Three-quarters of large councils planning to tighten eligibility for adult social care, finds survey

County Councils Network poll finds only one in five members are confident they will meet legal obligation to balance books next year, due to inflation and mounting demand

scissors with text budget on the black background
Photo: eskay lim/Adobe Stock

Almost three-quarters (72%) of England’s biggest councils plan to tighten eligibility for adult social care over the next two years due to high inflation and mounting demand, a survey has found.

Over half (56%) of County Councils Network members also said they were likely to make cuts to reablement and community-based adult social care services, the CCN reported today.

It found that just one in five authorities (22%) were confident that they would be able to meet their legal requirement to balance their budgets. Failure to do so would likely trigger cuts to discretionary spending – including non-statutory social care expenditure – and require councils to seek a government bailout.

The survey, responded to by 90% of the CCN’s 36 members, comes ahead of the government’s autumn statement next week, in which it is expected to set out public spending cuts of over £30bn a year from 2025 onwards. Though core funding for councils is likely to stay at expected levels up to 2025, these have been significantly eroded by inflation since they were set in 2021.

Research published last month by the network, the Society of County Treasurers and consultancy LG Futures found that county authorities faced a funding gap of £591m this year and £821m in 2023-24, due to inflation and demand pressures.

The network said the situation needed to be met by more funding for councils, not cuts.

“This County Councils Network budget survey paints a clear picture of what will happen if we do not receive more funding to address inflationary and demand pressures,” said Sam Corcoran, the network’s Labour vice-chair. “Councils will have little choice but to reduce vital everyday services and those for the most vulnerable in society, as well as economic growth projects and those aimed at tackling climate change. Reducing these all create a false economy that stores up problems for the future.”

How eligibility criteria can be tightened

Regulations under the Care Act 2014 set a single nationwide minimum eligibility threshold for care and support: the inability to achieve at least two of a set of ten outcomes, with significant impact on wellbeing, due to care and support needs arising from impairment or illness.

Local authorities are free to set criteria that are more generous than this, allowing them to tighten thresholds to the minimum when budgets are tight.

The threshold is also open to interpretation by practitioners, for example, in relation to what is meant by a significant impact on wellbeing, though any such interpretation would need to be defensible.

On this point, the care and support statutory guidance says significant should be given its everyday meaning, and that this will differ by person, adding: “Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.”

The importance of interpretation was highlighted by pre-Care Act research, published in 2013, which found that implicit changes to criteria had played a much greater role than formal changes in thresholds in reducing access to council-arranged care.

Another issue to consider is how the eligibility criteria translate into councils’ duties to meet care and support needs, under section 18 of the Care Act. Authorities need not meet eligible needs being met by a carer, though they should be ready to do so should the care arrangement break down. Also, many authorities have sought to make savings by seeking to meet unmet eligible needs more cheaply over recent years.


4 Responses to Three-quarters of large councils planning to tighten eligibility for adult social care, finds survey

  1. Belinda Schwehr November 12, 2022 at 7:52 am #

    The idea that local authorities have discretion to tighten the criteria through reinterpretation of the words in the “outcomes”, or the concept of significant impact, is a moot legal point.

    When the Isle of Wight tried to mess with Fair Access to Care Guidance under the old legislation, drawing a wobbly line through the extent of the risk to independence needed to trigger its help, depending on which sort of difficulty being considered, it was accused of “warehousing” elderly people for safety and hygiene purposes and forgetting inclusion etc. It was successfully judicially reviewed.

    ‘Defensible’ is a public law concept and in the control of the judiciary – the judges are protective of that control when it comes to interpretation of words operating as gateways to important rights. Suffolk has just proved that its view of what can even count as “support” was simply an error of law.

    Yes councils can and do have to make judgements about how much of anything by way of a care plan is enough to meet eligible need but that is also subject to legal challenge and it is not about eligibility at all. Those decisions have to be professionally respectable and articulated and transparent, not arbitrary.

