Table 5.9.1
LOCAL AUTHORITY PERSONAL SOCIAL SERVICES
CAPITAL EXPENDITURE AND INCOME 1993-94 TO 1997-98
£ million
| 1993-94 | 1994-95
| 1995-96 | 1996-97
provisional1
| 1997-98
forecast1 |
| Acquisition/upgrade of buildings | 147.9
| 160.7 | 169.0 |
| |
| Acquisition/upgrade of equipment | 37.1
| 40.3 | 31.0 |
| |
TOTAL SPEND | 185.0 |
201.0 | 200.0 | 190.0
| 189.0 |
Sale of buildings | 55.2
| 36.0 | 32.0 |
| |
| Sale of equipment | 13.8 |
9.0 | 8.0 | |
|
TOTAL SALES | 69.0 |
45.0 | 40.0 | 44.0
| 45.0 |
NET SPEND | 116.0 | 156.0
| 160.0 | 146.0 | 144.0
|
| | |
| | |
Footnote:
1. From 1996-97, a breakdown of total expenditure and
sales is no longer provided.
Capital Challenge
2. On 15 May 1996 the previous Government launched a
new three year pilot scheme to start in 1997-98, led by the Department
for the Environment, Transport and the Regions, called Capital
Challenge, under which local authorities were invited to bid competitively
for £600 million of credit approvals to fund their top priority
capital projects. Departmental contributions to the Fund were
made largely in proportion to their contributions to the Government's
total capital provision for local authorities. The Department's
contribution was £7.2 million in 1997-98, £11.6 million
in 1998-99 and £9.3 million in 1999-2000, a total of £28
million.
3. The outcome of the Capital Challenge pilot scheme
for the personal social services was reviewed by the Department
in April 1997. Three conclusions were identified:
(i) The bids involved more expenditure on transport, economic
development and leisure than on housing, education and personal
social services. As a result, personal social services received
proportionately fewer resources from the Fund than other local
authority services. Approved projects with a social services element
had a total value of £15.5 million. This may be because it
was difficult for social services projects to compete with projects
such as the Ramsgate Harbour Approach Road (£26 million)
and numerous town centre developments.
(ii) The projects which were funded supported developments
in community care, with their emphasis on independent living,
on information and access and there was a strong interest in services
for people with disabilities.
(iii) The review concluded that the challenge approach
tended to benefit larger authorities with well developed capital
investment strategies, with experience of previous capital project
based bidding rounds, such as for transport and regeneration projects
and with projects which were able to lever-in complementary support.
4. There has not been a further Capital Challenge scheme.
Issues about capital expenditure in local government, and in social
services in particular, have been the subject of consideration
in the Comprehensive Spending Review, the outcome of which is
not yet determined.
Private finance initiative (PFI)
5. The Department has been allocated an indicative £30
million PFI credit approvals for projects in the personal social
services for the year 1998-99. While the Department has not promulgated
any rigid criteria which must be satisfied if PFI proposals are
to be considered for support, it has informed local authorities
that it will give priority to projects which address social exclusion.
In particular, the Department will consider supporting innovative
approaches to the problems associated with social exclusion, which
can apply to any social services client group. Projects have to
have a capital base but do not need to provide residential care.
6. In order to enable the £30 million allocation
to benefit a number of social service departments, the Department
is keen to encourage projects with an average requirement of £5
million, although more expensive projects may be considered.
7. In the first year of local authority PFI credit approvals
allocations (1997-98) the Department supported five personal social
services applications.
8. Four of these were residential projects for the elderly,
where local authorities which had urgent capital investment needs
in their residential sector sought to develop partnerships with
other organisations with the help of a PFI arrangement. Following
the competitive tendering process, partner organisations were
selected, some from the voluntary sector and some from the private
sector. Quality issues and financial issues were both key features
in the assessment of the bids. One of the PFI projects also sought
specifically to address the needs of Asian elderly people. The
fifth PFI project was a joint project with the Priority Health
NHS Trust for the development of social services offices and a
clinic for mental health services.
