Supplementary memorandum by the Department
of Health
NOTE ON CHARGING ARRANGEMENTS FOR SOCIAL
CARE DURING THE WINTER PRESSURES INITIATIVE (HSS 25D)
INTRODUCTION
A total of £159 million additional resources
were allocated to Health Authorities in England for winter 1997-98.
Twenty-two per cent of this (£35 million) was transferred
to Social Services Departments, under section 28A of the 1977
NHS Act for projects where the indentified service need was specifically
for social care. Additionally, guidance (attached) made it clear
that all projects funded by the additional resources should be
developed in consultation with local Social Services Departments.
The guidance did not address the question of
charges. It would therefore have been understood by local authorities
that they continued to have the same discretion on social care
charging when involved in a winter pressures scheme as they have
generally. Information on the charging regimes adopted during
these schemes was not collected as part of the monitoring exercise
for this initiative. The following note is therefore based on
information that Inspectors in the Social Care Regions have obtained
from discussions with social services.
DISCUSSION
Many of the schemes introduced with winter pressures
money were innovative, short-term services, often combining both
health and social care. There is some evidence that where such
schemes provide intensive short-term rehabilitation or recuperation,
or are intended to divert individuals from admission to residential
or hospital care, or are to facilitate early discharge, charges
for the social care element have been waived. This applies both
to care at home and in some cases to residential and nursing home
care.
With their discretion on charging unaltered,
local authorities will have considered a number of factors in
deciding whether to charge for services offered as part of a winter
pressures scheme. These include:
— Cost and complexity of collecting
charges, particularly where the service being provided is of relatively
short duration;
— Risk of refusal to leave a free hospital
bed;
— Difficulty of accurate separation
of health care and social care costs in a mixed package;
— Volatility of many individual situations,
eg an individual who is "rapidly discharged" from hospital
to home may need to be quickly re-admitted if his/her condition
deteriorates overnight;
— Consistency with their regular charging
policy; and
— NHS funding a "substitute service"
for care that would otherwise have been provided in hospital.
There is some evidence that the short-term intensive
domiciliary care provided via winter pressures money is not being
charged for. The picture is more mixed in respect of short-term
rehabilitation or recuperation provided in residential or nursing
homes. Some schemes do charge for the social care element, but
others do not.
ILLUSTRATIVE EXAMPLES
The following are a few examples of winter pressure
schemes, some waiving their right to charge and others retaining
it:
(a) Rapid response scheme in Middlesbrough
provides up to 10 days, intensive domiciliary care with nursing
input to avoid emergency admissions. There is no charge. After
the 10-day period the follow through may be: no further service;
mainstream social care (with appropriate charges); or hospital
admission;
(b) An elderly persons' home in Blackpool
has been redesignated for rehabilitation after hospital discharge,
and provides therapy, as well as personal care. It is intended
to charge £50 per week for the care element; and
(c) Leicester City Hospital to Home Scheme
provides a multi-disciplinary assessment for elderly people whose
GP considers they may need hospital admission. Users receive intensive
home care and nursing support for two weeks. No charge is made
for the service. They are then reassessed and would have to pay
for any subsequent social care services they receive. There is
also a residential component for people who do not wish to remain
at home because they either live on their own or are anxious about
being alone. Ten beds in an elderly persons' home have been allocated
for the scheme, GP cover is available and again no charge is made
while the person is on the scheme.
December 1998
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