Contact: David Ward Ext. 7259

1 Executive Summary

1.1 The Government is introducing new mandatory guidance for charging policies for home care and non-residential services. There is a two stage implementation, with a number of actions required by 1 October 2002 and the remainder by 1 April 2003.

1.2 It is clear that, although the intentions of the County Council charging policy are close to the national guidance, the impact of implementing the required changes are significant. A full review of the policy and procedures is required. A number of parts of the Department of Health guidance do not concur with our policy and this will have a significant impact on the level of income generated from charges.

1.3 The table below gives a brief summary of the changes required in the guidance compared with Hampshire County Council's current charging policy.

1.4 The main impact of the proposals is a reduction in income to the County Council, estimated at over £2 million in a full year (£1m in 2002/03). This is particularly difficult in the light of the low level of Government funding for the County Council. Hampshire County Council's Standard Spending Assessment (SSA) is one of the lowest in the country and the increase in SSA for 2002/03 was the second lowest of any shire county. Hampshire County Council will be spending at 6.6% over SSA in 2002/03, in comparison with 5% below SSA in 1997/98. Hampshire Council Tax payers meet one-third of the cost of spending compared with 21% nationally.

1.5 The resulting changes in the charging policy will potentially benefit users in all bands. In some cases, a significant number of users currently being charged will no longer be required to contribute to the cost of their care.

1.6 Changes to the charging policy, and other potential measures required to meet the funding shortfall, require consultation with users. Initial discussions have taken place with user representatives and it is proposed to progress into formal consultation

1.7 A number of alternative measures to address the potential income loss are outlined in the report.

1.8 Intermediate care is a core element of the Government's programme for improving services for older people. It is expected to enable increased numbers of older people to maintain independent lives at home. The expansion of intermediate care is also important to the efficiency and effectiveness of the health and social care system as a whole.

1.9 Currently, Hampshire County Council policy does not include specific provision for charging for intermediate care although residential and domiciliary services provided by Hampshire County Council are chargeable. Appendix A details the definitions of intermediate care and proposed charging guidelines for dealing with intermediate care schemes.

2 Introduction

2.1 The Department of Health issued, after a period of consultation, a Local Authority Circular (LAC(2001)32) which draws local councils' attention to the issue of guidance for Fairer Charging Policies for Home Care and other non-residential Social Services. Councils are expected to implement this guidance under section 7 of the Local Authority Social Services Act 1970, the significance of this being that it makes the guidance mandatory.

2.2 The following are the main actions the Social Services Department will need to take to be ready for the first phase of implementation by 1 October 2002:

· Redesign and consult on the charging policy, allowing time to take account of responses, make and notify decisions;

· Identify existing users receiving income support whose overall income equals the defined basic levels, plus 25% to ensure that they cease to be charged;

· Identify users receiving more than 10 hours weekly home care, whose disability benefit is included in an assessment of income, to ensure that they receive an assessment of their disability costs;

· Make arrangements to carry out assessments of users' disability costs (requiring appropriate staff training).

· Identify users with earnings and ensure these are disregarded in any charge assessment.

2.3 The final phase of implementation should be in place by April 2003.

2.4 Draft practice guidance to help councils in devising and implementing charging policies was issued at the beginning of February 2002. This document had a four-week consultation period which ended on 13 March 2002. Regional workshops to help with the planning and implementation of the guidance were held during February 2002.

3 Implications for Social Services

3.1 The County Council's charging policy is based on an individual's ability to pay. Clients are financially assessed, taking account of disability-related expenditure, to determine their disposable income. As a consequence, they are placed in one of seven different bands, with upper limits for charges relating to each. Those on Band 1 (receiving income support only) receive an abbreviated, non-intrusive financial assessment and pay nothing. The County Council's policy does not take into account individuals' capital.

3.2 There is a requirement in the guidance that charges should not reduce users' incomes below basic levels of Income Support, plus a margin of 25%. This is not the County Council's policy and was challenged as part of the consultation process. This requirement will have the effect of reducing minimum disposable income by £23 per week (for older people) and is likely to have a significant effect on charges for clients in all bands other than those in bands 1 and 7. However, clients at the lower end of band 7 may move down to band 6.

3.3 The guidance also suggests that it would normally be reasonable to treat the difference between the higher and middle rates of attendance allowance as the element for night care, unless, for example, it is clear that the additional element is paid in respect of day-time care. This would have the effect of reducing disposable income by £18 per week for those clients not in receipt of night care but charged in band 3.

3.4 A clear requirement of the guidance is that a specific assessment of each user's disability-related expenditure should be made before disability benefits can be taken into account as income.

3.5 The County Council has a fairly comprehensive list of disability-related expenditure items that are taken into account in individuals' assessments. However, some changes may be required to accommodate additional items included in the guidance e.g. council tax and specialist clothing.

