Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health

Table 5.9.1

LOCAL AUTHORITY PERSONAL SOCIAL SERVICES CAPITAL EXPENDITURE AND INCOME 1994-95 TO 1998-99

£ million

1994-95
1995-96
1996-97
1997-98
provisional
1998-99
forecast

Maintenance
15.7
15.8
15.4
12.7
13.8
New acquisitions
185.3
184.2
178.7
148.1
160.2
TOTAL SPEND
201.0
200.0
194.1
160.8
174
Sale of buildings
36.0
32.0
45.4
32.6
33.6
Sale of equipment
9.0
8.0
11.3
8.1
8.4
TOTAL SALES
45.0
40.0
56.7
40.7
42.0
NET SPEND
156.0
160.0
137.4
120.1
132.0


Capital challenge

  2.  The Department has nothing further to add to its reply in 1998.

Private Finance Initiative (PFI)

  3.  The Department's criteria have remained unchanged. The Department is seeking to support innovative approaches to the problems associated with social exclusion. This can apply to any social services client group.

  4.  The Department now has seven approved social services PFI projects. Three of them have signed contracts with their partner organisations and all three are residential care projects for the elderly. The first signed contract involved the demolition of an old residential home and the building of a new high quality dual registered residential/nursing home, now nearing completion. The second contract involved the transfer of 17 homes to a housing association which has been providing care for a year now. The third completed project is also at the building stage and will be receiving its first clients in the autumn of this year.

  5.  There are four further projects which have been approved but which have not yet been completed. One of these is a joint social services and health offices and clinic project nearing completion. Two others are innovative projects for the care of elderly, involving close relationships with the local health trusts and providing new models of neighbourhood based services for the elderly. There is one residential care proposal for the building of four small children's homes.

  6.  The Department sent a letter to all social services departments in February 1999, inviting them to bid for the new allocation of £30m for the year 1999-2000. There has been a very strong response with many local authorities reporting their involvement in putting together business cases for PFI proposals. The Department is expecting three PFI learning disability proposals, three children's residential homes' proposals and two elderly people PFI projects in the next six months.

Local authority expenditure and available credit approvals

  7.  Table 5.9.2 shows total local authority expenditure and total available credit approvals.

Table 5.9.2

LOCAL AUTHORITY PERSONAL SOCIAL SERVICES CAPITAL EXPENDITURE AND DEPARTMENTAL CREDIT APPROVALS 1994-95 TO 1998-99

£ million

1994-95
1995-96
1996-97
1997-98
1998-99

TOTAL SPEND
201.0
200.0
194.1
160.8
174
CREDIT APPROVALS
140.3
144.0
102.9
68.2
53.7


  5.10  Changes to PSS Statistical Information

Could the department provide details of any forthcoming changes to statistical information the Department collects on personal social services?

Changes to current collections

Children Looked After

Introduction of the one third sample and the new aggregate return:

  1.  For the year ending 31 March 1998, authorities were asked to complete a new aggregate statistical return (the CLA100) to provide basic headline data for rapid publication. At the same time, the detailed child level return (SSDA903) was reduced to a one-third sample. The sample will provide a detailed annual analysis of the looked after population, which will be used together with the total figures provided on the CLA100 to estimate the full national picture.

Simplification of detailed return:

  2.  The classifications and related codes used for each child looked after by a local authority are being simplified. The intention is to introduce the simplified coding from April 2000.

Ethnic origin information on looked after children:

  3.  It is planned that ethnic data on children looked after will be collected from 1 April 2000 by means of a new field on the detailed child level return (SSDA903). This will only give information from 2001 onwards—some interim data collections will be needed in the meantime (see also "Ethnic origin data" below).

Key Statistics

  4.  The Key Statistics data collection was introduced in May 1998 to provide the most important pieces of currently available information on a "fast track" basis. The data for 1997-98, along with budgets for 1998-99, were published in September 1998. The 1999 collection of key statistics will be used to gather information about the Performance Assessment Framework indicators (see below).

