Can there be separate health or social services eligibility criteria for each client group, or each service which the authority provides?

No. The Care Act 2014 introduced national eligibility criteria (in the Eligibility regulations) which all authorities have to apply and the statutory guidance provides examples and guidance as to how these should be applied to various client groups. Local guidance on interpretation would need to stay within the very limited boundaries left.

The process of assessment should no longer be geared to assessing clients for specific services in any case. Guidance 10.47 “However the person chooses to have their needs met, whether by direct payment, by the provision of local authority-arranged or directly provided care and support, or third-party provision, or a mix of these, there should be no constraint on how the needs are met as long as this is reasonable. The local authority has to satisfy itself that the decision is an appropriate and legal way to meet needs, and should take steps to avoid the decision being made on the assumption that the views of the professional are more valid than those of the person. Above all, the local authority should refrain from any action that could be seen to restrict choice and impede flexibility.”.

This does not mean that a local authority cannot have eligibility criteria for access to a particular service which it provides (e.g. a specialist team). There is nothing in the law which specifically prevents this form of detailed criteria being created. However the authority must have a coherent non-discriminatory reason for so ordering its affairs and a prudent authority will have one eye on the s5 market shaping duty to promote diversity and quality in provision of services and considering carefully whether such criteria are consistent with maximising choice for clients. Additionally it will be important to ensure that the operation of such criteria in practice do not conflict with key legal duties (such as the s9 assessment duty which requires assessment for anyone with the appearance of needs for care and support). Other potential practical difficulties include that people do often fit into more than one client group and then that leads to difficulties for practitioners.

A factor tending more in the other direction, however, is that it makes logical sense to have a different form of words describing ascending levels of risk and dependency of different sorts, for different kinds of human difficulty. It obviously makes no sense to make practitioners squeeze people into pigeon holes which were designed for another type of problem altogether. The difficulties with which sensorily impaired people contend on a daily basis, for instance are not capable of being described in words which would also cover those faced by people with drug or alcohol problems. The same point can be made for people with a learning disability who are able bodied and people with no mental impairment whatsoever, but who are tetraplegic. We think the right thing to do, therefore is to use different words to describe the client group’s most common profiles, but to equate client groups’ overall range of presenting circumstances into 3 or 5 or however broad bands are thought to be appropriate. Thus clients in group 2 from different client groups would have equal entitlement to access a particular service.

We do not think that criteria should ever be related to entitlement to social care services in general, however, because this would conflict with the statutory national eligibility criteria.

Local authorities may also use client group specific resource allocation tables and we think that this is quite legitimate. However, there must be room for the lawful exercise of discretion in the application of such tables where there is evidence that they do not ‘fit’ a particular case. It is also vital to note that resource allocation processes only ever produce an indicative personal budget. A lawful actual personal budget will always be the amount which is sufficient to meet that individual’s assessed eligible unmet needs appropriately (s26 Care Act 2014).

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