Index of questions

• What is the difference between presenting needs and eligible needs?
• Who is responsible for deciding the level of eligibility and what happens if person disagrees with the practitioner undertaking the assessment or review?
• What happens if the practitioner believes the person should have a service but they fall below the threshold line?
• What happens if an individual has needs that are above the threshold line which the family wish to meet?
• Will all assessment reviews be face to face?
• Are there services we do not provide?
• What happens to people who have presenting needs and are not eligible for SSD assistance?
• Isn't this policy all about making cuts?
• How does FACS interface with other policies from other agencies?
• What if I think the policy is wrong?
• In an effort to manage our demand we may have to 'cap' the number of days of day care offered. I appreciate this isn't in line with identified need. How does this sit with FACS?
• Some of our staff think we should not be doing any open-ended contracts for shopping or meals help from now on. Is this correct?
• Can you clarify what is happening about meals, shopping, and housework?
• Will Social Services expect all non-emergency patients to have been screened using your eligibility checklist before accepting a referral?
• When you say that Primary Care staff need to be aware - to whom are you referring: GPs, Practice Nurses, Receptionists?
• What about the many issues for OT's around duty of care and our legal responsibilities?
• What about our experience at the half day awareness sessions from which we believe this approach will not lead to greater consistency?
• What about consistency in terms of the services we provide to people with similar eligible needs?
• How will we consider equity across the district for how we translate carers eligible needs into agreeing what we will do to support them?
• How will we identify families who would be assessed as having 'moderate' needs, but would benefit from preventative support to maintain their situation, and how will this be supported?
• How will we differentiate whose need we are meeting, when a need is expressed by both the carer and the cared for person?

See also:

More FAQs.  These links will take you to FACS questions and answers specifically relating to :

• Practice Issues
• Process Issues
• Decision Making About Services

What is the difference between presenting needs and eligible needs?

People have presenting needs both at initial contact and throughout an assessment or review. Once an assessment has been completed some needs will remain presenting needs, that is they are below the threshold line for services whilst others will be eligible needs as they are above the threshold line.

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Who is responsible for deciding the level of eligibility and what happens if person disagrees with the practitioner undertaking the assessment or review?

Discussion and disagreements should be addressed with the person and their carer at the assessment stage before completion of the Eligibility Criteria Checklist. If differences come to light at the point of completing the Checklist which are not resolved through discussion and negotiation, the practitioner, together with the responsible social services manager, should agree the eligibility level based on the analysis of the information gathered at the assessment/review.

The individual's reasons for disagreeing with the outcome should be recorded and she/he should be offered the opportunity to discuss this with the practitioner/manager and be offered access to the complaints process.

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What happens if the practitioner believes the person should have a service but they fall below the threshold line?

This question highlights the need to think in a different way. First, the checklist is not about deciding on which services someone will have or not have. It is about deciding whether someone is eligible for a service, based on the assessment of need and the impact of any identified risks to a persons safety or independence within a timeframe.

You need to predict the impact of the risk if the needs are not addressed. Is the risk likely to happen immediately without support (critical), within 3 months (substantial) , within 12 months (moderate) or longer than 12 months (low).

Secondly, the new approach is more sensitive to an individual's situation. In the past, following an assessment, a person was eligible for services depending on whether they were A,B,C,D category together with any local service criteria. This approach recognises that some of an individual's needs may be eligible for services whilst others may not. Hence an individual may have some needs above the threshold line for services and others below the line based on the assessment of their individual situation.

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What happens if an individual has needs that are above the threshold line which the family wish to meet?

It remains a presenting need and not one that requires social care support. It is important to clarify that the family is happy and willing to sustain this caring/support role and understand the impact of doing so.

The assessment should have identified the interaction between the individual/carer/environmental factors and addressed the sustainability of the carers situation either through a joint assessment or a separate carer assessment.

The Care Plan should clearly identify the presenting needs that family/neighbours are meeting as well as the eligible needs that the Social Services are meeting. Where all presenting needs are being met by family this should be recorded on the assessment summary.

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Will all assessment reviews be face to face?

No. Level 1 assessment will continue to primarily be undertaken over the phone. More reviews are likely to be face to face and the review team will need to test whether any can be done via questionnaire and still evidence eligibility.

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Are there services we do not provide?

The Eligibility Criteria Checklist is used following an assessment/review to decide whether someone has a level of needs and risks that are above the threshold line for services. The big change required is to think in terms of needs and the impact of any risks on those needs for the individual overtime, and not to think service solutions before we have completed the Eligibility Criteria Checklist.

