Hampshire County Council

Adult Social Care Policy Review Committee Item 7

29 March 2006

Review of equity and fairness in relation to income

Joint report by the Director of Adult Services and the County Treasurer

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims

Aim 5 - improving services, by ensuring that income from charges is maximised.

1.

Summary

1.1

The Executive Member for Adult Social Care, at her Decision Day on 9 December 2005, agreed a recommendation to consult service users and other interested parties on proposed changes to the Council's policy on charges for non-residential services. This consultation is now underway and the purpose of this report is to bring this to the Committee's attention and recommend that they advise the Executive Member of their views.

2

Impact Assessment

2.1

In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. One major purpose of the proposals is to promote equity between different groups of users of non-residential services.

3

Consultation with Local Members

3.1

Not applicable.

4

Introduction

4.1

The Executive Member for Adult Social Care, at her Decision Day on 9 December 2005, agreed a recommendation to consult service users and other interested parties on proposed changes to the Council's policy on charges for non-residential services.

4.2

The full report, Review of Equity and Fairness In Relation to Income, is available on Hantsnet at:

/decisions/decisions-docs/051209-ascexc-R1201115600

The following is a summary of the report

5

The current policy

5.1

Domiciliary services (including sitting services) are the only chargeable services. Service users are charged on the basis of the amount of service they receive and their ability to pay. An hourly rate of £11.36 per hour (to increase to £13.32 in April 2006) is charged. The service user's ability to pay is based on a financial assessment of his or her disposable income after usual living (Income Support level +25%), housing (rent or mortgage) and disability-related expenses have been taken into account. Income from paid employment is not assessable income while income from pensions, benefits and interest on bank accounts, for example, are. A maximum charge (75% of the assessed disposable income) is determined and the user is charged for the level of service they receive, up to this limit.

5.2

Users who have opted to receive a Direct Payment under Option A are not financially assessed, making, in effect, a flat-rate contribution towards the cost of the payment. The contribution made by recipients of Direct Payments Option B is determined by a financial assessment.

5.3

Financial assessments are carried out by the Financial Assessments and Benefits Team. This team visits service users in their own home and, in addition to calculating the charge (if any), they provide advice and support in applying for welfare benefits, such as Attendance Allowance and Disability Living Allowance. During the last six months of 2005, 1,600 of the 5,100 visits they carried out (31%) concerned benefits claims and some thousands of people have gained from this kind of help in the four years since the team came into being.

5.4

Charges for non-residential services for adults are regulated by the Government through mandatory guidance, Fairer Charging Policies for Home Care and other non-residential Social Services, issued in 2002 under section 7 of the Local Authority Social Services Act 1970. This guidance stipulates how financial assessments should be carried out - income and expenses that may be taken into account, for example.

5.5

In 2004/05, charges for domiciliary services raised £3.8m, against an expenditure of £55.1m. This is only a 6.9% recovery of charges against the increasing costs of care. The cost of carrying out assessments was 14% of charges, indicating that, even with other overheads not analysed in the report, the cost of collection is more than covered by the charges.

5.6

Around 51% of service users are assessed not to pay a charge. The average weekly charge paid is around £13.

5.7

Since October 2002, when Fairer Charging was introduced, a national study has been undertaken on behalf of Age Concern by the Institute of Gerontology at Kings' College, London, on the implementation of the Fairer Charging guidance. A report Fair Enough? was published in April 2004. The Council's charging policy has been compared with that of other local authorities, both by studying the findings of this research and by contributing to a project led by Essex County Council. Amongst the main points to emerge from this comparison were that the Council is:

· in line with national guidance in only charging service users for services provided after they have been notified of the level of the charge;

· broadly in line with other councils when assessing disability-related expenses;

· the only council (of the 150 covered by the King's College study) not to take account of a service user's capital when undertaking a financial assessment;

· only one of a handful of councils that does not take 100% of a service user's net income into account when calculating a charge;

· unlike many councils in that it does not have a maximum weekly limit for a service user's charges (the policy of only taking 75% of a service user's net income into account provides an in-built upper limit).

