Improved Reporting of Adult Social Care Finance and Activity DataRevisions to PSS EX1 return

Presenter: Nick Miller Feedback to pssex1@dh.gsi.gov.uk – closing date October 20th.

Outline of presentation/discussion

BackgroundObjectives / principlesTimescalesProposals with issues for consultationPersonalisation and low level interventionNext stepsDetails of memorandum lines

Full report at : csed.csip.org.uk or on IC website under PSSEX1.

Background

PSSEX1 history :

Introduced 2001-02Link to CIPFA actuals , RO and RA formsJoint IPF/DH (now IC)BVACOP and SEAFor variety of usersA commissioning focus

PSSEX1 provides:

Actuals incl overheadsBy 4 main client groups11 subdivisionsGross (LA own, external)Net (income from different sources)

PSSEX1 issues

Timing and useTo IC mid JulyAt LA level in public domain in February (provisional LA data October 2008)Cost to LAs of collationLAs internal use limited – link to activity data weak – no view of packages of careLAs benchmarking useCentral users – DH, Audit Commission, CSCI etc

Content Policy issues not covered –

Objectives of spend and outcomes (e.g. rehabilitation)

Personalisation Low level services Client groups missing

dementia/ carers.. Alternatives to long term

care in care homes …Comparability problems across time and councils

Principles guiding proposals

Benefit for councils – data more relevant and useable for managementBurden low – value highEarlier availability of data from centreMaintain time series & requirements of DH, CLG, AC Keep in line with BVACOPContribute to JSNA/ joint commissioning

To ensure secure delivery:Authoritative central point for queries / guidanceLink to other central returns and NASCIS Future-proof – Green Paper..Training

Outline of proposals‘New’ client groups memorandum lines – OPMHN, OPLD, CarersMemorandum items for expenditure – ‘of which…’ – some with purpose of spend (e.g. rehabilitation)Parallel activity measures where possibleReporting on support service / SSMSS ‘overheads’ – development of central allocation across expenditureNew measures from data of relevance to policy (Annex G)Work on linking activity and spend data at client level - and adding in quality and outcomes. Finance and activity returns to centre extracted from this local management tool. (See separate slides)

Proposed timescales (1)2008-09 Disaggregation via memo lines/activity measures

Voluntary: anonymous. Support services apportionment excluded/ included in memo lines

Support services costs (SSMSS) included as now Test tool to extract data from councils’ systems Develop outputs, including new measures

2009-10 Disaggregation OP/carers/sub-divisions: ? mandatory Support services now in SSMSS to be reported as

memo items but to be allocated by national formulae Continue/ finalise work on extraction tool or councils’

own equivalent and on national report requirements

Proposed timescales (2)

2010-2011 All councils report to new standards All support services ‘overheads’ allocated centrally

by formulae – ‘backward’ reporting possible of 2009-10 SSMSS allocation on formula basis

Data on services (for old SR1/RAP) all collated via new return… can/should care management data (referrals, assessments, reviews) also be covered?

Linkage to NHS and housing data locallyImplications for councils/ central collections / central users set out

Benefits

To all from Disaggregation within existing return Work on system to link activity and

expenditure locally – see separate presentation

New measures of spend relevant re new policy implementation Potential to link in objective of spend, quality of service measures and outcomes…..

Consultation issuesFrom OPMHN/ OPLD/ Carers split out?From memorandum items within subdivisions Are the proposed lines of sufficient

importance / policy relevance; adequately specified / defined; reasonably extractable?

De minimis items?From support services overheads to be reported and centrally pro-rata-ed? Should in-house care services be treated differently? Can we move to national formulae for allocation of support service costs for 2009-10 or do we hold this change over to 2010-11?

Self directed support

Link to IC proposals for reporting in RAPWhere user takes support as a Direct Payment, no change. Where user opts to use IB for services which fit within current subdivisions, show as now in financial reporting. Potential in data extraction to link the client’s IB agreement to any activity or spend data – this should allow extraction for any service sub-division or client group division of amount of spend which was subject to an IB agreement

Where user opts for services arranged by council which are not within current subdivisions (e.g. personal assistant/ non-standard day activity) show in ‘other’ as

now (but identify spend and activity via IB link above).

