Need Social Care?

Eligibility - Fair Access to Care

Adult Social Care

There is a wide range of community care services, for example, arranging help in the home, a day care service or making arrangements for providing a place in either a residential or nursing home. In order to establish whether an individual is eligible for a community care service, there are three stages to go through: -

1. Qualifying for a Community Care Assessment
2. Community Care Assessment to work out needs
3. A decision as to whether the individual is eligible to receive a service under Fair Access to Care Services

Stage One - Qualifying for an Assessment

The threshold for qualification of a Community Care assessment is a low one. Adult and Community Services – as the Local Social Services Authority - is under a duty to assess an individual where it appears to it that a person may be in need of community care services that the local authority may provide or arrange.

When an individual first makes contact with Adult and Community Services to enquire about services, they will be asked about their circumstances, to establish whether it appears that they may be in need of any such services. Where it appears that they may be in need of community services they will be referred to the relevant team for an assessment. The individual will not be asked about their financial circumstances at this stage and if the person appears to Adult and Community Services to be in need of social care services, they will receive an assessment regardless of their financial status.

Stage Two - Community Care Assessment - Working Out Needs

The Community Care Assessment is a process where Adult and Community Services with the involvement of the individual and where appropriate, in consultation with family members, carers or an advocate will gather sufficient information to work out what the individual’s needs are.

Stage Three - Deciding Who is Eligible for a Service

Adult and Community Services is not required to meet all needs identified in the assessment, this is because the demand for services outweighs the money available to provide services to meet all needs. In working out what needs we will meet we are required to have an Eligibility Criteria for services.

In setting our Eligibility Criteria we must follow Statutory Guidance set out in Fair Access to Care Services (FACS) Policy Guidance (Department of Health) 2002. FACS sets out an Eligibility Framework for all Adult Social Care Services. The Eligibility Framework is graded into four bands – critical, substantial, moderate and low, which describe the seriousness of the risk to independence or other consequences if needs are not addressed.

When setting its Eligibility Criteria the Local Authority has discretion, taking into account its resources, to decide which bands of need will be met. In common with most Local Authorities, Worcestershire County Council has decided it will only fund services to meet needs where the risk to independence or other consequences fall into the critical or substantial band. This is known as Worcestershire’s Eligibility Criteria.

The Local Authority does not have discretion as to what the bands themselves are or the factors to be considered in deciding into which band an identified need of a person goes this is prescribed by the Eligibility Framework as set out in FACS.

The four bands are as follows:-

Critical - When

• Life is, or will be, threatened; and/or
• Significant health problems have developed or will develop; and/or
• There is, or will be, little or no choice in control over vital aspects of the immediate environment; and/or
• Serious abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• Vital involvement in work, education or learning cannot or will not be sustained; and/or
• Vital social support systems and relationships cannot or will not be sustained; and/or
• Vital family and other social roles and responsibilities cannot or will not be undertaken.

Substantial - When

• There is, or will be, only partial choice and control over the immediate environment; and/or
• Abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or
• Involvement in many aspects of work, education or learning cannot or will not be sustained; and/or
• The majority of social support systems and relationships cannot or will not be sustained; and/or
• The majority of family and other social roles and responsibilities cannot or will not be undertaken.

Moderate - When

• There is or will be an inability to carry out several personal care or domestic routines; and/or
• Involvement in several aspects of work, education or learning cannot or will not be sustained; and/or
• Several social support systems and relationships cannot or will not be sustained; and/or
• Several family and other social roles and responsibilities cannot or will not be undertaken.

Low - When

• There is, or will be, an inability to carry out one or two personal or domestic routines; and/or
• Involvement in one or two aspects of work, education or learning cannot or will not be sustained; and/or
• One or two social support systems and relationships cannot or will not be sustained; and/or
• One or two family or other social roles and responsibilities cannot or will not be undertaken.

Needs are categorised as presenting needs and eligible needs. The purpose of the assessment of needs is to identify and evaluate an individual’s presenting needs and how they constrain to support his capacity to live a full and independent life [para 38 FACS]. During the assessment process information of all presenting needs is gathered and then evaluated against the risks to the individual’s: -

• Autonomy;
• Health and Safety;
• Ability to manage daily routines;
• Involvement in family or wider community life [para 42 FACS].

If the risk to independence if the need were not met is evaluated as either Critical or Substantial then the presenting need becomes an eligible need to be met by providing or arranging a community care service.

If an individual is assessed as having eligible needs, they may nevertheless be required to pay for or make a contribution toward some community care services – See our Charges for Services information.

Whether or not you meet the eligibility criteria for County Council funded services, our Access Centre can provide you with advice and information about sources of help and support within the community.

This information is also available to download.  (119.09 KB)

Contacting Adult Social Care Services

Call : 0845 607 2000

Email: socialcare@worcestershire.gov.uk

Post: Social Care, PO Box 585, Worcester, WR5 2NG

Fax: 01905 768056

Minicom: 01905 768052

Hospital Teams

Worcestershire Royal Hospital - 01905 760700

Alexandra Hospital - 01527 503873

Worcestershire Carers Unit - 01905 728824

Emergency Duty Team (Out of hours service) - 01905 768020