3.6 Hampshire's council taxes, incorporating precepts of other authorities (including district and parish councils) for Band D properties range from £836 to £889 with an average of £865 (£16.63 per week). This will reduce the weekly disposable income of those clients in bands three to seven by this amount as it is assumed that those in receipt of income support will have their council tax met through housing support.

3.7 For clients in Bands 2 and 3, the current policy is not to assess for disability-related expenditure as it is assumed to be taken into account in setting the upper limits of the weekly charge. These are based on one-third of the disability-related allowances appropriate to the band. It will be necessary to ensure that all band two and three clients (3,600 clients) are assessed for disability-related expenditure. This will have a workload implication for those responsible for undertaking assessments.

3.8 There is a requirement that, from April 2003, councils provide benefits advice at the time of an assessment of ability to pay charges. The County Council has a pilot scheme - the FAB Project (Financial Assessments and Benefits) - in the Winchester and Andover areas. This is based on the model adopted by Torbay Council, who have helped in getting the project started, and deals with both residential and non-residential assessments. The intention is to extend this to the rest of the County by April 2003. Although pump-priming investment is required, and is built into the Social Services budget for 2002/03, the financial and other benefits are likely to far outweigh any disadvantages.

3.9 The Government's policy is to encourage those who wish to take up employment, including disabled people. Disregarding earnings in assessing ability to pay charges is seen as a means of removing a barrier to work for disabled people. The Government believes it is right, therefore, that councils should disregard all earnings in charge assessments for non-residential social services.

3.10 The County Council does not disregard such earnings in its present policy. While it is unlikely to affect the majority of clients, this will have an impact on the charges for clients in disability groups under retirement age.

4 Estimated financial impact

4.1 Records of users' financial circumstances are incomplete. Clients reliant on income support have a shortened financial assessment and are required only to identify whether or not they receive disability living allowance or attendance allowance and at what level. This is a deliberate part of the policy adopted by the Social Services Committee in 1995 and results from a consultation with service users which indicated that while the majority accepted `means-tested' charges, they also wanted the assessment to be as simple and non-intrusive as possible. It is therefore difficult to estimate the financial impact of the new Government guidance with precision. However, it is clear that the 25% buffer will have a very significant impact on most of the bands - to the extent that a high proportion of the clients in bands 2, 3 and 4 will end up paying nothing. The other changes described above will add to this loss of income. For example, the table below, which sets out the average weekly contribution in each of the six chargeable bands demonstrates clearly the impact that allowing council tax payments of £16.63 per week will have.

Band	No of Users	Av. charge per week	Annual Income
	( as at February 2002)	£	£'000
1	1131	No charge	-
2	2328	10.00	1,210
3	1358	12.00	847
4	655	7.00	238
5	746	14.00	543
6	303	26.00	410
7	450	31.00	725
Total	6971		3,973

4.2 The reduction in average charge per week between bands 3 and 4 is due, in the main, to the fact that those on band 4 are not in receipt of income support but these clients may offset disability related expenditure. Those service users in bands 2 and 3 are not currently assessed for disability related expenditure.

4.3 The total income estimated for this year from charges for non-residential services is £3.9 million. Of the 5,840 clients who are charged it is possible that the new charging guidelines will reduce this number to, or even below, 2,154 (37%) chargeable clients. It is likely that most clients currently on bands 2 and 3 (63%) will become non-chargeable.

4.4 The total estimated loss of income resulting from all of the Government's changes is approximately £2 million per annum, which equates to around 50% of total income from non-residential charges.

4.5 In addition, the new guidance will bring new management, training and administrative costs as well as costs for consultation and publicity and systems changes. The total estimated costs are £250,000, the majority of which is of a `one-off' nature.

5 Options

5.1 It is necessary to identify alternatives that would generate sufficient income to balance the anticipated loss arising from implementation of the Department of Health guidance. This is the assumption within the 2002/03 Revenue Budget. Failure to achieve this would result in a pressure on the budget which could lead to service adjustments.

5.2 A number of options have already been identified as possibilities for either increasing charges or introducing new ones. These were considered by the Resources Sub-Committee of the Social Services Committee in January 2000.

· Increasing rates within the non-residential charging policy

· Charging for day care - learning disabilities and mental health

· Review of parental contributions for looked-after children

· Charging for services for children with disabilities

· Charging for transport

· Charging for aids and equipment

5.3 Section 17 of the Health and Social Services and Adjudications Act 1983 (HASSASSA Act 1983) gives local authorities a discretionary power to charge adult recipients of non-residential services. Consideration of the Disability Discrimination Act and Human Rights Act requires that an equitable approach to charging is taken and that no group is unfairly discriminated against. This has been reinforced in the Department of Health's National Service Framework for services for older people, published last year. The Carers and Disabled Children's Act gives powers to Local Authorities to charge carers, of all ages, for services that are for their benefit. Under the Children Act 1989, Local Authorities can require the parents of children looked after by the Authority to make a contribution towards the cost of their child's maintenance.

