How Fair is Fair Access to Care?

Abstract

Care management is designed, amongst other main objectives, to ensure cost-effective use of public money, including targeting resources on greatest need, through eligibility criteria. However, evidence accumulated to demonstrate marked inequities evolved over time, both within and between local authorities, as documented, for instance, by both the Audit Commission and the Royal Commission on Long-term Care. There were also particular concerns about those close to the threshold. Fair Access to Care Services, published by the Department of Health in 2002, was intended to reduce inequities. The study reported here reviews evidence of its fairness in practice, and further informs the debate by comparing both access to care and charges for that care in two inner London local authorities. It is argued that the new procedures make the rationing process more transparent, improve assessment practice, do not restrict care manager discretion as much as might be expected, but that inequities continue. These inequities are partly due to ‘street level’ decision-making by front-line practitioners, but also to a large extent due to decisions by senior managers and commissioners in relation to policy implementation locally, and the profile of providers from the private, voluntary and statutory sectors.