9. Two of the local authorities involved have signed
off their PFI projects—one of these has transferred its
staff and its clients to its partner organisation, while the other
has begun the demolition of its residential home. The other three
authorities expect to complete and sign off their PFI projects
in the next three months.
10. For the year 1998-99, the Department is hoping to
support a wider range of projects, including the development of
children's resources centres which include a residential and an
outreach component.
5.10 Changes to PSS Statistical Information
Can the Department provide details of any forthcoming changes
to statistical information the Department collects on personal
social services?
Review of PSS Statistics
1. In 1997, the Department of Health (DH) carried out
a full review of its collections of PSS statistical information
following the 1996 wider DOE (now DETR) efficiency scrutiny review
of information flows between central and local government. The
results of the Department's review were circulated to Directors
of Social Services in England in December 1997. Copies of the
reference guide to the changes are in the House of Commons library.
The majority of changes were timed to take effect in 1998-99.
2. New statistical developments and proposed changes
to existing returns, arising directly or indirectly from the review
and on which work continues, are summarised below.
Proposed changes to existing PSS collections
Children Looked After
3. Work is in hand to simplify the codes which are used
in the return for the details of each child looked after by a
local authority, in order to make the codes easier to use and
the data easier to analyse. The intention is to introduce the
simplified coding from April 1999.
PSS Current Expenditure
4. The return on which details of PSS spending are recorded
is just one of the current expenditure forms collected by DETR.
Following the efficiency scrutiny referred to above, DETR have
proposed changes to these forms for 1998-99. Discussions are still
under way with the DETR working group with oversight for the financial
returns to determine the precise level of detail to be included
on the PSS return. The aim is appreciably to reduce the detail
collected and improve its reliability, while retaining the key
information for policy monitoring, calculation of unit costs and
other uses.
Proposed new collections
Key statistics for social services
5. This is an initiative to determine the most important
pieces of currently available information, and to collect and
disseminate them on a fast track basis. The aim is to produce
a set of data useful for illuminating the main policy and management
issues on social services at central and local level. The emphasis
is on providing a manageable set, including finance and activity
data, initially concentrating on bringing together and rationalising
existing data sources (such as DH statistics, and Audit Commission
Performance Indicators). Collection and dissemination of the first
set of key statistics will be completed by autumn 1998.
Referrals, assessments and packages of care
6. This is the main statistical development project in
the adults and elderly area which will provide a framework for
defining and collecting person-based information locally on the
main aspects of the community care assessment process. The project
is currently being piloted, with collections being introduced
on a staged basis, commencing with the 1999-2000 year.
Children in need
7. The main DH statistics on services for children, largely
on children looked after by local authorities and children on
child protection registers, only cover about 20 per cent of children
and families served by social services departments. In addition,
the expenditure information collected leads to difficulties and
unreliability when calculating unit costs. The review of PSS statistics
therefore endorsed the continuation as a priority of the development
of a framework for the categorising and reporting of services
for children in need, and associated activity and finance statistics,
leading to a routine annual collection during 1999-2000. In this
instance, children in need refers to all children in contact with
social services and for whom an activity is undertaken or a service
provided.
Children looked after
8. Indicators for looked after children covering a range
of outcomes, including educational performance, are considered
to be increasingly important and work is in hand to pilot a range
of possible indicators during 1998, leading to a new collection
from April 1999.
Ethnic monitoring data
9. It is proposed to begin collection of information
on ethnic group and gender of all local authority social services
staff as part of the coordinated DH/Local Government Management
Board surveys of local authority staff, with effect from September
1999. The categories of ethnic group to be used are likely to
be those proposed by Commission for Racial Equality (local authorities
will be able to use more detailed ones than this if they wish),
unless there are significant changes in the categories for the
2001 census, which will become clearer later this year.