5.4 Hampshire County Council currently operates a mixed economy of charging regimes across client groups:

· Most charges for non-residential services for adults over the age of 18 fall within the remit of the Non-Residential Charging Policy, although there are some day care services provided to these client groups that remain non-chargeable and charges for meals services are treated separately.

· Services to Children and Families are charged under the parental contributions policy. This policy is applied to the parents of mainstream looked-after children but not to those receiving other non-residential services at Family Centres, etc., or parents of children with disabilities receiving respite or residential care services.

· Transport services and the provision of aids and equipment are currently non-chargeable and provided across client groups.

5.5 A summary review of these options follows.

6 Non-residential charging policy

6.1 The current Hampshire County Council Non-Residential Charging Policy was introduced in 1994 and is based on banding of service users according to their level of disposable income. Weekly upper limits are set based on a proportion of the disposable income left.

6.2 The Department of Health guidance introduces a number of additional disregards of income in the calculation of disposable income available for charging.

6.3 Options for revising the current policy with a view to partially reducing this significant loss of income have been considered:

· Remove the banding system and apply standard hourly and daily charges to all service users;

· Revise the current banding system and apply differing hourly and daily charges to services users, depending upon their disposable income and banding.

In both options, further revisions to the current policy were considered:

· After allowing additional disregards, all the remaining disposable income being available for charging.

· Introduce a maximum charge as a standard upper limit for all service users with savings capital of zero to £18,500 per week (this is the capital threshold used in assessing charges for residential services: an increase in this figure is expected to be announced soon).

· Service users with savings capital above £18,500, or who decline a financial assessment to pay the `full cost' of their care (i.e. no maximum weekly charge).

6.4 The maximum income that could be generated from each of the options is estimated to be:-

Option	Income £
1	1,603,500
2	1,048,900

These figures, however, must be treated with great caution because of the limitations of available data described above. Service users will not be able to contribute more than the disposable resources they have, once allowance is taken of all the factors outlined above. One important part of the consultation work described below is fact-finding about benefits and disability-related expenditure and this will allow much more reliable estimates to be produced.

7 Charging for day care - learning disability and mental health

7.1 Currently, day services for adults with a learning disability or mental health problems are non-chargeable. The Social Services Committee's decision in 1996 to provide exemption for day services is based on the premise that they provide ongoing social education for adults. However, a growing emphasis on equity between client groups, reinforced by the new guidance, means that this policy position is no longer tenable.

7.2 The options that could be considered are:

· Continue the policy of not charging

· Introduce charging on the same basis as for day services for people with a physical disability and older people

7.3 The introduction of charging for day care services for these client groups could potentially generate income of £100,000 per annum. Once again, however, more needs to be discovered about the financial circumstances of users of these services before reliable estimates can be made. Initial estimates are that relatively small numbers of service users will actually pay, given the fairness and generosity of the charging regime in allowing a range of disregards from disposable income.

8 Parental contributions

8.1 Parents of Hampshire children looked after by the Local Authority are required to make a weekly parental contribution towards the cost of the child's maintenance, unless the child is in care in certain legal circumstances (e.g. an Interim Care Order).

8.2 Parents undergo a summary financial assessment. If they are in receipt of Income Support and/or certain other benefits, Hampshire County Council cannot legally require them to make a contribution.

8.3 The current rate of parental contribution is a flat rate of £16.05 per week, with an income forecast for 2001/2002 of £20,000.

8.4 Income collection from parental contributions is currently not being maximised. Only 74 children from a total looked after population of 766 has a parent financially assessed to establish their liability to make a parental contribution. A large number of the parents of these children are known to be in receipt of Income Support.

8.5 Some inconsistency in approach and application of the policy has led to low levels of income achievement and the economics of collection becoming increasingly questionable. In these circumstances, it would not be advisable to attempt any change in policy at this stage. Attention should be concentrated on enforcing the current policy and establishing a firm foundation from which other more radical revisions can be made at a later date. Consideration needs to be given to a more centralised approach to administration of assessment and collection. This would achieve economies of scale and a more consistent and effective approach to collection. Consideration could be given to including the administration of parental contributions in the brief of the Financial Assessments and Benefits Team, which would undoubtedly increase the incidence and accuracy of assessments.

8.6 Clearly, a significant increase in the contribution rate would be unpopular with parents, particularly those already paying their contribution. However, if the rate can be justified as reasonable in the circumstances then any resistance from parents should not be sufficient reason for not increasing the contribution. With a significant increase in the parental contribution and a financial means test, it would be necessary to establish clear criteria and mechanisms for parents to appeal against paying their assessed contribution on the grounds of financial hardship.

9 Charging parents for services for children with disabilities

9.1 There are currently no charges levied on parents for services provided to their children with disabilities, despite the fact that many parents receive Disability Living Allowance care and mobility components in respect of the child.

9.2 Introducing a charging regime to these services would bring them into line with services for adults and the expectation placed on other liable parents to make a contribution towards the cost of their child's care.

