Key findings

• The introduction of a national minimum eligibility threshold at the FACs ‘moderate’ level was estimated to lead to an overall 23% increase to 1.37 million in the number of local authority-funded social care clients, for 2010/11.
• Gross expenditure was estimated to increase by £2.4bn to £18.8bn, for 2010/11. The additional annual gross expenditure was estimated to rise to £3.3bn for 2020/21, with the overall trend through time overwhelmingly reflecting the changes experienced by the older client group.

Why was the research needed?

The 2003 Fair Access to Care Services (FACS) guidelines were introduced to provide local authorities with a common framework for determining individuals’ eligibility for social care services and to address inconsistencies across England. Under FACs, the needs of assessed individuals are categorised as critical, severe, moderate or low. Each English local authority decides which of these groups are entitled to public support and the minimum eligibility threshold therefore varies across the country.

In recent years, an increasing number of councils have restricted publicly-funded services to critical or severe needs. FACs criteria are also subject to interpretation and earlier CPEC research has demonstrated they are not applied consistently. The Government’s policy response is to introduce national minimum eligibility criteria for adult care and support and this required robust analysis of the potential economic implications of the introduction of a new eligibility policy.

What did the research team do?

This study quantified the annual costs from 2010 to 2020 of introducing national minimum eligibility criteria at the ‘moderate’ FACs level in England. The analysis, using CPEC macro and dynamic microsimulation models, incorporated: publicly available data on local authority characteristics including service provision, expenditure, demography and eligibility; and findings from a 2011 national survey of eligibility criteria in England (79 local authorities took part) carried out by CPEC, including details of how clients and expenditure are distributed across the four FACS groups. The results were applied individually to the 152 local authorities in England and aggregated to provide national-level estimates.

Research impact

• This research and additional analysis fed directly into the policy development work at the Department of Health that led up to the June 2013 publication of the Draft national eligibility criteria for adult care and support: a discussion document.
• The analysis was commissioned by Scope and provided projected cost implications for a nationally applied minimum eligibility threshold at the FACs ‘moderate’ level. In preparing the draft regulations, the Department of Health also asked the research team to carry out further work to estimate the additional cost to the system of introducing new national minimum thresholds. 
  
  This work estimated that the additional cost of local authorities of meeting a national eligibility criteria set at the FACs ‘substantial’ level was likely to be around £23 million. The published proposed national threshold is set ‘at a level which would in terms of its practical outcome be equivalent to ‘substantial’ in the current system’.
  
  Local authorities will not be able to restrict eligibility beyond this threshold. Additionally, eligible needs will in future be described in the language of the Care Bill, focused around the impact on well-being.

Further reading

Implications of setting eligibility criteria for adult social care services in England at the moderate needs level, PSSRU Discussion Paper DP2851
Fernández J-L, Snell T, Forder J, Wittenberg R (2013)  

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