10. The Department is also taking forward work to develop
the collection of ethnic origin information on children looked
after by local authorities. This will build on "Looking After
Children: Assessing Outcomes in Child Care", which includes
the recording of ethnic origin as part of the essential information
which should be included in the case information for each child
looked after.
5.11 Research on outcomes and effectiveness of social care
Can the Department provide details of any research work currently
being sponsored by the Department on the outcomes and effectiveness
of social care?
New Research Initiative on Outcomes of Social Care for Adults
(OSCA)
1. In the context of enduring policy interest in value
for money, efficiency and effectiveness in social care, the Department
of Health has commissioned, on the basis of open competitive tender,
a research and development initiative on outcomes of social care
for adults. The initiative is budgeted at £2.5 million, and
consists of a linked series of 13 studies. The purpose of the
initiative is to deliver research evidence which can inform the
planning, commissioning and delivery of services which are valued
and cost-effective, and which promote better outcomes for users
and carers.
2. Client group areas covered include older people, learning
disability, mental health, alcohol and carers. The studies are
of three types:
(i) systematic reviews of research evidence on social
care outcomes;
(ii) development and testing of new ways to assess and
measure social care outcomes; and
(iii) evaluative studies of the (cost-) effectiveness
of social care interventions.
3. Key projects include:
(i) an evaluation of early primary care interventions
for older people with dementia and their carers;
(ii) a ten-year follow-up study of community care outcomes
for people with mental health problems and people with learning
disabilities discharged from long-stay institutions during the
1980s;
(iii) a study to predict outcomes for carers, based on
secondary analysis of large-scale datasets;
(iv) a cost-benefit evaluation of an open-access detoxification
service;
(v) evaluation of a standardised assessment instrument
for measuring outcomes of social care for older people living
at home;
(vi) development of client- and carer-focused measures
of outcomes of social care for people with severe mental illness;
and
(vii) development of a research reviews and information
capacity to support evidence-based social care policy and practice.
4. Arrangements have been set in place to co-ordinate
the research initiative, involving policy/research workshops,
a newsletter for wide distribution to social services and health
authorities, and voluntary sector agencies, and effective dissemination
of research findings to those responsible for planning, commissioning
and providing services.
5. The research and development initiative on outcomes
of social care for adults started in 1997 and is due for completion
in 1999-2000.
Social Care Research and Development Programme: further research
in progress on outcomes and effectiveness of social care
6. In addition, the Department of Health supports a range
of other research in progress on the effectiveness and outcomes
of social care. For the social care of adults, studies include:
(i) a major evaluation of community care for very dependent
older people and their carers assessed by social services in 10
local authority areas;
(ii) evaluative research on community care for older people
with dementia and their carers;
(iii) research to map and evaluate care management arrangements
for older people and people with mental health problems;
(iv) evaluative research on the quality, costs and outcomes
of different types of residential provision for people with severe
learning disabilities; and
(v) a programme of developmental research in collaboration
with social services departments to develop and test new approaches
to assessing and measuring community care outcomes for older people,
people with physical impairments, and their carers.
7. For the social care of children, studies include:
(i) a research initiative to investigate ways in which
parents can be better supported to help look after their children
effectively;
(ii) a group of studies to monitor and evaluate the early
stages of implementation of the Children Act; and
(iii) a major research and development exercise on "Looking
after Children", designed for use by practitioners to plan
and assess children's progress while in public care.
In addition, a literature review has been completed looking
at research which links costs and outcomes of social care for
children.
Research on Costs and Outcomes of Social Care for Children
8. A research literature review of the limited existing
body of research has already been completed and is being prepared
for publication. To complement policy on quality, effectiveness,
value for money and evidence based practice, a research initiative
on costs and outcomes of social care for children is in the late
stages of planning by officials. If approved by Ministers, this
work may explore, for example, the reasons behind what appear
to be rising costs in child care and consider how expenditure
in this field can be appropriately related to aims and justified.