9.3 There are currently 280 Hampshire children with disabilities receiving some form of respite care service.

9.4 The principle of a parental contribution is already accepted in the organisation and could easily be adapted and extended to care for children with disabilities.

9.5 A separate form of charging regime for services for children with a disability (other than parental contributions), even though based on a similar set of principles to that which exists for adult services, would have to have unique features (for example, an earnings disregard might prove difficult to incorporate) and would need to be developed carefully, guided by consultation with affected parties. Legal opinion would need to be sought on the provisions of the Disability Discrimination Act. Early implementation, therefore, would not be possible.

10 Charging for transport

10.1 Under Section 2(1) of the Chronically Sick and Disabled Persons Act 1970, local authorities have a statutory duty to arrange or provide transport services. The Children Act 1989 also encourages authorities to provide services to children in need, which includes general support and transport.

10.2 Transport is required in order to access and provide social care services and is provided through a wide range of mechanisms.

10.3 Whatever the mode of transport, or the purposes for which it is used, service users are not charged for the service.

10.4 The Department of Health Guidance is clear that flat rate charging is only appropriate where the charge is in respect of services that replace everyday living expenses (e.g. meals). All other charges should be considered in the context of the total care package provided to the service user. It would be necessary, therefore, to include any charge for transport within the service user's financial assessment and charge for the total cost of their care package.

10.5 While the Best Value review of transport (a progress report on which was received by the Social Care Policy Review Committee at their last meeting) has identified some ways of achieving greater efficiency in this area, the issue of charging was not considered and, as a consequence, there is no easily available information on the numbers of service users transported each year. In this context, it is tentatively estimated that income of no more than £90,000 per annum could be generated from this option. However, this figure is likely to be reduced even further due to service users already paying at their upper limit when all elements of their care package are taken into consideration.

10.6 Whilst maintaining a recording and payment collection system for transport services would be relatively simple for service users with an existing care package and financially assessed via the non-residential charging policy and process, it would be far more complex for those accessing the service on a more ad hoc basis outside of a care package.

10.7 Given the limited residual income that would be generated by introducing a transport charge, it is not be considered to be cost-effective to pursue this option, given the initial set-up costs and administrative workload and particularly in the light of other proposed increases in the cost of care.

11 Charging for aids and equipment

11.1 The Equipment Service is available to Hampshire residents of any age with a permanent or short-term disability. Equipment is provided, without charge, to enable service users to live independently, and safely, in their own homes. The service is part of the Authority's response to its duties under the Chronically Sick and Disabled Persons Act 1970, NHS Community Care Act 1990 and Carers Recognition of Services Act 1995.

11.2 A consultancy report "Equipment Charging Review" (June 2000) considered the appropriateness of charging for equipment services commissioned or provided by the Social Services Department and fed into the Best Value review of these services. The main options considered by the review were: -

1. Maintain the current policy not to charge

2. Introduce a refundable deposit

3. Introduce a flat rate charge

4. Charge per item of equipment

5. Charge for a specific timescale (e.g. per week/month)

11.3 Option 2 would have cost implications but little potential to generate significant levels of income as all monies collected would have to be returned. The only revenue possible would arise from encouraging service users to return equipment, thereby saving the value of items currently not being returned.

11.4 The Department of Health Guidance was published subsequent to the 2000 review and its requirements regarding the application of flat rate charges (as discussed in relation Transport) impacts on each of options 3, 4 and 5.

11.5 Were charging to be introduced, it would need to be allied to the existing Non-Residential Charging Policy. This would ensure service users have an integrated financial assessment of their ability to pay for all their care services. The level of income collection would be limited by the upper limits of disposable income available to service users, many of whom would already be in a non-chargeable situation or paying at their upper limit.

11.6 Any proposals to introduce charging would need to be discussed with other (health service) partners involved in each of the equipment stores, as any changes to existing agreements would have to be agreed.

11.7 Any potential adverse impact on partnership and joint working would need to be assessed. The implications of providing an equitable service for all service users would also need to be considered, given health equipment is provided free of charge.

11.8 There is ongoing work to pool budgets with the NHS. The guidance on pooled budgets expects the social care elements of service purchased through a pooled budget to be subject to the local authority's charging policy, while the health services would remain free at the point of delivery. For equipment services this would be particularly difficult to unpick as equipment often serves a purpose that could be labelled health or social care.

11.9 The update on the Best Value Improvement Plan received by the Social Care Policy Review Committee last month reported that implementing charging would not be cost-effective.

12 Overall

12.1 The maximum potential income, which might be generated from the areas detailed in this report, are summarised in the following table. The cautionary notes expressed earlier about the reliability of the data on which these estimates are based apply.

12.2 If these sums could be achieved the loss of income from implementation of the Department of Health guidance would be reduced to approximately £370,000.

