2. GENERAL EXPENDITURE ISSUES
2.4. Expenditure on Community Care
2.4.1 Could the Department provide a
table showing, by service, net expenditure in real terms by central
and local government on community care, broken down by residential
and non-residential care (taking into account relevant service
pay and price increases), over the most recent five year period
for which such data are available? Could this data include Social
Security and Housing expenditures contributing to Community Care
objectives? Could it also show this data in graphical form? [2.5.1]
1. Table 2.4.1 provides details of
central and local government net expenditure on services for community
care in England, for 1997-98 to 2001-02, the latest year for which
information is available. All figures have been adjusted to 2001-02
prices using the latest Gross Domestic Product deflator.
2. Community care expenditure is taken to
mean expenditure on non-residential and residential care provided
or arranged by local authorities for adults; community health
services provided by the NHS for adults; certain social security
benefits which support community care objectives; and certain
expenditure on housing. Calculation of local authority expenditure
by client group involves a degree of estimation.
3. The data in the table are set out in
graphical form in Figure 2.4.1. The graph shows that since
1997-98 there has been real terms growth in expenditure on all
services, with the exception of the Department for Work and Pensions
(DWP) supported residential care. The reason for the decline in
the DWP supported residential care expenditure was as a direct
result of the April 1993 community care reforms. These reforms
transferred care management and funding responsibility for new
admissions to independent sector care homes to local authorities
and ended the former system of higher Income Support payments
for people in such homes unless they had preserved rights.
Table 2.4.1
NET EXPENDITURE ON SERVICES FOR COMMUNITY
CARE (2001-02 PRICES) ENGLAND.
| | |
| | £ million
|
|
| 1997-98 |
1998-99 | 1999-2000
| 2000-01 | 2001-02
|
|
| A. Local Authority Domiciliary Care (1) (2)
| | | |
| |
| Assessment and Care Management | 859
| 870 | 923
| 965 | 1043
|
| Direct Payments | 0
| 11 | 43
| 50 | 56
|
| Home Care | 1,331
| 1,350 | 1,415
| 1,441 | 1,484
|
| Day Care for Older People | 189
| 198 | 206
| 241 | 259
|
| Day Care for Other Adults | 548
| 571 | 599
| 623 | 640
|
| Equipment and Adaptations | 81
| 70 | 74
| 111 | 122
|
| Meals | 52 |
49 | 53
| 59 | 58
|
| Other Services | 384
| 404 | 426
| 348 | 353
|
| Total A | 3,443
| 3,523 | 3,741
| 3,838 | 4,015
|
| B. Community Health (3-7) |
| | | |
|
| Chiropody | 81
| 91 | 99
| 108 | 142
|
| Family Planning | 52
| 60 | 66
| 73 | 94
|
| Immunisation and Surveillance | 3
| 3 | 3
| 4 | 2
|
| Screening | 53
| 61 | 67
| 74 | 88
|
| Professional Advice and Support | 93
| 115 | 118
| 122 | 57
|
| General Patient Care | 905
| 998 | 989
| 978 | 741
|
| Community Mental Health | 495
| 551 | 637
| 736 | 769
|
| Community Learning Disability Nursing | 330
| 366 | 387
| 411 | 387
|
| Health Promotion | 48
| 55 | 58
| 61 | 29
|
| Services to GPs Under Open Access | 190
| 220 | 277
| 344 | 457
|
| Other Community Health Services | 260
| 328 | 384
| 449 | 454
|
| Total B | 2,510
| 2,848 | 3,085
| 3,360 | 3,220
|
| Total A plus B | 5,953
| 6,371 | 6,826
| 7,198 | 7,235
|
| C. Local Authority Residential Care for (1) (2)
| | | |
| |
| Older People (Aged 65 or over) | 2,186
| 2,232 | 2,312
| 2,258 | 2,293
|
| Adults aged under 65 with: |
| | | |
|
| A Physical Disability or Sensory Impairment |
167 | 176
| 188 | 193
| 200 |
| Learning Disabilities | 631
| 669 | 725
| 783 | 828
|
| Mental Health Needs | 168
| 174 | 178
| 197 | 210
|
| Total C | 3,152
| 3,251 | 3,403
| 3,431 | 3,531
|
D. Income Support: Residential Care,
Nursing Homes and Residential Allowance Cases (8-13)
| 1,825 | 1,671
| 1,530 | 1,439
| 1,363 |
| Total C plus D | 4,977
| 4,922 | 4,932
| 4,869 | 4,894
|
| E. Other Social Security Benefits
| | | |
| |
| Attendance Allowance (14) | 2,286
| 2,360 | 2,424
| 2,484 | 2,566
|
| Disability Living Allowance(14) | 4,368
| 4,568 | 4,759
| 4,973 | 5,290
|
| Invalid Care Allowance | 684
| 698 | 727
| 738 | 774
|
| Independent Living Fund (9 and 15) | 100
| 102 | 111
| 116 | 127
|
| Social Fund Community Care Grants (16) | 84
| 83 | 81
| 81 | 81
|
| Total E | 7,522
| 7,810 | 8,101
| 8,391 | 8,838
|
| F. Housing | |
| | |
|
| Adaptations to all LA Dwellings for Older People and Disabled Adults (17)
