‘These eligibility regulation changes undermine one of the Care Act’s key aims’

Changes to the national eligibility threshold plans could spell bad news for informal carers, argues Belinda Schwehr

After months of consultation – and over 4,000 comments – the Department of Health has published its final statutory guidance and regulations for the Care Act 2014, including plans for the new national minimum eligibility threshold for social care.

The final national threshold marks a tightening of previous plans and, among key changes, now demands that one condition of a person qualifying for care is that their care needs prevent them from meeting ‘two or more’ outcomes from a prescribed list of 10 (see box below).

Here, Belinda Schwehr, from Care and Health Law, gives her take on the government proposals….

The outcomes dilemma

The activities relevant to eligibility are still to be described as ‘outcomes’ in the final regulations. Presumably this is so that people will have to say they were actually asked about their preferred outcomes. However, the ‘outcomes’ are now set out in an exhaustive and final list, not an inclusive one in relation to previous examples of essential abilities that were listed as basic care activities.

Final regulations for the proposed national threshold published today
Secondly, the activity of ‘cleaning and maintenance of one’s home’ that was included in drafts has now morphed into being able to ‘maintain a habitable home environment’. That’s true for the carers’ own separate criteria as well. In a similar vein, ‘getting up and dressed’ has been replaced by ‘being appropriately clothed’.

Thirdly, one has to manifest inability in ‘two or more’ of the ‘outcomes’ on the list. There is no obvious steer as to what a council should do with a person who presents with just ONE, but highly significant, area of inability.

The ‘positives’

Within this, I acknowledge that:

  1. the underlying cause of the inability can now merely relate to or arise from mental or physical impairment or illness, not just be directly ’caused’ by those things, so this is good for people with substance abuse issues and issues not culturally seen as mental impairments;
  2. the extended definition of what constitutes someone being ‘unable’ to meet an outcome has been kept in, still allowing for people to assert need even though they can achieve the activity albeit with difficulty;
  3. difficulty with developing relationships, as well as maintaining them, has been allowed for, and trips to medical appointments have now been excluded, no doubt as the responsibility of the NHS, for those not able to get there themselves.

The impact on carers

But overall, the changes described above risk undermining the economically rational presumed policy behind the Act: to incentivise informal carers to do much more of the valuable support, and willingly, by making them eligible for actual money to spend on their own housework and childcare and make up for their doing, for free, the much more expensive support, like night-sitting.

The new formulation effectively obliges that army of carers out there to carry on doing domestic support for their relatives and leaves them ineligible for support or money for their own household’s backfilling. This seems incredible, particular if a political party wants the woman’s vote coming up to a general election.

National eligibility threshold: What the regulations say

An adult’s needs meet the eligibility criteria if—

(a) the adult’s needs arise from or are related to a physical or mental impairment or illness;
(b) as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified in paragraph (2); and
(c) as a consequence there is, or is likely to be, a significant impact on the adult’s well-being.

The specified outcomes are—
(a) managing and maintaining nutrition;
(b) maintaining personal hygiene;
(c) managing toilet needs;
(d) being appropriately clothed;
(e) being able to make use of the adult’s home safely;
(f)  maintaining a habitable home environment;
(g) developing and maintaining family or other personal relationships;
(h) accessing and engaging in work, training, education or volunteering;
(i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
(j) carrying out any caring responsibilities the adult has for a child.

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