Nationwide care threshold ‘will exclude hundreds of thousands in need’

Charities warn plans to introduce threshold at 'substantial needs' would "perpetuate unfair system", but ministers point to improved support for people without eligible needs.

Councils would be obliged to provide care for people with ‘substantial’ eligible needs and carers who meet a defined threshold, under government plans issued today.

The proposals would end the ability of local authorities to set their own threshold – unless it were more generous than the national minimum – and would create a new eligibility framework for social workers carrying out assessments to operate.


Proposed eligibility threshold for care

An adult would meet the criteria if their care needs meant they were

  • unable to carry out one or more basic personal care activities resulting in significant risk to any aspect of their well-being;
  • unable to carry out one or more basic household activities, resulting in significant risk to well-being;
  • unable to fully carry out caring responsibilities for a child;
  • in need of support to maintain family or other relationships, with significant risk to well-being from a failure to sustain them;
  • unable to access work or education, resulting in significant risk to well-being; or
  • unable to access the local community, resulting in significant risk to well-being.

Source: Draft national minimum eligibility threshold for adult care and support


However, older people’s and disability charities, who have campaigned for a lower ‘moderate’ threshold, have attacked the plans, warning they would l shut hundreds of thousands of people in need out of the system. The proposals were set out in draft regulations under the Care Bill, the legislation currently going through Parliament designed to shift the emphasis of social care from crisis response to promoting well-being.

‘Basic minimum entitlements’

“We know people are often confused about what care they can expect from their local authority and far too many end up having to fight for the care that they need because the rules are so complicated,” said care services minister Norman Lamb. “In my view, we need to be clear about the basic minimum entitlements to services so that everyone can be reassured there is some level of support they can expect, regardless of where they live.”

However, the government’s intention is for the threshold to be equivalent to the current ‘substantial’ band, under the 2010 Prioritising need in the context of Putting People First guidance, which is already used by 86% of authorities in England. This means this particular reform would have limited effect, primarily requiring the three authorities currently with a ‘critical’ threshold to lower it, at a modest cost of £23m a year.

Introducing a national threshold at ‘moderate’ would have provided state-funded support to an additional 260,000 people at a cost of £2bn a year if introduced in 2010-11, found research by the Personal Social Services Research Unit for disability charity Scope, published this year.

The Care and Support Alliance, which represents the major older people’s and disability charities, said it was “disappointed” by the decision on the threshold.

‘Unfair system’

“Setting the threshold to entry at ‘substantial’ will  perpetuate an unfair system which excludes hundreds of thousands of people who need support with everyday tasks, resulting  in increasing isolation, declining physical and mental health and becoming unable to take part in work or volunteering,” said alliance chair Richard Hawkes, chief executive of Scope. “We cannot see how the Bill can achieve its aims of promoting well-being, if the new eligibility system is set at substantial.”

The College of Social Work also criticised the decision, saying it reflected  “The government’s assertion that setting eligibility at substantial reflects the current position ignores the fact that so many authorities have raised their threshold in recent years in order to achieve their savings targets,” said adults’ faculty chair Bernard Walker. “Social workers see the impact of this every day in the course of their work, with the anxiety and hardship faced by people in very difficult circumstances.”

However, Care and Support Alliance members said they would continue to campaign for a lower threshold over the next year. The draft criteria will now be subject to initial consultation, before the publication of revised regulations for formal consultation next spring.

The final regulations would need to passed by a vote of both Houses of Parliament next year, allowing the possibility of a more generous threshold emerging. However, the government is likely to be opposed to finding the extra resources to fund this, with local authorities facing year-on-year cuts in their resources over the coming years.

Better support for those without eligible needs

Ministers believe wider reforms enacted through the Care Bill will introduce a more preventive care system. These include:

  • Strengthened rights to assessment and new rights to support for carers, against a proposed threshold set out in the draft regulations, at a cost of £175m a year;
  • New duties on councils to provide preventive services and information and advice on accessing care and support to their local populations;
  • A new duty on councils to provide people deemed ineligible for care at assessment with information and advice on meeting their needs and preventing them from deteriorating.

In future, assessment would not act “primarily as a gateway to the adult either receiving care and support or not”, but help people identify their needs and plan their support, regardless of eligibility, said the Department of Health consultation document on the draft regulations.

“It is critical to our new approach that people who do not have eligible needs at the time of the assessment also receive personalised information and advice, and are supported to access care and support and other services available in their local community.”

Respond to the proposals

The Department of Health is consulting on the implications of the draft regulations until 29 November 2013, and responses should be emailed to

It is also going to be holding regional workshops in September and October 2013 to test the practical implications of the proposals, and will commission analysis of their impact, ahead of the publication of revised regulations for formal consultation next spring.

The process will be overseen by a group of DH officials and social care leaders, led by the Social Care Institute for Excellence. In addition, the DH is setting up a working group of service users, carers, practitioners and academics to test options for a possible new assessment framework, to be introduced alongside the eligibility framework.

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