‘Implicit’ changes to eligibility criteria have driven substantial cuts in client numbers

‘Implicit’ changes to eligibility criteria have shut many thousands of people out of the council-funded care system in England during the past three years, suggests research published today.

Large reductions in the number of people receiving council-arranged care, particularly since 2009/10, are “significantly more acute” than explicit changes in Fair Access to Care Services eligibility thresholds made over that time.

“It seems that “implicit” eligibility policies (the interpretation on the ground of the stated local definitions of eligibility thresholds) might have shifted significantly through time without an equivalent reflection in terms of changes in the “explicit” local eligibility thresholds,” said the research by the Personal Social Services Research Unit, commissioned by campaign coalition the Care and Support Alliance.

From 2005/06 to 2012/13, the number of people receiving formal packages of care from their council fell by 320,000, found the PSSRU team at the London School of Economics. Researchers calculated that, given the rising numbers of older and disabled people in the population over that time, 453,000 fewer people were receiving care in 2012/13 than would have done in 2005/06 given a consistent level of eligibility.

Biggest cuts implemented since 2010

The vast majority of the reduction – 281,000 of the 320,000 cut in the actual number of service users, and 382,000 of the 453,000 needs-adjusted cut – happened after 2009/10, when the government’s programme of deficit reduction began.

However, councils tightened formal eligibility criteria more significantly from 2005/06 to 2009/10, when the proportion of authorities setting a ‘substantial’ threshold rose from 59% to 76%, than from 2009/10 to 2011/12, when the proportion of ‘substantial’ councils rose from 76% to 80%.

The findings illustrate the extent to which both professional discretion and managerial decision-making influence the way the four FACS eligibility bands – low, moderate, substantial and critical – are applied. They are also in line with findings from previous research by the PSSRU, which uncovered significant variations in the interpretation of eligibility criteria between social work professionals asked to assign 24 service user case studies to one of the FACS bands.

The government recently consulted on draft eligibility regulations to implement a standard national eligibility threshold for care, which would be implemented from April 2015 through the Care Bill.

The proposed threshold is designed to be equivalent to the current substantial band, and has been heavily criticised for this reason by the Care and Support Alliance, who would like to see a national threshold imposed at the lower moderate threshold.

However, the Association of Directors of Adult Social Services has warned that the proposed threshold is in effect lower than substantial, and therefore liable to leave councils facing increased costs from a rising population of eligible service users.

Community services hit harder than care homes

Today’s research, whose publication coincides with the second reading of the Care Bill in the House of Commons, also found that the cuts in the number of service users were concentrated among users of community-based care – contrary to the policy imperative of shifting services out of care homes into people’s homes.

Since 2009/10, the number of users of community services on councils’ books fell by 27% from 980,000 to 711,000, while the number of residential and nursing home clients fell by 4%, from 229,000 to 219,000.

“This is likely to reflect the fact that people with the lowest levels of need, who generally live in the community, have been disproportionately affected by the hardening of local eligibility thresholds,” said the report. It said this meant the “shift to supporting more people to live at home will not be readily realised”.

The study also found people with learning disabilities had been relatively protected from cuts in service numbers compared with other groups. When adjustments are made for rising levels of need in the population, 5% fewer people with learning disabilities were receiving services in 2012/13 than in 2005/06, compared with 48% fewer people with mental health problems, 39% fewer older people and 33% fewer adults with physical disabilities.

In spending terms, the study found that social care spending was £1.5bn lower in 2012/13 than in 2005/06 when adjustment is made for inflation and rising levels of need.

Caveats

Researchers added the following caveats to their findings:-

• They do not account for improvements in councils’ ability to prevent or reduce needs for care, for example through services such as reablement;
• They do not account for service users benefiting from council grants to voluntary organisations to fund social care support.

However, the report added: “Notwithstanding these caveats, the scale of reductions in spending and provision which we have revealed here are almost certainly without precedent in the history of adult social care.”

With government spending on councils set to fall in each of the next two years, and most probably beyond, it said these reductions would be implemented “in services whose foundations have already been seriously eroded”.