National eligibility threshold proposed for Welsh adult care

Proposals to establish a country-wide eligibility threshold in Wales have been heralded as a means of ending the postcode lottery for adult social care.

Charities, care providers and council leaders all backed the idea in last week’s report from the Independent Commission on Social Services in Wales. and its accompanying proposal to give service users portable ­assessments, enabling them to move areas without losing their right to care.

“This will help to reduce the wide variations in current care services across Wales,” says Age Cymru’s head of policy and public affairs, Graeme Francis. He adds that it would build on decisions already taken by the Welsh government to reduce variations in care charges between councils.

“We’ve essentially got a postcode lottery of social care and people want above all to know where they stand, what they’re entitled to, how much they have to pay for it,” says Mario Kleft, honorary chief executive of Care Forum Wales.

He says it is “bureaucratic” and “no longer appropriate” to have separate assessment and eligibility frameworks for each of Wales’s 22 local authorities.

Though a final decision on these proposals will come in the Welsh government’s social services White Paper early next year, the Welsh Local Government Association has already started looking at how they would work in practice.

The association has long lobbied for the change as a way to iron out differences in the cost, quality and accessibility of care between areas.

Its director of social services and health improvement, Beverlea Frowen, says it was also about “future-proofing” the system for any changes in the way care is funded.

The Commission on the Funding of Care and Support, which reports next July on the future funding of care for England, is likely to have significant implications for Wales, and this is expected to propose a national eligibility and assessment system.

Frowen says a feasibility study into a common assessment framework would start in January, with an initial report due this autumn.

Although Wales is set to be leading the way in ending the postcode lottery, this is not true of personalisation.

The Independent Commission on Social Services found commitment to the principles of personalisation “are not always reflected by real changes in practice”, reflecting “limited understanding of what a personalised service looks like”.

It called for the Welsh ­government to give a stronger commitment to the idea and to work with councils and providers to widen access to information, advice and advocacy, to enable users to make an informed choice about their care.

However, contrary to the approach taken in England, where the government wants all users to be on personal budgets by 2013, with most receiving direct payments, the independent commission said personal budgets were not essential, and users could exercise control in other ways.

This sentiment reflects the more collectivist political culture, says Paul Swann, policy officer at Disability Wales.

He says, although disability activists looked on in envy at the rapid roll-out of personal budgets in England, “we realised the importance of incorporating the Welsh traditions of mutuality, co-operative working and community into our thinking”.

This means enabling people to have access to traditionally delivered services, commissioned by councils, if this is what they wish.

However, Swann said that, even within this distinctive Welsh context, “massive culture change is needed in local government” to provide users with genuine choice and control, because many councils and social workers remained “ambivalent” about direct payments.

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