Fair access to care services (FACS): prioritising eligibility for care and support
The social care and NHS policy context - Changes in policy, terminology, practice and resourcing since 2010
- Government policies promoting localism, restructuring benefits and encouraging greater integration between the NHS and social care all influence the opportunities available to individuals and carers, the pressures placed on them and the outcomes they can achieve.
- Government has further emphasised the value and benefit of employment, both for individuals needing care and support and for their carers.
- Social care has felt the impact of a wider policy debate about the balance of responsibilities between the individual, the family and the state: arguments around the Dilnot Report  on funding long-term care are a particular example.
- The government wishes to build the capacity of the community to provide more care and support, as seen in policies on volunteering, supporting carers  and encouraging dementia-friendly and mental-health-friendly communities. 
Policy change has often been accompanied by new terminology.
- ‘Personalisation’ and ‘co-production’ remain key concepts in social care, with some capacity to challenge traditional patterns of service provision and shift the balance of power between professionals and individuals/carers receiving support.
- ‘Integration’ within and between the NHS and social care has been a long-standing and much debated policy objective, but the notion remains ill-defined, and the term is applied in widely divergent ways.
- ‘Wellbeing’ is the overarching principle in the draft Care Bill. The term has become widely used as shorthand for a range of beneficial personal, psychological and social outcomes, which may be enjoyed by individuals, families and communities. In the new NHS and local authority structures, health and wellbeing boards and health and wellbeing strategies are crucial mechanisms for coordinating the activities and plans of adults’ and children’s social care, the NHS and public health, housing and a wide range of local public services such as education, transport, parks, leisure, policing and the environment.
- In the changing adult social care scene, social work has not always found it easy to define its distinctive role and professional contribution. In many local authorities, the stress on personalisation has left social workers uncertain about what they have to offer.
- Some employers have been slow to grasp the importance of social work and social care knowledge and expertise. This is vital for supporting and safeguarding the growing numbers of disabled and older people, in complex and often vulnerable circumstances, with multiple physical, sensory and mental health conditions, affected by poverty and poor housing, and often neglected or harassed by neighbours.
- Assessment in these areas is underpinned by the Mental Capacity Act, which requires local authorities to use a human rights framework, and assessments in these cases must consider people’s ‘liberty’, ‘family life’ and protection from harm.
Resources for care and support
The effects of the economic downturn have tended to outweigh other factors in the thinking of many in central and local government. The Association of Directors of Adult Social Services (ADASS) calculates that between April 2011 and March 2013, £1.89 billion was removed from local authority social services budgets. While all authorities have experienced significant resource constraints, there are wide variations in how they are managing the consequences. Some have adopted a ‘retrenchment’ approach, applying eligibility criteria more strictly, reducing levels of support to individuals, withdrawing services and increasing charges. Others have preferred to look at alternative ways to use the resources they have available, working with the NHS to transform commissioned services, investing in early intervention and prevention to reduce demand for higher-dependency care and support, and working with voluntary and community sector bodies and with a wider range of commercial and private sector services to spread scarce resources further.