13 Financial Assessments and Benefits (FAB)Team

13.1 A pilot project - the FAB team - has been operating in the Winchester and Andover areas of the county since October 2001. A team of dedicated assessors, based at The Castle have been visiting users of both residential and non-residential services in order to ensure that they are fully aware of their financial liability and to advise and assist in claiming benefits.

13.2 The main benefits of this approach have been:

· Increasing income through ensuring clients are accurately and promptly assessed and that they claim benefits to which they are entitled. This has increased income to both the service users and the department and, by reducing delays, means that there are less disputes and consequently a likely reduction in the amount of debts that need to be written off.

· Releasing care management time. Although still seen as part of a care manager's role, the detailed financial assessment being carried out by a trained `expert' means that some care management time is freed up. The recent Best Value review report on care management, which looked at the impact of the pilot, estimated that the equivalent of 30 full time equivalent care managers' time across the county could be released for other areas of work such as reviewing and taking on more cases as a result of the transfer of clients on preserved rights.

· Enhancing the benefits advice to clients. The visiting officers have been trained to provide advice on a wide range of benefits including income support, attendance allowance, disability living allowance, severe disability premium, Housing Benefit and Council Tax. These claims are monitored and followed up where necessary with the relevant agencies.

13.3 There has been some very positive feedback on the service provided by the team both formally and informally. For example, a questionnaire sent to 64 clients resulted in 89% rating the service provided at 5 out of 5. It is too early to fully assess the other benefits, including additional income, but this will be done in the next few months.

13.4 The proposal is to extend this service across the whole of the county, in tandem with the implementation of revisions to the non-residential charging policy. Detailed proposals, including a request for additional staff, will be submitted to the Policy and Resources Executive Member in April 2002.

14 Consultation

14.1 Initial meetings have taken place with groups representing service users. At these meetings, the way in which the Government's new guidance impacts on Hampshire County Council and its current charging policy has been outlined and proposals for consultation with service users have been put forward and discussed. The meetings have been used to seek the views and assistance of these representative groups to ensure that the consultation with users is handled in a sympathetic and understanding manner.

14.2 The meetings were very valuable in clarifying the issues on which it was appropriate to consult service users and the methods to be used. It is clear that the consultation will need to be carried out in two parallel streams:

· consulting with existing users of non-residential services on changes to the policy arising from the Government's new guidance;

· consulting with users of non-chargeable services where they may be asked in the future to make a financial contribution.

14.3 Both have significant fact-finding elements since further information from service users about their expenses and receipt of benefits will be of great value in refining financial estimates. The questionnaire which it is proposed should be sent to existing users of chargeable services is attached at Appendix A.

14.4 In order to meet the tight timescale required for implementation on 1 October 2002 and to allow an appropriate time to consult with service users, it is necessary to begin full consultation at the end of March. Conclusions will need to be drawn from the consultation in May 2002, before any changes to systems or policies can be recommended

15 Intermediate Care

15.1 Intermediate care is a core element of the Government's programme for improving services for older people. It is expected to enable increased numbers of older people to maintain independent lives at home. The expansion of intermediate care is also important to the efficiency and effectiveness of the health and social care system as a whole.

15.2 Although the Hampshire County Council charging policy includes charging for residential and domiciliary services, the Department of Health considers that all intermediate care should be free at the point of use. Hampshire County Council will need to agree with health partners that the NHS has underlying responsibility for such services.

15.3 A number of intermediate care schemes are currently being developed in partnership with health utilising funding available within the Building Care Capacity grant.

15.4 Attached at Appendix B is a draft document which sets out guidelines for charging for intermediate care and related services. The recommendation is that such services, limited normally to a six-week period, should be free of charge.

16 Recommendations

1. That approval be given to consult with users about how best to implement the changes required to the County Council's charging policy for non-residential services, with a view to reporting back to the Executive Member in June 2002 on the outcomes of those consultations once completed.

2. That approval be given to fully investigate the charging options identified in the report and report back on potential solutions to the Executive Member at the meeting in June 2002.

3. That approval be given to the introduction of the charging policy for intermediate care as set out in Appendix B.

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works.

2. Documents which disclose exempt or confidential information as defined in the Act.

Review of Social Services Non-Residential Charging Policies

CHANGES TO CHARGES FOR SERVICES APPENDIX A

QUESTIONNAIRE

We need your help

Because the government has given us new rules about how we must charge for services, we need to make some changes to the way we currently charge. Some changes we have no choice about - but others we don't want to make until we have some information from you, and we have heard your views. There is more information about this on the next page.

We'd find it very helpful if you would take the time to fill in this questionnaire and send it back to us in the envelope provided by 7 May 2002 at the latest. You don't need a stamp.

If you want to, you can ask a member of your family or a friend to help you fill in the questionnaire.

What is the questionnaire about?

The questionnaire asks you for your views about the changes we might make to the way we charge for services - and also asks you for a little information about your circumstances to help us make our new charging system as fair as possible.

It isn't a vote.

What will happen to the information in the questionnaires?

