Fair access to care services (FACS): prioritising eligibility for care and support
The social care and NHS policy context - What is current local authority practice?
The Department of Health (DH) commissioned SCIE in September 2012 to prepare a report on the current position in adult social care assessment and eligibility. It was interested in questions of practice, process, decision-making and consistency in assessment and eligibility. The SCIE survey, alongside other work, provides information about the current situation for the government to consider when implementing its plans to introduce a national minimum eligibility threshold and ‘to develop and test options for a potential new assessment and eligibility framework, in consultation with people who use services, carers, academics, local authorities, social workers, and health and care professionals’. 
SCIE used a range of evidence including:
- published research on the operation of the assessment and eligibility framework since the DH issued its revised guidance in February 2010
- a survey of assessment and eligibility practice in 28 local authorities with adult social services responsibilities – this covered different types of authority and had a reasonable geographical spread
- interviews, face to face or by teleconference, with managers in a dozen authorities on current challenges, changing priorities and emerging practice in assessment and eligibility
- discussions with, and nearly 40 questionnaire responses from, people with experience of being subject to assessment and eligibility processes in their own local authorities.
The 2012 report of a survey of FACS assessment criteria among local authorities in England by the Personal Social Services Research Unit,  based on responses from 85 local authorities (57 per cent of English social services authorities), provides a thorough and detailed analysis of the relationships between the FACS bandings, central and local government priority-setting, individual needs assessment and variations in care manager decision-making.
The 2012 SCIE report Crossing the threshold by Melanie Henwood  examines the implications of the Law Commission and Dilnot Commission reports for eligibility and assessment in care and support. The report explores the rationale for moving to a ‘more objective’ model of assessment and a national eligibility threshold, as recommended by the Law Commission  and Dilnot Commission.  It examines the benefits, and some potential risks, in these moves.
Other relevant studies include a forward-looking ADASS report, ‘The case for tomorrow: facing the beyond: a joint discussion document on the future of services for older people’ (2012).  This examines the pressures on the care system for older people of increasing demand, rising expectations, restricted resources and trends in provision and the market. It looks at the changes needed in the way services are shaped and delivered and identifies an action agenda for the government to support local management and innovation.
The Audit Commission has also produced ‘Reducing the cost of assessments and reviews’ (2012)  an adult social care briefing for councils, setting out its analysis of spending on these activities, and how some authorities have achieved low-cost approaches through reconfiguring services and staffing.
The key findings emerging from the SCIE study  were as follows.
- The FACS banding system remains the basis for assessment and eligibility decision-making across all authorities.
- In many council areas, initial contact is made through either a call centre or a centrally located contact point. One local authority found that 50 per cent of callers receive information, advice or redirection at this point and do not proceed further. Those requiring a full community care assessment are likely to be referred to a local or specialist team, but practice varies between authorities.
- Social care assessment and eligibility functions are under severe strain. They are serving a number of different and often competing objectives – personalising support, safeguarding individuals at risk, complementing individuals’ and carers’ existing support, rationing scarce funds, maintaining fairness and equity, and enabling joint working.
- Assessment is rarely a one-off event or process. A number of councils use a stepped process or pathway with different kinds of assessment at different points. Some authorities use a ‘triage service’ where callers are referred at first to a third sector resource, such as Centres for Independent Living or Carers’ Centres, for initial advice and sometimes ‘light-touch’ support.
- There is a debate about the nature and purpose of assessment. Some view it simply as a means to decide who should or should not receive public funds to support their social care. Others regard it as a form of service in itself, helping individuals with complex circumstances and multiple conditions to understand the options available, and steering them towards a variety of solutions from numerous different local sources.
- The growth of reablement services has significantly affected processes and outcomes of assessment and review in some authorities.
- The assessment and eligibility system does not operate in isolation. It is connected to, and influenced by, other systems such as prevention, joint working, commissioning, means-testing and budget restrictions.
- More integrated working between social care and the NHS is a major factor, critically important to individuals and their carers, but complicated by the implementation of the NHS reform programme, and the need to develop complementary working between the two services.
- Individuals and carers requiring social care support may also typically have health, housing, income or inclusion needs. Assessment and eligibility functions in these different arenas should be coordinated to avoid duplication and repeated questions.
- There are wide variations among councils in the way self-assessment is viewed, understood and supported.
- In some authorities FACS assessment and eligibility, and early intervention, prevention and reablement, are no longer treated as two separate systems. They are applying a more dynamic whole-systems approach, looking at strengths, needs and resources in the round.
- Authorities are seeking to improve consistency in a range of ways: internal and external benchmarking; increased training and skill development for key staff groups; more engagement of individuals and carers in service design and quality assurance; and better guides, manuals and procedures.