To be eligible or not to be eligible, that is the question

I was conducting some online research the other day about how Scottish local authorities go about offering free personal care and social care more broadly to older people. By the way, it's important to remember that those two things are not synonymous, the former is much more about the real personal stuff like hygiene, dressing and mobility whereas the latter can be about things like transport and shopping. Anyway, to cut a very long story short, basing their approach on Scottish Government (SG) guidance - newly fashioned in 2009 after lots of consultation - all local authorities use eligibility criteria to determine who gets services. Because resources are limited, those who are most at critical or substantial risk of harm are prioritised to recieve services. That might be logical and fair just now but, as WRVS has pointed out, unless we, as a society, can start to move towards preventative services which mean there are progressively less and less people at that level of risk, we're very soon going to crash mightily into the buffers of unaffordability, with casualties all round.

To be fair to both Scottish central and local government they all seem committed to the idea of 'adopting a strong preventative approach to help avoid rising levels of need' (that's a direct quite from the SG guidance) but it appears that limited resources mean, in fact, that few local authorities if any can commit to providing the extensive preventative services that they would ideally like to. Reading the local authority responses to the the 2009 consultation, some of them seem very pro-prevention indeed. Unfortunately, reviewing their eligibility criteria in 2010, these two examples illustrate the spectrum of the way they are apparently obliged to function (I will spare their blushes and let them remain anonymous):

‘The Health and Social Care Department assessment prioritises assistance to those whose needs have been assessed as being within the Critical and Substantial categories. People whose needs have been assessed in Moderate or Low categories may (my italics) receive help to maintain or develop abilities or to prevent further deterioration.’

‘LOW – you or others are at low risk of harm or loss of independence. For these needs, we will not (my italics) provide services. However, we will offer advice and information about alternative sources of support.’

Let's be clear, I'm not saying this is all local authorities' fault. What I am saying is that, sooner or later, some radical funding decisions need to be made about what money goes to which bit of the public sector and to the voluntary and private sector partners that work with it. With that in mind, here's a telling quote for you from the House of Commons Health Committee Report on NHS Continuing Care from way back in 2005:

“The question of what is health and what is social care is one to which we can find no satisfactory answer, and which our witnesses were similarly unable to explain in meaningful terms."

It only takes a little dot-joining to detect the radical solution that statement might be taken to imply but I'll let you work that one out for yourselves. Happy figuring!