FACS and fantasies…

Another day, another Guardian article about proposed cuts to adult social care funding, and the predicted dire consequences for services and for people.

Councils must manage their expenditures to match their incomes, and in social services they have a handy mechanism whereby they should, in theory, be able to cut costs without legal challenge: ‘Fair Access to Care Services’ [FACS] – originally published as Section 7 guidance in 2002, and superseded in 2010 by ‘Prioritising Need in the Context of Putting People First’.

FACS is less than the last legal word on eligibility but more than just a vague rule of thumb. In essence, if a person is not satisfied with either the process or the outcome of their assessment of eligibility for social care or support, they can turn to FACS and ask: ‘Have they followed the guidance?’ If the answer is substantially ‘no’, then, in general terms, there would be a case to take to judicial review.

Central to FACS has been a move away from any determination of eligibility for social services that was primarily or largely based on degree of disability or impairment. The old codification of ‘mild’, ‘moderate’ or ‘severe’ learning disability, for example, might or might not survive as a paradigm for describing and determining comparative disability, but it was to have no bearing on an assessment of whether the person had ‘low’, ‘moderate’, ‘substantial’ or ‘critical’ risks to their independence as scripted by FACS.

While it may be more than likely that a person with a severe learning disability and, perhaps, additional profound physical disabilities would be eligible for social services, it was also to be the case that someone else with but a mild disability who was at risk of losing their job because they couldn’t get to work on time would – according to FACS – be at ‘Critical’ risk to independence. For the former you might need to put in a top-cost, 24/7 care package; for the latter maybe just buy him an alarm clock, or get someone to phone at 7 in the morning to check he was up. The scope or cost of the package required to meet the eligible need was for the Council to determine, but the principle of eligibility was not a matter of impairment but of risk to independence whatever the impairment.

So far so rather wonderful. Councils then were asked to plan their budgets (no sniggering at the back!) according to the funds they could reasonably apply to adult social services and the likely cost of meeting risks to independence in the four FACS categories: Critical, Substantial, Moderate, Low. They are entitled to say – they need some figures to support their argument – “We can no longer afford to meet Moderate needs, but only Critical and Substantial needs” and that, therefore, from next financial year [or even during a financial year] people who had been assessed as eligible for social care and support would no longer be eligible and services could be lawfully withdrawn.

Guidance and common sense as well as common decency would argue that if you withdraw an established and necessary support service from someone, it’s pretty likely that their situation will deteriorate until they become eligible once more at the higher threshold at even greater cost, and that, therefore, the game may not make the candle cost-effective never mind worthy. There are counter arguments about ‘learned dependency’, though perhaps more a case for providing time-limited interventions with specific outcomes rather than offering sine die – or purpose – day care lest something worse befall.

Be any of that as it may, buried in the comments on the Guardian article is a lament from a worker for a London council that eligibility for services is once more by degree of impairment and not risk to independence:

‘Services have been cut to those assessed as having moderate to mild learning disabilities, these include day services as well as outreach services. These people have been abandoned; there is nothing to take the place of the services that are gone. For now I still have a job but we are only supporting those with severe and profound disabilities.’

Assuming that is a full and factually accurate statement of the Council’s position and procedure then one has to ask: who are these folk who don’t understand that social services is a legal system of duties and powers and not a matter of personal discretion? Is it indeed possible that ten years after the introduction of FACS one of its key principles on eligibility is not known or simply ignored? You bet.

Whenever I train social care staff in FACS – from senior managers to front-line staff – an early question is always: “When was the last time you re-read the FACS documents, those essential manuals that guide you in the theory and instruct you in the practice of adult social work?” It is a naughty question, because from the embarrassed silences and avoiding glances out the windows the next question inevitably is: “OK, so how many of you have ever once read FACS, have ever sat down and thought ‘I really need to know what I’m doing here – what is required, what is forbidden and what is a matter of professional discretion’?”

If it’s three out of thirty I’m doing well. Is that any way to run a bath let alone a social services department? No. But neither is it acceptable that – if it is the case – local people are not up in arms saying: “You may not, but we have read FACS; we know what you can and cannot do, and you can’t do that!”

Of course when local people finally wake up to the reality of Personal Budgets / Self-Directed Support / ‘Cash For Care’ and find out how Councils have been manipulating the processes and mechanisms in order to cut corners and costs, why then there will be some right and proper fireworks. Too late possibly though for anything more than sound and fury: the last government set off on the road of substituting adult social care based on need with a means-tested welfare benefit system; this government is merely seeking to finish the job:

“We used to give you £500 towards your support needs, but from this year it’s been reduced to £450 because we can. Take it or leave it.”

“Right ho!”

You don’t fancy that? Nor do I.

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March 26, 2013 · 12:01 pm

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