We will use the information you give us to help us make the changes to the way we charge for services as fair as possible for everyone.

The questionnaire is completely anonymous - we don't need your name, and what you say can't in any way affect the services you get from us.

We have put a reference number on the questionnaire. It does not identify you - it tells us whether you are over or under 65, and which of our `charging bands' you come into. This will help us know whether different groups of people think differently about the changes we are suggesting.

If you have any questions about the questionnaire, please ring ...

[BOX]

If you would prefer, we can send you the questionnaire in larger print, on an audio cassette, or in braille. Ring Lori Cunningham on 01962 847728.

WHY ARE THERE CHANGES?

Charges and the County Council

The County Council has charged for services for many years. The way we decide how much you should pay each week takes account of your income and your outgoings so that you only pay what you can afford towards the cost of the help you get.

The government has now given all Social Services departments some new rules about how we should charge for services, so that people are treated in the same way in all parts of the country.

There will be no changes until October.

What do the changes mean for you?

The new rules are more generous than the old ones. More details are given on the sheet headed `How our charging policy works now - and the changes the new rules make'.

The majority of people will pay less for their services, some will get free services - but some people may pay a little more. Some examples of how charges will be worked out are given on a separate sheet. We can't give every case, but we hope that you find these examples helpful.

When will you know what your new charge will be?

Introducing all the government's changes will mean that we have the option to change some details of our existing system (see more details in the section `What do the changes mean for Social Services?').

We won't be making a decision about our changes until we have had your questionnaires back - so we won't have the full details of the new policy until the summer.

We won't be able to tell you exactly what your new charge will be until you have had a financial assessment using the new rules.

However, we promise you that no one will be charged more than they can afford. And, as now, if you feel you can't pay what you are asked, you will be able to ask us to look again at your financial assessment.

A more detailed financial assessment

Another change will be that we are obliged to ask everyone for full details of their income (excluding any earnings from paid employment) and outgoings. This includes details of benefits, and of the extra expenses people have because they are ill, disabled, or getting old.

We already take account of a number of 'disability expenses', and the government has suggested more. We have listed these in part two of the questionnaire. It would help us draw up as fair a policy as possible if you would tell us which of these expenses apply to you, and roughly how much you spend on them - and to tell us of anything that we've left off the list.

What do the changes mean for Social Services?

We will get a lot less money from charges - so that the contribution charges make to the provision of services could be cut by half.

Our aim is not to cut services - but within reason we also want to make sure that we maximise the money we get from any charges we make. This will help us go on providing the services that you need.

How can we do this?

First and foremost, we can make sure that you get all the benefits that you are entitled to.

We are setting up a team of specially trained staff who will concentrate on financial assessments and benefits advice, and will help you apply for any further benefits that you may be entitled to.

If you get extra benefits, it may mean that you will be asked to contribute some of the money you get towards the cost of your help - but the plus side will be that you will keep more than you are asked to pay, and will therefore be better off as a result.

It will help us a great deal to know which benefits you get now - so please fill in part one of the questionnaire. You don't need to tell us how much you get.

We have some other suggestions about what we could do - and we would like your views about these. They are given in part three of the questionnaire.

PART ONE

WHICH BENEFITS DO YOU GET?

We would find it very helpful if you could give us details about which benefits you are getting now.

This information will help us in our work of making sure that you are getting all the benefits you are entitled to, and will tell us who needs our help first. For more details see the section headed `How can we do this?' on the facing page.

Please tick all the benefits that you get - you don't have to say how much money you get

income support

[ ] income support

basic premiums

one of the following

[ ] pensioner (over 60)

[ ] disability (under 60)

add ons

[ ] severe disability

[ ] enhanced disability

[ ] carer

[ ] family

[ ] disabled child

other benefits

[ ] DLA

[ ] AA

[ ] constant attendance allowance

[ ] severe disablement allowance

[ ] exceptionally severe disablement allowance

[ ] long-term incapacity benefit

[ ] disabled person's tax credit

[ ] invalid care allowance

[ ] housing benefit

[ ] council tax benefit

[ ] any other benefit (please say what it is) ........................................

PART TWO

WHAT ARE THE EXTRA EXPENSES YOU HAVE BECAUSE YOU ARE ILL, DISABLED - OR GETTING OLD?

As now, we will be making sure that the extra expenses you have because you are ill, disabled or old are taken into account when we assess your income and your outgoings. We would find it very useful to have an up-to-date survey of these expenses.

