Fair Access to Care Services (FACS): implementation in the mental health context of the UK

Abstract

Since April 2003, all adults requiring social care services must have an assessment to determine their eligibility, which is set within the four-level framework of Fair Access to Care Services [FACS; LAC (2002)13]. This paper examines the implementation of FACS by community mental health teams in eight sites in mental health partnership trusts, and one in a mental health and social care trust in the UK. Twenty-eight respondents (managers within trusts and social services departments) participated in in-depth qualitative interviews, which were undertaken between August 2004 and February 2005. The interviews covered: consultation with users and partner organisations; training and briefings for staff; FACS thresholds; integration of FACS and the Care Programme Approach; and the impact of implementing FACS on budgetary arrangements between health and social care. Using the framework analysis approach to analyse data, it was found that FACS implementation in mental health services has been somewhat haphazard, and has identified real differences between health and social care approaches to eligibility determination, assessment and priorities. In particular, the type and amount of consultation, training and induction into FACS was variable, and in some cases, unacceptably poor. While FACS may have reduced variability between authorities, the exercise of professional judgement in the operation of FACS and the lack of high-quality preventative services remain as potential sources of inequity within the system. The authors conclude that FACS has revealed and reinforced a growing separation rather than an integration of mental health and social care ideas and practices, at least in the participating sites.

Integrating health and social care in community mental health teams in the UK: a study of assessments and eligibility criteria in England

“…The Modernising Adult Social Care (MASC) research programme report concludes that health staff's unfamiliarity with social care perspectives, and lack of knowledge of referral and other processes, can act as a barrier to partnership or service integration. In the qualitative component of the present study (Cestari et al . 2006), we found evidence that assessments of mental health and social care needs are being kept apart in some services, which was not the policy intention.…”

“…Their circumstances are the most complex. In practice, the FACS assessment and review may or may not form part of the CPA process (Cestari et al . 2006).…”

Initial Assessment and Eligibility for Secondary Care Mental Health Services: Not a Simple Equation

“…A study undertaken in nine similar services at almost the same time (Cestari et al, 2006) noted some obstacles to the introduction of FACS into mental health services, these being integration of FACS with CPA, increasing separation between mental health and social care ideologies, and that: the type and amount of consultation, training and induction in FACS was… unacceptably poor (p474).…”

“…For two-thirds of councils the [FACS] threshold for care-managed services was set at 'substantial' in 2005/6, and a number of councils are expecting to raise their eligibility thresholds in 2006/7 (CSCI, 2006 exclusion rather than (fair) access, therefore? Similar problems arise with conflicting views of CPA and FACS.…”

“…As Cestari et al (2006) notes, for some partnership trusts in their study it is: the illness variable that determines access to health care services and relegates FACS considerations to a secondary status (p478). This is clearly not what is intended in the new guidance on CPA.…”