Select Committee on Health Memoranda


4.  Personal Social Services Resources And Activity (continued)






4.2  FEES, CHARGES AND GRANTS

  4.2.1  Could the Department provide an update of Tables 4.2.1 and Figures 4.2.1? [4.2.1]

  1.  Table 4.2.1(a) updates last year's information and provides separate figures on residential care for each client group. Figures 4.2.1(a) and 4.2.1(b) illustrate the recent national trends in the percentage of gross expenditure on home care/home help for all client groups recouped through sales, fees and charges and the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges. The charges are not a social services fixed rate.

  2.  The table shows that the percentage of gross expenditure recouped in sales, fees and charges for residential care for older people fell from 39% in 2000-01 to 38% in 2001-02 and 36% in 2002-03. The main reason for this is that prior to April 2002, higher rates of income support were available to people entering independent homes compared with councils' own homes.

  3.  The chief element of income support accounting for the higher rate is residential allowance (which equates to housing benefit and was introduced in 1993 to give independent residential care an edge over council homes). Most income support is taken into account by the means-test for residential care. Therefore the more people entering independent residential care prior to 2002, the greater the fees and charges councils would recoup—the amount recouped rose from £1,388 million in 2000-01 to £1,434 in 2001-02 and £1,535 million in 2002-03.

  4.  Note that residential allowance is no longer available to individuals entering independent care homes. Transitional arrangements were in place for residents in receipt of the residential allowance prior to April 2002. It ceased entirely for existing residents from October 2003. The fall in the recoupment rate in 2002-03 may, in part, reflect the inclusion of former Preserved Rights clients for whom local authorities assumed responsibility in April 2002.

  5.  The amount recouped for home care and home help service also rose from £200 million in 2000-01 to £211 million in 2002-03; in each year it represented 12% of gross expenditure.

Variations in charges for domiciliary services

  6.  Figures 4.2.1(c) and 4.2.1(d) illustrate the percentage of gross expenditure recovered in charges by each local authority for home care and meals services, the two main items of service provided in a domiciliary setting. Table 4.2.1(b) sets out in tabular form the percentage of gross expenditure on home care recouped through sales, fees and charges.

  7.  At the local council level, there is a wide variation in the amounts raised in sales, fees and charges made for domiciliary provision. Local councils are free to decide on whether to levy charges and upon the level of charges, provided that guidance on assessing ability to pay is observed—although the first statutory guidance published on charges for domiciliary services was not required to be fully implemented until April 2003.

  8.  Wide ranges of charging policies were in operation during 2001-02, ranging from flat rate charges to income-related charges. We have considered how best to 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 study of local council charging practices (published as "Charging with Care" in May 2000). In November 2001, we issued guidance, "Fairer Charging Policies for Home Care and other non-residential Social Services". The guidance should have been implemented in two phases, by 1 October 2002 and 1 April 2003 and will not, therefore, be fully reflected in the table covering 2002-03.

  9.  There are a number of instances where local authorities have reported that they raised no sales, fees and charges income for home care services provided; at the other extreme, some authorities reported recouping in excess of 25%. 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.

  10.  For England as a whole, 12% of the direct cost of the home care service was recouped in sales, fees and charges to clients. Within authorities, the actual figures reported varied from zero in the case of five authorities to 25% or more also in five authorities. The middle 50% of authorities had recoupment rates between 8% and 15% compared to rates between 7% and 16% for the previous year.

  11.  For meals services the overall England recoupment rate was 43%: LA figures range from zero in 23 authorities to 96% in one authority (six authorities reported no expenditure). The middle 50% of authorities had recoupment rates between 18% and 54% compared to rates between 28% and 58% for the previous year.

Variations in charges for residential services

  12.  Figure 4.2.1(e) illustrates the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges. Table 4.2.1(c) tabulates these figures. Tables 4.2.1(d) to 4.2.1(f) provide similar information for adults with a physical disability or sensory impairment, adults with learning disabilities and adults with mental health needs.

  13.  The charges levied on individual residents in care homes are determined nationally. The overall recoupment rate for residential provision for older people in England was 36%. LA figures varied between 0% in one authority and 52% in two authorities. This may again just reflect misreporting by local authorities. The middle 50% of authorities had recoupment rates between 32% and 39%, as against 33% and 42% in the previous year.


 
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