Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report :

EXECUTIVE SUMMARY

1) Summary of Decision Area:

1.1. To approve the proposed model for `Putting People First' in Hampshire as outlined in the report of the Commission of Inquiry into Personalisation and the future of adult social care.

1.2. To note the recommendations contained with the report of the Commission and the authority's response to the consultation `The Case for change - Why England needs a new care and support system.'

2) Issues Covered in Report:

2.1. The report covers the work and recommendations of the Commission of Inquiry into Personalisation and the future of adult social care, that was agreed by Cabinet on 21 January 2008.

2.2. It describes a proposed new model for the delivery of adult social care in Hampshire, based on the findings of the Commission.

2.3. The report includes the authority's response to the government consultation `A Case for change - Why England needs a new care and support system'. This is attached as a appendix 1.

3) Recommendations:

It is recommended that:

3.1. Cabinet takes note of the recommendations contained within the report of the Commission of Inquiry. The full report can be accessed on http://www3.hants.gov.uk/getting-personal.pdf.

3.2. Cabinet approves the Hampshire Model as set out in the Commission report and supports its planned incremental implementation within available resources from April 2009. The model is described in full as Appendix E on the above link.

3.3. Cabinet notes the authority's response to the consultation `The Case for change - Why England needs a new care and support system'.

MAIN REPORT

1) Purpose of the Report:

1.1 The future of adult social care presents great opportunities and challenges to society, the government, all local authorities, health services and every individual across England. The publication in December 2007 of Putting People First; a ground breaking concordat, outlined a shared vision for the transformation of adult social care and called for central and local government and the NHS to make a strong commitment to the personalisation of care services over the next three years.

1.2 Despite councils spending more money on services, demographic pressures, changes in health care and higher user expectations mean that demand exceeds resources. In the coming years even fewer people will be able to receive publicly funded social care. The government and all political parties have voiced concerns about how much support families can and should be expected to provide. More people have to fund their own care and for those people who do there is very little information available for them to help find the best possible solution to their care needs.

1.3 In response to these issues and with strong cross-party support, Hampshire County Council set up the Commission of Inquiry into Personalisation and the future of adult social care in January 2008 so that it could think positively about the issues and plan for the future through examining research, engaging with the public and receiving input and expertise from highly knowledgeable and well regarded Commissioners. Personalisation is a term used to describe a number of ways in which vulnerable adults can receive a mixture of local authority and government money directly for the care services they need with out direct social services involvement. They will be helped in making an assessment of their needs and finances by social workers who will also involve and consider the needs and availability of informal carers. The purpose of the Commission was:

· To make recommendations to government on the national implications for achieving services that put people first;

· To develop a system for adult social care that will truly make a difference to the quality of care and support offered to the residents of Hampshire and provide a model for change which might be drawn upon by other local authorities;

· To inform the County Council's response to the consultation for the green paper on the future funding of care.

1.4 Hampshire's Commission of Inquiry has tackled one of the most important national issues facing us all: the future of adult social care for the growing elderly population and disabled people.

1.5 The purpose of the report is to describe the workings of the Commission, its recommendations and the proposed model for change for Hampshire. It is also to share the authority's response to the green paper consultation which is attached as appendix 1.

2) Contextual Information:

The purpose, work and findings of the Commission

2.1 The concordat Putting People First: a shared vision and commitment to the transformation of Adult Social Care, published 10th December 2007, made manifest a commitment to transforming care services by 2011. Transformation involves moving to a more person-centred or `personalised' adult social care system which emphasises the individual's dignity, right to self-determination, choice, control and power over the support services they receive. The vision gives greater recognition to the importance of prevention and requires a whole system change.

2.2 Concurrently, a sense that the existing funding regime is unfair and disadvantages people who need only a `little bit of help' or have saved for their old age has been growing. Demographic pressures have made the present system unsustainable. In response the government is undertaking a major consultation exercise to inform a Green Paper on options for reform.

2.3 Recognising the need to respond to the personalisation agenda proactively, and wishing to identify ways of tackling the unfairness and unsustainability of the current system, the Leader of Hampshire County Council, Councillor Ken Thornber, set up the Commission of Inquiry into Personalisation and the future services for adults in need of support and care.

2.4 The approval to set up the Commission, its membership and structure was given by Cabinet on 21^st January 2008.

2.5 Commissioners from a range of backgrounds and from different parts of the care and political spectrums were invited to participate in the Commission. This was to ensure a balance of views and perspectives and also to incorporate a variety of expertise and experience to provide a full and comprehensive consideration of the complex issues under consideration.

