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

Useful information and definitions

Adult Social Care Outcomes Framework 2013–14 (ASCOF)

This sets outcomes measures for social care in local authorities for the year 2013–14. These relate to four overarching domains – quality of life, delaying or reducing the need for care and support, individuals and carers having a positive experience of care and support, and safeguarding.

Carers

Family members, friends or neighbours who, without payment, support another person with social care needs.

Carers and Disabled Children Act 2000

This Act sets out the responsibility of the local authority to provide assessment of the risks to a carer’s role and the power to provide support either directly to a carer or through a service to the adult needing or using support. The assessment framework for carers closely models that for adults seeking or using services, but focuses on the risk to the sustainability of the caring role. The Carers (Equality) Act 2004 requires assessments to address employment, education, training, recreation and leisure. Parents of disabled children or young people can also ask for an assessment where the local authority is clear that they have a responsibility to the child or the young person and their family.

Carers’ Centres

Carers’ Centres are independent charities that deliver a wide range of local support services to meet the needs of carers in their own communities. All Carers’ Centres provide access to the following core services:

  • information and advice about benefits, breaks, respite and support services, carer assessment procedures, aids and adaptations
  • emotional support – opportunities for carers to talk through their concerns, both individually and in group sessions, thus helping to alleviate isolation and stress
  • community consultation – carers need a unified voice in any locality to ensure that they have an impact on decision-making, influence local policy, planning and outcomes, and link in to the regional and national decision-making bodies.

Centres for independent living (CILs)

These are grassroots organisations controlled by disabled people using services or managing their own support that provide information, services and peer support to adults who want to consider, or are using, direct payments, personal budgets and other methods to maintain control over their own lives. They apply social model approaches and an integrated view of support needs. They can provide advice and support on recruiting and employing personal assistants, payroll and financial management, dealing with employment problems and establishing tailored arrangements for independent living.

Children and Families Bill 2013

This Bill aims to put the needs and rights of children at the centre of policy and procedures to reduce delays in getting the support they need and, when they cannot live with their own families, to move to a permanent family more quickly. The Bill proposes children with special needs should have a plan, which covers their education, health and social care needs until they are 25, that their views and those of their parents should be heard, and that they should have more choice about the support they use.

Clinical commissioning groups (CCGs)

CCGs are clinically-led groups that include all the GP practices in their geographical area, and enable them to influence commissioning decisions for their patients. CCGs will be overseen by NHS England, which will manage primary care commissioning and hold the NHS contracts for GP practices. CCGs work with patients and health care professionals, and in partnership with local communities and local authorities. On their governing body, groups will have, in addition to GPs, at least one registered nurse and a doctor who is a secondary care specialist. All GP practices must belong to a clinical commissioning group.

Common assessment framework (CAF) for children in need and their families

The CAF for children in need and their families provides a systematic basis for collecting and analysing information to support professional judgements about how to help children and families in the best interests of the child, including how to keep them safe. The assessment has safeguarding and promoting the child’s welfare at its centre and evidence is collected in relation to:

  • children’s or young people’s developmental needs
  • the parenting capacity of those caring for them
  • family and environmental factors.

Communities

Groups of people who share common interests. These may occur because they live in the same geographical area, and feel the impact of any changes or loss of resources or amenities. Alternatively, the individuals may have issues or ways of life in common although they may be geographically spread, nationally and internationally. For example, the Deaf community, faith groups, different black and minority ethnic groups and lesbian, gay, bisexual and transgender (LGBT) people share a history and a heritage, and often a shared experience of facing exclusion, discrimination and harassment.

Complaints: Local Authority and NHS Complaints Regulations 2009

These regulations provide a unified system for complaints for local authorities and the NHS. They include a duty to cooperate in the handling of complaints. There is a statutory requirement for cooperation between the two organisations.

Direct payments

Cash payments made to individuals who have been assessed as eligible for publicly funded social care support. Cash payments enable individuals to choose the support that best meets their needs and that will achieve agreed outcomes. Those who want it can receive help with handling a direct payment, and specific provision is available for those who lack capacity.

Eligibility criteria

These are set out in the ’Prioritising need’ framework guidance. [1] The aim is to ensure that there is fair access to services for individuals living in the same authority and, depending on the council’s resources, for individuals with similar levels of social care needs in different parts of England. The criteria describe in an open and transparent way the evidence of levels of social care need that should be demonstrated during an assessment.

Eligible needs

The social care needs of the individual that fall into the different bands of eligibility. The bandings are: critical, substantial, moderate and low. The wording of the four bands is prescribed nationally.

Equality Act 2010

This Act brings together existing legislation and statutory instruments promoting equality and challenging discrimination on grounds of gender, disability and ethnic background, and makes comparable provision against discrimination in provision of goods and services, including health and social care services, on grounds of age, faith and sexual orientation. It creates an extended duty for the public sector to promote equality and to tackle poverty.

General population

All adults and children living in a local authority’s boundaries.

Health and wellbeing boards and strategies

The joint health and wellbeing board, convened by the local authority, brings together CCGs and health providers, adult and children’s social care, education, housing, public health and police. It is responsible for identifying the health and wellbeing needs of the local population, based on the joint strategic needs assessment, and planning how they will be met. The board’s analysis and plans constitute the basis for the local health and wellbeing strategy

Healthwatch

Healthwatch is responsible at national and local levels for ensuring that the views of people using health and social care services are collected and reported. Local information is coordinated at the national level by Healthwatch England, whose chair is a board member of the CQC.

Independent living

People are able to maximise the choice and control they have over their lives, and have access to support that best fits their needs, preferences, aspirations and culture. Supportive communities contribute to people’s capacity to exercise choice and control over the way they live their lives and the support they can access.

