Web Agenda/Minutes Summary Document

Meeting Name:
Adult, Community Services and Health Overview and Scrutiny Panel

Meeting Date:
06/24/2009 Pick

Meeting Time:


Location:


Sub Committee / User Forum etc (if required):




Members Present:

Non-Members Present:

Confidentiality: Part I


Document Type: Agenda


Document Status: Final

COUNCILLOR MRS ENDACOTT, MRS S EVANS, LENTON, MAJEED, MEADOWCROFT, MRS NAPIER & MRS PROCTOR

SUBSTITUTE MEMBERS
COUNCILLORS BASKERVILLE, HERDSON, MRS KEMP, MRS LUXTON, PENFOLD, D. WILSON & MRS YONG

ITEM	SUBJECT	WARD	PAGE NO
1	ELECTION OF CHAIRMAN AND VICE-CHAIRMAN To appoint a Chairman and Vice-Chairman for the 2009/2010 Municipal Year.
2	APOLOGIES FOR ABSENCE To receive any apologies for absence
3	DECLARATIONS OF INTEREST To receive Declarations of Interests from Members of the Panel in respect of any item to be considered at the meeting.		-
4	PERSONALISATION WITHIN ADULT SOCIAL CARE To consider the report being submitted to Cabinet on 25 June 2009 on the proposal to undertake a limited scale live implementation of the core element of personalisation, known as “self-directed support”, in order to test and refine the process in advance of a full-scale implementation.	All	1
5	LOCAL GOVERNMENT ACT 1972 – EXCLUSION OF THE PUBLIC To consider passing the following resolution:- “That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the remainder of the meeting whilst discussion takes place on item 6 on the grounds that it involve the likely disclosure of exempt information as defined in Paragraph 3 of part I of Schedule 12A of the Act"	-	-

Date: 25 June 2009

Member Reporting: Councillor Dudley

Contact Officer(s): Allan Brown 01628 683701

Wards affected: All

1. SUMMARY

This report seeks authority to undertake a limited scale live implementation of the core element of personalisation, known as “self-directed support”, in order to test and refine the process in advance of a full-scale implementation. A live implementation necessitates a new policy in respect of residents’ contributions to the cost of their own care, for which authority to go out to consultation in summer 2009 and then report back to Cabinet on the results in October, also is sought.

The Department of Health White Paper Our Health, Our Care, Our Say in 2006 directed all local authorities in England to develop personalised care services. This was reinforced by Local Authority Circular 1 2008 Transforming Social Care, which specified a requirement to introduce personal budgets for all citizens who are eligible for publicly funded community-based social care and support. A personal budget is the sum of money allocated to a person requiring care and support from the borough. It is determined by using the score from a Self Assessment Questionnaire (SAQ) designed to identify the person’s level of need and then converting this score into an indicative funding amount using a Resource Allocation System (RAS) based upon the total funding available. More information on this process is given in Appendix 1.

In August 2008 the Director of Learning and Care established a Transforming Social Care programme board, charged with delivering the requirements of personalisation in accordance with LAC1 2008, and within the limits of the medium term financial plan, since when the Adult Services unit and its support departments have been developing the processes, procedures and structures necessary to realise the benefits of personalisation.

2. RECOMMENDATION: That:

1) The Director of Adult and Community Services be authorised to proceed with a limited scale live implementation of Self-Directed Support beginning in December 2009,
2) That a consultation be undertaken in respect of a new Council policy for contributions towards the cost of their non-residential Social Care.

3.1 Background

There are two national strategic drivers of personalisation. Firstly, greater choice and control for recipients of adult social care and other support services over what it is that they receive and by whom it is provided, arising from extensive consultation with existing service users and their families/carers. Secondly, the demographic challenges presented by an ageing population and increasing longevity make it inevitable that more citizens will require help, and this means that the current model of social care will become economically unsustainable.

To this end, all local authorities in England are expected to have made “significant progress towards redesign and reshaping their adult care services by 2011” (LAC1, 2008). What this means in measurable terms is that the Borough will be given a target for the percentage of its total client base that is in receipt of a personal budget by 1^st April 2011. This target is currently the subject of discussion between the Head of Adult Services and Government Office for the South East, which has delegated authority from the Department of Health to agree local achievement targets.

The Transforming Social Care programme board has commissioned and is overseeing a portfolio of projects to develop and implement personalisation, which encompasses the self-directed support process (see Appendix 1), development of the market for services, workforce and structure, financial arrangements, and communications. Lessons learned from the experiences of thirteen pilot sites are being incorporated into the Council’s process developments. The Council is in receipt of a Social Care Reform Grant, £957k over the 3 years 2008-09 to 2010-11, with which to introduce the programme.

The programme board recommends that a controlled and phased implementation of self-directed support would be the most appropriate model of delivery, in order to balance the need to demonstrate real progress within the specified timescale, with the ability to mitigate process and financial risks, and to refine elements of the new operating procedures based on experience with a relatively small number of citizens.

The programme board recommends a start date of 1^st December 2009 for the phased implementation, beginning with new referrals into the older people service group, and progressively introducing other adult service groups between February and April 2010.

In order to allow for a comprehensive evaluation of the phased implementation, and any further process refinements arising from this, it is proposed that converting the balance of existing service users to self-directed support will not begin until July 2011 (that is, 12 months’ experience of managing all new referrals, followed by a three month evaluation period).

A personal budget will be set according to the assessed needs or desired outcomes of each service user. Service users will be financially assessed in order to ascertain how much they can afford to contribute towards their personal budget; the Council will make up the difference. The Council’s current policy in respect of the financial assessment of service users is based upon assessing for contributions towards the cost of specific services, such as home care; it is not appropriate for assessing for contributions towards personal budgets. Therefore a new policy to address contributions to personal budgets is required which will ensure fair and equitable treatment of all client groups.

Approval is sought for a public consultation in order to determine the views of interested parties to this proposed change. The consultation would begin as soon as practicable following receipt of approval, and is proposed to run for six weeks. A draft contribution policy, the consultation document, and a description of the consultation process are set out in the appendices to this report.

There has recently been a national consultation exercise on contributions, the results of which are expected to be taken forward in the “Care and Support” Green Paper planned for June 2009.It is proposed that a further report to Cabinet be produced for October this year which will include the results of both the local and national consultation exercises, and the Care and Support Green Paper. A final version of the new contributions policy will be submitted to this Cabinet in November for approval.

Having provided a personal budget it follows that services provided by the Council, should be costed, appropriately priced and charged against that budget. A policy in respect of charging for services, and the proposed rates of charge will be brought to the October cabinet. As a result of this the true cost of services provided directly by the Council (currently home care, day services for older people and learning disabled, and respite care) will become apparent to personal budget holders, who will be able to choose whether or not to buy these services with their budget. This issue will be the subject of a separate report to Cabinet in due course by the head of procurement on the future delivery options of Council-provided services.

In cases where the services are so highly specialised that there is no realistic alternative in the current immature external market, it will be vital to ensure a smooth transition to personal budgets. The recommended approach is a phased introduction of full cost pricing, in order to ensure that the facility continues to be affordable and available to a small number of vulnerable users and their families. This will also give the in-house services a fair opportunity to demonstrate their value proposition to budget-holding residents.

4. OPTIONS AVAILABLE AND RISK ASSESSMENT

4.1 Options

	Option	Comments	Financial Implications
	1. Begin a limited-scale implementation of self-directed support before December 2009.	The care management processes, financial arrangements, and required systems cannot be developed and implemented in time.	Revenue Capital
	2. Begin a limited-scale implementation of self-directed support in December 2009.	Optimal balance between process integrity, capacity, risks and the need to demonstrate progress towards personalisation. This is the recommended option.	Revenue Capital
	3. Begin a full-scale implementation of self-directed support on or after 1st December 2009.	The scale and complexity of launching self-directed support to all service groups at once is likely to exceed the unit’s capacity to manage service quality and risks.	Revenue Capital

There is a risk that the process of self-directed support will not enable citizens to achieve their outcomes and that they will therefore be dissatisfied with the Council’s service to them. This risk will be mitigated by thorough preparation and testing, including learning from the experience of the 13 local authorities that were selected by government as early adopters in 2007, and by opting for a limited scale implementation in which any service shortfalls may be quickly remedied and procedures subsequently refined.

There is a risk that the process by which personal budgets are calculated could generate in aggregate a sum that exceeds the current Adult Services care budget, creating a financial pressure. This risk will be mitigated by allocating a sum of money to the Resource Allocation System (RAS - the pool of money available to be disbursed in personal budgets and the method of personal budget calculation within that) that represents the current Adult Services care budget less a sum that will enable incorrect individual allocations and any unforeseen contingencies to be dealt with.

There is a risk that the introduction of personal budgets, and the greater choice of service that these will offer, may result in an increase in the number of people coming forward to request assessment of need. Experience from early adopting authorities suggests that ethnic minority communities in particular will accept publicly funded care if enabled to direct their own package of support. The allocation of funds through the resource allocation system will be made in recognition of this risk.

There is a risk that the care needs of particular service groups are so difficult to model that reliable personal budgets cannot be generated from the resource allocation system. This risk can be mitigated by falling back to basing personal budgets on the cost of equivalent current care packages until such time as a reliable Resource Allocation System can be developed.

