Health and social care rights

Explains your rights to social care, and how this differs from healthcare. Includes information on eligibility, needs assessments, financial assessments, and how local authorities may meet your needs. Applies to England and Wales.

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Eligibility for social care

Are my needs eligible for social care support?

The local authority will not meet every need for care and support that you have. Your needs will only be met if they satisfy the eligibility criteria.

When the local authority is considering whether you have eligible needs, it will look at:

  • what kind of health problem causes your needs for care and support
  • whether your needs affect your ability to do certain things
  • how your needs affect your day-to-day living.

The law on eligibility is slightly different depending on whether you're in England or Wales.

What are the eligibility criteria in England?

To meet the eligibility criteria in England, you must show that:

  1. Your needs for care and support arise from certain health problems.
  2. As a result, you're unable to do certain things.
  3. There is a significant impact on your wellbeing.

1. Your needs for care and support arise from certain health problems

Firstly, you'll need to show that your needs for care and support arise from certain health problems. This includes:

  • mental health problems
  • physical ill-health
  • disability
  • learning disabilities
  • cognitive disabilities
  • dependence on alcohol or drugs.

You don't need to have a specific diagnosis to be eligible for social care and support.

2. As a result, you're unable to do certain things

Next, the local authority will assess whether you're unable to do certain things. These are:

  • eating and drinking
  • maintaining personal hygiene
  • managing toilet needs
  • being appropriately clothed (dressed)
  • being able to make use of your home safely
  • keeping your home clean, safe and hygienic
  • developing and maintaining family or other personal relationships
  • accessing and engaging in work, training, education or volunteering
  • using necessary facilities or services in the local community including public transport, and recreational facilities or services
  • carrying out any caring responsibilities you have for a child.

In England, you need to show that you're unable to achieve two of these outcomes.

What does it mean to be 'unable' to do something?

Being unable to do something doesn't necessarily mean that you can't do it at all. It can include when you are:

  • unable to do something without assistance (including being prompted by someone else to do it)
  • able to do something without assistance, but it causes you significant pain, distress or anxiety
  • able to do something, but doing so would endanger you or people around you
  • able to do something, but it takes you significantly longer than would normally be expected.

3. There is a significant impact on your wellbeing

The final stage of the eligibility criteria is that, as a result of not meeting the outcomes, there is, or is likely to be, a significant impact on your wellbeing.

Example

Cate has severe depression. She is physically able to wash and dress, but will go for long periods of time without washing or dressing unless reminded. She is unable to maintain her personal hygiene or be appropriately clothed. This makes it difficult for her to find work, and affects her social and economic wellbeing.

In England, Cate could have eligible needs for care and as she is unable to achieve two outcomes and this has a significant impact on her wellbeing.

What are the eligibility criteria in Wales?

To meet the eligibility criteria in Wales, you must show that:

  1. Your needs for care and support arise from certain health problems.
  2. As a result, you're unable to do certain things.
  3. You don't have a carer or access to community support that can meet your needs.
  4. You're unlikely to achieve a personal outcome without help from the local authority.

1. Your needs for care and support arise from certain health problems

Firstly, you'll need to show that your needs for care and support arise from certain health problems. This includes:

  • mental health problems
  • physical ill-health
  • disability
  • learning disabilities
  • cognitive disabilities
  • dependence on alcohol or drugs
  • age.

You don't need to have a specific diagnosis to be eligible for social care and support.

2. As a result, you are unable to do certain things

Next, the local authority will assess whether you're unable to do certain things. These are:

  • eating and drinking
  • maintaining personal hygiene
  • managing toilet needs
  • being appropriately clothed
  • being able to make use of your home safely
  • keeping your home clean, safe and hygienic
  • developing and maintaining family or other personal relationships
  • accessing and engaging in work, training, education or volunteering
  • making use of necessary facilities or services in the local community including public transport, and recreational facilities or services
  • carrying out any caring responsibilities you have for a child.

In Wales, you need to show that you're unable to achieve one of these outcomes.

3. You don't have a carer or access to community support that can meet your needs

When the local authority is deciding whether you have eligible needs, they'll consider whether you have:

  • a carer who is willing to meet your needs
  • access to community support to meet your needs.

If you have the assistance or support of either of these, you will not be considered to have eligible needs.

4. You're unlikely to achieve a personal outcome without help from the local authority

The local authority will look at whether you're unlikely to achieve one or more of the personal outcomes identified in the needs assessment process without care and support or direct payments arranged and provided by the local authority.

Example

Kanak has generalised anxiety disorder and agoraphobia. He's physically able to leave his flat, but becomes severely anxious, especially when he's in crowded areas. He can't shop for himself or go to his local sports and leisure centre. Living more independently is an outcome that he wishes to achieve. He doesn’t have a carer who is willing to meet his needs.

In Wales, Kanak would be considered to have eligible needs, as he is unable to make use of facilities in the community and is unable achieve one outcome identified in his assessment without care and support.

What happens after my assessment?

Based on the assessment, the local authority will make a decision about what your needs are and whether they meet the eligibility criteria. It must give you a written record of this decision. If you have an advocate or someone authorised to act on your behalf, they should get a copy too.

If you are eligible for social care, then the local authority must help you plan your care and support.

If you're not eligible for social care, the local authority must give you:

  • reasons for making its decision
  • written advice and information about what can be done to meet your needs or for you to achieve your personal outcomes, and what can be done to prevent or delay your needs for care and support from developing
  • personalised and specific advice based on your needs assessment. They shouldn't just send you a standard letter.

If you disagree with the decision they've made, you can make a complaint about it. You may wish to challenge the decision in court. If you do this, you may want to take legal advice.

Can the local authority provide care and support if I don’t meet the eligibility criteria?

The local authority has the power to provide you with care and support even if you don't meet the eligibility criteria, but in practice this happens rarely.

 


This information was published in February 2018. We will revise it in 2020.


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