Supplementary note to Question 163
Q163 Dr Taylor: I do not need you to look
at them now but tables 35b to 35e show different costs of nursing
care costs, costs per week at local authority rest homes, independent
rest care and home help per hour. These variations are absolutely
amazing. Nursing care costs, £240 per person per week
up to £753; cost per week local authority rest homes, nought
to £2,400; independent rest care, £204 to £720;
home helps per hour, £8.6 to £25. Is there any
possibility of looking at these and trying to get a national tariff
or whatever you call it for these because are those variations
acceptable? Are they inevitable? Could you reassure us that you
are aware of them and you are going to do something about them?
Answer
The answer as requested is broken down in to
the following four sections.
1. where the data comes from;
3. how we quality assure; and
4. what our view is of each of the variations
referenced, ie how much is data and how much is real.
1. Where the data comes from
1.1 The data comes from councils/local authorities
with adult social services responsibilities. Presently there are
152 councils/local authorities with adult social care responsibilities
in England.
1.2 The data is collected and published
by the NHS Information Centre for Health and Social Care (NHS
IC). Data includes:
— annual expenditure data for individual
councils/local authorities and aggregated national data;
— annual expenditure data covering the
services commissioned (day care, home care, residential &
nursing care etc ie community and "institutional");
— annual expenditure data covering the
services commissioned for particular client groups (eg older people
65 years plus, and younger adults (18-64) with mental health,
learning disability and physical disability needs);
— a break down of expenditure on services
provided internally (own provision), externally and also jointProvision
as well as voluntary arrangements for service provision;
— details of activity levels for all of
the services provided above;
— details of income from Client contributions
(Sales, Income, fees & charges), income from Joint arrangements
and income from the NHS);
— average unit costs (per hour or per week)
by councils/local authorities for particular services;
— Details of grant funding; and
— Narrative to accompany any of the above.
1.3 Definitions of the expenditure categories
are given in the CIPFA Service Expenditure Analysis (SEA) for
Social Services which form part of their Best Value Accounting
Code of Practice (BVACOP).
1.4 The data is reported annually on the
form PSS EX1—the personal social services expenditure return.
1.5 The PSS EX1 has been the responsibility
of the NHS Information Centre since April 2005. Prior to this
date it was collected by the Department of Health.
2. What do we use it for
2.1 The data provided on the PSS EX1 is
the only source of data collected by the Department of Health
on council/local authority adult social care expenditure.
According to the NHS IC, the PSS EX1 is
used by:
— CQC to monitor the performance of adult
social care services across councils in England.
— Audit Commission as part of the comprehensive
area assessment process.
It is used by the Department of Health for:
— Accountability purposes to the public
and parliament and briefing to Ministers.
— To support the CSR process and other
analytical purposes.
— Benchmarking of council expenditure to
identify variations in practice.
— Monitoring of adult social care expenditure
against national policy agendas.
It is also reviewed and used by CIPFA and ADASS
(association of directors of adult social services) for policy
review, monitoring and benchmarking purposes).
3. How we quality assure
3.1 The PSS EX1 has been the responsibility
of the NHS Information Centre since April 2005.
3.2 The data comes from councils/local authorities
with adult social services responsibilities.
3.3 Data checks, beyond those already built
in to the PSS EX1 return, are undertaken by the NHS IC and
also the commercial arm of CIPFA that sets data definitions and
processes across government services.
3.4 The data is initially published as "interim"
with subsequent versions published later in the year culminating
in "final" data.
3.5 The Department of Health has an active
agenda to improve and increase transparency of data in particular
to eradicate extreme values. These include on-going discussions,
review and analysis of the data with the NHS IC, CIFPA and representative
Councils.
3.6 The Department of Health has taken a
number of steps to improve the reliability of finance information
provided by councils on their personal social services expenditure.
In particular, the NHS IC has recently rolled-out an online NHS
IC portal the National Adult Social Care Intelligence Service
(NASCIS).