    The whole point of the Covid Easements was that a duty is still a duty. Councils need Cost of Living or Loss of Market Control Easements now!

    Most councils are already in clear breach of duty, ignoring the rule that one can’t ration assessments, for instance, due to shortage of staff.

    Carers – mainly women – and legal aid law firms’ refusal to take cases on – are what is shoring up the notion that we even HAVE any social services right now.

    We have lost sight of the Rule of Law and will never see it back again, in my view. This is what it means to integrate social services into the NHS – where the legal duty to provide a comprehensive Health Service is agreed by judges to be a target duty only, unenforceable by individuals and therefore meaningless to government in any legal sense.

    • Anonymous November 15, 2022 at 9:52 am #

      Thank you. I was hoping you would comment.

      This a prime example of where there is simply not enough money to deliver what is in Law, so ‘hard decisions’ aka unlawful decisions are being made by senior management across the country. It will be very interesting that this comes at a time when LAs will be inspected by CQC again.

  2. Pete Feldon November 14, 2022 at 4:39 pm #

    It is unfortunate that the impractical notion of ‘tightening eligibility’ has gained such credence that some local authorities think that they can do it. As you rightly imply one of the main ways of doing this would be to develop policy guidance on how social workers should evaluate significant impact on wellbeing. This is essentially a professional social work judgement and I think it would be difficult to do in a defensible way, as Belinda Schwehr points out. If there are any examples, perhaps the CCN could encourage its members to publicise them.

    The expression of the pressures created by the underfunding of social care takes place in the decisions to determine how needs will be met and how much funding will be allocated to meet needs sufficiently, and not as part of the decision about whether or not an individual has eligible needs.

    Social workers employed in the 72% of County Councils who expect to ‘tighten eligibility’ may find the BASW guidance “An Ethical Approach to Meeting Needs in Adult Social Care” helpful in rebutting any policy initiatives of this nature.

  3. Marc Melton November 16, 2022 at 4:35 am #

    Biggest issue councils have is they contract out the care to be provided to mostly corporately functioning care companies:
    I have first hand experience and knowledge of one care company in kings lynn which housed 11 residents and yet still accounted a £16000 profit on its accounts for just ONE MONTH!!!
    My contracting out to a private business the councils remove liability to themselves but at a cost to the taxpayer and sadly the person who is supposed to be receiving the care.
    Do these councils lack understanding of how the sector operates? A majority of large care companies have shareholders who demand returns on their investments. To achieve this they need consistent revenue streams, provide the bare minimum to get a “pass”, delay action and implementation. They opt for a “farm” like approach often bunching those in their care together as one unit for ease of function.
    Where I was in adult mental health the total number of FUNDED hours for the 11 residents for a week would often mean it was impossible for staff to provide.
    Central government needs to intervene and review these money sucking machines that day they care they may just then understand why people like myself who want to care have to sadly leave the industry for the sake of thier own humanity and mental health!
    An example might be 2 staff members starting at 7am expected to assist 11 residents with breakfast duties and other morning routines, medications and morning observations. 3 hours of cleaning later without any break the same 2 staff would then need to assist with lunch and again medications. 3 hours later again no breaks the same 2 staff would need to do evening medications and assist with dinner and to do 11 afternoon observations only then 1 staff will be allowed to finish for the day maybe around 7pm with the other expected to be alone with 11 residents all of whom have been section under the mental health act, for the evening , a well known period for a person mood to take a dip, to do 11 more evening observations, clear up and clean up after dinner, do medications before bed and then do a sleep in shift between 10pm and 7am (no 11 hour rest allowed.

    All the while in FULL ppe mask, visor apron gloves, in an environment ment supposed to feel like the residents home with no formalised private opportunity for a break to collect their own thoughts, without beating able to use a mobile phone. Oh and if they put a foot out of place some auditor internal or external will come down on them the team and anyone else they can do with a few thousand ton of bricks onky tooffer no support themselves.