Please tick all items that apply to you, and give the amount you spend each week for each item that you have ticked.

general

[ ] domestic help

[ ] food: special diet for medical reasons

[ ] gardening

[ ] heating: extra heating for medical reasons

[ ] metered water costs above average

[ ] home maintenance

[ ] incontinence: aids and laundry

[ ] replacement bedding, for example because of incontinence

[ ] lifeline/alarm/security system

[ ] medication

[ ] personal care arranged privately

[ ] privately arranged respite care

[ ] special clothing or footwear / costs of wear and tear to clothing or footwear caused by disability

[ ] transport costs if not covered by mobility component of DLA or available from us (for example, transport to day centres)

equipment maintenance

[ ] bed (powered)

[ ] hoist

[ ] reclining chair (powered)

[ ] stairlift

[ ] wheelchair (manual)

[ ] wheelchair (powered)

other

[ ] loan or debt repayment

[ ] travel: visiting partner in hospital or residential care

[ ] purchase of disability-related equipment, including equipment or transport needed for work

[ ] expenses associated with personal assistants (for example, meals or transport costs)

OTHER EXPENSES

Please give details

PART THREE

WHAT DO YOU THINK?

Apart from the changes that the government has given us, we would like to make some changes to our existing policy that will help us maximise the income we get from charges. This will help us continue to provide the services you need.

None of these changes will increase charges by a large amount - the new policy, like our old policy, will be based on what people are assessed as being able to afford.

QUESTION 1

Should everyone pay the same rate per hour / session?

If we do this, it will make our policy simpler - and therefore cheaper to administer.

The new assessment process will change what we take into account when we work out what amount of your income can be counted towards a weekly charge (your `disposable income'). A single rate per hour/session would be higher than the rate people are currently paying in the lower charging bands - but don't forget that you cannot pay more in charges than the disposable income you have, and that what you pay does not affect the amount of care you receive.

For example, if you have £9 a week income that is counted towards your charge, it would cover three hours of home care if the rate were £3 an hour, and one hour if the rate were £9 an hour. The total amount you pay would not change, nor would the amount of care you get.

I think that everyone should pay the same rate per hour / session

[ ] Yes

[ ] No

QUESTION 2

When we make a financial assessment at present we only take account of the interest people get on their savings when we calculate their income. We will not be changing this.

Should we also take account of people's actual savings and capital?

I think you should

A [ ] keep things as they are now and only take account of the interest earned on savings and investments

B [ ] only take into account savings and investments over a certain level (say £11,500)

C [ ] take account of all savings and investments

D [ ] take account of all savings, investments and the value of any property

QUESTION 3

Should we change our existing `upper limits', now that an extra living allowance is built into the financial assessment - so that more `disposable income' is taken into account?

We currently have `upper limits' to what you can pay each week from your `disposable income'. These ensure you have money left for other expenses that are not covered in the general living allowance or in the disability related expenses allowances.

The government's new rules add an extra 25% on top of your general living allowance. This is also meant to ensure that you have the money you need for other expenses.

I think that more `disposable income' should be taken into account when working out a weekly charge

[ ] Yes

[ ] No

If you have answered Yes, what do you think would be a reasonable `upper limit'?

[ ] 75% of disposable income

[ ] 50% of disposable income

[ ] 25% of disposable income

FURTHER COMMENTS THAT YOU WANT TO MAKE

Please continue on another sheet as necessary

Thank you for taking the time to complete this questionnaire. Please send it back to us in the freepost envelope supplied - you don't need a stamp.

HOW OUR CHARGING POLICY WORKS NOW - AND THE CHANGES THE NEW RULES WILL MAKE

1 We charge for
care or help at home
care or activities provided by a day centre or day services
sitting or companion services

Will this change?
No

2 We don't charge for day services for people with learning disabilities, or for people with mental health problems

Will this change?
Yes - the government says that everyone using non-residential services must be included in our charging policy.

3 We only take account of the income of the person getting services - we do not include the income of other members of your family or of anyone looking after you.

Will this change?
No

4 We advise people about the benefits that they might be entitled to.

Will this change?
No - in fact we will have a team of specially trained staff who will concentrate on financial assessments and benefits advice.

5 We ask people about their financial circumstances, and as a result they come into one of our seven 'charging bands', which have a range of different rates for services.

If you get income support we only ask for details of any benefits you get. You come into one of the first three charging bands. People in band one do not pay for services.

If you don't get income support we ask for more details of your financial circumstances and for details of your living expenses (including rent or mortgage) and of any extra expenses you have because you are ill, disabled, or getting old.

From the details you give us about your financial circumstances we work out your weekly 'disposable income' - that is, the money you have left each week after you have covered all your living expenses.

Will this change?
Yes - several bits will change.

People who get income support must have a full assessment of their finances and their expenses, and we work out their 'disposable income'.

We will no longer have seven 'charging bands' as everyone's financial assessment will be the same.

We still take account of your living expenses and the extra expenses you have because you are ill, disabled or getting old - but in addition you will get an extra 25% more than we allow now for your living expenses AND there are some new expenses that we will also take account of, including any council tax you pay.

6 When we ask for details about people's financial circumstances we don't take into account any savings or capital they have - only the interest they get from savings.

Will this change?
We could change this.

7 When we ask for details about people's financial circumstances we take into account of any income they have from paid employment.

Will this change?
Yes - in the new policy we will not take earnings from employment into account.

