Review and Development of Adult Social Care Relative Needs Formulae

Jude Ranasinghe, Director17 September 2013

Presentation Overview

Current adult social care spending/funding Care Bill and future funding implications Remit of our research/timescales Impact assessment Activities to date Local authority funded clients Self-funders Modelling local financial implications

Planned Expenditure 2013/14

Total planned expenditure in 2013/14 of £14.650bn

Adult Social Care Strategy£0.1bn0.4%

Older People including Older Men-tally Ill£6.6bn45.1%

Younger Adults with Physical Disability or Sensory Impairment

£1.5bn10.1%

Younger Adults with Learning Disabilities

£5.1bn34.9%

Younger Adults with Mental Health Needs

£1.1bn7.3%

Other Adult Social Care£0.3bn2.2%

Current Adult Social Care Funding

Funding received through council tax; fees and charges; specific grants;

and general grant

Significant funding received through general grant via Relative Needs

Formulae (RNF) – part of Business Rates Retention system

RNF are a set of formulae accounting for relative differences in costs of

delivering services – younger adults and older people

But formulae currently ‘frozen’ and not expected to be updated until next

reset (at least 2020/21)

Specific grants – NHS funding for social care (£859m) Local Reform

and Community Voices (£42m), Community Capacity (capital £129m) –

all use the current RNF

Current Adult Social Care RNFCurrent formulae developed in 2005, implemented in 2006/07

Younger adults (18-64):

Basic amount for all resident adults aged 18-64 Deprivation top-up (DLA, never worked/l-t unemployed, routine

occupations, no family) Area Cost Adjustment

Older people (65+): Basic amount for those aged over 65 Age top-up aged 90+ Deprivation top-up (AA, Income Support/Pension Credit, rented

accomm, living alone) Low income top-up (LA charges) Sparsity top-up (domiciliary care) Area Cost Adjustment

Care Bill and Implications for Future Funding

• Reform currently taking place in relation to ASC funding

• May 2013 - Care Bill incorporating clauses to implement Dilnot

proposals placed before Parliament

• July 2013 - DH consultation paper, “Caring for our future: Consultation

on reforming what and how people pay for their care and support” 

• Essentially, affects eligibility for social care support in terms of:

• Care need

• Means test

• Particular issue is that people currently self-funding their care will need

to be assessed and will become eligible for LA support

Care Bill and Implications for Future Funding

1. Care plan/account: to assess and monitor needs/outcomes/spending

2. Cap on lifetime costs of care, with full state support after the cap: older adult cap £72k from 2016/17, younger adult cap TBC

3. Free support for those transitioning into adult social care: zero cap for clients turning 18 with eligible care/support needs i.e. no means test

4. Extend the means test: upper limit changing from current £23,250 to £118,000 in 2016/17 for home owners receiving residential care

Care Bill and Implications for Future Funding

4. Standardise general living “hotel” costs: from 2016/17, contribution of £12,000 p.a. for residential care living costs

5. Standardise national eligibility criteria: national minimum eligibility threshold in Care Bill from 2015/16 (level TBC)

6. Deferred payment scheme should be extended to a universal entitlement: will be nationally available from 2015/16

Remit of our Research - Formulae

1. Local authority funded clients, although not currently planned to update

until next reset of system (2020/21). However, is currently used for DH

specific grants and NHS funding for social care

2. Introduction of the universal deferred payments scheme from 2015/16

3. Assessment/metering costs from 2015/16 (£335m in total for 2. and 3.)

4. Introduction of the cap on eligible care costs from 2016/17

5. Changing the capital limits for people in residential care from 2016/17

We are not looking at quantum of funding

Impact assessment by DH on costs of social care funding reform

Impact Assessment of Funding Reform2010/11 prices (£m) 2016/17 2019/20 2025/26

Older people – cap and means test extension 360 1,150 1,940

Older people – assessment, case mgt, review 210 230 290

Working age – all costs 100 210 420

Total costs 660 1,590 2,640

Reduction in AA/DLA benefit costs (130) (250) (340)