2.6 The scope and volume of material was immense and required dedicated input from all Commissioners over a prolonged period of time. They were often faced with conflicting and contradictory views and had to carefully consider all the submissions to retain a balance during the process. Hampshire County Council gratefully acknowledges the vast amount of experience and expertise brought by the Commissioners and recognises the huge commitment made.

2.7 Service users and carers were actively involved in the work of the Commission throughout its duration. The Commission also established a reference group of service users, carers and user led organisations which worked alongside the Commission to consider the key points that people wanted to see included in the new model for adult social care in Hampshire. Many of its members attended the public sessions and were fully involved in hearing the evidence presented and participating in the round table discussions that were a feature of each session.

2.8 In order to facilitate informed debate in which stakeholders, including Hampshire residents, could `have their say' in shaping the future of social care, a general call for evidence was made through a press release on the 21^st of January 2008. At the same time a web site was established as a vehicle to both receive evidence and to keep the public and organisations informed of the work of the Commission.

2.9 The Commission wanted to hear from as broad a range of people as possible and extensive use was made of Hampshire County Council's publications and the `free' and `paid for' press to encourage people to give their views. Leaflets were distributed to numerous community groups and the Commission was present at various public events to promote discussion and engagement and receive feedback. Direct approaches were made to a wide variety of private, public and voluntary sector organisations which resulted in the following evidence being received from:

o 132 independent members of the public, of which 27 submitted evidence in confidence;

o 36 organisations;

o 27 members of staff in Local Authorities including HCC.

2.10 In addition, two pieces of evidence on demographic change and economic diversity in Hampshire were commissioned.

2.11 A comprehensive range of published research and opinion pieces on the future shape of social care, which were hitherto highly disparate, were gathered and analysed. Summaries of this literature and the evidence submitted to the Commission were presented in a series of 10 briefing papers. These were considered to be of a very high standard and were used in the development of Personalisation, a rough guide launched by the Social Care Institute for Excellence on 23^rd October.

2.12 The scope and volume of material was immense and required dedicated input from all Commissioners over a prolonged period of time. They were often faced with conflicting and contradictory views and had to carefully consider all the submissions to retain a balance during the process.

2.13 Work of the Commission was divided into four main subject areas. This was to ensure that the Commission could focus on the issues to be considered in a manageable way and build on the evidence received throughout the process.

2.14 The four areas were

o People and carers

o Funding and partners

o The care market

o The local authority

2.15 These areas became the basis of public sessions held in April, June, July and September. Attendance at each session was by ticket. These were advertised through press releases, direct marketing and via the web site. Approximately 20 members of the public and 70 representatives of organisations and groups attended each event.

2.16 Each hearing was addressed by 6 or 7 speakers who made keynote presentations on relevant topics followed by questions from the Commissioners. Several of the speakers were service users or carers who provided powerful testimony on their experiences of receiving care and what they wanted to see changed for the future. The morning sessions were followed by round table discussions to address some of the key issues raised. Following each hearing the Commissioners spent time together discussing and agreeing key areas.

2.17 The Commission concluded its work in early November 2008 and published its report on 25^th November. The running costs of the Commission were contained within the allocated budget of £100,000. The report contains a set of national recommendations and the formation of a proposed complementary local model for `putting people first' in Hampshire based on the findings of the Commission. This model is subject to Cabinet approval.

3) Key Issues

3.1 The Commission conducted a wide ranging and comprehensive examination of all the key issues relating to Personalisation and the future of adult social care. The following are some of the issues considered by the Commission.

· Personalisation is the right way forward but measures are needed at a national level to ensure that its benefits can be maximised.

· Pressure on local authority budgets has led to social care being restricted to an increasingly small group of recipients. Local authorities have had to ration services through the application of tighter eligibility criteria and the extension of means testing.

· Increasing demographic pressures, changes in health care and higher user expectations are creating pressure on the funding pot.

· There is a need for greater fairness for those who do not currently receive any publicly funded help. As the majority of people do not qualify for such help they do not perceive that they have a stake in the social care system.

· For people in crisis, the fact that health care is free at the point of delivery and social care is means tested is hard to understand. People are confused and distressed at being asked to pay for the help they assume they would be entitled to free of charge at a time when they are feeling vulnerable.

· People who have saved, often modest amounts, do not qualify for any publicly funded support nor, in practice, do they get any information or advice. As a result many feel isolated, unsupported and confused. They feel that they are being treated unfairly because they have saved for their old age. They think it is unjust that people who have worked hard all their lives and paid their taxes should get no help whatsoever, yet people who have not saved get support.

