I was interested to read about this case in Reading last week, where the local authority was challenged regarding a decision not to support a disabled woman who is HIV+ according to the Fair Access to Care Criteria which would indicate that although she had irrefutable ‘needs’ – they were not at a substantial level which qualified for assistance under the National Assistance Act (1947).  As the article goes on to say, she lost her bid because, according to the judge

She is not so badly off that she is entitled to be “looked after” at public expense.

In some ways, I’m surprised there are not more of these types of cases. I was involved in a situation with threatened litigation a few years ago myself. The question in that case as with this lay on the levels of needs and what the council was obliged to provide.

There is a story that has done the round in both the local authorities I worked in about a poor Care Manager who wrote up a care plan saying a person needed to live in better accommodation and then this was challenged in court and the council were obliged to provide new accommodation for the person in question. I have no idea if this story is true but it was used as a word of caution by older, more experienced social workers to younger colleagues to be careful about wording and writing what you are recommending as opposed to what you being is absolutely essential!

Although there is no doubt in my mind that we (and by that I am referring to those working in Adult Social Care) would love to provide all the necessary services to all the people who might benefit even in the slightest, the resources just do not exist.

This is where you see the social worker as gatekeeper role which was envisaged in the NHS and Community Care Act. It is an adjustment of the mind to move from the promotion and advocacy role that is presented in training to the gatekeeper role and keeper of resources that has morphed into care management in some senses.  Of course decisions about funding rarely lie with social workers and are taken way up the management line, it is still a mindset that is encouraged when assessing – what is this person entitled to? What criteria do they meet? Rather than what could possibly be provided to add quality to their lives.

I remain a bit of a fanciful dreamer, even after almost 10 years of practice and I know money and resources are limited so we cannot possibly give everyone what they want but there has to be a balance somewhere.

My only hope is that the personalisation agenda will move things on somewhat and that individualised budgets will prove to be as wonderful as the literature makes them sound.

2 thoughts on “Entitlements

  1. I think it could be – theoretically at least – after all, it’s hard to argue against user choice and more flexible care. Saying that, I remain a little sceptical although I was trying to be positive in the post!

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