Fair access to care services (FACS): prioritising eligibility for care and support
Initial contact - Early intervention, prevention and wellbeing
Putting People First says that there needs to be “a locally agreed approach ... utilising all relevant community resources especially the voluntary sector so that prevention and early intervention and enablement become the norm”.(‘Investing in prevention and wellbeing’, DH, 2010, Section 33)
Mrs Evans’ story, part 2 – positive outcome of prevention
Mrs Evans’ daughter used information to discuss falls with her mother. They went together to talk to Mrs Evans’ GP. No medical problem was diagnosed, but Mrs Evans decided to go to a local class for older people to improve her balance, and began to regain her confidence.
The ‘Investing in prevention and wellbeing’ section of the 2010 DH guidance ‘Prioritising need’ makes early intervention and prevention integral to the implementation of FACS. SCIE’s recent survey of local authority assessment and eligibility practice found that growth in the availability and use of reablement services had become an important factor in helping people regain capability and reducing their care and support requirements.  Reablement is offered both to support people after a hospital stay or a spell in temporary care, and as an option to offer in reviews.
About 20 per cent of the people who use care and support in their own homes fund their own care, either completely or in part. This percentage varies in different areas of the country. The Institute of Public Care estimates that 270,000 older people pay for care (including housework, shopping etc.) in their own home.  Laing and Buisson  calculate that £1.1 billion is spent privately on non-residential services. In addition, there is a group of people who fund their care until their resources have reduced to the level at which they qualify for publically funded support.  Providing them with information and signposting them to sources of support are key to preventing, minimising or delaying the need for more complex health and social care support in the future. Good practice requires that staff provide people who are funding their own care the same service as for individuals and carers who would be eligible for publically funded care and support.
In early intervention, staff should:
- always have prevention, early intervention and reablement at the front of their minds when carrying out any aspect of their work
- recognise that the need for care and support is not static, and identify and work with individuals and their support networks where there is a risk of deterioration or where problems are escalating – In such cases early intervention could prevent or delay the need for social care support
- provide targeted interventions to address specific barriers preventing individuals from achieving agreed outcomes
- help people seeking support to access short-term health or technological support and reablement, to promote independence and reduce risks
- use predictive tools that can identify and target individuals at risk, or who could potentially benefit from signposting and early decision-making
- identify sources of support for individuals and carers on the edge of needing social care, or who have low or moderate social care needs, to help them retain control over their lives and achieve the outcomes they want
- keep up to date with their authority’s development of voluntary and community capacity, telecare and other technology applications.
The Care Bill includes a new statutory principle to promote individual wellbeing as the driving force underpinning the provision of care and support, and a responsibility on the local authority to shape the market for care and support services. This requires the authority to promote services, or take steps intended to prevent, delay or reduce people’s need for care and support. The focus will be on being proactive and deploying earlier interventions to reduce dependency, rather than just providing intensive services at the point of crisis (Clause 2).
The Bill defines ‘wellbeing’ in terms of:
- physical and mental health, emotional wellbeing and personal dignity
- protection from abuse and neglect
- control by the individual over day-to-day life (including over care and support provided to them and the way in which they are provided)
- participation in work, education, training or recreation
- social and economic wellbeing
- domestic, family and personal relationships
- suitability of living accommodation
- the individual’s contribution to society.