Where needs are above the line discussion should take place with the individual and or their carer about how best they may be assisted. The Matching Needs and Services document provides useful guidance on this issue. However, it is not exhaustive and not intended to prevent creative problem solving. Sometimes simple responses can substantially alleviate risk.

Where presenting needs are below the threshold line we must ensure that the person is given good information and advice and/or we contact the relevant agency on behalf of the person if that is what they want.

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What happens to people who have presenting needs and are not eligible for SSD assistance?

There are a number of issues to consider such as:

• Using Care Direct to find local/national information.
• Using Care Direct or the Department of Work and Pensions for benefits advice.
• Is there a need that can be met via Supporting People?
• Redirection to preventive services. If there is a gap in the preventive services required to support the person , discuss this with your social services manager to ensure the information informs the commissioning strategy and wider planning within the county council and partner agencies and to agree a way forward for this individual.
• For some key services a more flexible approach to commissioning is being introduced. This will mean some services will be sponsored by Social Services and provided at a subsidised rate for people who have both eligible and presenting needs and who require the service subsidy. Further details will be provided on this as the approach develops.

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Isn't this policy all about making cuts?

• Whilst FACS is one approach to managing the balance between available resources and demand it bases decision making on good practice principles. It is an important part of rooting out discrimination. FACS decision making will fall out of the assessment of an individuals situation and is underpinned by the policy objectives of assisting people to remain at home safely and promoting an individual's independence. Eligibility decisions are person centred as they are based on an individual's situation and the impact of any risks on needs.
• FACS also helps us to be clear about what Social Services core business is.
• FACS would be introduced irrespective of the level of budget available.

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How does FACS interface with other policies from other agencies?

FACS must only be used for decision making about access to services that are arranged or provided by Devon Social Services. It must not interfere with services that are provided by other agencies as they have their own criteria and policies for matching demand and resources. An example would be DFG's, where our assessment of risk can be used to inform another agency who may choose to take it into account. Equally social care services should not be used to meet a need that is the core business of another agency.

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What if I think the policy is wrong?

• Is it a policy problem. Has the practitioner identified an unforeseen problem with the policy? Is this a query that others in the team are concerned about and which, following local discussion, remains unclear? If so, advice the policy officer either via your practice supervisor or through the FACS internet pages.
• Is it about adapting to a very new way of working whereby decision making is focused on needs and risks and not on services? This may especially be the case in relation to the development of ideas about services for particular client groups. If so, discuss this with your practice supervisor/team and consider how you could adapt/change what you do and identify any learning needs.
• Is it about a misunderstanding of the policy? Check your understanding out with colleagues/practice supervisor and try and resolve locally. If not discuss with the policy officer as outlined above.
• Is it about not agreeing with exercising eligibility and therefore the practitioner intends to inflate all needs and risks to ensure they are above the line? But what is achieved by this? The threshold line has been set taking account of Devon's resources and the national policy requires that we meet needs in a hierarchical way. There is increased demand and limited resources and so if someone gets a service who was assessed below the line, this will lead to difficulties in the Directorate's ability to meet the needs of those people who are assessed as being above the line. This will lead to inequity, a reactive approach to managing our resources and could lead to the level at which the threshold line is set being increased.
• Is it about the need for improved preventive services to avoid people with moderate or low needs becoming substantial or critical? Please refer to the note above re prevention.

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In an effort to manage our demand we may have to 'cap' the number of days of day care offered. I appreciate this isn't in line with identified need. How does this sit with FACS?

• You need to look at the Matching Needs and Services guidance. Presumably an assessment or review has indicated an individual's needs relating to social contact and/or carers support. In order to have the need met FACS requires that the individual has a need above the threshold line which is therefore an eligible need. How we meet that need is a separate issue which the Matching Needs and Services guidance provides a useful framework to consider responses.

• The important point here is that FACS requires us to separate out the assessment of needs from the decision making about whether an individual has a presenting or eligible need. The Eligibility Criteria Checklist is used to evidence whether someone has an eligible need. It is only at this point that you should consider the type of service response that might best assist with meeting the needs and risks.

• Conventions which limit service provision by type are generally not compliant with FACS because they may not be Countywide, and they are not considering the overall picture. For example there maybe risks if limits leave eligible needs unmet. It is important to remember that leaving eligible needs unmet could lead to risk for the user and their carer, and leave the County open to legal challenge. If local conventions are felt to be necessary, this should be discussed with the policy officer as a matter of urgency.

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Some of our staff think we should not be doing any open-ended contracts for shopping or meals help from now on.

