Health

How councils decide who needs care

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Media captionPhilip Francis explains how a needs assessment works

Anyone who wants their local authority to help with their day-to-day care will first have to be assessed to see whether or not they are entitled to council support. This is the gateway to getting either services or direct financial payments for care.

In most local authorities in England, only people whose needs are very high are eligible for help with such things as getting up, washing and dressing. From April 2016, even if you are paying for yourself, to ensure the cost of your care counts towards the government's new care cap, you will have to be assessed.

Only what are called "eligible needs" will count towards the cap. There is a separate financial assessment. At the moment, anyone with assets above £23,250 does not get help paid for by their council.

So how does it work?

Philip Francis is a social worker who carries out needs assessments in Hertfordshire. Usually he visits people in their home so he can get an idea of what their life is like, what they can do for themselves and what they need help with. He may also give them advice on equipment that can make their lives easier.

"The main focus of my role is to ensure and promote wellbeing and to support their independence," says Mr Francis.

During an assessment, it is his job to work out the right level of care. "Basically it is a chat so we'll sit down with the person, we'll identify what their need might be," says Mr Francis.

"So if, for example, it is a need that is affecting their ability to complete tasks in the kitchen or tasks in the bathroom, we would look at [whether] they get help from a family, neighbour or friend.

"If a person says they are struggling with a certain issue, we might ask them to try to perform that thing, for example, getting on and off a chair safely. It is just to ensure they are completing that task safely or to see if they might need some equipment to help them do that."

Other people

Family, friends and health professionals may also be asked for information, with the permission of the person being assessed. If someone is struggling to explain what they need, there is a duty on the authority to provide them with an advocate.

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Image caption Assesors look at how people cope with daily tasks such as washing and dressing

In Hertfordshire, as with most local authorities across the UK, only people who have what are called substantial or critical needs are eligible for support. From April 2015, there will be a national minimum level at which people get help. The terms used will be different, but in practice it will be set at what is currently substantial need.

Mr Franics says deciding whether someone is entitled to help means weighing up what the impact would be if they don't get support.

"For instance," he says, talking about the question of critical needs, "would their life be in danger? For substantial need, would they be able to partially complete a task but need some support to do so."

According to a report by charity Independent Age and think tank the Strategic Society, for someone to be eligible for support, they are likely to need help with at least three day-to-day tasks. These are known as activities of daily living (ADL). This might, for instance, be help with preparing meals, bathing or getting in and out of bed.

But even when someone is not eligible for local authority support, Mr Francis says, the assessment is important.

"It is about providing information and advice at the right time, signposting to other organisations."

What happens next?

After the assessment is completed, the local authority will draw up a care and support plan that offers that person a budget for their care. A review is usually carried out a few weeks later to check the plan is working and then there will regular reviews, often after six or 12 months.

The number of people getting local authority support is falling. The latest report from the charity Age UK says in the past three years, the number of people aged 65 and over getting council-funded care in England has dropped from just over a million to nearly 850,000.

The Local Government Association says councils do protect the most vulnerable, but that they are chronically underfunded. The Department of Health says it has put an additional £1.1bn extra funding into social care this year in addition to extra funding in previous years. It says it is for local authorities to decide how they spend their budgets.