5.12 Fees and Charges (formerly A6)
Can the Department update table A6.1 of HC297 providing separate
figures on residential care for each client group? Would the Department
quantify the degree of variation in domiciliary charges between
authorities. Would the Department provide a commentary?
Will the Department provide an analysis, to include chart,
tables and commentary, of (i) the recent national trend in the
percentage of gross expenditure on residential accommodation for
older people recouped through fees and charges and (ii) the recent
national trend in the percentage of gross expenditure on home
care/home help for all client groups recouped through fees and
charges.
Will the Department provide an analysis, to include chart,
tables and commentary of (i) the local authority variations in
the latest year in the percentage of gross expenditure on residential
accommodation for older people recouped through fees and charges
and (ii) the local authority variations in the latest year in
the percentage of gross expenditure on home care/home help for
all client groups recouped through fees and charges.
1. Table 5.12.1 updates table A6.1, provided last year
and, as requested, now provides separate figures on residential
care for each client group. Figures 5.12.1 and 5.12.2 illustrate
the recent national trends in the percentage of gross expenditure
on residential accommodation for older people recouped through
fees and charges and the percentage of gross expenditure on home
care/home help for all client groups recouped through fees and
charges. It is not possible to include 1993-94 and earlier years
in this analysis as the data for these earlier years were collected
on a different basis.
2. The table shows that the percentage of gross expenditure
recouped in fees and charges for residential care for the elderly
rose from 30 per cent in 1994-95 to 33 per cent in 1996-97; in
absolute terms the amount recouped rose from £529 million
in 1994-95 to £818 million in 1996-97. The amount recouped
for home care and home help service also rose from £63 million
in 1994-5 (representing 7 per cent of gross expenditure) to £103
million (9 per cent of gross expenditure) in 1996-97.
Variations in charges for domiciliary services
3. Figures 5.12.3 and 5.12.4 illustrate the percentage
on gross expenditure recovered in charges by each local authority
for home help/home care and meals on wheels services, the two
main items of service provided in a domiciliary setting. Table
5.12.2 sets out in tabular form the percentage of gross expenditure
on home care/home help recouped through fees and charges.
4. At the local authority level, there is a wide variation
in the amounts raised in fees and charges made from domiciliary
provision. Local authorities are free to decide upon the level
of charges to raise on domiciliary services in the light of what
it is reasonable to expect the client to pay. A wide range of
charging policies are in operation ranging from flat rate charges
to income-related charges.
5. There are a number of instances where local authorities
have reported that they raised no fees and charges income for
services provided. At the other extreme, two authorities reported
recouping over 100 per cent of their expenditure for certain services.
Such wide variability of individual authority figures points to
issues of data quality and there is a risk that misreporting of
data by local authorities has had an effect. The current Key Statistics
exercise initiated by the Department will help to reinforce the
message to local authorities that it is important they report
their PSS financial data accurately on the central returns.
6. For England as a whole, 9 per cent of the direct cost
of the home care/home help service was recouped in fees and charges
to clients. Within authorities, the actual figures reported varied
from zero in the case of 13 authorities to 32 per cent in one
authority. 50 per cent of the authorities had recoupment rates
between5 per cent and 12 per cent.
7. For meals on wheels services the overall England recoupment
rate is 44 per cent: local authority figures range from zero in
five authorities to over 100 per cent in two authorities. 50 per
cent of the authorities had recoupment rates between 31 per cent
and 61 per cent.
Variations in charges for residential services
8. Figure 5.12.5 illustrates the percentage of gross
expenditure on residential accommodation for older people recouped
through fees and charges. Table 5.12.3 tabulates these figures.
9. The charges levied to individual residents in care
homes are determined nationally. The overall recoupment rate for
residential provision for the elderly in England was 33 per cent.
Local authority figures varied between zero in four authorities
and 55 per cent in one authority. This may again just reflect
misreporting by local authorities. 50 per cent of the authorities
had recoupment rates between 15 per cent and 40 per cent.
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