All such contracts should be for 12 weeks only and will need to be 'reviewed' at the end of that time or it should be stated that if people need services to continue then they need to contact SSD themselves. Is this correct? If so, is it a review or a monitoring exercise at 12 weeks? An SS6 or an SS3?

• Wherever appropriate we should consider time limited contracts whereby the service user/carer is advised of the end date and this is recorded on the care plan/contract. The individual/carer/provider are advised to come back to us if they are concerned about services stopping. This is no different to what you have been doing and we used the training as an opportunity to remind staff of this. The important words here are 'where appropriate'. For some people it will just not be appropriate to go down this route. However, we must ensure staff consider it as an option as this approach ensures:
  
  
• Targeted use of services.
• Streamlines the process for staff and service users as a review will not be required. The service user / carer should have been assessed as able to re contact us. How to do this should have been clearly explained to them, and contact details given on the care plan.

This is one option available and one which we believe we should use more effectively.

• The FACS guidance states that we should review all new services within 12 weeks of them being set up. The review team will not undertake these reviews as they will be prioritising the back log. PCM currently achieve this via the SS6 monitoring form. We need to think about how we will manage this new requirement for Help Desk cases particularly. We also need to question whether any changes are required to the current PCM approach. This is something we will work on over the next few months as we need to understand the potential impact of this on resources. The review team experience will assist us with this thinking.

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Can you clarify what is happening about meals, shopping, and housework?

I was under the impression that these services would not continue but our Referral Co-ordinators have said that their training said they would until independent services replaced them.

• This relates to the issue of whether an individual has an eligible need. This decision is based on the level of needs and the impact of risks on those needs for the individual. Once it is established that the individual has an eligible need (in this example in relation to managing their daily routines) the next step is to consider the most efficient and effective ways to meet the need(s). The Matching Needs and Services guidance should assist here.

• Wherever possible our first response, even for people above the threshold line, should be to consider whether they can resolve the issue for themselves. We should use Care Direct and the Department of Work and Pensions to help people maximise their income via increased benefits. Where we know there are alternatives that the person or their carer can access direct such as the supermarket free/cheap delivery this should be considered.

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Will Social Services expect all non-emergency patients to have been screened using your eligibility checklist before accepting a referral?

• The FACS checklist should not be completed to screen whether to refer to SSD as clearly our duty to assess stems from the NHS and CC Act which states that we should undertake assessment where people appear to be in need of CC services and appear to have significant needs. The FACS checklist sets out the level and types of needs and risks that Devon SSD will be able to meet and those that will be redirected. It is only used after assessment, hence there is an important link with SAP.

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When you say that Primary Care staff need to be aware - to whom are you referring: GPs, Practice Nurses, Receptionists?

It is helpful for all primary care staff to be aware of the FACS criteria for the following reasons:

• To support an open and fair approach towards individuals. FACS is a major plank of both government and local action in rooting out and eliminating age discrimination. One approach will be used to determine eligibility for social care services across all adult services (mental health, learning disability, physical disability, sensory and older people services).
• To ensure consistency of approach, e.g. the options available to individuals include support from Care Direct or other information/advice giving agencies, making their own arrangements, referral to SSD if they meet the legal duty for assessment and do not want to make own arrangements.
• To ensure that individuals expectations are not raised inappropriately at point of contact/referral to SSD.
• To ensure NHS staff are aware of the SSD core business in terms of the level and types of needs that can expect a service response.
• To support good working relationships.

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What about the many issues for OT's around duty of care and our legal responsibilities?

For example if a client only needs one service like a walking frame their needs are therefore below our threshold. If they then say they cannot afford to buy the frame I would be at risk of being accused of gross negligence if I did not provide the frame and I could be struck off. Also Disabled Facilities Grants do not fall within the Fair Access guidelines because clients rights are governed by different rules…

• Eligibility is not determined by the number of services a person receives but by the level of needs and the impact of any risks presented by the individual's situation. Eligibility is only determined following an assessment of need. As part of your assessment you will need to determine the impact of any risks to the persons safety or independence on the needs identified, taking account of the persons attitude to risks. (In your example the need was in relation to her mobility). You should then use the Eligibility Criteria Checklist to identify whether the impact to the person's safety and/or independence is critical, substantial, moderate or low risk in managing their home environment, personal care and daily routines due to their mobility issues. If a person is at risk walking without a frame, and the risk is above the level of the threshold, then they are eligible for the service. This formalises what is good assessment practice, linking that good practice to eligibility decision making.
• Every worker employed by DCC must operate within the policies of the County Council. Additionally, this policy closely follows a nationally set policy and eligibility framework which have been subject to extensive consultation at national level with the relevant agencies and professional groups. In essence, that policy states that each council should set eligibility within the context of assessed needs and risks and can take account of its resources in meeting those needs in a hierarchical way. Councils must have sufficient resources to meet critical needs before we consider substantial needs and so on.
• The local policy is clear that other agencies have their own eligibility criteria for such situations as Disabled Facilities Grants (DFG' s) , NHS continuing health care and intermediate care. These policies are separate from eligibility decisions about access to social care services.

