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Revising the criteria
Making a list of all the pieces of law covering the eligibility of people and their carers to access care services can be a big exercise! Well, there’s a new piece of legislation in the field of health and social care that came into operation on 1st April which aims to make clear what adults with care needs can get and how they can get it. The Care Act 2014 (passed last year, and operational this year) removes a lot of the long list of previous care law.
One of the key elements of the new Act is identifying who is eligible for services. This has been a controversial issue for many years. The controversy is around the issue of rationing. So here’s the dilemma. There’s a large and growing number people with care needs arising from physical and mental health problems, but a limited amount of the financial resources needed to provide for these.
The so-called Gloucester judgement in 1997 highlighted the dilemma for many authorities. The judgement said that if the local authority assessed a service user as being eligible to have their care needs met, it had to meet them, not argue that it couldn’t afford to. In response to this, national guidance was issued that allowed local authorities to set out their eligibility criteria; if a service user met them, their care needs had to be funded. If they fell below these, the authority was not obliged to meet the needs, and more commonly might just help with information and advice. The problem with this system, called Fair Access to Care Services, or FACS for short, was that different authorities set their ‘bar’ at different levels. There were four levels with FACS - critical, substantial, moderate or low - so some authorities might meet moderate needs or above, others might only meet substantial and critical needs. It is one of the issues that the Care Act has reformed with a new national eligibility threshold.
Over the threshold
I want to have go at simplifying how the threshold works, and point to some resources that might help in terms of assessing the needs of people with mental health problems. There are three elements to this threshold that have to be met:
- The person has needs arising from a physical or mental impairment or illness
- The person can’t achieve two or more outcomes from a list of basics of daily living
- As a result of not achieving these, there is likely to be a significant impact on their well-being
The problem with criteria like this is they are more difficult to measure for people with mental health problems. The Care Act Support Guidance chapter on eligibility includes a couple of examples where someone with autism is assessed. You might also want to look at the Social Care Institute for Excellence’s website which includes some practice examples. As the Act starts to be implemented we will no doubt see the effect on people with mental health problems with some real life examples to draw on.
David Beckingham – QCS Expert Mental Health Contributor