AGENDA ITEM ?
BOROUGH OF POOLE
COMMUNITY SUPPORT OVERVIEW GROUP
15 JANUARY 2008
REPORT OF HEAD OF ADULT SOCIAL SERVICES COMMISSIONING
REVIEW OF FAIRER CHARGING POLICY
1. PURPOSE OF REPORT
1.1. To review the workings of the Fairer Charging Policy agreed in October 2002 and to agree levels of charge for 2008/9.
2. DECISIONS REQUIRED
2.1. Members are asked to note the working of the Fairer Charging scheme and to agree that, in line with the concept of “fairness”:
· The full home care Charge should rise to £18.54 per hour in 2008/9.
· Day services should be brought within the scope of the Fairer Charging scheme and be charged at £6 per day or £3 per session.
· Transport to day services should also be brought within the scheme, and also be charged at £6 per day or £3 per journey.
· Meals continue as a flat-rate charge, set at £3.10 in 2008/9.
3. BACKGROUND
3.1. ‘Fairer Charging’ was introduced in October 2002 following guidance issued by Department of Health in November 2001. Concern had been mounting for some time that the way in which Local Authorities charged for services was difficult to justify: the range of charges was very wide and the charging schemes in use were often seen to be unfair. Local Authorities were still enabled to set charges on an individual basis, but the way in which they arrived at those charges had to follow a fixed pathway and in particular, they were forbidden from charging for people on the lowest levels of State benefit.
3.2. Fairer Charging applies only to non-residential care services: all residential care services are charged for in accordance with a national scheme summarised in the “Charges for Residential Accommodation Guidelines” (CRAG). Local Authorities have no power to vary the application of these guidelines.
3.3. In 2002, the former Care Policy and Advisory Group was asked to consider a number of proposals which together led to a Fairer Charging Policy. These were:
· Should Poole charge for Social Care services? This was agreed.
· What Social Care services should it charge for? It was agreed that Poole would charge for home care services in accordance with people’s disposable income but not charge for day care services. There would be flat-rate charges for meals and for transport to day care as allowed for in the Department of Health Guidance.
· Should Poole take into account Disability Benefits? Members agreed to do so, recognising that the Guidance also required them in this case to take into account items of disability-related expenditure (DRE).
Members also accepted that the Guidance meant that they could no longer charge for items of assistive equipment such as hoists or raised toilet seats and that all client groups must be charged on the same basis. This meant that older people who had been charged for attendance at Day Centres were no longer so charged, to bring them in line with people under 65 who had never been charged for Day Centre attendance.
Following these decisions, a specialist team was created in Financial Services to undertake financial assessments and to ensure that benefit take-up was maximised. Since 2005, this has been a joint team with The Pension Service which has both completed all required financial assessments and enabled Poole residents to receive nearly £2.0m in additional benefits in 2006/7 as a direct result of undergoing a Fairer Charging assessment.
3.4. The scheme has worked satisfactorily for a number of years:
· Financial Assessments are carried out on all people who receive home care services and as a result of Fairer Charging, about 50% of them pay no charge at all; about 40% pay a fixed Fairer Charge and about 10% pay a full charge.
· The flat rate charged for meals has risen slowly with inflation and so has the charge for transport. An initial proposal to raise the latter charge by more than the rate of inflation in 2007/8 drew a number of complaints and led to a decision to review the Fairer Charging scheme.
3.5. This review has led to consideration of a number of key principles: these clearly underpin the recommendations for changes in the scheme which follow.
· Income generation plays a significant part in the maintenance of both high levels of service and our current eligibility criteria (enabling Poole to score amongst the highest in the country for the number of people helped to live at home). Income should therefore be maximised before consideration is given to reducing service levels. The alternative to meeting savings and efficiency targets by increasing income is the reduction in services to significant numbers of residents, and attendant reduction in the attainment of performance targets.
· Those who can afford to pay for services should do so: this principle applies to residential care services and should apply equally to non-residential services. Subject to a maximum charge (see 4.3 below), the taxpayer’s subsidy to the cost of services should be reduced for those who can afford to pay for them.
· Nil charges for day services can be seen a promoting dependence on Council services, rather than promoting independence through a creative and personalised approach to building individually-tailored packages (in line with the concordat published by Department of Health on 10 December 2007).
· Provision of transport as a flat rate can also be seen as promoting dependence at a substantial cost to the Council: individual journeys cost more than £20 each and have led to total spend of more than £1m a year for Adult Social Services transport.
4. RECOMMENDATIONS
4.1. Following the review, no change is recommended to the way in which Financial Assessments are carried out and the rules which are applied in so doing. However, a number of recommendations are made in respect of charging for individual services.
Day Services
4.1.1. It is recommended that the Fairer Charging scheme should, from 1 April 2008, apply to day services provided for adults. In November 2007, Day Centre registers revealed that 604 people were currently attending day services; of these, 237 have already had a Fairer Charging Assessment as they also use home care services. Sixty of those 237 have full charge for home care and so would, in the first instance, be expected to pay a full charge also for day services. The other 177 would, because it is a fixed income-related charge, pay no more than their current Fairer Charge.