Net costs 530 1,340 2,300

Source: DH Social Care Funding Reform Impact Assessment, April 2013

Impact Assessment

Source: DH Social Care Funding Reform Impact Assessment, April 2013

Impact Assessment

Source: DH Social Care Funding Reform Impact Assessment, April 2013

Project Timetable

Project initiation/

engagement Autumn 2012

LA contact, feasibility work and

data collection piloting

Spring 2013

LA and care home data collection –Summer/

Autumn 2013

Analysis and modelling

Spring 2014

Peer review/ consultation/

formula outputs Summer

2014

National data

collection, local data

verification, analysis

Winter 2013

Activities to Date – General and LA Funded

Engagement with ASC stakeholders – Steering Group (monthly) and Project

Advisory Panel (quarterly)

Approval from National Research Ethics and local Research & Governance

Committees

Pilot process for LA data collection with c.10 LAs

Development of data guidance/definitions/templates

Now working with 65 LAs to actually collect data

Activities to Date – Self-funders

Feasibility study on availability of self-funder data

Asked LAs about information held on self-funders

Investigating potential data sources on domiciliary care

Draft survey for distribution to private sector residential care homes on self-

funders

Local Authority Data Collection – Volunteers by Type/Deprivation

Authority Type Number Deprivation Level: Low Deprivation Level: Medium Deprivation Level: High

County Council 14

Buckinghamshire Cambridgeshire

HampshireOxfordshire

Surrey

EssexGloucestershire

Suffolk  

DerbyshireEast Sussex

KentLancashireLincolnshire

Nottinghamshire

Inner London 9Camden

Kensington and ChelseaWestminster

Hammersmith and Fulham 

HackneyHaringeyIslingtonNewham

Tower Hamlets

Outer London 9MertonSutton

BexleyHillingdonHounslow

 

CroydonEalingEnfield

Waltham Forest

Metropolitan Borough 13

KirkleesLeedsSeftonSolihull

Stockport 

CoventrySt. Helens

 

BirminghamManchester

OldhamRochdaleSandwell

Wolverhampton

Unitary Authority 20

Bracknell ForestCheshire East

CornwallIsle of WightIsles of ScillyShropshireWiltshire

York

BedfordMilton Keynes

North SomersetNorthumberland

ReadingSwindonTorbay

BlackpoolDurham

HartlepoolLeicester

Peterborough

Total 65 23 16 26

Local Authority Data Collection – Volunteers by RegionRegion County

CouncilInner

LondonOuter

LondonMet.

BoroughUnitary

AuthorityRegional

Total% of

All Auth.

EAST 3       2 5 45%

EAST MIDS 3       1 4 44%

LONDON   9 9     18 55%

NORTH EAST         3 3 25%

NORTH WEST 1     6 2 9 39%

SOUTH EAST 6       4 10 53%

SOUTH WEST 1       6 7 44%

WEST MIDS       5 1 6 43%

YORKS & HUMBER       2 1 3 20%

Auth. Type Total 14 9 9 13 20 65 43%

% of All Auth. 52% 64% 47% 36% 36% 43%  

Data Collection from LAs

Collecting data at small area level (Lower Layer Super Output Area)

Using activity data from national returns for consistency/control totals by client group and care type

Residential care – ASC Combined Activity Return (admissions in 2012/13, care home address and pre-care address)

Non-residential care – Referrals, Assessments and Packages of Care Return (clients as at 31 March 2013)

Separated requirements into ‘core’ and ‘supplementary’

Team of 10 researchers, range of on- and off-site support to LAs

Secure data transfer portal managed by University of Kent

Data Collection from Care Homes

Also seeking data at LSOA level from private sector care homes

Interested in numbers of self-funders and publically supported

Numbers from outside the LA area

Room price data

Length of time self-funders have been resident

Will combine this information with other data e.g. wealth characteristics, to identify nature of self-funder population and likely implications for future LA support

Modelling Local Financial Implications of the Care Bill

Also offering separate support to LAs looking to undertake more detailed local modelling

Reviewing range of national and local data sources

Advising LAs on key local data

Building a bespoke local long-term model, with guidance

Will allow for ‘what-if’ scenarios

Reporting summary implications

Next Steps

Continue work with 65 LAs on LA-funded clients

Run self-funder survey with care homes

Verify and analyse data

Analyse/collate national datasets e.g. Census, benefits

PSSRU will develop formulae

Further Information

Dedicated project website at www.adultsocialcarernf.co.uk/ Contains a range of information/documentation/latest news

Contact directly at jude.ranasinghe@lgfutures.co.uk or on 01908 424387

This research has been commissioned and funded by the Policy Research Programme in

the Department of Health.  The views expressed in this presentation are not necessarily

those of the department.