Fair access to care services (FACS): prioritising eligibility for care and support

The social care and NHS policy context - Current FACS eligibility criteria and Care Bill proposals

The definitions of the four FACS eligibility bands – critical, substantial, moderate and low – have been specified nationally, and have remained unchanged since 2003. Table 1 outlines the criteria for individuals associated with each band. The bands rank eligible needs in terms of risks to the individual’s independence and wellbeing, and the consequences of their needs not being met. Within each band, as the ‘and/or’ links indicate, the FACS framework does not give more weight to some criteria than others. Sustaining involvement in work, social support systems, and family roles and responsibilities, should be considered alongside risks to life and health, loss of choice and neglect.

Table 1: FACS bandings and eligibility criteria for the individual

Critical – when:

  • life is, or will be, threatened; and/or
  • significant health problems have developed or will develop; and/or
  • there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
  • serious abuse or neglect has occurred or will occur; and/or
  • there is, or will be, an inability to carry out vital personal care or domestic routines; and/or
  • vital involvement in work, education or learning cannot or will not be sustained; and/or
  • vital social support systems and relationships cannot or will not be sustained; and/or
  • vital family and other social roles and responsibilities cannot or will not be undertaken

Substantial – when:

  • there is, or will be, only partial choice and control over the immediate environment; and/or
  • abuse or neglect has occurred or will occur; and/or
  • there is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or
  • involvement in many aspects of work, education or learning cannot or will not be sustained; and/or
  • the majority of social support systems and relationships cannot or will not be sustained; and/or
  • the majority of family and other social roles and responsibilities cannot or will not be undertaken

Moderate – when:

  • there is, or will be, an inability to carry out several personal care or domestic routines; and/or
  • involvement in several aspects of work, education or learning cannot or will not be sustained; and/or
  • several social support systems and relationships cannot or will not be sustained; and/or
  • several family and other social roles and responsibilities cannot or will not be undertaken

Low – when:

  • there is, or will be, an inability to carry out one or two personal care or domestic routines; and/or
  • involvement in one or two aspects of work, education or learning cannot or will not be sustained; and/or
  • one or two social support systems and relationships cannot or will not be sustained; and/or
  • one or two family and other social roles and responsibilities cannot or will not be undertaken

Source: ‘Prioritising need in the context of “Putting people first”: a whole system approach to eligibility for social care’ (Department of Health, 2010).

Eligibility criteria for individuals should be seen in their wider context and not in isolation. They are a guide to local authorities undertaking assessments among those entitled to publicly funded social care support in the community. Staff undertaking assessments should be aware of the following.

Table 2 sets out the criteria for carers. These aim to enable the carer to sustain their caring role by identifying any support they may require.

Table 2: Levels of risk for sustainability of the caring role

Critical – when:

  • their life may be threatened
  • major health problems have developed or will develop
  • there is, or will be, an extensive loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role
  • there is, or will be, an inability to look after their own domestic needs and other daily routines while sustaining their caring role
  • involvement in employment or other responsibilities is, or will be, at risk
  • many significant social support systems and relationships are, or will be, at risk

Substantial – when:

  • significant health problems have developed or will develop
  • there is, or will be, some significant loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role
  • there is, or will be, an inability to look after some of their own domestic needs and other daily routines while sustaining their caring role
  • involvement in some significant aspects of employment or other responsibilities is, or will be, at risk
  • some significant social support systems and relationships are, or will be, at risk

Moderate – when:

  • there is, or will be, some loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role
  • there is, or will be, some inability to look after their own domestic needs and other daily routines while sustaining their caring role
  • several social support systems and relationships are, or will be, at risk

Low – when:

  • there is, or will be, some inability to carry out one or two domestic tasks while sustaining their caring role
  • one or two social support systems and relationships are, or will be, at risk

Source: ‘Prioritising need in the context of “Putting people first”: a whole system approach to eligibility for social care’. (Department of Health, 2010).

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