| 87 | 97
| 97 | 95
| 106 |
| LA Grants; Disabled Facilities Grants (18) |
110 | 115
| 122 | 134
| 145 |
Housing Corporations; Approved
Development Programme (ADP) (19)
| 67 | 76
| 137 | 124
| 119 |
| LA Sponsored RSL (LASHG) (19) | 50
| 55 | 49
| 58 | 50
|
| Total F | 314
| 342 | 406
| 412 | 420
|
| Total E plus F | 7,836
| 8,152 | 8,507
| 8,803 | 9,258
|
| Grand Total A to F | 18,766
| 19,445 | 20,265
| 20,870 | 21,387
|
|
Footnotes:
Parts A and C
1. Local Authority expenditure for 2000-01 and 2001-02
is obtained from the PSS EX1 return; individual service lines
include overhead costs. For years prior to 2000-01 it is obtained
from the RO3 current expenditure return but with a share of overhead
costs allocated to service lines on a pro-rata basis. Figures
for 2000-01 and 2001-02 are therefore not strictly comparable
with those for earlier years. The RO3 return was redesigned in
1998-99 and equipment and adaptations and meals were made memorandum
items leading to some under-recording and consequent inflation
of the other services expenditure; data for these items for 1998-99
and 1999-2000 are therefore not strictly comparable with those
for earlier years. Expenditure on direct payments was only recorded
from 1998-99 onwards.
2. Assessment and care management, although included
under local authority non-residential care in Part A, also includes
expenditure which is relevant to residential care (Part C).
Part B
3. As it is not possible to supply net expenditure figures
from the Hospital and Community Health Services (HCHS) programme
budget figures are gross expenditure and this may mean that they
are slightly overstated.
4. For figures derived from HCHS programme budget analysis,
it has been assumed that the following has been spent on adults:
approximately 90% of chiropody, 95% of family planning, 1% of
immunisation and surveillance, 100% of screening, 35% of professional
advice and support, 95% of total general patient care, 95% of
community mental illness nursing, 80% of community learning disability
nursing, 70% of health promotion and services to GPs under open
access and other community spending. It has also been assumed
that 100% of maternity care is spent on the delivery and no costs
are associated with the mother, and 100% of community detail is
spent on children.
5. The above allocations have been taken from the HCHS
Programme Budget.
6. Administration costs for community health services
are not separately identifiable and are not included in the community
health figures.
Part D
7. Figures for 1999-2000 onwards are on a Resource Accounting
and Budgeting basis.
8. All figures are based on information received from
DWP ASD Information Centre on caseload and average weekly amounts,
except for Independent Living Fund which is 85% of GB Outturn.
9. Any change in expenditure from previous published
figures is due to enhancements to methodology or the availability
of more up to date information.
10. Income Support Quarterly Statistical Enquiries May 1996
to February 2002.
11. Expenditure is based on Preserved Rights Residential Care
and Nursing Home cases and Residential Allowance cases for England.
12. Excludes unemployed claimants who are now provided for
by Jobseekers Allowance.
Part E
13. Disability Living Allowance replaced Attendance Allowance
(for people under 65) in 1992.
14. Expenditure for Independent Living Fund estimated as 85%
of GB outturn as at September 2002.
15. Final Grant Expenditure Information derived from Social
Fund Computer System.
Section F
16. Source: Housing Investment Programme (HIP) Annual Plan
returns (section 5) and HIP BPAM from 2001 onwards.
17. Disabled Facilities Grants are paid to the private sector,
including RSL tenants, and also to LA tenants; figures shown represent
totals of mandatory and discretionary grants under relevant Acts.
Source: ODPM P1D returns; and HIP HSSA 2002 return for 1997-98
onwards.
18. Housing Corporation ADP approvals for schemes by Registered
Social Landlords (mostly housing associations) in respect of homes
for rent and sale to certain "special needs" groups
(frail elderly, people with mental health problems, learning,
or physical disabilities) and one "general needs" group
(elderly with warden support). This covers the Corporation's own
programme and joint schemes, and also local authority-sponsored
schemes using Local Authority Social Housing grant. Source: Housing
Corporation Stewardship Report: elderly and disabled categories
only.
|
