Contact: Yvonne Le Brun Ext: 7790

1. Summary

The following decisions are sought.

To agree the departments arrangements for introducing the national framework for determining eligibility for all adult Social Care Services

1.1 To agree that the eligibility criteria for Hampshire County Council Adult Social Care Services be set to include the Critical and Substantial categories of the Department of Health framework for fair access to care.

1 Recommendation

2.1 That the Executive Member approves the above in order to enable the implementation of Fair Access to Care Services by April 2003.

2 Reason(s)

2.1 In May 2002 the DOH issued policy guidance on Fair Access to Care Services. (LAC 2002/13) This guidance provides a framework for determining eligibility for all adult social care services.

2.2 Councils are required to use the guidance to review and revise their eligibility criteria in consultation with local stakeholders, including current service users, NHS bodies and other appropriate local organisations. The guidance also includes a general update on assessment and care planning for adults seeking social care support and reminds councils of their responsibilities for reviewing care plans and reassessment of needs at regular intervals.

2.3 There is a requirement that each local authority reviews its eligibility arrangements and puts into practice all necessary changes by April 2003.

3 Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

Not Applicable.

4 Dispensation granted by the Standards Committee

Not Applicable.

5 Reason(s) for the matter being dealt with if urgent

Not Applicable

Approved by: Date of decision:

Councillor Felicity Hindson

Contact: Yvonne Le Brun Ext: 7790

1 Introduction

1.1 In May 2002 the DOH issued policy guidance on Fair Access to Care Services. (LAC 2002/13) This guidance provides a framework for determining eligibility for all adult social care services

1.2 Councils are required to use the guidance to review and revise their eligibility criteria in consultation with local stakeholders, including current service users, NHS bodies and other appropriate local organisations. The guidance also includes a general update on assessment and care planning for adults seeking social care support and reminds councils of their responsibilities for reviewing care plans and reassessment of needs at regular intervals.

1.3 There is a requirement that each local authority reviews its eligibility arrangements and puts into practice all necessary changes by April 2003.

2 Background

2.1 The eligibility criteria is an essential tool to help local authorities balance demand for services against available resources and was introduced with the implementation of Community Care Legislation in 1993. Hampshire County Council has regularly reviewed its eligibility criteria to ensure that care is provided to those most in need. Eligibility criteria is considered at all seven stages of Care Management and there are four key management decision points in the application of the eligibility criteria, namely:

The reception and assessment/emergency decision which identifies who gets priority for assessment

The post assessment decision which matches the needs identified with eligibility to resources

The resource allocation decision which matches needs to appropriate services

The Review decision which identifies changes to needs.

Currently, services are only made available to those people who meet the Eligibility Criteria Category 1

(i) Anyone whose physical, mental or emotional problems mean they are at risk to themselves or others

(ii) Anyone whose physical, mental or emotional state would markedly worsen or who would need residential care without immediate help.

(iii) Anyone faced with immediate severe problems because of family breakdown.

(iv) Anyone whose development has been seriously impaired by abuse, neglect or lack of stimulation.

2.2 The need for guidance on eligibility criteria for adult social care was identified in the 1998 White Paper "Modernising Social Services". Different councils are using different eligibility criteria and reviews of ongoing eligibility are patchy. This leads to considerable variation in access to adult social care which in turn leads to unfairness.

2.3 At the heart of the Fair Access to Care Services (FACS) is the principle that councils should operate just one eligibility criteria and requires that there should not be eligibility criteria for different services.

2.4 To help determine eligibility, the guidance provides a national framework for councils to use. (Appendix 1)

2.5 The guidance is issued under section 7(1) of the Local Authority Social Services Act 1970 and is, therefore, not merely a guide. The Authority is not permitted to vary the wording, as confirmed by the County Councils Legal Services.

2.6 The framework is constructed by identifying 4 factors that are judged key to maintaining the individuals independence.

_ Physical and Mental Health and Safety

_ Management of daily routines

_ Home Environment

_ Involvement in family and wider community life.

2.7 The guidance prioritises the risks faced by individuals into 4 bands:

_ Critical

_ Substantial

_ Moderate

_ Low

2.8 The risks within the framework relate to both immediate and longer term risks. In so doing, the guidance is intended to support a preventative approach to adult social care.

2.9 Once the authority decides where to draw the eligibility line it must use the exact working of the bands above, to describe the needs it will meet.

3. Approach Adopted

3.1 A steering group was established with representatives from staff, Health, independent sector and users of services who produced a tool (Appendix 2) to assist and inform the application of the national framework.

3.2 Wider consultation with departmental staff, Local Implementation Teams via Service Managers, Primary Care trusts via Partnership Managers, Legal Department, Disabled Persons Consultation Group, Hampshire Users Bureau and the Voluntary Sector.

