Dilnot to urge overhaul of care eligibility frameworks

The Dilnot commission on care funding will recommend an overhaul of the main eligibility frameworks for adult social care in order to end the postcode lottery for services, it has signalled.

It also looks set to propose the retention of attendance allowance, a move that will prove popular with older people’s charities who vigorously opposed the previous Labour government’s plans to scrap the benefit and roll it into the social care system.

The news was revealed exclusively to Community Care by former Labour health minister Lord Norman Warner, one of three members of the commission appointed by the coalition to consider the long-term reform of adult care funding.

Ahead of the commission’s report in early July, Warner said its ambition of setting a national eligibility threshold for adult social care – revealed last month by commission chair Andrew Dilnot – required an overhaul of the fair access to care services (FACS) and continuing care frameworks.

“My judgement is that the way FACS is structured and continuing care is structured do not guarantee national eligibility, said Warner, who was speaking to Community Care at a conference on social care reform organised by the healthcare consultancy LCS International Consulting. “Unless we are going to ignore all the evidence that’s come before us someone has to deal with [this],”

FACS governs eligibility for council-funded social care and enables councils to restrict care at one of four thresholds of need:  critical, substantial, moderate or low. Warner’s comments suggest that a national eligibility threshold could not be delivered simply by reducing FACS’s four bands down to one.

His remarks also complement the conclusions of the Law Commission’s review of adult social care law, which this week called for existing assessment and eligibility systems for social care to be streamlined and a clearer national definition of continuing care – the system of NHS-funded social care for people with serious health conditions.

“The continuing care part of the system is impenetrable,” said Warner.

He also gave backing to attendance allowance, saying it was the “only one of the three assessment systems [that] is easy to understand”. Dilnot had earlier told the LCS conference that, despite the case for redistributing money from benefits into social care, there were arguments in favour of retaining attendance allowance.

“We actually might want, as a community, for the state to intervene at the very beginning of somebody’s care journey to give them some support with the extra costs but also to help encourage them to make some of the adaptations in their lifestyle or living accommodation that might help,” he said.

The commission has already ruled out backing free personal care funded out of general taxation in favour of a partnership approach in which individuals pay for a proportion of their care costs. Warner has also signalled that it will not call for a compulsory system of payments to govern individual contributions to the care system, such as social insurance or an estates tax, and back a voluntary approach instead.

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