Future Services Consultation 2024 - Adult social care charges proposal

Background

From 8 January to 31 March 2024, Hampshire County Council invited residents, partners, and stakeholders to provide their views on options to change and reduce some local services to help the Authority address a £132 million budget shortfall faced by April 2025.

One of the options proposed was to use all (100%) of an adult’s assessable income when calculating their contribution towards their non-residential care and support costs.

Who responded to the proposal?

4,077 responses to this proposal were received via the consultation Response Form, including 54 responses from organisations and 34 responses from democratically Elected Representatives.

Within these responses there were 603 people who were non-residential care users or their relatives. Of these, 431 paid towards their care and 94 did not pay towards their care.

Respondents were invited to add further comments to support their views on the proposal via an open-ended question. This allowed people to expand on impacts they felt the proposed changes would cause and suggest alternative courses of action. 1,218 respondents chose to provide comments on this proposal. In addition, 14 people also mentioned this proposal in a general ‘further comments’ box at the end of the response form.

Alongside this 51 unstructured written contributions were received, 37 from individuals, 3 from elected bodies and 11 from organisations.

In order to help capture the views of young people about the consultation, members of the Hampshire Youth Forum (aged between 11 and 18) were invited to consider the proposals and attend a discussion group to share their feedback.

Who responded: demographics of individual responses

• Just over two fifths (43%) of responses from individuals were from those aged 45 to 64, with just under a third (31%) aged 65 or over. Just under 1% were from those aged under 25, and 16% were aged 25 to 44
• The majority of respondents were from non-ethnic minority groups (i.e. White British, English, Welsh, Scottish or Northern Irish) with 7% of responses from an ethnic minority group.
• While the majority reported no health or disability issues, around 1 in 5 (21%) reported a health or disability issue that impacted their day-to-day activities either a little or a lot.
• Just over a fifth of respondents (22%) had children and young people under 19 in their household.
• 9% of respondents came from households with the lowest income (up to £20,000), 28% had an income of £20,001 to £60,000 and 23% were from households with higher incomes (£60,001 or more).
• Responses were received from residents of all districts in Hampshire, ranging from 116 in the borough of Gosport to 473 in the district of East Hampshire.

No demographics were captured about the individuals who provided unstructured responses to this proposal.

Please note this was an open consultation the respondents were self-selecting so do not provide a representative sample of the total Hampshire population.

Levels of agreement with the proposal

There was no majority consensus on this proposal, however, respondents were more likely to disagree than to agree, and to do so strongly.

• 48% overall disagreement (26% strongly disagreed)
• 42% overall agreement (14% strongly agreed)
• 9% were neutral

What is driving disagreement with this proposal?

Certain groups of people were notably more likely to oppose the proposal compared to the total sample, these were:

• Responding organisations (64% disagreement)
• Non-residential care users and their relatives (68% disagreement) - and this was true whether they paid for (70% disagreement) or did not pay for their own care (64% disagreement).
• Respondents whose activities were limited by health or disability (57% disagreement)
• Respondents aged 45-64 (50% disagreement)
• Those with household incomes of less than £20,000 (56% disagreement)
• Respondents from the districts of Basingstoke and Deane (55% disagreement), Rushmoor (54% disagreement) and Fareham (54% disagreement)

Those aged 65 or over were not notably more likely to oppose the proposal than younger respondents. This is a key finding and does not immediately seem to make sense as it would seem those who are more likely to be affected by the proposal (those over 65) are less concerned by the change than those unlikely to yet be affected (those 45-64).

Looking at where people found out about the consultation may help to explain this, as those aged 65 and above are more likely to have completed the consultation in response to a letter or email, which is notably higher than those of younger age groups. The lower opposition may therefore reflect a more detailed explanation of the personal impacts upon invitation to respond to the consultation.

Driving disagreement with the proposal was a feeling that people should be left some disposable income. This was mentioned by 28% of those opposed to the proposal who also left a comment (824 respondents), as summarised in this example:

Also driving disagreement was the feeling that people have contributed enough to the system over their working lives (expressed by 14% of the 824 respondents who left a comment and were opposed to the proposal):

What is driving agreement with this proposal?

Certain groups of people were notably more likely to support the proposal compared to the total sample, these were:

• Higher incomes - those with a household income of over £60k (56% agreement)
• Living in Winchester district (54% agreement)
• Living in rural areas (50% agreement)

Driving support for the proposal was belief that we should take an individual centred approach to charging (12% of the 249 respondents who agreed with the proposal and left a comment mentioned this):

Of the 249 respondents who supported the proposal and left a comment, 4% felt that wealthy people should foot their own care bill and the same proportion felt that all families or individuals should pay for their own care. This latter point in particular was notably more likely to be mentioned by those who agreed with the proposal (4%, compared to 1% for all responses):

Main impacts of the proposed change

The overall comments provided about this proposal were also analysed to understand what potential impacts the proposal could have if it were to be implemented.

368 out of the 1,218 respondents (30%) who chose to provide comments on this proposal mentioned a potential impact of the proposal in their feedback.

There was concern that this proposal would impact on vulnerable people (expressed by 32% of those who mentioned an impact), on older people (22%), those with disabilities (18%) and those on a lower income (18%).

There was also a concern that the impact of the change would be that clients needing non-residential care would not be able to afford the extra cost (17% of comments mentioning an impact) and that this may lead them to cancel or not fund their care (16%). One respondent summed these issues up quite concisely:

Indeed 2% of all those leaving a comment (1,218 respondents) said that implementing this proposal might cost more in the long term.

Impacts on protected characteristics

1,083 people said they thought the impacts related to any protected characteristics. They were most likely to indicate that the proposal would impact people because of:

• disability - 55% (concerns about isolation and costs of living)
• age - 50% (concerns about the impact on older people’s wellbeing and costs of living)
• poverty - 35% (concerns about the strain of increased charges on people with lower incomes and the rising cost of living)
• rurality- 14% (concerns around the cost of living in those areas).

Other characteristics were also mentioned but at much lower levels.

Suggested alternatives to the proposal

258 out of the 1,218 people (21%) who chose to provide comments on this proposal made a suggestion about any alternatives to the proposal or how they felt the service could be carried out differently.

Respondents who commented suggested the following:

• Taking an individual centred approach to calculating support (without formulas or rigidity in using them) was mentioned by 34% of those who suggested an alternative
• To save money by alternative means (30%)
• Increase/means test payments (11%)
• Use alternative income calculation (10%)
• Families/individuals should pay (6%)
• Increase taxes instead (5%)
• Lobby Central Government for additional funds (5%)

Other suggestions were mentioned in lower proportions.

Comments on the consultation

Some concerns were expressed about how the proposals were developed / the criteria used for selection.

Comment/ concern

• Difficult to assess if all expenditure would be taken into account
• Query about how an individual's income is calculated
• Supporting documents are misleading - they don't show that many people surrender their state pension to go towards their care
• The HCC website does not provide enough detail about what counts as 'expenditure' when undertaking the financial assessment
• Lack of clarity around whether the 100% of assessable income calculation allows for some discretionary spend for social activities or ongoing home maintenance etc.
• Not possible to answer as some care seems to come from NHS, and it isn't clear who pays for what
• I would ask if your figures for cost of living used to determine the amounts of assessable income, are up to date given the sudden rise of it in recent years