out of personalisation.
The guidance is designed to apply until the implementation of the green paper reforms to long-term care, which would introduce a new national eligibility and assessment system.
CSCI proposed replacing FACS with a system under which resources were allocated to individuals at three levels of “priority for intervention”:
● Immediate – without immediate support a person’s well-being would be seriously threatened.
● Early intervention – well-being may be threatened within six months without support.
● Longer-term intervention – well-being may be threatened within a year without support.