Social services workforce—gender and ethnic data

  5.  The DH has developed a joint approach to the collection of workforce data through DH's own collection each September of local authority social services staffing data on the staffing return and the rolling programme of workforce surveys, led by the Association of Directors of Social Services (ADSS). Agreement has been reached with ADSS that DH should commence collecting gender data on local authority social services staff from September 1999, and ethnic data on staff from September 2000.

New collectionsChildren in need

  6.  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 20-25 per cent of children and families served by social services departments. The lack of central information for children who are not looked after or on a child protection register is one of the most glaring gaps in PSS information currently. DH has been working with a pilot group of local authorities to set up a database system to enable local authorities to collate information on children in need, in terms of numbers of children seen, their need category, the amount of contact hours with professional staff and expenditure incurred by the local authority. Based on this pilot work, DH is planning to go ahead with a national collection in February 2000.

Outcome indicators for looked after children and care leavers

Outcome indicators for children looked after

  7.  Pilot work has been carried out to identify the most useful and reliable indicators of outcomes for looked after children. A full collection from all authorities is to be introduced to cover the year from 1 October 1999. The list of questions to be used, including a number relating to educational attainment and school attendance, an indicator on offending rates, and a series of indicators of the health care received by these children, is currently being finalised.

Outcome indicators for care leavers

  8.  In parallel with the outcome indicator collection, a new child based collection is being finalised to collect data on educational qualifications of young people leaving care aged 16 or over. This will provide data to enable the DH to assess progress towards one of its important targets for children's social services. It will also enable educational outcome data to be linked to data on the care histories of these children to permit further analysis. This collection has been introduced to cover the year from 1 April 1999.

  9.  In addition, local authorities will also be asked to provide data about the occupation and accommodation of their care leavers after they have left care. Starting in April 1999 this scheme will require authorities to keep in touch with young people leaving care aged 16 and provide data when they reach 19 years old. Data collection will begin in 2001-02.

RAP (referrals assessments and packages of care) project

  10.  This major statistical development project in the adults and elderly area will provide a framework for defining and collecting person based information on the main aspects of the community care provision and assessment process. Data collections under this project are currently at the "dress rehearsal" stage with the full implementation of this annual collection planned from 1 April 2000. Additional "modules" on the cost of packages of care and on waiting times are being developed.

Workload and performance of registration and inspection units

  11.  A new collection on registration and inspection unit staffing and workload has been introduced commencing with data for 1998-99. Both Local Authority and Health Authority inspection units are covered by the new survey. This is intended to be an annual collection, but the level of detail required in future years may be rather less than for the first year. The collection is important to underpin the annual monitoring of performance of inspection activity, as required in the National Priorities Guidance, and to provide baseline information for the implementation of the new Commissions for Care Standards proposed in the Social Services White Paper.

Ethnic origin data

  12.  There is very strong support within the DH, from Ministers and officials and also from data providers, for collection of ethnic data on workforce and clients. As such this represents a very high priority, across the range of activity for which DH is responsible. It has been agreed within DH's statistical division that, in principle, such data should be collected on a basis consistent with the 2001 census categories; with a transition period for datasets where ethnic data are already being collected in whatever form (generally based on 1991 census categories, or variants of them).

  13.  DH is consulting with other government departments and with local authority representatives, the Commission for Racial Equality and Race Equality Unit on a "DH ethnic framework", to ensure that it is the same as, or consistent with, ethnic frameworks proposed for use in other contexts.

  14.  Once the ethnic framework is agreed, the DH will prepare a list of the datasets for which ethnic data will be collected, using the new ethnic codes, and an implementation timetable for the data collection concerned.

Other related developments

  15.  The following are not strictly data collections but are key developments in assessing social services performance arising from the Social Services White Paper:

Social Services Performance Assessment Framework

  16.  The Performance Assessment Framework (PAF) will be introduced in 1999-2000 following wide consultation. It consists of around 40 indicators structured into five areas of performance. The PAF fits into the context of the new approach to assessing and managing social services performance following on from the White Paper "Modernising Social Services". Similarly, a subset of the PAF indicators will be used within the Best Value local government performance management structure.