There is a risk that citizens will spend their personal budgets on inappropriate services that will not meet their needs, with a consequent safeguarding risk, and which may also represent a misuse of public funds due to irresponsible or fraudulent behaviour. This risk will be mitigated by a number of checks and approval steps built into the self-directed support process, in which risk indicators may result in the council insisting that a person’s budget be managed on his or her behalf rather than being issued as a cash payment. Regular reviews of outcomes, the frequency of which will be at the council’s discretion, will enable care workers to identify inappropriate use of funds and take corrective action.

There is a risk that the price of some care services will increase as a result of individuals commissioning their own care, and therefore the authority no longer being in a position to enter into long-term block contracts with providers. New commissioning strategies focusing on, for example, framework agreements are being planned in order to mitigate this risk. In this way the council intends to lead the development of new services and associated markets.

5. CONSULTATIONS CARRIED OUT

This report includes a request for approval to consult on a new contribution policy as described.

A national consultation on fairer charging has recently been concluded, and the results, which will inform our own policy, are expected to be published later this year.

6. COMMENTS FROM THE OVERVIEW AND SCRUTINY PANEL

Overview and Scrutiny Panel meets on 24^th June, and comments will be reported to Cabinet.

7. IMPLICATIONS

The following implications have been addressed where indicated below.

Citizens are referred to Adult Services for help. The Access Team carries out an initial screening assessment to determine whether the person appears to be eligible in terms of level of need and financial means. If so, a self-assessment (with support if required) is offered. Note that every citizen is entitled to an assessment of need, but may not be eligible for publicly funded support.

Self-assessment

Citizens complete a self-assessment questionnaire, which enables them to express their desired outcomes. This results in a points score. At this stage the Finance and Benefits Team (FAB) may be asked to carry out a financial assessment to determine whether the person will be required to contribute to the cost of his/her care.

Personal budget allocated

The points score from the completed questionnaire is converted to a sum of money, the provisional personal budget, by the Resource Allocation System.

Support Planning

Citizens are advised of their provisional budget, and complete a support plan, which describes what services are going to be purchased in order to meet the outcomes expressed in their self-assessment, and how or with what help the citizen proposes to manage his or her budget. As with the self-assessment, help and advice will be offered for those without the capacity or will to design their own care package.

Authorisation

A qualified care worker will scrutinise the proposed support plan to ensure that it appears to meet the stated outcomes (i.e. will be effective), is lawful and affordable. Subject to these tests the support plan will be approved, the personal budget finalised and made available to the citizen. The budget will comprise some combination of service fund (held in an account by the council and released on receipt of invoices for services delivered) and cash, depending on the citizen’s wishes and the council’s view of the risks in any individual case.

Services delivered

Citizens can in principle commission their own care directly with providers, although in practice we expect most people to seek help either from the council, or from a third party broker of services.

Monitor, and review outcomes

At a frequency to be determined by the council, the citizen’s outcomes will be reviewed and, where necessary, amendments to the support plan and/or personal budget will be made.

Appendix 2


Draft Policy for contribution to a personal Budget

The council currently operates a ‘Fairer charging’ contribution policy which assesses people’s ability to pay for domiciliary services and sets out flat rate (subsidised) charges for meals on wheels, day care and the first 4 weeks of overnight respite care.

The introduction of Personal budgets will enable people to choose how they meet their needs\outcomes and what services they will use. Therefore using the current contribution policy for personal budgets would create a number of problems

High levels of administration would be required to identify and monitor those services which are contributable

Contributions to certain services would discourage people from using them, where as these services may be the most appropriate to meet their needs

Identifying contributable services when a personal budget is provided via direct payment would be extremely difficult and require a high level of monitoring or reliance on the service users.

Can assume a loss of income resulting from people not using contributable services or they cannot be identified.

Service users could be confused by the flat rate contribution. Under a personal budget they could be asked to contribute from their budget the cost of the service and then be asked to contribute a flat rate sum from their private income to the same service.

Personal Budget Level	Maximum Weekly Contribution	Contribution amount
£350	Full Charge	£350
£350	£200	£200
£350	£150	£150
£350	£100	£100
£350	£50	£50
£150	Full Charge	£150
£150	£200	£150
£150	£150	£150
£150	£100	£100
£150	£50	£50
£50	Full Charge	£50
£50	£200	£50
£50	£150	£50
£50	£100	£50
£50	£50	£50

assessed to pay full cost
who are currently paying less than their maximum weekly charge
receiving services that are either not chargeable or charged at a nominal flat rate (e.g. day services and respite care)