‘Low level interventions’ ‘Strong & Prosperous Communities’ interest in wellbeing of whole population and sub groups – council and other agencies’ contributionPSS EX1 identifies grants to voluntary sector and othersCouncils will have own local knowledge of ‘low level’ services – some following assessment but often without specific details of those benefiting? Joint Strategic Partnership / council responsibility to collate data – may be part of LAA?

Next stepsLetter to DASSs/ Treasurers from John Bolton seeking feedback by October 20 and volunteersUse IC’s and other road-shows to seek comments/ volunteersDH consulting with DCLG on status of PSSEX1 return in futureFollowing end of IC consultation, meet CIPFA PSS EX1 working party and others to review feedback and agree any changesIC to issue new requirements and voluntary items details for 2008-09 and 2009-10 in November along with IC new returns detailsWork on extraction tool and reporting from itAgree source/content of advice and ‘training’ for councils

Sub-divisions memo items (1) (Annex C – with link to detail for each at Annex J)

Row 1: ASSESSMENT / CARE MANAGEMENTOf which Initial points of contact – CRM Occupational therapists engaged in assessment and care managementSupport staff to assessment and care managementNB – all three memo lines will be reported across all client groups

Rows 2 and 3: NURSING CARE / RESIDENTIAL CARE (combined)Of which:Rehabilitation / intermediate careRespite careShort term care

Sub-divisions memo items (2) (Annex C – with link to detail for each at Annex J)

Row 4: SUPPORTED / OTHER ACCOMMODATION(NB – where Supporting People funds are being used these should

NOT be included here but continue to be reported as line 11 for each

client group)Of which:Adult placement schemes – permanent residentsAdult placement schemes – temporary residentsAdult placement schemes – respite residentsSupported living / group homesRefuges / hostels not registered with CSCICommunity support servicesExtra care housing – accommodation elementRow 5: DIRECT PAYMENTS (for all client groups together)Of which

DPs to carers (to be reported as a memorandum item under the new Division for Carers) – see belowAdministration supporting DPs

Sub-divisions memo items (3) (Annex C – with link to detail for each at Annex J)

Row 6: HOME CARE

Of which:

Rehabilitation / re-enablement

Extra care housing – personal care element

Live in home care

Night sitting (waking) – numbers of cases and costs may be small so may be merged with night sleeping

Night sleeping - numbers of cases and costs may be small so may be merged with night sitting (waking)

Day sitting

Sub-divisions memo items (4) (Annex C – with link to detail for each at Annex J)

Row 7: DAY CARE

Of which Employment related services (excluding sheltered employment which is reported separately at line J1 under SEA rules)

Row 8: EQUIPMENT AND ADAPTATIONS

Of which Telecare equipment and its maintenancePrescriptions for equipment and their management costsICES Store costs + associated transport

Sub-divisions memo items (5) (Annex C – with link to detail for each at Annex J)

Of which

H3 substance abuse (addictions) split into

Alcohol abuse –

Residential / nursing care expenditure

Other services.

Drugs / solvent abuse (with or without alcohol abuse)

Residential / nursing care expenditure

Other services.

Row 10: OTHER SERVICES (page 36)

Of which

Meals on wheels and frozen meals

Lunch clubs meals

Row 9: MEALS

Sub-divisions memo items (6) (Annex C – with link to detail for each at Annex J)

TOTAL SUPPORT SERVICES costs – all costs allocated as overheads (including corporate recharges)

Of which: Client support (and specifically:

– welfare benefits, advocacy, advisory services)Operations support (and specifically:

– performance management, planning, contract management, commissioning, brokerage)

IT Finance – excluding financial assessmentFinancial assessmentTraining Premises and property costsTransportOther support costs

Examples of new measures from memorandum items (from Annex G)

Rehabilitation / intermediate care in care homes as % of total spend on care homes (excluding respite care)Rehabilitation / re-enablement home care as % of overall home careSupported accommodation as % of ((care home spend – respite - short term care)+ supported accommodation spend)Direct payments spend as % of all ‘community support’ spend (including respite, short term care, rehabilitation in care homes) Telecare spend as % of total equipment spendEquipment ‘prescriptions’ spend/total equipment spend

Examples of new measures from memorandum items (from Annex G)

Carers’ services costs (including respite care)/ total services costsDirect payments to carers / (all carers services + respite care)Employment related day services for each <65 group / all day services for each < 65 group% of overall spend on home care which is committed to rehabilitation, live-in home care, night sitting/ sleeping etc% of OPMHN expenditure committed to residential + nursing care, to community services