Fair access to care services

Are you eligible to receive a service from Adult Social Care?

It is our priority to help you maintain your independence, health and wellbeing but we have limited resources.  When you are assessed by Adult Social Care we use a set of eligibility criteria to determine who is eligible to receive community care services.  These criteria are set out in national guidelines from the Department of Health called 'Fair access to care services'.

All Local Authorities must follow this criteria when assessing new and existing service users aged 18 and over. This enables us to ensure that those in greatest need and at highest risk receive services.  It also ensures that anyone requesting a service is dealt with fairly.  These guidelines categorise what the risk to independence would be if your needs are not met.  There are four categories: critical, substantial, moderate and low.

Eligibility criteria

The eligibility criteria are the conditions you have to meet to get help from us.  Councils are allowed to decide whether they have enough resources to provide help for all four of the eligbility criteria bands, or just for some of them.  You will find details of the four eligibility criteria bands further on.

In Liverpool, we have resources to provide services to people in the critical and substantial band. For people falling into the low and moderate band we will provide information and advice on how to access community based alternatives which best meet their needs. You can find more information on community resources through the Liverpool Family Services Directory.

We review our eligibility criteria every 12 months.

How does it work?

When you contact us for help we will offer you an assessment.  This looks at your situation and shows what help you need.  Together, we will work out how much your independence is at risk if you don't receive help.

When working out the risk to your independence, government guidance says we need to focus on 4 factors that are central to a person's independence.

  • Autonomy and freedom to make choices. This is about your ability to make choices affecting your situation.
  • Health and safety, including freedom from harm, abuse and neglect, and taking wider issues of housing and community safety into account.
  • The ability to manage personal and other daily routines.
  • Involvement in family and wider community life, including leisure, hobbies, unpaid and paid work, learning and volunteering.

We will also take into account:

  • Help you have from carers and other agencies.
  • Risks faced by others such as your carers.
  • Which risks are acceptable to you, or are a natural part of independent living.
  • What are the priorities for an assessment?

We aim to complete your assessment within 4 weeks of your first contact with social care.  This may not be feasible in all cases but where possible, we are committed to achieving this target.

Eligibility criteria bands

Band 1 - Critical

People who are in a crisis situation or are actually at risk or pose a serious risk when:

  • Life is or will be threatened; and/or
  • Significant health problems have developed or will develop; and/or
  • There is or will be little or no choice and control over vital aspects of the immediate environment; and/or
  • Serious abuse or neglect has occured or will occur; and/or
  • There is or will be an inability to carry out vital personal care or domestic routines; and/or
  • Vital involvement in work, education or learning cannot or will not be sustained; and/or
  • Vital social support systems and relationships cannot or will not be sustained; and/or
  • Vital family or other social roles and responsibilities cannot or will not be undertaken.

Band 2 - Substantial

People and/or carers who are having significant difficulties in coping and are potentially at significant risk, when:

  • There is or will be only partial choice and control over the immediate environment; and/or
  • Abuse or neglect has occurred or will occur; and/or
  • There is or will be an inability to carry out the majority of personal care or domestic routines; and/or
  • Involvement in many aspects of work, education or learning cannot or will not be sustained; and/or
  • The majority of social support systems and relationships cannot or will not be sustained; and/or
  • The majority of family and other social roles and responsibilities cannot or will not be undertaken.

Band 3 - Moderate

People and/or carers who are finding it hard to cope and there is some risk to their health, when:

  • There is, or will be, an inability to carry out several personal care tasks or domestic routines; and/or
  • Involvement in several aspects of work, education or learning cannot or will not be sustained; and/or
  • Several social support systems and relationships cannot or will not be sustained; and/or
  • Several family and other social roles and responsibilities cannot or will not be undertaken.

Band 4 - Low

People whose quality of life could be improved but their situation is stable and there is no risk to them or their carers, when:

  • There is or will be an inability to carry out one or two personal care or domestic routines; and/or
  • Involvement in one or two aspects of work, education or learning cannot be sustained; and/or
  • One or two social support systems and relationships cannot or will not be sustained; and/or
  • One or two family and other social roles and responsibilities cannot or will not be undertaken.

What happens next?

We will give a level of risk to each of the four factors of independence by matching the risks identified to you, to the circumstances described in the Government's four eligibility bands - critical, substantial, moderate or low.  Your overall eligibility band will be the highest of the four levels.

For example, if the risk to your level of independence is:

  • Low for autonomy and freedom of choice.
  • Substantial for health and safety.
  • Substantial for managing personal and daily routines.
  • Low for family and social involvement.

This would mean that your overall eligibility will be the highest of the four levels - so in this example you will be in the substantial eligibility band.  This means we can meet all your needs that are substantial.  We can't meet any that are moderate or low as they are outside our eligibility criteria, but we will signpost you to other services and support in the community that may meet those needs.

Carrying out an assessment does not necessarily mean we will give you a service.

What happens if i'm not eligible?

We will write and tell you whether you are eligible or not.  If you are not, we will provide you with advice and information about other sources of help in the community.

You can also make a complaint if you are unhappy with our decision - see further information at the end of this page.

What happens if my needs change?

If your needs change you should contact Careline or your social worker and ask for a review.  We will work out if you meet the eligibility criteria. You may find you are in a higher eligibility band, or that you no longer meet the criteria at all.

If you don't meet the criteria, the services will stop.  We will give you notice that this is going to happen and you may still access the service for up to four weeks while you make other arrangements. We can also provide information and advice about other sources of help.

Further information

This page has this Related Information: