Archived decisions
Hampshire County Council
Executive Member - Adult Social Care Item 3
28 July 2006
Change to the Eligibility Criteria under which Community Care Services are Delivered
Report by the Director of Adult Services |
Contact: John Clifton Ext: 7283 email: [email protected]
Approved by: |
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Date of decision: |
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Councillor Patricia Banks |
Hampshire County Council
Executive Member - Adult Social Care Item 3
28 July 2006
Change to the Eligibility Criteria under which Community Care Services are Delivered
Report by the Director of Adult Services |
Contact: John Clifton Ext: 7283 email: [email protected]
2 2.1 |
Impact Assessment Views will be sought from organisations representing black and minority ethnic groups. |
3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 |
Government's Fair Access to Care Eligibility Criteria Under the Fair Access to Care Guidance there are four categories of eligibility and these are set out as follows: Critical: Someone's need for help is `critical' if one or more of the following circumstances apply: _ life is, or will be threatened _ significant health problems have developed, or will develop _ there is, or will be, little or no choice and control over vital aspects of the immediate environment _ serious abuse or neglect has occurred, or will occur _ there is or will be, an inability to carry out vital personal care or domestic routines _ vital involvement in work, education or learning cannot, or will not be, sustained _ vital family and other social roles and responsibilities cannot, or will not be, undertaken Substantial: Someone's need for help is `substantial' if one or more of the following circumstances apply: _ there is, or will be, only partial choice and control over the immediate environment _ abuse or neglect has occurred, or will occur _ there is, or will be, an inability to carry out the majority of personal care or domestic routines _ involvement in many aspects of work, education or learning cannot, or will not, be sustained _ the majority of social support systems and relationships cannot, or will not, be sustained _ the majority of family and other social roles and responsibilities cannot, or will not, be undertaken.
Moderate: Someone's need for help is `moderate' if _ inability to carry our several personal care or domestic routines _ involvement in several aspects of work cannot be sustained _ several social support systems, relationships, family and other social roles cannot be sustained _ several family and other social roles and responsibilities cannot, or will not, be undertaken Low: As above, but to a lesser degree, i.e. they can sustain most roles. Since these criteria were introduced, Hampshire's policy has been to provide services to people in the top two categories of critical and substantial. The eligibility criteria for Hampshire County Council Adult Social Care services were set to include the Critical and Substantial categories of the Department of Health framework for Fair Access to Care from April 2003 (as approved by the Executive Member on 21 March 2003). HThere are still some people in the lower two categories who were receiving care prior to the introduction of the Fair Access to Care guidelines who will be assessed to establish whether it would be appropriate to remove them from service if they do not meet the current categories of critical or substantial. The budget pressures on the Adult Services Department are well documented elsewhere (see Hampshire County Council Cabinet 26 June 2006). The Department provided in excess of £11m more care than it was funded for in 05/06. That pressure continues into this financial year and it is essential that the amount of care provided meets the available budget level insofar as is reasonable and lawful. The Department is providing care to more people than it can afford and care packages have been increasing in size and cost. One part of the financial recovery programme is to review the application of eligibility criteria. This will have implications across the whole system and family, friends and voluntary organisations will need to be more engaged in support individuals in need. The case studies in the appendix to this report illustrate that the assessed need of the individual is not hugely different between the categories of critical and substantial. What is different is the ability of relatives and friends to provide support networks of care. Accordingly, if someone is receiving considerable amounts of care from a relative and that relative becomes ill, then the individual will often move into the category of critical rather than substantial. As the circumstances of individuals are often complex and changing, it is proposed that if the categories of persons eligible for a service change then a programme of training, briefing and development for care managers and their managers will be undertaken by the Department. The training and development process will also be informed by the feedback that comes from consultation . While action will be taken to review all people in the two lower categories of the eligibility criteria with a view to re-categorising them or removing service, the Department will also be taking steps to ensure that services are not provided for those clients whose needs are such that they should be receiving NHS funded continuing care. This is as important for the Department as it is for users, as NHS funded care is free at the point of delivery. This work will be carried out in conjunction with health partners, and will be informed by Department of Health guidance on the issue as well as legal advice. The Department will undertake a consultation and information giving process if the Executive Member takes this decision. The process will last for three months. The process will be designed to inform organisations and individuals of the Department's proposal to adopt eligibility criteria at "critical" only for community care assessments and will consult on this proposal, its implications and issues surrounding implementation. The consultation process will seek views from people affected by the proposal which will include: Organisation of and for users and carers; private sector providers; voluntary sector providers; voluntary organisations; the NHS; District Councils, staff and organisations representing black and minority ethnic groups and the Social Care PRC. In accordance with the Cabinet report the process will be subject to legal advice. Timescale. As August is a difficult month in which to consult, the process will begin in August but will be reported at the Executive Members' Decision Day in December. If the Executive Member agrees to a change then implementation would start in January 2007 provided that it remains appropriate in the light of the current timetable. |
Recommendation(s) | |
That: |
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The Executive Member agree to the information and consultation process to move to eligibility criteria critical only to begin in August and the outcome of which to be reported at the Executive Member Decision Day in December 2006. |
Section 100 D - Local Government Act 1972 - background papers
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
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I/Social Services/HQ/Dep Dir/06 28-Jul-06
Appendix 1.
Appendix 1 - examples of critical and substantial need.
