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Call to overhaul access to care to end gatekeeping culture

Support planning should be available to all older and disabled adults who want it, regardless of their eligibility for formal social care, to move the system away from gatekeeping resources.

That was the message from sector leaders in a paper on reforming access to social caredesigned to influence the government’s forthcoming White Paper. It said the existing system denied people access to support planning until their needs reached eligibility thresholds, promoting dependency and preventing people from making best use of informal resources in their communities and their own assets to promote their independence.

The call comes from four organisations seen as being in the vanguard of personalisation: self-directed support pioneers In Control, Shared Lives Plus, which represents smaller providers, Community Catalysts, which helps promote the development of non-traditional support services, and Inclusive Neighbourhoods, which is promoting the local area co-ordination (LAC) model of accessing support.

Their proposals are similar to the LAC model. All councils would be under a duty to commission an open-access planning and navigation service, to provide support with life to all adults regardless of eligibility for care, with a view to promoting independence and delaying people’s need for formal services. Resulting plans would be portable so they would be available if or when people became eligible for formal social care.

Such services would most likely be delivered by community organisations, including user-led organisations, though potentially employing social workers to advise on support planning. They would help people meet their needs by accessing community resources and drawing on informal support networks; for instance, people experiencing isolation could be put in touch with clubs that matched their interests.

Councils would also commission a complementary community development function to help develop informal services to meet gaps identified by planning discussions with older and disabled adults.

“It’s not about providing people with a right to services but an entitlement to a planning discussion,” said Alex Fox, chief executive of Shared Lives Plus. The proposed service would be chiefly funded from existing resources spent on information, advice and assistance for people in the care system, which Fox said was currently not spent well.

There would still be a need to gate-keep access to formal services, but community care assessments would need to be reformed to be more focused on helping people build resilience and independence, rather than on making people prove how dependent they are, said the paper.

How likely is this model to be taken up in the White Paper?

The paper’s proposals are in line with care services minister Paul Burstow’s plans to make the care system less crisis-based and more focused on preventing and delaying people’s need for care, including through initiatives such as local area co-ordination. This report’s themes will feature strongly in the White Paper; however, the government may be reluctant to impose a duty on councils to commission an open-access planning and navigation service on the basis that this could be seen as prescriptive. The White Paper is due next month.

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