Adult social care eligibility criteria - innovations and developments: report

Appendix B

Midlothian's Midway Approach: the case for the defence

Graham Kilpatrick, Service Manager, Midlothian HSCP

Graham offered a senior management perspective – as chair and manager of a resource allocation panel in Midlothian. He described himself as playing devil's advocate, putting forward a case for the defence. He described changes in practice in Midlothian in recent years, highlighting the importance of good conversations, focusing on strengths and the role of communities. He spoke of the need to understand trauma and to address inequalities.

Considering the case for eligibility criteria

Most of Graham's presentation looked at the need for eligibility criteria and some of the key questions to consider if looking to replace them. Graham began by looking at why they were introduced in the first place, linking this back to the 1968 Social Work Scotland Act and the statutory duties to assess needs and decide if a service is required to meet those needs. Eligibility criteria were introduced to aid (individual and collective) decision making [to make decision making less subjective / variable – and to be more equitable, consistent and transparent]. Graham acknowledged that eligibility criteria have become a crude tool for managing how the overall annual budget is spent and being accountable for financial decision making. This also relates to the 1973 Local Authority Scotland Act [section 95]. If someone is assessed as having eligible needs then legally the fact that there is insufficient budget isn't in itself a reason not to meet that need. The way round this is to tighten eligibility criteria (rather than demand more budget to meet assessed needs).

Reconciling assessment and allocation

Graham spoke of two systems; the system for assessing individual needs and the system to make sure the money flowing in was used to meet the cost of individual support packages as fairly and transparently as possible – and the need to reconcile the two. He suggested doing this by categorising outcomes into three types (see below).

• Outcomes that mitigate risk and can be allocated funding
• Outcomes that influence how support is provided within the allocated budget
• Outcomes that don't meet criteria for statutory services – in which case explore Universal services / other areas of support

A key concern when thinking about switching off eligibility criteria is one of cost – is it to be cost-neutral or require additional funding? If there is more funding, eligibility criteria would loosen and the current system could work. If not, Graham discussed various aspects of budget where it is difficult to see how spend could be reduced e.g. learning disabilities where 50% of spend is accounted for by 16% with highly complex needs requiring 24/7 care.

Learning

Speaking about his experience of the resource allocation panel in the Q&A session, Graham stressed that the majority of requests were approved because practitioners knew and understood local policy and eligibility criteria and worked to present their cases in terms of demonstrating a clear assessment, and a need under eligibility criteria. In some situations, workers know if something meets eligibility criteria and the panels can be helpful to them. What is less clear is how many people are screened out prior to getting to the panel stage.