Report calls for national service to tackle adult social care postcode lottery

A national assessment service should take over adult social care assessments from councils to reduce unequal access to support in England, a report proposes.

The call follows an analysis showing large differences in access to publicly funded long-term care between councils with similar social and economic characteristics.

Under the proposals, councils would continue planning care but would no longer determine eligibility. Social workers could instead focus on helping people access services and community support.

The King’s Fund has set out the reforms in a six-point plan to tackle inequalities in adult social care across England.

Its analysis found that 59 per cent of councils had access rates for publicly funded long-term care at least 20 per cent higher or lower than those of their closest statistical neighbours.

The differences affected services for working-age adults, older people or both groups.

Variation between statistically similar councils was up to 101 per cent for working-age adults and 60 per cent for people aged over 65.

The think tank said the findings showed inconsistencies in access to care, despite councils operating under the same national eligibility criteria established by the Care Act 2014 and associated regulations.

It argued that subjectivity in assessments meant people with equivalent needs could receive different decisions depending on where they lived.

The report, developed by King’s Fund senior fellow Simon Bottery and adviser James Bullion, proposes a national service to determine levels of need and funding entitlements.

Assessments would use standardised measures, including a frailty index, to establish levels of need and place individuals into categories with funding entitlements linked to the cost of appropriate care.

Technology would help streamline the process, with face-to-face assessments carried out where needed and support provided by local authority staff.

The service would also cover NHS continuing healthcare and Attendance Allowance, a benefit for disabled older people.

Carers’ assessments and financial assessments would be included, with the latter determining how much individuals should contribute towards their care and monitoring their progress towards the proposed cap on costs.

The wider proposals call for universal access to state-funded long-term care for people with eligible needs, excluding accommodation and food costs in care homes.

Individuals would make co-payments covering a percentage of their care costs, based on their income and assets, with a lifetime cap to protect against exceptionally high payments.

The report also recommends replacing local funding arrangements with a national system, potentially funded through social insurance contributions or taxes on wealth and property.

Care entitlements would be standardised according to assessed needs, while local care planning would account for personal circumstances and existing strengths.

The proposals come amid wider concerns about access, quality and funding in adult social care.

According to the report, around 220,000 people in England do not receive funded care because of means-testing, while approximately one in seven face lifetime care costs of £100,000 or more.

It also identified problems with quality and personal choice, including home care commissioned in 15-minute visits and only a quarter of people using direct payments.

Workforce pressures remain significant, with around half of care workers paid at or around the national living wage and 6.2 per cent of posts vacant.

The report also highlighted poor coordination between health and social care, including delayed hospital discharges and separate assessments for services and benefits covering similar needs.

Under the reforms, councils would concentrate on care planning, safeguarding and helping people obtain appropriate support.

Social workers would take a greater role in connecting individuals with NHS services, housing organisations and the voluntary sector.

Bullion, a former Care Quality Commission chief inspector and president of the Association of Directors of Adult Social Services, suggested this could help councils strengthen personalised care and approaches focused on people’s existing strengths.

Local practitioners would continue safeguarding vulnerable adults and supporting those who lacked capacity to make relevant decisions.

The King’s Fund said bringing assessment responsibilities currently spread across 153 councils into one national organisation would also save money.

However, it acknowledged that councils would still need substantial resources for assessments, reviews, care planning and safeguarding.

The report stated: “We anticipate that significant resource would still be required at local authority level for support in assessment and review, care planning, safeguarding and the other responsibilities set out in this paper.”

The proposals reflect the think tank’s argument that reform must address not just funding pressures but unequal access, fragmented services and the need for more personalised support.