6

Proposals for changes to the policy on charges for non-residential services

6.1

The following five proposals were put to the Executive Member for Adult Social Care - that the Council should:

1. take account of a service user's capital (savings and investments) in the financial assessment;

2. assess charges based on 100% of a service user's disposable income (assessable income less allowable outgoings);

3. include day care and similar or equivalent services as chargeable services;

4. merge Direct Payments Option A with Option B;

5. introduced an upper limit to the weekly charge in the event of 2 above being agreed.

6.2

The reasons for making these proposals were to:

· eliminate some unfairnesses in the current policy (such as service users with a moderate income but no savings/investments being asked to make a financial contribution towards the cost of services but those with a low income but substantial savings/investments not);

· bring the Council more into line with the charging policies of other authorities;

· raise more income - especially important in view of the Adult Services' budget position for 2006/07;

· deal with the apparent non-compliance of Direct Payments Option A with charging regulations (Regulation 5 of The Community Care, Services for Carers and Children's Services (Direct Payments)(England) Regulations 2003, made under the Health and Social Care Act 2001. This regulation states that 'for the purpose of making the payment... the responsible authority shall determine, having regard to the prescribed person's means, what amount or amounts (if any) it is reasonably practicable for him to pay towards securing the provision of the relevant service').

6.3

The Fairer Charging guidance states that councils can take capital into account but that their methodology must not be less generous than that set out in the guidance on charging for residential accommodation (CRAG). Amongst these regulations are capital thresholds whereby service users with £20,500 or more in capital (which can include property, including the service user's home) are expected to bear the full cost of services provided. Capital of less than £12,500 is disregarded. Where a service user has capital of less than £20,500 and more than £12,500, ability to pay is assessed by taking into account as weekly income £1.00 for every £250 or part of £250 over the £12,500. These thresholds were used in the consultation in order to obtain the views of service users. In applying these regulations to non-residential services, it is envisaged that property would not be taken into account.

6.4

The financial implications of the proposed changes (full-year effect)::

1. taking account of a service user's capital - unknown as information on service users' savings and investments is not collected at present;

2. assessing charges based on 100% of a service user's disposable income - in the range of £222,000 to £537,000;

3. including day care and similar or equivalent services as chargeable services - unknown as many users of such services do not at present have a financial assessment;

4. merging Direct Payments Option A with Option B - unknown as Option A recipients do not at present have a financial assessment;

5. introducing an upper limit to the weekly charge - little effect.

6.5

Recommendations, in the light of responses to the consultation on these proposals, will be taken to the Executive Member, Adult Social Care, at her Decision Day on 28 April 2006.

7

The consultation

7.1

The aim of the consultation approved by the Executive Member for Adult Social Care was to get feedback and comment from service users, user groups, Adult Services staff, and members of the public about the proposals for changes to the non-residential charging policy. The consultation started at the beginning of January 2006 and continues until the end of March 2006.

7.2

The user consultation focuses on contacting all users of those services which are affected (and/or their agents or carers) individually so that they can give their own comments. Groups representing the interests of users have also been involved but were not expected to take on a co-ordinating role, or to gather views from all users. All users who are affected, and/or their agents, were sent clear, relevant information about the proposals for changes to the charging policy (in the format they need). Everyone was sent a feedback form for their comments (with a postage paid envelope), the questions asked focusing on the fairness and equity of the proposals for both service users and the tax payer. Alternative ways of giving feedback, particularly email and a telephone helpline were provided, a special phone number and email address being set up for the purpose.

7.3

Around 9,500 letters were sent to service users.

7.4

The feedback form included a question about charging for day care/services but only those people receiving day care/services who also received a chargeable service (domiciliary care or sitting service) - and who therefore had some experience of the financial assessment process - were included in the consultation. Recognising that there were many users of day care/services (particularly in the learning disability care group) who did not have such experience, and therefore would be unclear what policy would be applied and would have difficulty in commenting on possible changes to the policy, the Executive Member for Adult Social Care agreed that a second consultation should be held once any changes to the policy were agreed. This is timetabled for May to July 2006, again for twelve weeks.

Recommendation(s)

That:

1

The Committee advises the Executive Member, Adult Social Care, on the proposals contained in this report for changes to the policy of charging for non-residential services for adults.