Agenda item
Adult Social Care Charging Impact Assessment - Follow-Up
Minutes:
The Committee received the report of Joanne Starkie (Head of Strategy and Policy for Health Adults and Community) on the Adult Social Care Impact Assessment follow up.
Summary of key points:
- Charging came in at end of 2017. The original impact assessment identified nine key areas for improvement. The assessment was conducted by a stakeholder panel that included carers. The Panel oversaw the strategy and came up with an action plan. Areas for improvement included: communications, future approach to charging and respite, clarity on charging, improving support to maximise income and avoid debt, direct payments, developing an appeals policy, approach to impact assessments and approach towards those who might end support due to charging.
- Communications was a critical issue and the council had since produced an easy read guide, produced clearer letters for correspondence, the financial assessment team offered surgeries at the carers centre to provide face to face support. REAL was consulted again to advise on making the assessment clearer. Pre-paid cards were also rolled out.
- With regard to respite care, the service was looking into alternative financial modelling to see if free respite was feasible and whether this would negatively impact other parts of the service.
- The Panel had agreed a core set of measures to measure the impact of charging.
- The situation at end of last April was similar this April; over half are being charged, 171 people have not completed an assessment form yet and so are being charged the full rate. Last April this figure was at 240.
- Last April 129 people were being charged the full amount capped at £250.00. This time it was 78 people.
- Last April 950 people were not paying for care; this had gone up to 1070.
- 171 had not filled in a financial declaration form by this April compared to 240 people last April. These people are being charged.
- On average 54 people have requested reassessment compared to 147 requests when charging was first brought in.
- Older people and those from a white background are more likely to be charged the full amount. Those from a South Asian background and those with learning disabilities are being charged at a lower rate or not at all.
- The number of people getting an assessment per month reduced. It was difficult to establish cause and effect due to other factors so need to look into this more.
- In the original impact assessment 47 care packages stopped due to charging this went up to 88 as of this April. Some of this was due to starting and stopping a package.
- There is a process in place to manage risk of those who want to end their package. There is a charging waver panel chaired by Divisional Director of Adult Social Care.
- Impact on wellbeing and satisfaction is ambiguous. Wellbeing gone down by 2 points but satisfaction gone up by 4 points. Last time this was reversed.
- Next steps are to continue looking at the core set of measures. It is important to note the action plan is still in progress. Communications will remain a top priority.
Summary of Member questions and officer response:
What is considered a ‘close family member’ in the charging policy?Would a son-in law be considered close family? Officers said they could check the policy wording.
How many people are employing carers? There were approximately 500 people who employed their own care staff. Officers agreed to provide the exact figure post meeting.
The drop from 204 to 154 seems large is that in line with what was expected? The report had noted this and the issue would be further explored.
Nine cases going to debt panel is shocking. Last meeting councillors were given the impression that officers would do the utmost to prevent people going to the debt panel. Can we have more information on the following?
· Reasons why the nine cases went to debt panel and three issued a county court judgement
· The Framework for the Charging Waver Panel
· Details on what support is provided to people to avoid debt and county court judgements.
Officers agreed to provide the information.
Councillor Francis expressed concern over the figures that were presented. He said some of the data was different to what was shown to Council when setting the budget, in particular the figures around the proportion of people who would have to pay. At the budget meeting councillors were told that two-thirds would not have to pay for care and one-third would, however, six months later the proportions had reversed. The figures in the follow up report showed that approximately 45% were not paying and 55% were. This amounted to around 1200 people paying for care and 1000 not paying. Over 250 people were paying over £100.00 a week. He said overall the situation was fundamentally at odds with what councillors agreed to in the budget.
Moreover, with regard to income generation and cost to this authority, he said councillors were told net savings would amount to £1.05 million to the council but in actuality there was significant income generation over and above what was budget for. Councillors should have been made aware of this.
Members also challenged the independence of the review. They said Councillors were led to believe there would be independence in the review but the review seemed to have been internally commissioned with little input from councillors or constituents. Some Members said that a truly independent review may have acknowledged that the policy may have required a fundamental alteration, such as reducing charges or scrapping the charges altogether.
The Committee requested information on the number of people who received Attendance Allowance and Personal Independence Payment. Officers agreed to provide this.
Members recommended that the action plan should be outcome based and clearly indicate how an improvement had been made for residents. They said they could not meaningfully scrutinise the information presented as it was.
The Committee requested to view the survey results from REAL, officers said they could provide this.
The Committee requested information on the approach to spouses in the Charging Policy, especially debt recovery in relation to spouses.
The Committee asked for financial data showing the amount being raised from charging and the amount being spent to administer charging since inception.
In response to Member concerns, officers said they were willing to provide additional data to enable councillors to better scrutinise. With regard to the terms of reference for the review user group, officers explained that due to the follow up being on a smaller scale a core set of measures were selected by the user group to be reported against. If councillors were interested in other measures officers could provide the information. The information on Attendance Allowance would be picked up.
What is the timeline for the respite financial modelling? Officers said this was a budgetary issue and would have to be addressed during the Medium Term Financial Strategy Refresh which was due to take place in October 2019. Officers said the Committee would be given an opportunity to comment on the strategy in advance of its publication.
ACTIONS:
- Officers to check the charging policy wording for clarification on the definition of close family member.
- Officers to provide the Committee with figures on the number of people employing care staff.
- Officers to provide the Committee the Framework for the Charging Waver Panel, details of the support provided to help people avoid debt and county court judgements.
- Officers to provide the Committee with the number of people claiming Attendance Allowance and Personal Independence Payments.
- Officers to provide the Committee with the survey results from REAL.
- For Members to inform Officers which additional measures they wish to scrutinise.
- Officers to provide the Committee with information on the charging policy approach to spouses and debt recovery in relation to spouses.
- Officers to provide the Committee with the financial data showing the amount being raised from charging and the amount being spent to administer charging since the inception of the charging policy.
- For officers to involve the Committee in the Medium Term Financial Strategy discussion around financial modelling for respite.
RESOLVED:
- For officers to provide the information requested by councillors for further scrutiny.
Supporting documents:
- Charging Follow-Up Impact Assessment Report, item 7. PDF 241 KB
- Appendix 1 Health Scrutiny PP_follow up impact assessment, item 7. PDF 150 KB