  17.  All the indicators are derived from existing data sources or those soon to come on stream described above. The consultation process highlighted areas where development of further data collections should be concentrated.

Key Indicators Graphical System (KIGS)

  18.  KIGS is a computer-based system providing a graphical representation of important social services indicators, covering budgets, expenditure, unit costs, staffing, and services for adults and children. It is a useful tool for examining indicators and their relationships. The 1999 release will include information for the Social Services Performance Assessment Framework.

5.11  Research on outcomes and effectiveness of social care

Could the Department provide details of any research work currently being sponsored by the Department on the outcomes and effectiveness of social care?

  1.  In the children's field, we are at the commissioning stage of a programme of studies designed to look at costs and effectiveness in child social care. It is hoped that a programme of studies (of the order of 10 studies) will come on stream in Autumn 1999.

  2.  A recently completed programme of studies considered the effectiveness of intervention on children looked after in residential care.

  3.  Current studies of effectiveness on children's services include the following:

    (i)  longitudinal studies of children looked after in residential and foster care;

    (ii)  factors associated with positive outcomes for troubled adolescents and children;

    (iii)  evaluation of "Enabling Parents", a community programme supporting parenting skills;

    (iv)  an evaluation of "Mellow Parenting", a family support programme aimed at families with children under five on the child protection register;

    (v)  an evaluation of support services for children adopted out of care.

  4.  In the adult field, we have commissioned a series of 12 linked studies on outcomes of social care for adults (OSCA). The purpose of this initiative is to deliver research evidence to inform the planning, commissioning and delivery of cost-effective services. The client groups served are older people, learning disability, mental health, alcohol and carers. The study titles are:

    (i)  the management and effectiveness of home care assistants;

    (ii)  older people with dementia and their carers: professional intervention in primary care;

    (iii)  routine use of a standardised assessment for measuring the outcomes of social care;

    (iv)  integrating social and health care: a comparative study of outcomes for older peoples and their carers;

    (v)  subjective and objective quality of life assessment: their interrelationship and determinants;

    (vi)  evaluating goal attainment in community learning disability services;

    (vii)  client and carer focussed measure of social care outcomes for adults with severe mental health problems;

    (viii)  ten years on: outcomes and costs of community care for people with learning disabilities and mental health problems;

    (ix)  a cost-benefit study of an open access detoxification centre;

    (x)  caring relationships over time: predicting outcomes for carers;

    (xi)  carers needs and the Carers Act: evaluating the process and outcomes of assessment;

    (xii)  developing evidence-based social care policy and practice.

5.12  Fees and Charges

Could the Department update table 5.12 providing separate figures on residential care for each client group? Could the Department quantify the degree of variation in domiciliary charges between authorities? Could the Department provide a commentary?

Could 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?

Could 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 last year's information and 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 figures for the period prior to 1994-95 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 32 per cent in 1995-96 to 35 per cent in 1997-98; in absolute terms the amount recouped rose from £672 million in 1995-96 to £955 million in 1997-98. The amount recouped for home care and home help service also rose from £83 million in 1995-96 (representing 8 per cent of gross expenditure) to £128 million (10 per cent of gross expenditure) in 1997-98.

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 is in operation ranging from flat rate charges to income-related charges. Our Recent White Paper "Modernising Social Services" published on 20 November 1998 explains the issue of charging for non-residential services. The Government believes that the scale of variation in the discretionary charging system, including the difference in how income is assessed, is unacceptable. We intend therefore to consider how we might improve the system in the light of both the Royal Commission's report on the funding of long term care, and the Audit Commission's survey of local authority charging practices. Our aim is to establish greater consistency and fairness in charging.

  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, one authority reported recouping 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 Performance Management Framework for Best Value in Personal Social Services 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, 10 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 15 authorities to 30 per cent or more in three authorities. Fifty per cent of the authorities had recoupment rates between 6 per cent and 15 per cent compared to rates between 5 per cent and 12 per cent for the previous year.

