The government’s proposed national eligibility threshold for adult social care is more generous than intended meaning more funding would be required to implement it, the Association of Directors of Adult Social Services’ president has said.
The proposed eligibility criteria, published last week, are designed to be equivalent to the ‘substantial’ band in current guidance, which is the threshold used by 86% of councils. As a result the Department of Health is allocating only £23.5m to implement the policy, most of which would be used to enable councils with the higher ‘critical’ threshold to lower it.
However, Adass president Sandie Keene warned that the proposed criteria, which would be implemented under the Care Bill, looked more generous than the ‘substantial’ band, meaning councils would potentially be left out of pocket.
Threshold ‘lower than substantial’
“It’s not the same as substantial,” said Keene. “The perception is that it’s lower than substantial.”
The proposed threshold covers the same areas of need as the substantial band within the current Prioritising need in the context of Putting People First guidance, but uses different wording. For example, the substantial band provides for people to receive support where “there is, or will be, an inability to carry out the majority of personal care or domestic routines”. The proposed threshold says people would receive support if they were unable to carry out one or more basic personal care tasks or household activities, resulting in significant risk to their well-being.
Older people’s and disability charities have attacked the proposed criteria for being too tight, saying the government should set it at equivalent to the current ‘moderate’ band.
“The real risks [from the eligibility threshold] are what the bottom line is,” said Keene. “The risk to local authorities is that the threshold is too low, the risk to people is that it’s too high.”
Lack of consistency
Keene also questioned whether the proposed criteria would achieve the government’s ambition of providing consistency in access to care between areas, citing initial testing that has been carried out with a number of local authorities.
“The purpose of this is that we have national consistency; the early signs were that there was no consistency in the way people were applying the criteria and in the outcomes from this,” she added.
She said the initial testing was based on giving frontline staff vignettes of people whom they might assess, and a true test of the criteria would have to be more extensive. The government is now consulting on the draft and plans to hold regional workshops in September and October and commission an analysis to further test their impact.
Criteria focused on deficits, not strengths
A further issue raised by Keene is that the proposed criteria, like the current guidance, would require older and disabled people to demonstrate what they are not able to do in order to access support. This is in contrast to the government’s policy objective, through the Care Bill, to provide earlier and preventive support to people that builds on their strengths and abilities.
Keene admitted that it was a challenge to construct criteria that emphasised people’s strengths, rather than their deficits, but said this should be attempted as far as possible.
“The ultimate concern is that this is reduced to a tick-box exercise, she said. “Social workers are experienced in looking at all of people’s circumstances and their abilities,” she said. “The purpose of the Care Bill is on prevention and working with people’s abilities. There’s a paradox there.”