Memorandum by Age Concern England
RELATIONSHIP BETWEEN HEALTH AND SOCIAL SERVICES
(HSS 34)
5. ORGANISATIONAL
AND FUNDING
SYSTEMS AND
PROCESSES FOR
PLANNING, COMMISSIONING
AND SERVICE
DELIVERY
5.1.1 Age Concern believes that the views
of older people, their carers and representatives should be actively
sought about whether services proposed would meet their perceived
needs; in monitoring their effectiveness; and, further, that agencies
must be able to demonstrate that common concerns have been addressed.
5.1.2 The expectations and perceived needs
of many users and carers are remarkably simple. For example, research
(Update Issue 4, Nuffield Institute for Health, September
1997) shows that most users and carers want domiciliary care workers
to be reliable, competent, cheerful and kind. Work from the Fife
Users Panel (If they would listen, Age Concern Scotland,
1997) identified the basic of concerns of older people that they
should not be discharged from hospital back to an unheated home,
without food, with an unmade bed, and a delay before they receive
any domiciliary services. It is astonishing that issues such as
these, which have been raised for decades, have still not been
fully addressed.
5.1.3 Older people may not be best served
by current funding systems. For example, an individual's need
for services or equipment tends not to conveniently begin and
end in one financial year; yet local authority budgets are set
and must be balanced on an annual basis. In contrast, NHS Trust
hospitals will be allowed to balance their budgets over a three-year
period. There may therefore be a need to consider, and develop
models, for, a "life cycle" approach to budgets for
statutory agencies to better plan, commission and deliver services
more in line with the ways in which needs for these may arise
and continue.
5.1.4 If statutory agencies are to plan
effectively on a longer-term basis, there is also a need for central
Government to consider its role in the "life cycle"
approach to budgets. For example, the unexpected change in funding
levels from Government for community care services from social
services departments in 1994 led to reductions in services for
many older people, contrary to local authorities' plans which
had been based on original Government calculations. Age Concern
believes that setting of national criteria for eligibility will
prove helpful for planning and budgetary purposes.
5.1.5 Age Concern believes that:
— the views of users and carers
must be taken into account in the planning process;
— "life cycle", budgets
could more closely follow the pattern of an individual's need
for services.
The effect of self funding
5.2.1 There are key problems for local and
central Government in planning for those who will need financial
support or services in the near future which also impact on those
individual older people. For example, an increasing number of
local authorities do not arrange places in homes for self-funding
residents. This means there is no accurate information as to how
many residents will, as their capital reduces, become eligible
for local authority financial support, nor at what point during
any one financial year that may occur.
5.2.2 Without this knowledge further budgetary
problems are created for local authorities. If criteria have already
been tightened, the net effect of unforeseen residents approaching
their authority for support may be to further tighten criteria
and reduce availability of services generally. This has an inevitable
domino effect on those waiting inappropriately in hospital, and
those waiting in the community who may seek to make greater calls
on primary health care services.
5.2.3 Individuals who are assessed as self-funding
for residential and nursing homes, but whose capital is tied up
in property, may have no immediately available money from which
to pay for care. Local authorities have the power to help pay
towards care costs whilst property is waiting to be sold through
the creation of a legal charge against its value. However, this
is only a power and not a duty.
5.2.4 More and more individuals are reporting
to Age Concern that their authority is refusing to create a legal
charge, which we believe is linked to problems with budgets which
are set and must be spent on an annual basis. Although ultimately
the legal charge will be repaid to the authority, this may not
be in the same financial year that the charge was created. Authorities
may increasingly feel that, faced with annual budgetary constraints,
they can ill afford to tie up their budgets in this way. This
is causing huge problems for individuals as the only option may
be to seek commercial loans which can cause older people extreme
anxiety and may be difficult to obtain.
5.2.5 Age Concern believes that:
— the Government must investigate
the way in which local authorities can be made aware of the rate
at which self funders in their areas become eligible for financial
support;
— where people who require residential
or nursing home care have a home to sell and want the local authority
to make arrangements pending the sale of the home, the authority
should have a duty to do this and not assume that the person can
fund themselves in the interim.
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