· People feel that the level of the savings and capital disregard in financial assessments for eligibility for financial help is set too low and excludes too many people who need care and have moderate savings.

· For older carers, the effects of loss of earnings during working age does not end at 65: the loss of earnings means that people lose the opportunity to financially plan for their retirement, leaving them at risk of poverty in old age. Older carers cannot `retire'; they carry on working long hours due to their caring role at a time when their own physical and mental health may be deteriorating.

· The concept of `charging' conflicts with the development of Individual Budgets. A more coherent approach - that promotes co-payment but places the onus on the government not the citizen - is that charges should be replaced by citizen `contributions' based on a means test.

· People in different local authorities face differing allocation and charging regimes and there is deep unhappiness at the perceived unfairness in the system and the lack of portability of entitlement.

· Service users, carers and other stakeholders stress the importance of `a little bit of help' and preventative services for people who might be considered to have `Moderate' to `Low' eligibility for services in the current system and are thus excluded from help in most areas.

4) The Hampshire Model

4.1 The model for the future of adult social care in Hampshire was evolved and formulated upon the learning and recommendations from the Commission. This model is an holistic, grounded and practical model for `putting people first' in a local authority in partnership with health and other key partners, moving the personalisation agenda from rhetoric to reality.

4.2 Work in developing this model and the process of consultation has been done in compliance with and in the spirit of the Hampshire Compact, which is the framework for the working relationship between the County Council and the voluntary and community sector.

4.3 Some of the recommendations of the Commission can only be implemented once there is national acceptance and relevant policy changes. Such recommendations include

o An increase in the threshold for means testing from the current level of £22,250 to £50,000 for people with savings and capital.

o A review of the relationship between eligibility and the tax and benefit system to include removing the overlapping benefits rule for carers who lose their entitlement to Carers Allowance once they reach 65 and receive the state pension.

o That the performance targets for Primary Care Trusts are reviewed to incorporate measures that give them an incentive to invest in preventative services.

Other recommendations that can be implemented without national policy changes include

o A universal offer of help with information and advice regardless of where people live, how much money they have and whether they are assessed as being eligible for social care.

o Free urgent social care for up to 8 weeks for all those at risk of admission to hospital or are being discharged from hospital, and in need of urgent social care.

Action will be taken on issues within the power and financial capacity of the County Council and its local partners that were raised during the work of the Commission. Some of these issues were:

o Balancing risk and the duty of care with the wishes of individuals to make their own choices in life.

o The cost of in-house services.

o The impact on existing service providers.

4.4 The direct actions Hampshire County Council will take include:

o Ensuring that personalisation is offered to all, including people who use mental health services and people with drug and alcohol problems.

o Establishing with its partners a joint choice, empowerment and risk policy which promotes transparent practices, incorporating a light touch in relation to audit and an explicit approach to balancing risk with the promotion of choice.

o Moving to a transparent model for all in-house services.

o Supporting service users to lead and undertake monitoring and quality assurance through user-led organisations in order to improve the quality of services available.

o Facilitating provider forums and a stakeholders working group to lead the development and shaping of new services.

o Promoting use of integrated health and social care personal budgets for older people with dementia.

o Through the new Hampshire senate local authorities at all levels will seek to strengthen the integration of all relevant county and district services

4.5 The Hampshire model builds on the current self directed support project. Further roll out will commence from April 2009 with staggered implementation throughout 09/10 and future years. Implementation will be influenced by resources available and the national settlement in future years as well as the outcome from the green paper.

4.6 Current budget planning for 09/10 takes account of a part year implementation of many of the model's proposals including for example self directed support, early intervention and prevention, the contact centre and reablement.

4.7 There is a strong resonance between several of the Hampshire County Council Adult Service areas for performance improvement and the Hampshire Model. Examples of outcomes and services where the model will deliver improved performance are set out in the report on the Adult Services Performance Assessment rating also presented to Cabinet today.

4.8 An implementation plan with detailed transition activities, longer term changes, timescales, implementation dates and communications plan is being formulated. This will ensure successful deliver of the proposed model over an agreed timescale, within agreed budgets and meeting performance standards as required.

5) Conclusions:

5.1 The Commission heard views and examined evidence on how the whole system could be changed through the concept of personalisation to ensure that people are given more choice and control over the care they receive. .

5.2 The recommendations offered the Commission's report provide the potential for whole system change that will truly transform adult social care for the future. The model for adult social care for Hampshire is built on these recommendations and outlines the County Council's intentions for practical delivery.

6) Recommendations:

Please see Executive Summary for recommendations

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