Cutting the cake fairly: CSCI publishes review of eligibility criteria for social care
22 October 2008
Everyone, regardless of their needs or how much money they have,
should, as a minimum, have a proper discussion about their care
needs and good information and advice about care choices, according
to a new report by the Commission for Social Care Inspection,
published today.
In the longer term the report backs the need for radical reform
to the organisation and funding of the care and support system, as
the Government has already acknowledged. So as well as reviewing
the impact on people and their carers of the current means of
deciding who should receive publicly-funded care, CSCI’s report
also looks at possible future funding models and different ways
they might allocate public funds to individuals needing care and
support.
Launching the report, “Cutting the cake fairly”, CSCI Chair Dame
Denise Platt said:
“We were pleased to be asked by the Government to undertake this
review in the light of our report last January which showed the
impact on individuals and their families of the increasingly tight
thresholds for help set by councils. As this report shows, people
and their families experience stress and bewilderment trying to get
the care they need and the complex systems for determining how they
might be helped defeat many.”
“Our findings demonstrate that the current system of determining
eligibility is both heavily criticised and not aligned with present
policy. The number of people seeking care and support has been
rising and will continue to do so. Whilst most people accept that
not everything can be provided by the State, they want a fairer and
clearer system and one which both promotes their well-being and, if
they need care and support, enables them to make informed decisions
about the options available. Our review indicates there is some way
to go before everyone can benefit from that approach.”
The review found that some people are benefiting from
council-funded schemes aimed at those falling below local
eligibility criteria. However, the overall picture confirms that
people looking for support frequently fail to have an opportunity
to have their needs properly taken into account and advice about
the choices open to them. People who do not meet the eligibility
criteria manage as best they can but often at great cost in
financial, emotional, personal and physical terms, both to them and
their family carers.
It is generally accepted that some method is needed to decide
who should receive publicly funded care but the review found
considerable criticism about the current eligibility criteria and
how they operate in practice. Many concerns centre on the lack of
transparency and fairness in the way criteria are applied as well
as their apparent incompatibility with new approaches centred on
self-assessment, individual choice and control.
CSCI makes a number of recommendations (see Notes to Editors)
designed to challenge traditional thinking which sees social care
services in a narrow and limited way and to improve the operation
of eligibility criteria. The report also recommends a clearer,
simpler, framework for deciding who is a priority for
publicly-funded support. And it raises important questions about
the development of individual and personal budgets, including the
impact of charges which individuals may need to pay and when a
person’s own resources are taken into account. It therefore
recommends the development of a single, national formula for
determining such budgets in order to increase transparency and make
it easier for people to take their assessment from one local
authority to another.
Looking to the future, Dame Denise commented:
“The questions about the role of our care and support services
in future, including how they will be funded, grow in urgency – as
this report shows. Politicians across the political spectrum, both
nationally and locally, have a responsibility to work towards an
enduring solution.”
Notes to editors
The Terms of Reference of the review are set out at Appendix
1.
The recommendations are:
(i) Better arrangements that offer universal
support.
Eligibility criteria for access to public funding for social
care services should be seen in a broader context that is more
consistent with Putting People First and offers some level of help
and advice to everyone seeking it. Three key elements are
identified to ensuring better arrangements that offer universal
support -
- strengthening communities so all citizens can access local
services which promote their general health and well-being;
- assisting individual choices so everyone gets good advice,
information and an assessment of their care and support needs as
well as, where appropriate, advocacy and brokerage;
- prioritising funding for individual needs on a clearer basis
and ensure decisions about allocating public funds to individuals
follow an assessment of needs.
(ii) Improve the response to people needing
assistance, including the quality of response people
receive when they first contact the council. The report also
suggests ways of improving the assessment process.
(iii) Replace the FACS criteria with a revised way of
allocating public funds to individuals and reinforce the
need to make a clear distinction between assessing a person’s needs
and their financial means. DH should consult on three ‘priorities
for intervention’ rated according to the urgency of response
required:
- immediate intervention – without immediate support to remove
barriers to people’s dignity and quality of life, a person’s
well-being would be seriously threatened;
- early intervention – where problems may develop and threaten a
person’s well-being within 6 months if support is not
provided;
- longer-term intervention - where people’s well-being would be
threatened within the year without targetted, evidence–based
interventions.
(iv) A national resource allocation formula to
underpin individual/personal budgets so that, rather than each
council devising its own system, there would be a common approach
across the country.
(v) A range of measures to support the implementation of
the proposed arrangements, including:
- ways of improving the initial response from councils to people
seeking support
- considering, in appropriate circumstances, a short period of
re-ablement to maximise what people can do for themselves before
any final decisions about ongoing needs for support.
Six background papers accompany the report
Just under 3,000 people completed an online survey; nearly 100
written submissions were sent in; over 100 people took part in a
consultative event; consultations involved people using services
and carers and a range of interested organisations; an advisory
sounding board of key stakeholders met to discuss the evidence.
The Chair of CSCI is Dame Denise Platt DBE and the Chief
Inspector is Paul Snell.
Media contacts
- Ray Veasey 020 7979 2094
- Andy Keast-Marriott 020 7979 2093
- James Hedges 020 7979 2089