8 Most people who use the 'direct payments scheme' (where people are given the money we would have spent on their services and use it to arrange their own care) do not give us details of their financial circumstances, and get a flat rate payment.

Will this change?
Still to be resolved.

9 We have an upper limit to what you can pay each week, no matter how much care you get. Our upper limits mean that you have money left as a `buffer', to cover any extra expenses.

Will this change?
We might change this.

We currently build the 'buffer' in at the end of the assessment - only taking part of your disposable income into account when working out your weekly charge. The government builds a bigger buffer in during your financial assessment (the extra 25% for general living expenses). Under the new rules you will have considerably less 'disposable income' at the end of your financial assessment that can be considered for charges - and the government assumes that we will take all of it into account when working out your weekly charge.

10 You can choose not to give us details of your financial circumstances. However, if you don't have a financial assessment, we automatically put you in band 7 (the highest rates in our sliding scale) and because we don't have any details of your finances, we can't give an upper limit, and you are charged for all the help you get.

Will this change?
No - though there will no longer be a `band 7'.

Appendix B

Guidelines re charging for social care elements of intermediate care schemes and other schemes developed with health using Cash for Change funding

1. Intermediate Care - Definition

1.1 Intermediate care schemes are services that meet all the following criteria:

_ Are targeted at people who would otherwise face unnecessarily prolonged hospital stays or inappropriate admission to acute in-patient care, long-term residential care or continuing NHS in-patient care;

_ Are provided on the basis of a comprehensive assessment, resulting in a structured individual care plan that involves active therapy, treatment or opportunity for recovery;

_ Have a planned outcome of maximising independence and typically enabling patients/users to resume living at home;

_ Are time-limited, normally no longer than six weeks and frequently as little as 1-2 weeks or less; and

_ Involve cross-professional working, with a single assessment framework, single professional records and shared protocols.

2.0 Domiciliary and/or Day Care Services

2.1 For home care or day care arranged as part of an intermediate care package, councils have discretion whether or not to levy charges, although the DOH "considers that all intermediate care should be free at the point of use".

2.2 In the light of the above it has been decided not to charge where home or day care is an integral part of a time-limited intermediate care package (as defined in paragraph 1.1) and distinct from existing home care support being arranged for the individual by the council.

2.3 When planning and discussing developing new schemes or extensions to existing schemes, we should take into account the amount of potential lost income when determining the level of SS funding that goes into a scheme, however, this is a separate issue from the principle not to charge at the point of use outlined above.

3.0 Residential Care Services

3.1 Where councils arrange some elements of residential intermediate care, e.g. accommodation & personal care, these are treated as a temporary residential placement. Councils may either apply the normal means test for residential accommodation or apply a special temporary rate for up to eight weeks. To meet the "all intermediate care should be free at the point of use" view, councils need to agree with health service partners that the NHS should have underlying responsibility for such services within the framework of a jointly planned and jointly funded intermediate care service. According to the Intermediate Care Guidance Note, councils would need to transfer associated resources, net of charge income, to the NHS under section 28BB of the NHS Act 1977 & as per Health Act 1999 to put this into effect. We have not entered into any such arrangements with health partners to date for schemes developed through Cash for Change funds, partly due to the speed at which proposals have had to be worked up.

3.2 In the light of the above it has been decided to apply a temporary rate of zero, i.e., not charging for these services at all for a maximum period of six weeks.

3.3 It is, however, extremely important, that agreement is reached with health partners, that the NHS retains underlying responsibility for such services, and a written agreement to that effect should be obtained.

4.0 Other Cash for Change funded schemes and/or packages

4.1 Where packages (either domiciliary or residential/nursing) have been arranged using Cash for Change funding and they do not meet the definition of an intermediate care service as outlined above, they should be charged for as per our usual policies. This applies to residential or nursing placements or domiciliary care packages, where they are not time-limited at the time of the placement starting, and regardless of the nature of the contract or the location (if bed-based).

5.0 Implications

5.1 Where we are using Cash for Change funds to create additional nursing capacity, we should be charging regardless of the location, i.e. even if they are on a hospital site, unless the length of stay is six weeks or less. Cash for Change can be used to contribute to nurse-led units but should incorporate a netted off charge within the contribution.

5.2 There must be clear arrangements set in place to ensure that a client who goes onto receive a service (of whatever type) after a period of intermediate care, is charged in the normal way for that service.

5.3 It will be important to ensure that users and carers are made aware of the different nature of the services they are receiving, particularly if the location of their service is not changing.

5.4 We must ensure that we comply with the time limits, i.e. maximum of six weeks, and only agree to a "non-charged" extension of the six weeks if there is clear evidence from a multi-disciplinary assessment (involving a care manager) and individual care plan that the outcome for the user will benefit from an extension over the six weeks.

5.5 When future schemes or extensions of existing schemes are developed, we should be seeking a contribution from health to offset lost income, prior to use of the Health Act flexibilities to create a pooled budget for such a service.