3.3 Awareness raising of IT implications in conjunction with SWIFT presentations and developments

3.4 Presentations to all Adult Teams in Areas.

4. Impact

4.1 The guidance confirms that when setting their eligibility, councils should take account of the resources locally allocated to adult social care. Because of the different resource positions of councils, the guidance does not require councils to reach similar decisions on eligibility, or to provide similar services to people in similar need. (DOH 22/08/2002)

4.2 The Guidance reminds Authorities that it is fully consistent with the financial settlements for Personal Social Services resulting from the Governments spending reviews in years 2000 and 2002, therefore, should have limited resource implications. (LAC 2002) 13 DATED 11.02.03.

4.3 The attached report (Appendix 3) provides an analysis of the impact of the eligibility criteria when applied to a sample of 97 current users. Whilst this is a small unrefined exercise it does give some indication where a small sample of users who currently access services would be placed if assessed against the new criteria. It also indicates that drawing a line for eligibility under the Substantial level of risk would include the majority of people currently assessing services. Drawing the threshold any higher could remove entitlement to services from a number of current service users and leave the authority open to legal challenge as to the reasonableness of the criteria. Drawing the threshold lower would fall outside the resources of the department.

5. Monitoring and review of the FACS process

5.1 The national policy requires councils to audit and monitor their performance in respect of Fair Access to Care Services in the following ways:

_ Gauge the extent to which different groups are referred and following assessment go on to receive services.

_ Monitor the quality of the assessment and eligibility decisions for their staff.

_ Audit service effectiveness with reference to care plans and reviews.

_ Monitor the speed of assessment an subsequent delivery of service in accordance with the local Better Care Higher Standard Charter and the Care Management Quality Standards.

_ Monitor the timing and frequency of reviews.

6. Next Steps

6.1 Development of Operational guidance for individual care groups to be incorporated into the Care Management Practice Manual.

6.2 Publications: Discussions being arranged with the Communications office with regards publicity material for the general public, for staff and for inclusion in the Better Care Higher Standards Charter.

6.3 Training: Presentations have been made at adult specific care group team meetings across the county, in addition to short briefings in localities using the opportunities created by SWIFT roadshows (the new electronic Social Care System). These are intended to raise awareness of the impending changes and highlight the need for staff to attend formal training sessions to support the implementation of the eligibility framework.

6.3.1 It is proposed that a series of half day workshops are delivered in various locations around the County to inform existing staff working in fieldwork teams in all adult and older persons services.

6.3.2 Target Group: Service Managers; Team Managers; all qualified Social Workers; Care Managers and Unqualified Care Managers.

6.3.3 Because of the very limited time available until 7 April implementation date, it is anticipated that the training programme will have 3 phases.

Phase 1: Target Group: Service Managers (Approx 80 staff)

4 half day workshops delivered in late March

Phase 2: Target Group: All qualified Social Workers; Care Managers and Unqualified Care Managers.

20 half day workshops delivered in April, May and June.

Phase 3: Target Group: All new staff or those unable to attend any of the initial programme. Training will be advertised in the Social Services Training Directory and delivered in July and October 2003 and February 2004.

6.3 Information Technology Until SWIFT is operational in 2004 it is proposed that the current eligibility criteria screens are disabled with a minor adjustment being made to screen 5 of 6 in order to capture the new criteria for the Performance and Assessment Framework (PAF) indicators.

7. Financial Implications of Implementation

7.1 The Guidance reminds Authorities that it is fully consistent with the financial settlements for Personal Social Services resulting from the Governments spending reviews in years 2000 and 2002, therefore, should have limited resource implications LAC (2002) 13 dated 11.02.03. We will closely monitor implementation of the new criteria to ensure it does not impact negatively on department budget.

8. Summary

8.1 Whilst the existing Departmental Eligibility Criteria has been well received and used across all care groups, anecdotal and training experience has informed us there remains a perception that some user groups are treated less well than others.

8.2 Front line staff who have had the opportunity to pilot application of the anticipated criteria have found the new framework easy to use and helpful in reaching difficult decisions in a fair and consistent manner.

8.3 The Department of Health Guidance does give the opportunity for a fairer representation of need and is helpful in determining levels of need. In particular it allows for representation of need to be spread across bands which describe critical need as well as risk to independence if needs are not addressed. This could help capture service provision of a preventative nature.

9 RECOMMENDATIONS

That the Executive Member approves the following:

9.1 To agree the department's arrangements for introducing the national framework for determining eligibility for all adult Social Care Services.

9.2 To agree that the eligibility criteria for Hampshire County Council Adult Social Care Services be set to include the Critical and Substantial categories of the Department of Health framework for fair access to care.

9.3 The Executive Member receives an updated report in 6 months advising of the impact on the department's budget.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act