Indicative allocation

At an early stage, the person eligible for publicly funded services is told roughly how much money it is likely to cost to obtain the support that meets their needs. The approximate amount of money informs support planning. The final amount of the personal budget will only be set when there is an agreed support plan that specifies agreed outcomes that meet eligible social care needs.

Individual seeking or using services

Any individual who has approached or been referred to a social care organisation requesting services or support of any type.

Joint strategic needs assessments (JSNAs)

JSNAs are assessments of the current and future health and social care needs of the local community – needs that could be met by the local authority, CCGs or an NHS commissioning board. The policy intention is for health and wellbeing boards also to consider wider factors that impact on their communities’ health and wellbeing, and local assets that can help to improve outcomes and reduce inequalities.

Local authorities

Councils/local authorities with responsibilities to provide or commission social care services for adults who are living within the council’s boundaries.

Mental Capacity Act 2005

This Act provides a statutory framework for acting and making decisions on behalf of people who have been assessed as lacking capacity to make specific decisions themselves. It outlines five principles that must underpin every stage of the process. It can also be used by people who want to prepare for the time when they may lack capacity in the future. The Act sets out who can act and take decisions on behalf of an individual deemed to lack capacity, the situations in which the authority to act applies and the processes that should be followed.

NHS continuing health care

A package of ongoing care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as defined in guidance. Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. Eligibility for NHS continuing health care places no limits on the settings in which the package of support can be offered or on the type of service delivery. A decision-support tool has been developed to ensure that assessing practitioners take into account the full range of factors relevant to reaching decisions about a person’s eligibility for NHS-funded continuing care. Where the need is urgent, a fast-track tool is also available. Health and social care practitioners should work together on the assessment, and ensure the adult and carers or family members are able to participate as fully as possible.

Outcomes

The results a person wants to achieve through accessing their own social care or receiving social care support. The aim is to evaluate how the individual’s needs impact on their independence and wellbeing in the immediate and longer term, and how to reduce or remove the blocks to achieving the results that have been agreed.

Personal budget

Individuals who are eligible to receive publicly funded social care support are allocated an agreed amount of money so that they can direct the funding to meet their needs in ways that best suit them. These can be managed by the individual, a relative, a carer, the local authority or a third sector organisation.

Personal health budget

A personal health budget is an amount of money to support a person’s identified health and wellbeing needs, planned and agreed between the person and their local NHS team. The aim is to enable people with long-term conditions and disabilities to have greater choice, flexibility and control over the health care and support they receive. Consultation is taking place on the scope for a personal health budget to be allocated in the form of a direct payment. A significant programme is also under way to consider the implications of developing integrated personal health and care budgets.

Personalisation

This policy involves putting the outcomes that people want to achieve at the centre of assessment, planning, implementation and reviews. The aim is to promote the individual’s wishes about the outcomes they are aiming to achieve, the solutions that best fit their circumstances, and the ways they prefer to maximise their independence, dignity and wellbeing. A second component of personalisation is an emphasis on early intervention and prevention to reduce or delay the need for social care support, and providing information and advice for all, including people who may not be eligible for publicly funded social care support.

Presenting needs

The full range of issues or problems identified when an individual first contacts, or is referred to, a local authority seeking social care support. Some or all of them may fall outside the definitions determining eligible needs.

Primary prevention

This refers to action taken at the strategic level locally, regionally and nationally to avoid problems occurring in the population. Examples include strategies to promote healthy lifestyles and to prevent poverty, obesity, alcohol-related problems and domestic violence. Workers in adult care are mainly involved in trying to reduce the impact of problems that have already arisen, but their work is supported by action taken at the level of neighbourhoods and whole populations.

Putting People First 2007

A joint protocol on adult social care, endorsed by government departments, local authorities, cross-sector providers, professional and standards bodies, setting out a vision for the reform of adult social care services to promote personalised support, help people exercise choice and control over the way they receive support, and encourage strong and supportive communities.

Resource allocation system (RAS)

A system that seeks to calculate, in a clear and rational way, how much money a person is likely to need to arrange support for their eligible needs. The system helps the person to understand how the amount of money they have been allocated was arrived at, and to use the information to make their own choices and direct the way their support is provided.

Safeguarding adults board

Under the Care Bill, local authorities will have a responsibility for convening a statutory multi-agency safeguarding adults board, parallel to the safeguarding children board, and be responsible among other things for developing inter-agency safeguarding strategies and conducting safeguarding adults reviews. The government has consulted on whether a new power is needed for local authorities to access and see a person who may be at risk of abuse or neglect. The core members of the board are nominated by the local authority, CCGs in its area and the chief police officer.

Self-assessment

Self-assessment involves the council providing information a person can use to make their own preliminary assessment of their needs, and whether and how far they are likely to meet local eligibility criteria. The assessment focuses on the outcomes the individual and their family/carers want to achieve in meeting their eligible needs. It looks at the individual’s situation as a whole, taking into account the resources in their own support networks and the needs of family members and others who provide support. The local authority’s duty to assess needs can be met through self-directed assessments which are proportionate to the person’s needs and situation. The self-assessment then feeds into the person’s self-directed support plan.

Self-funders

Individuals, carers or family members who:

  • pay for their own care and support because their financial resources are above the level to receive publicly funded care
  • make a contribution to the cost of their care
  • pay for their care for a period until their personal resources fall below the maximum level
  • have family members/friends supplementing the cost of their care.

Third sector organisation

An organisation that is a registered charity, also called a voluntary organisation.

Universal services

These are services that can be accessed by the general population, and include advice and information, health, education, housing, training, employment, recreation and leisure, transport, community support groups and services provided in the commercial and business sector. Access to these services is not dependent on having been assessed as having eligible social care needs.

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