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What about our experience at the half day awareness sessions from which we believe this approach will not lead to greater consistency?

During the case study exercise we really struggled to agree on whether the person was critical, substantial , moderate or low even though many of us in the group work together now and work within the same service user group…

• I am sure this is in part due to the limitations of a case study exercise. Having said that you raise an important issue. We know that we have limited consistency of approach currently and your small group experience demonstrates this. FACS provides us with a framework within which to understand those variations and to consider how we need to change to address them. It also challenges the way we have made decisions about an individual's access to services.

• Teams will need to have a forum to discuss the decisions practitioners have reached using FACS. This should also be an integral part of the supervisory role.

• Your supervisors will need to bring the issues that you have been unable to resolve locally to the regular practice supervisors meeting so that we can share learning across the county and develop greater consistency.

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What about consistency in terms of the services we provide to people with similar eligible needs?

• Some people have raised consistency in relation to people with similar needs getting the same level and type of service. This goes against the idea of a person centred approach. Whilst needs may be similar the risks arising from the needs and the time frame within which they are likely to occur will vary according to individuals situation. Hence eligible needs may require very different service responses.

• Having said that The Matching Needs and Services Guidance provides a framework to assist practitioners and managers with developing a more consistent approach to the use of community care services. It will need further development as we use it and the Practice Supervisor group will have an important role in shaping this. Hence you need to ensure that you share any issues about the Matching Needs and Services Guidance with your social services manager.

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How will we consider equity across the district for how we translate carers eligible needs into agreeing what we will do to support them?

Is there any practice guidance / principles which would help workers and practice supervisors to do this?

• It is important for us to remain person centred in our assessments so that we understand the impact and sustainability of the caring role for the individual. Whilst needs may be similar the risks to the sustainability of the caring role and the time frame within which the risks are likely to occur will vary according to individuals situation. Hence eligible needs may require very different service responses.

• Having said that The Matching Needs and Services Guidance provides a framework to assist practitioners and managers with developing a more consistent approach to the use of community care services. It will need further development as we use it and the Practice Supervisor Group will have an important role in shaping this. Hence you need to ensure that you share any issues about the Matching Needs and Services Guidance with your social services manager with particular reference in this example to using it with carers.

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How will we identify families who would be assessed as having 'moderate' needs, but would benefit from preventative support to maintain their situation, and how will this be supported?

• First, we will assess families as we do now as part of the care management and Care Programme Approach and identify carers who are providing or intend to provide substantial and regular care to an individual. We will then ask carers if they wish to have their needs and views taken into account. If so, we will offer them a joint or separate assessment (for carers of people on enhanced CPA we must always offer a separate assessment).
• Even where people chose not to have an assessment we should still offer information and advice and, where relevant and with the agreement of the carer, make contact with other agencies on their behalf.

• In the light of feedback from staff and carers the care management forms have been revised to more effectively address carers needs and outcomes at each stage of the process (referral, assessment and review).
• The current mainframe system has also recently been changed to ensure that we can capture carers in their own right without having to make them into service users - this is for joint and separate assessments. We will be able to capture the outcome of the assessment which should give us some information upon which to build the carer strategy. The new IT system will assist this issue.

To consider your second point.

• This is a really important issue as it is about recognising the role of carers who are assessed as moderate or low in terms of eligibility for community care services. This is an important part of developing a coherent and sustainable strategy for carers support and needs to be addressed not only by Social Services but also as a wider County Council and partner agencies issue. We need to agree how we are going to capture views and ideas about this.

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How will we differentiate whose need we are meeting, when a need is expressed by both the carer and the cared for person?

• This is an assessment issue. My simple answer is that you should use the carer assessment practice guidance to assist and feedback where there are any gaps in this. For some circumstances negotiation between the carer and cared for person will be required.

• An issue which came up during the FACS training is that we can sometimes make assumptions about this issue without checking it with the carer and cared for person. For example, we may assume that if a carer is on holiday for 2 weeks the need is for carer support. However the carer may be more than happy, willing and able to continue caring but is taking some holiday. In these circumstances it is the cared for person who needs assistance whilst the carer is away.