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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views


Eligibility

The current care and support system has often been said to be complicated and unfair, because local authorities are able to set their eligibility thresholds at different levels. Even where local authorities set their criteria at the same level these can be interpreted differently.

As a result, people often feel unsure about whether they are eligible for care and support, and fear that a local change in the threshold will mean losing the care they need. To make access to local authority care and support clearer and more equal across England, and to ensure a minimum level of need which must always be met, we are introducing a national minimum eligibility threshold.

The draft eligibility regulations have already been subject to considerable consultation.

The draft guidance on assessment and eligibility, together with the draft Care and Support (Eligibility Criteria) Regulations 2014, cover:

  • the national minimum threshold, which describes needs which meet the eligibility criteria for adults with care and support needs and carers
  • how to interpret the eligibility criteria
  • considering the impact of needs on the person’s wellbeing

Read Factsheet 3: assessments and eligibility and
Factsheet 8: the law for carers

The eligibility regulations are intended to allow local authorities to maintain existing access to care and support, in the vast majority of cases.
Respond to question 14 below.

The eligibility regulations have been revised following engagement to date, to focus on outcomes and reflect how the new system will ensure a personalised approach to care and support. Some stakeholders have continued to ask whether the regulations could go further to reflect the person’s outcomes, while maintaining the threshold at the level of having a significant impact on the person’s wellbeing.

To make the wording more outcomes-focused we have in particular looked at the definition of the adult’s ‘basic care activities’, which are the essential care tasks that a person carries out as part of normal daily life. The question is whether these could be described as outcomes rather than activities.

The draft regulations define these activities as eating and drinking, maintaining personal hygiene, toileting, getting up and dressed, getting around one’s home, preparing meals, and cleaning and maintenance of one’s home.

As currently described, these activities define needs which are widely understood, and are used to inform the discussion about what outcomes the person wants to achieve. However, using a list of activities or tasks in this way risks undermining the focus on outcomes which is espoused by the Act in other areas, and we would like to consider alternative approaches during consultation.

If we were to redefine these basic care activities as outcomes, the following might be an example of the sorts of concepts that could be used:

  • managing/maintaining nutrition for good health
  • maintaining personal hygiene and everyday appearance
  • living comfortably and safely at home
  • cleaning and maintaining one’s home

Respond to questions 15 and 16 below.

Section 21 of the National Assistance Act 1948 requires local authorities to provide residential accommodation in certain cases. Under the new framework, the eligibility criteria will apply to the provision of all types of care and support including residential accommodation.
Respond to question 17 below.

The assessment and eligibility guidance sets out what local authorities should be doing when assessing an adult or carer and determining whether they have eligible needs.
Respond to question 18 below.

Question 15: Do you think that the eligibility regulations give the right balance of being outcome-focused and set a threshold that can be easily understood, or would defining ‘basic care activities’ as ‘outcomes’ make this clearer?

Read: guidance on assessment and eligibility The Care and Support (Eligibility Criteria) Regulations 2014 Annex C of the consultation: Consultation to date on the draft eligibility regulations Back to eligibility

Question 16: Does the current definitions of ‘basic care activities’ include all the essential care tasks you would expect? If not, what would you add?

Read: guidance on assessment and eligibility The Care and Support (Eligibility Criteria) Regulations 2014 Annex C of the consultation: Consultation to date on the draft eligibility regulations Back to eligibility

Question 17: Are you content that the eligibility regulations will cover any cases currently provided for by section 21 of the National Assistance Act 1948?

Read: guidance on assessment and eligibility The Care and Support (Eligibility Criteria) Regulations 2014 Annex C of the consultation: Consultation to date on the draft eligibility regulations Back to eligibility

Question 18: Does the guidance adequately describe what local authorities should take into consideration during the assessment and eligibility process? If not, what further advice or examples would be helpful?

Read: guidance on assessment and eligibility The Care and Support (Eligibility Criteria) Regulations 2014 Annex C of the consultation: Consultation to date on the draft eligibility regulations Back to eligibility

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