by Colin Slasberg
When Fair Access to Care Services was replaced with the Care Act Eligibility Regulations, the aim was to eliminate the ‘post code lottery’ of provision through the introduction national eligibility criteria.
The government view was that the postcode lottery was the product of councils being able to choose how many of the four FACS bands it would consider eligible. It had come to the view that the problem was by the time of the change a minor one.
The ‘vast majority’ of councils operated at the same level of ‘critical’ and ‘substantial’. It expected the new national eligibility threshold to take effect at that level. The policy intention was that the new national criteria ‘describes a level that can maintain current practice’. A seamless transition was anticipated.
There was just one fly in the ointment. Three councils – West Berkshire, Northumberland and Wokingham – operated a ‘critical’ only policy under FACS. Surely this would mean they would require additional resources to climb up to the level of all the rest.
The government’s Impact Assessment looked at this. But it actually made the rather surprising finding that ‘spending is either close to or above the median of their statistical neighbours, and in some cases the proportion of services provided to over 65’s significantly above the median’.
This might have disturbed the government view of the post code lottery, but didn’t. It simply decided these councils would not receive any extra funding. But they objected, and began judicial proceedings. Government responded by agreeing to a piece of detailed research to explore the facts. Using the Freedom of Information Act, the result can now be made public.
The research focussed on what had actually changed since the transition to the national eligibility criteria. It found that ‘the case for a new burden on the councils has not been established’. And accordingly ‘no additional funding should be awarded’.
So the national eligibility had made no difference for these councils. This was, in fact, entirely predictable. It would apply to all councils. The Audit Commission identified as long ago as 2008 that eligibility criteria made no difference to spending levels.
This is a finding replicated in recent months by the Institute of Fiscal Studies who found very large differences in spending levels between councils, but which bore no discernible relation to need.
They did find large differences in how spending levels had changed amongst councils in recent years, some reducing much more than others. However, these changes bore no relationship to need or eligibility criteria.
The differences stemmed simply from differences in how much of each councils’ spending was supplemented by local taxes prior to the large cuts in government grants. Those with more local tax were cushioned and those with less more exposed to cuts.
How much longer can government and sector leaders maintain the pretence that eligibility criteria determine ‘need’, and hide the unpalatable truth that it is resources – and resources alone – that determine how councils see what is ‘need’.
Once the pretence has gone, they will perhaps be open to working with people and their real needs as previously outlined in these columns.
Colin Slasberg is an independent social care consultant