  7.  For meals on wheels services the overall England recoupment rate is 45 per cent: LA figures range from zero in nine authorities to over 100 per cent in five authorities. Fifty per cent of the authorities had recoupment rates between 32 per cent and 62 per cent compared to rates between 31 per cent and 61 per cent for the previous year.

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 35 per cent. LA figures varied between zero in 3 authorities and 54 per cent in one authority. This may again just reflect misreporting by local authorities. Fifty per cent of the authorities had recoupment rates between 18 per cent and 42 per cent compared to rates between 15 per cent and 40 per cent for the previous year.

Table 5.12.1

FEES AND CHARGES AS A PERCENTAGE OF GROSS EXPENDITURE BY TYPE OF SERVICE

England
£ million

1995-96
1996-97
1997-98



Gross
current
expenditure
1
Fees and
Charges
Fees and
Charges as a
percentage
of Gross
current
expenditure
Gross
current
expenditure
1
Fees and
Charges
Fees and
Charges as a
percentage
of Gross
current
expenditure
Gross
current
expenditure
1
Fees and
Charges
Fees and
Charges as a
percentage
of Gross
current
expenditure

Residential care for:
Residential care for Children
599
14
3%
586
21
4%
614
21
3%
Residential care for Elderly
2,102
672
32%
2,494
818
33%
2,732
955
35%
Residential care for people with a Physical Disability
141
31
22%
169
39
23%
186
48
26%
Residential care for People with Learning Disabilities
509
107
21%
604
136
23%
673
163
24%
Residential care for People with Mental Health needs
134
36
27%
170
49
29%
193
55
28%
Other residential provision
18
3
17%
20
4
19%
20
4
19%
Non residential care:
of which:
Home care/home helps
1,028
83
8%
1,130
103
9%
1,231
128
10%
Day centres and lunch clubs
597
20
3%
622
25
4%
651
30
5%
Meals on wheels2
76
33
44%
83
37
44%
86
39
45%


Footnotes:
Source: RO3 return

  1.  Excluding administrative and training overheads.

  2.  Includes £15 million of fees and charges reported as "sales" for 1995-96, 1996-97 and 1997-98.





Table 5.12.2

PROPORTION OF NON RESIDENTIAL COSTS RECOUPED IN FEES & CHARGES: HOME CARE/HOME HELPS

England
£ thousands

Fees and
Charges
Gross current
expenditure
Fees and Charges
as a percentage of
Gross current
expenditure