4.1.2. The remaining 357 service users would need to be assessed to pay a Fairer Charge before any such charge could be levied. They would have to be assessed within a limited time frame, concentrating on those with the highest attendance first and this would require the employment of an additional Financial Assessor for a period of 6 months within Financial Services.
4.1.3. The rate of charge should be broadly comparable to other Authorities locally that charge for care. In the South West, the range of charges varies between £5 and £20 per day (against a full cost of approximately £70 per person per day). It is therefore suggested that a rate of £6 per day (or £3 per half-day session) would be a reasonable charge.
4.1.4. The current charge for transport is a flat rate of £3 per day or £1.50 per journey. It is recommended that Fairer Charging applies to transport, ie that people who can afford to do so following a Fairer Charging Assessment should also pay a higher charge for their transport, whereas people who cannot afford to do so will in fact pay a nil charge for transport. The full cost of a journey is over £20 and it is again noted that similar Authorities locally charge between £5 and £6 per day for transport to day services. It is therefore recommended that in Poole the charge be increase to £6 per day (or £3 per journey).
4.1.5. It is very difficult to estimate how many people will pay full cost, how many will pay a Fairer Charge and how many will pay nothing at all. It is therefore not possible to state what the income to the Council is likely to be until all the Fairer Charging Assessments have been carried out. This is because every individual’s circumstances are different. As noted above, at present roughly 50% of people are assessed as paying no charge at all and about 40% pay a Fairer Charge for all their Council social care services including home care and day services, whereas only 10% pay a full cost. With the cost of employing an extra Assessor for 6 months and the substantial reduction in the yield from a flat-rate transport charge, it is likely that the introduction of Fairer Charging to day services will lead to no more than £55,000 per annum in additional income to the Council. It must be stressed, however, that this is no more than an estimate based on an extrapolation of current trends and no doubt Members will wish for the true level to be reported to them at a later stage.
Home Care
4.2. Home care is already charged in accordance with a Fairer Charging scheme. As noted, approximately 10% of people pay the full charge which is currently £15.24 an hour. This charge is in effect subsidised insofar as it is based on the average cost charged to the Council by a number of independent sector home care agencies. The average unit cost of an hour of home care is, however, £19.88 and takes into account all providers including the independent sector and the Council’s own in-house service. It is recommended that it would be fair that those who can afford to do so should be expected to pay the full cost of home care: these will be people with more than £21,500 in cash savings and usually with a comfortable income as well. At the same time, it is recognised that it would be unfair to expect the charge to increase by such a large amount in a single year, and it is therefore recommended that a rate part-way between the expected inflation-linked rate for 2008/9 and the true cost be established. This would result in a cost of £18.54 per hour. Assuming that the proportions of people paying full cost remain the same, this would result in an additional income to the Council of £169,560.
Maximum Charge
4.3. As part of its Fairer Charging Guidance, Department of Health recognised that charges to full cost payers should not reach such a level as to provide a perverse incentive for them to enter residential care rather than remain living independently in the community. It therefore suggested that a maximum charge be fixed and in 2002, Members agreed that this would be fixed at approximately 85% of the cost paid by the Council for a Level 2 residential bed. In 2008/9 it is proposed that this should therefore rise by inflation from £301 to £313. Although very few people pay the maximum charge at the moment, it is anticipated that with additional charges for attendance at day services and transport, together with an increase in the cost of home care, a larger proportion of older people in particular will have their liability for fees capped in this way.
4.4. People with learning disabilities currently tend to pay only flat-rate charges for meals and transport. They will therefore tend to benefit from the introduction of Fairer Charging to day services and to day service transport. This is because they tend to have little in the way of additional income above State benefits or indeed of savings or capital. Overall, they are likely as a group to benefit from the introduction of Fairer Charging.
Meals
4.5. As noted, meals are specifically excluded from the Fairer Charging guidance as both the base level of Income Support and other benefits are set at such a level as to enable people to provide themselves with meals. Charges for meals were set at £2.90 in 2007/8. The normal increase would take this to just over £3.00 and it is suggested that this figure is rounded up for practical purposes to £3.10. This would produce a small extra income to the Council of £19,418.
5. CHARGES AND INCOME SUMMARY
5.1. Home Care would rise from £15.24 to £18.54, yielding £169,560.
5.2. Day Services would be charged at £6 per day, or £3 per session.
5.3. Transport would be charged at £6 per day, or £3 per journey.
5.4. Between them, these two new charges would yield £50,000 approximately in the first full year.
5.5. Meals would rise from £2.90 to £3.10, yielding £19,418.
John Dermody
Head of Adult Social Services Commissioning
Contact Officer: Nick Molland
Telephone No: 01202 261144
Date: 18 December 2007
Report Ref: Jo/Finance/13 Jan 08 - Report to CSOG about Fairer Charging
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