to this new way of working together (NHS England, 2015a). In Wales the 2014
Social Services and Wellbeing Act gives the government the power to compel
integration between health and social services where it deems local progress
to be inadequate.
According to statute, local authorities are required to assess the needs of
people who might need social care, and if those individuals are eligible for
support, to provide that support. There are no eligibility criteria across the
United Kingdom; rather, they are determined locally and they often depend
on what funding is available. The Care Act 2014 introduced national eligibility
criteria for the first time in England, but there is still great variation across the
United Kingdom.
If an individual meets the eligibility criteria, the local authority must
commission (i.e. purchase) or provide residential accommodation and
non-residential services as necessary; a social worker makes these arrangements
and provides the written care plan for the individual. For non-residential
services in England the local authority has to offer individual direct payments
instead of services, as long as the individual can manage direct payments and
wants to take them. The local authority sets a standard rate that it pays for those
in residential care, but the rate varies between authorities.
There are national thresholds for how much an individual is expected to pay
for residential care in England. Charges range from nothing to the full costs.
All the assets of an individual are taken into account, including the value of
their house if they own it, as well as their income from pensions, social security
benefits and other sources. The Department of Health provides guidelines to
local authorities on how much they should charge for non-residential services,
and the local authorities decide what to charge within those guidelines.
Cost-based charges are preferred to charges placed in usage bands, and charges
should not reduce an individual’s income below the basic income support level
plus 25%, and an individual’s savings (but not other assets) may be taken into
90 Health systems in transition United Kingdom
account. Individuals may arrange to pay their own costs by working directly
with care providers, but that places them outside the state system. The Care Act
2014 promoted the rights of patients receiving social care in England.
In Northern Ireland nursing or residential home funding is subject to means
testing, which includes the value of the person’s house (unless a spouse or
dependent still lives there). A 1999 report recommended free personal social
care across the United Kingdom, and in 2002 Scotland introduced it (after
initially deciding not to) but England, Wales and Northern Ireland did not.
As the United Kingdom population ages and the number of older people
needing care increases, the question of how to fund long-term care becomes
more pressing. Because of the reduction in the number of long-stay hospital
beds, many of the services once provided free at point of use in NHS hospitals
are now provided in means-tested residential and nursing homes, with the
attendant costs to individuals.
The Care Quality Commission regulates and inspects all social care
providers in England, including care homes, nursing agencies and home care
agencies, based on standards established by the Department of Health in 2000
and amended in later legislation. The Care Inspectorate registers and inspects
care homes in Scotland. In Scotland NHS Healthcare Improvement Scotland has
a set of quality indicators and a best-practice statement for learning disabilities,
but there is still a risk of services not meeting the needs of such patients.