Critical need.
Mrs A is aged 83, she has diagnosis of vascular dementia, and lived with her husband who was her main carer. Mrs A also has ischaemic leg ulcers which are so painful she is prescribed morphine and District Nurses attended daily to dress her ulcers. Her mobility is variable, she has a shuffling gait, she uses a Zimmer frame but still experiences falls. Mrs A had a stroke 5 years ago and has some left sided weakness as a result. Mrs A has a very poor appetite and is prescribed fortified nutritional supplement drinks.
Mr and Mrs A were supported by a package of care (under substantial eligibility criteria) to assist with personal care, washing and dressing of daily 30 minutes visits provided by an independent care agency.
They have one daughter who lives nearby, who is recently widowed.
Mr A attended to all of his wife's other needs himself. He also had health problems of Chronic Obstructive Airways Disease (which made him breathless), arthritis, diabetes and partial sight loss. A carers assessment had been carried out in the past and Mr A wanted to look after his wife himself as far as possible.
Last month Mr A experienced severe chest pain and went to see his GP who arranged for him to be admitted to hospital immediately.
Mrs A's needs are now critical:
· `Life is or will be threatened' - she is at high risk, if left at home without supervision, of causing harm to herself - ie cooker use, wandering looking for husband, not aware of common dangers.
· `Significant health problems' - morphine needs to be monitored.
· `There is, or will be, little or no choice and control over vital aspects of the immediate environment' - Mrs A relies on carer who is no longer able to continue due to acute episode of ill health.
· `Serious abuse or neglect has occurred/ or will occur' - Mrs A is at risk of self neglect as she cannot initiate care for herself
· `There is or will be, an inability to carry out vital personal care or domestic routines' - Mrs A does not have the cognitive ability to recognise that she needs to eat and drink, she would be unable to use the toilet and to date has remained continent due to her husband's prompting. She is in need of immediate support.
Mrs A was assessed and urgently placed in a specialist dementia care residential home on a respite basis as a short term intervention to meet her critical needs. As Mr A has now died it is likely that she will remain in the rest home on a permanent basis.
Critical need.
Mrs B - not previously known to the Department, fell out of bed and was seen by the GP recently, who assessed her as needing no further medical intervention. Both Mrs B and other agencies then began to contact Adult Services Reception & Assessment Team frequently. The initial request was for meals, but a picture began to emerge of someone who was struggling with more issues than that, with some of these difficulties predating the fall.
The joint agency Local Intermediate Care Team (which includes Adult Services domiciliary carers) were approached to provide some immediate assistance and try to help establish what her full needs are. A picture of not eating or drinking properly became clear. Mrs B was calling the warden several times a day and had been found with pans burning on top of the gas cooker. Some levels of confusion are apparent, but it is difficult to establish at this early stage whether this is due to recent illness or a more ongoing problem. Her own GP is currently on holiday and we are requesting that the locum GP refer for a specialist psychiatric assessment. In the meantime Home Care are visiting each lunch time to try to ensure that she has eaten and assist in building up a fuller picture of her circumstances. Two carers are needed as she lashed out at one of the initial carers from the Intermediate Care Team when they touched her on the arm.
Because of the immediate concerns about her health and wellbeing this was felt to be critical both in terms of the urgency with which we had to respond and the need to provide services. The case will be reviewed as the situation stabilises.
Substantial need.
Mr C is aged 69, has a diagnosis of multiple sclerosis and he is wheelchair dependent. He suffers with involuntary spasms of his limbs to varying degrees which makes it difficult for Mr C to cook own meals, feed himself or hold a drink. He requires hoisting for all transfers.
Mr C is supported at home with a package of care (under substantial eligibility criteria) to assist with personal care, washing, dressing and toilet management of 45 minutes in the morning daily with 2 carers and 30 minutes afternoon daily, again with 2 carers.
Mr C's wife attends to all of her husband's other needs herself. She also has her own health problems, she is insulin dependent diabetic and is currently waiting for a heart bypass operation. A carers assessment has been carried out to support Mrs C's need for respite. Respite is provided in the form of one day a week at a day centre and 4 weeks respite a year in residential care under the Direct Payments Scheme.
Mr and Mrs C have two daughters. One lives 200 miles away, the other lives locally, she has 3 young children and has also been diagnosed with Multiple Sclerosis.
Mr C's needs are substantial:
· There is, or will be, only partial choice and control over the immediate environment - Mr C relies on a carer whose own health is now compromised therefore there is a limit to how much care she is able to provide.
· There is, or will be, an inability to carry out the majority of personal care or domestic routines - Due to Mr C's physical disabilities he needs assistance with all transfers i.e. hoisting from bed to chair. He needs assistance with washing, dressing & toilet management.
Substantial need.
Mr D has multiple health problems including past cerebral vascular accident (stroke), confusion and prolapsed bowel. He lives with his wife who is providing all meals. His son had been visiting each morning and each evening to carry out all personal care, helping his father out of bed, washing and dressing him and getting him ready for the day - then doing the whole process in reverse at the end of the day. Mr D's son was under some stress and approached us for some support. Adult Services have provided morning and evening care two days a week.
Adult Services assessed this a substantial rather than critical case as, albeit with some difficulty, the family had been managing until then and the son was still prepared to continue. If, as is often the case, the carer had been at immediate risk of breakdown his needs would have been defined as critical.