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

Key points for GPs, CCGs and health and wellbeing boards

  1. Adult social care includes a wide range of care and support provision for working age and older individuals, and support for carers. The main groups receiving care and support include disabled people, those with sensory impairments, people with learning disabilities, people with mental health or substance misuse problems, and older people with a variety of physical, sensory, intellectual and mental health difficulties. Many people experience multiple disabling conditions, requiring flexible combinations of social and health care services. Some people may be assessed as lacking capacity to make their own decisions, and may need family members, local authorities and the NHS to act within the principles of the Mental Capacity Act 2005 (MCA).
  2. Unlike the NHS, adult social care is neither a universal service nor provided free at the point of need. People must have a formal assessment of their care and support needs in order to qualify for local authority-funded social care. If they meet the eligibility criteria for support, a financial assessment of their means determines how much of the costs they must meet themselves. Most adult social care services are provided in the private, voluntary or not-for-profit sectors, with the local authority acting mainly as commissioner. Adults will receive a personal budget which they can take in the form of direct payments or personal budgets, to enhance their individual choice and control of their own support arrangements.
  3. Disabled people of all ages have the option of purchasing adult social care and support services for themselves or with assistance from relatives, and many do. This group includes people who do not meet the local authority’s eligibility criteria, or whose means exceed the qualifying limit. Local markets in home care, residential care and other services provide competition on quality and price. Under the Care Bill, the local authority is responsible for promoting diversity and quality in service provision. The local authority must provide information, advice and support to help people and their carers assess their needs and options, even if they do not meet the council’s eligibility criteria or qualify for funding support.
  4. Many people assessed for publicly funded social care and support also have significant physical and/or mental health conditions and demonstrate multiple morbidities. Both current and future legislation prohibit the use of social care funding to purchase services which the NHS, as a universal service, has a duty to provide. People in residential and nursing home care, or receiving high levels of social care support in their own homes, have the same entitlement to the full range of health services, free at the point of need, as everyone else. Provision of appropriate health care may reduce or remove the need for social care and support.
  5. The boundaries between social care and health care commissioning and provision have shifted, and are likely to change further. Many people in residential and nursing homes today, or receiving high levels of care and support in their own homes, would in the past have been cared for in NHS long-stay care. Advances in medical and surgical techniques and treatments have enabled many more people to return to full fitness, or to manage at home with residual impairments or long-term conditions. People requiring residential or nursing home care are likely to have significantly higher levels of physical, intellectual and mental health impairment now than would have been possible even in the recent past.
  6. GPs and other health care professionals have valuable information which can assist assessment and eligibility decisions for individuals and carers. Assessments aim to consider the person and their needs and abilities in the round, taking into account the present and future implications of any health conditions affecting their capability, capacity to cope and requirements for care and support. It is important that, with the individual’s consent, the practitioners who are familiar with the individual, carer and family can contribute their expertise to their assessment and care and support plans. If a person has been assessed as lacking capacity, information should be shared as part of multi-agency Best Interests decision-making.
  7. Health and wellbeing boards are strategic bodies whose job is to promote the health and wellbeing of local people. These Boards, created under the Health and Social Care Act 2012, are responsible for assessing the health and wellbeing needs of the entire local population; presenting the results in a Joint Strategic Needs Assessment (JSNA); and preparing a Joint Health and Wellbeing Strategy (JHWS) prioritising action in the short, medium and longer term and underpinning commissioning decisions across health, social care, housing, education and wider local authority functions.
  8. Promoting partnership, joint commissioning and joint and integrated working across health and care is increasingly important. The Care Bill includes specific duties on local authorities to promote integration and cooperate with partner organisations including NHS bodies. Wherever possible there is a duty to consider whether needs could be met more effectively by using the flexibilities of Section 75 of the National Health Service Act 2006, enabling lead commissioner, integrated provision and pooled budget arrangements to be used.
  9. The Care Bill provides for a new national assessment framework for adults and carers, new support entitlements for carers, a national minimum eligibility threshold, and a new system for funding and charging for care and support. It will introduce a cap on individual liability for eligible social care costs. People funding their own care, in full or in part, will be able to be assessed for their eligibility, and contributions will be recorded in their care account to determine progress towards the cap. People paying for their care will have the same rights to information and advice, and to reablement and prevention, as anyone else. GPs should be aware of the importance of encouraging adults to seek assessment of their needs, in order that their contributions towards an individual care account can be logged.
  10. The Care Bill sets out for the first time a statutory framework for adult safeguarding. It will require the local authority to establish a Safeguarding Adults Board (SAB) to strengthen protection for adults at risk of abuse or neglect. The core statutory members of the SAB are the local authority, relevant clinical commissioning groups, the chief police officer and any other persons specified in regulations. If an adult has died as a result of abuse or neglect, or survived serious abuse or neglect, and there is cause for concern about how agencies worked together, the SAB must arrange a safeguarding adult review. GPs may be asked to contribute to individual Safeguarding Adults reviews.

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