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2012 Conference Presentation

Equity EnglandUnited Kingdom

7 September 2012

Assessing eligibility for care: the English case

Tom Snell, London School of Economics, United Kingdom
Jose-Luis Fernandez, London School of Economics, United Kingdom


Fair Access to Care Services (FACS) guidelines were introduced by central Government in 2003 to provide English local authorities with a common framework for determining individuals’ eligibility for social care services and to address inconsistencies in outcomes across the country. Using these guidelines, local authorities assess needs according to a universally-adopted scale ranging from low to critical but retain the autonomy to decide the level at which individuals are eligible to receive care.

While the eligibility policies adopted by local authorities are publicly available, little use has been made of FACS classifications as a measure of (and means of addressing) regional variation in targeting practices. To this end, PSSRU at the London School of Economics conducted a survey of English local authorities in the second half of 2011, collecting authority-level data on the allocation of resources from over 80 local authorities and responses to hypothetical case studies from over 600 local authority care managers and assessors to gain an insight into the assessment process.

Early findings from the survey suggest that, other things equal, systematic differences in the classification of dependent individuals exist between local authorities, and in particular between local authorities with different eligibility thresholds. According to the findings, care managers from local authorities with more restrictive eligibility criteria are more likely to “up-code” the need rating given to hypothetical cases, effectively limiting the influence of local FACS policies in determining eligibility for the receipt of care. Expanding on these findings, the paper (due for completion prior to the conference) will discuss the role and effectiveness of the FACS framework both as a measure of variability and as a means of influencing policy across local authorities.


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