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2014 Conference Presentation

(Inter)national systems AustraliaEnglandFranceGermanyNew ZealandThe NetherlandsUnited Kingdom

2 September 2014

International review of assessment and eligibility for long-term care

Raphael Wittenberg, University of Oxford, United Kingdom
Christophe Eleftheriades, CHSEO, University of Oxford, United Kingdom


The Government described the current system of locally determined eligibility for long-term care as ‘’confusing and unfair for many” and committed in 2012 to develop and test options for a potential new assessment and eligibility framework for England. To inform work on the development of the framework the Department of Health commissioned a study by the Centre for Health Service Economics and Organisation (CHSEO), University of Oxford, to review international experience on assessment and eligibility for publicly funded care and support.

The aims of the study included to discuss and formulate objectives for an adult social care eligibility framework for England, describe the way in which eligibility for supported social care is determined in a number of OECD countries, evaluate comparator frameworks with regard to the identified objectives, and develop options for improving the English eligibility and assessment framework. The study explored the evidence on how these five specific issues are addressed in practice in England and five other countries. Those countries are Australia, France, Germany, the Netherlands and New Zealand, which cover a range of different funding systems and of assessment and eligibility frameworks. It considered the advantages and disadvantages of the different approaches in terms of the promotion of different objectives, in particular different dimensions of efficiency and equity.

One of the key issues under debate has been achievement of the best balance between national minimum eligibility criteria to promote geographical equity and local discretion to permit criteria to reflect local needs and priorities. Greater national uniformity should mean that (at least the perception of) variation in eligibility for services is reduced and that portability of assessments between areas is improved. It might however make the targeting of resources to needs less satisfactory, in which case maximising outcomes for given resources would not be best promoted by a system that left minimal scope for local discretion. Another key issue under debate is how to take account of unpaid (informal) care in determining the eligibility of the person needing care. If emphasis is placed on achieving equality of access to similar care packages, a carer-blind system, where eligibility is unaffected by the presence or absence of unpaid care, may seem more equitable. If greater emphasis is placed on achieving similar outcomes for all people needing care, however, a carer-sighted system may seem more equitable.

Since the completion of this study the Government has consulted on the Care and Support (Eligibility Criteria) Regulations 2014 which set out the new national eligibility threshold for adults with care and support needs and for carers.


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