BARKING & DAGENHAM
0
5356
0
BARNET
711
11266
6
BARNSLEY
920
6415
14
BATH & NORTH EAST SOMERSET UA
289
2609
11
BEDFORDSHIRE
1062
8655
12
BERKSHIRE
991
27043
4
BEXLEY
1462
5126
29
BIRMINGHAM
819
23182
4
BOLTON
837
5260
16
BOURNEMOUTH UA
963
4434
22
BRADFORD
1571
10846
14
BRENT
74
7011
1
BRIGHTON & HOVE UA
733
8183
9
BRISTOL UA
420
9415
4
BROMLEY
1209
8398
14
BUCKINGHAMSHIRE
2007
11019
18
BURY
404
3915
10
CALDERDALE
652
5901
11
CAMBRIDGESHIRE
3189
14266
22
CAMDEN
464
9879
5
CHESHIRE
2504
19324
13
CITY OF LONDON
73
673
11
CORNWALL
2423
16678
15
COVENTRY
713
9172
8
CROYDON
523
5573
9
CUMBRIA
0
9990
0
DARLINGTON UA
157
1222
13
DERBY UA
0
5882
0
DERBYSHIRE
8
23054
0
DEVON
3461
18761
18
DONCASTER
977
7895
12
DORSET
2343
9090
26
DUDLEY
1205
7477
16
DURHAM
1043
12991
8
EALING
182
8268
2
EAST RIDING OF YORKSHIRE UA
1061
6901
15
EAST SUSSEX
1506
12069
12
ENFIELD
569
8960
6
ESSEX
2573
40003
6
GATESHEAD
348
6061
6
GLOUCESTERSHIRE
34
9537
0
GREENWICH
342
9935
3
HACKNEY
1
9535
0
HAMMERSMITH & FULHAM
0
7165
0
HAMPSHIRE
3014
22878
13
HARINGEY
575
7178
8
HARROW
513
5491
9
HARTLEPOOL UA
194
1631
12
HAVERING
1011
8726
12
HEREFORD & WORCESTER
2669
2661
100
HERTFORDSHIRE
0
25117
0
HILLINGDON
675
4594
15
HOUNSLOW
531
4816
11
ISLE OF WIGHT UA
609
2613
23
ISLES OF SCILLY
2
5
40
ISLINGTON
691
10004
7
KENSINGTON & CHELSEA
349
6236
6
KENT
6890
35030
20
KINGSTON UPON HULL UA
460
5578
8
KINGSTON UPON THAMES
502
3247
15
KIRKLEES
1545
10423
15
KNOWSLEY
0
4328
0
LAMBETH
221
8341
3
LANCASHIRE
2396
35244
7
LEEDS
896
18625
5
LEICESTER UA
24
5508
0
LEICESTERSHIRE
1095
12050
9
LEWISHAM
635
8569
7
LINCOLNSHIRE
1097
11096
10
LIVERPOOL
2486
16022
16
LUTON UA
296
3710
8
MANCHESTER
2111
16660
13
MERTON
324
4597
7
MIDDLESBROUGH UA
227
3033
7
MILTON KEYNES UA
561
3651
15
NEWCASTLE UPON TYNE
725
11263
6
NEWHAM
0
12729
0
NORFOLK
3446
20931
16
NORTH EAST LINCOLNSHIRE UA
578
3527
16
NORTH LINCOLNSHIRE UA
349
3357
10
NORTH SOMERSET UA
404
3260
12
NORTH TYNESIDE
907
5317
17
NORTH YORKSHIRE
2165
9121
24
NORTHAMPTONSHIRE
336
9172
4
NORTHUMBERLAND
1678
10852
15
NOTTINGHAMSHIRE
2693
17709
15
OLDHAM
708
4885
14
OXFORDSHIRE
3002
16167
19
POOLE UA
757
3428
22
PORTSMOUTH UA
432
5245
8
REDBRIDGE
386
7793
5
REDCAR & CLEVELAND UA
364
3018
12
RICHMOND UPON THAMES
431
6368
7
ROCHDALE
326
6917
5
ROTHERHAM
1206
6615
18
RUTLAND UA
48
645
7
SALFORD
1748
8081
22
SANDWELL
891
9391
9
SEFTON
766
8065
9
SHEFFIELD
107
16422
1
SHROPSHIRE
1063
8448
13
SOLIHULL
521
5036
10
SOMERSET
0
128
0
SOUTH GLOUCESTERSHIRE UA
341
3069
11
SOUTH TYNESIDE
466
4656
10
SOUTHAMPTON UA
694
5795
12
SOUTHWARK
544
15120
4
ST HELENS
757
4816
16
STAFFORDSHIRE
2952
16261
18
STOCKPORT
803
10362
8
STOCKTON ON TEES UA
0
3508
0
STOKE-ON-TRENT UA
889
6447
14
SUFFOLK
2136
18412
12
SUNDERLAND
1396
7738
18
SURREY
2587
17442
15
SUTTON
689
4583
15
SWINDON UA
1782
5788
31
TAMESIDE
505
6422
8
TOWER HAMLETS
0
5829
0
TRAFFORD
704
5249
13
WAKEFIELD
930
7108
13
WALSALL
683
6080
11
WALTHAM FOREST
400
8842
5
WANDSWORTH
962
8994
11
WARWICKSHIRE
2160
10919
20
WEST SUSSEX
1534
15434
10
WESTMINSTER
491
10151
5
WIGAN
1345
6395
21
WILTSHIRE
931
7455
12
WIRRAL
916
8634
11
WOLVERHAMPTON
0
9555
0
YORK UA
692
3759
18
ENGLAND TOTAL
127748
1230770
10


Source: RO3 return.








 
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