3.7 NASCIS
3.8 NASCIS was launched by the NHS IC on
17 July 2009. As well as providing earlier access to data
for councils via pre-release access rules, it also provides greater
transparency and therefore identification of extreme values. NASCIS
allows councils to view their own data along with that for their
comparators via the various analytical tools available. It contains
some pre-populated reports, two of which are based on expenditure
data, and all the expenditure data is available for user-led analysis
via an online analytical processing tool.
3.9 DH work to revise and improve the PSS EX1
This work falls in to two sections:
3.10 Firstly, the Department's work to revise
the PSS EX1—Over the last two years the Department has been
working with councils and the NHS IC to improve the quality and
scope of the data submitted by councils. Pilot changes were implemented
for 2008-09 data, and these will remain work in progress
whilst councils make the necessary changes to their finance systems.
3.11 Secondly, the Department's work to
refresh the PSS EX1—Social care is presently experiencing
a significant transformation and reform agenda, in particular
the national rollout of personal budgets. The Department has been
working with key stakeholders to identify issues and challenges
that councils are facing, in particular accounting for personal
budgets and personalisation. This work, whilst still to be signed-off
by all parties, goes a long way to improving the quality and scope
of data collected. Significantly, proposed changes include:
— spending information will be recorded
at an individual level rather than a service level for everyone
with an on-going social care package;
— a new set of spending categories that
are more closely in line with the policy objectives of Putting
People First. Information could be used to inform decision-making
at three levels:
— at individual level when developing support
plans and at reviews;
— at local level aggregating individual
information to inform commissioning decisions, strategic planning
and performance management; and
— at national level to understand how resources
are being used and inform policy-making.
The proposals will help "triangulate"
information across all levels and therefore improve the quality
of data requested, captured and reported.
3.12 Finally, our work on LA "Use of
Resources" is designed to ensure that Councils take greater
ownership for the data they report.
4. What our view is of each of the variations
referenced, ie how much is data and how much is real
4.1 Some of the unit costs submitted by
individual councils appear very high or low. These were drawn
to the attention of the councils concerned but not all were able
to submit revised data in the time available. Caution should therefore
be exercised when using the more extreme values for individual
councils. Likely errors are:
— incorrect attribution of expenditure
between "own provision" and "provision by others";
— incorrect attribution of expenditure
between "nursing care placements" and "residential
care placements";
— incorrect attribution of expenditure
between client groups; and
— expenditure supplied net of client contributions
rather than including client contributions in expenditure, and
showing client contributions in the appropriate income column.
4.2 Therefore, the NHS IC will have brought
to the attention of Councils providing "spurious" data,
eg why Southwark and Harrow shows a figure of £0, but was
unable to obtain clarification from the Council as to the actual
unit cost.
4.3 The NHS IC informs DH that it will have
contacted each Council that supplied "blank" information
or "zero" information. However, if additional information
is not supplied by the Councils concerned then NHS IC is obliged
to report the data that is supplied (and which should be signed
off by the Council's Director for Adult Social Care).
4.4 There are of course good reasons for
national variations in unit costs, including "market"
variations and differences in service commissioning and provision,
and significant analysis is carried out by both DH and regulators
(Audit Commission), CQC as well as PSSRU, ADASS and CIPFA bench
marking clubs.
4.5 Therefore, with regards to:
— Zero and nil/blank values these will
be due to poor data quality as provided by Councils.
— Wide variations in unit costs some of
this will be real and some will be down to differing interpretations
for calculating unit costs. For example, a common cause of inconsistency
is the allocation & apportionment of indirect overheads.
4.6 The Department of Health has approached
the NHS IC to seek further clarification on the NHS IC data quality
assurance processes in order to prevent these issues recurring.
4.7 We have previously raised with NHS IC
the impact of "poor" quality data for measuring efficiency
and effectiveness across Councils and over time, as well as the
implications for accountability to Ministers and Parliament.
4.8 Any measures to improve the quality
of data will have to be discussed with Dept. for Communities and
Local Government, ADASS, CIPFA and Councils. Therefore, the Department
of Health has limited mandate over information standards.
11 February 2010
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