Meeting documents

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The Council Executive is asked to agree that:

7.1 Our records show that approximately 697 people receive 2 hours or less domiciliary care per week. Most of these people qualify for this service under the moderate band because they require a limited amount of help with personal care or domestic tasks. We have estimated that if the threshold was drawn under the substantial band this could potentially release over £300,000 net from the budget used to purchase/provide domiciliary care per year.

7.2 This net figure takes into account the loss of income from charges paid by users of the services.

7.3 This estimate also allows for the fact that not all of the 697 people receiving 2 hours or less domiciliary care have low care needs. Some people who receive small packages of care nevertheless have high needs and are supported by a carer. In these situations care would continue to be provided in order to support the carer in their caring role (see appendix 1 - substantial band).

7.4 It is a statutory requirement that everyone currently receiving a service would have to have their needs re-assessed before any decision could be taken to remove services, there would not therefore be an immediate impact. However, in 2005/06 we would expect to achieve a significant part of the £300,000

7.5 359 people receive a meals only service. Meals cost £2.94 of which the service user contributes £2.05; savings from meals are therefore likely to be relatively small. It is our current practice to encourage people who require help with meals to purchase frozen meals from an independent provider, however approximately 20% of all the people receiving the community meal service have a frozen meal delivered by Commercial Services. If frozen meals were discontinued for people who receive a meals only service then this would produce a saving of approx. £15,797.50 per year.

8.2 In deciding where to draw the threshold in 2003, we looked at the current patterns of service provision. We proposed a threshold just into the moderate band where `there is or will be an inability to carry out several personal care and/or daily routines'. This applies, for example, to a person who needs help to carry out a strip wash, hygienic cleaning and/or heat up meals on a regular basis and who, without this help, would face a threat to their physical well being (appendix 1 shows where the current threshold is drawn ). Following a consultation exercise in 2002 with organisations representing users of our services, Social Services staff and colleagues in the health services and independent providers, this threshold was agreed by the councillor with executive responsibility for Social Services in April 2003.

8.3 Government practice guidance states that hospital discharge arrangements can over-ride eligibility criteria. This is in order to ensure that people are not kept in hospital longer than necessary. A care package is generally reviewed within 6 weeks of discharge and the eligibility criteria will then be applied.

4.4 Bath and North East Somerset Social Services spends the largest proportion of its budget on Adult services, primarily to older people. Current and predicted growth in demand means that it has become necessary to further prioritise services and ensure available resources are focussed on those with greatest needs. Social Services are experiencing considerable budget pressures during this financial year (2004/05) which are unlikely to improve in 2005/06. One way in which we can manage expenditure is to draw eligibility criteria more tightly to concentrate resources on those with the greatest needs.

5.1 The proposal to re-draw eligibility criteria under the substantial band means that people needing only limited support to carry out personal care and domestic tasks (less than 2 hours per week) will no longer be eligible for a service from Social Services. The proposed new threshold is shown in appendix 1.

4.6 Factors taken into consideration

a) carry out a community care assessment of all new clients and will conduct a re-assessment of existing clients to ensure that all eligible needs have been considered,

b) Ensure that any assessment is needs led. There will be no blanket ban on the provision of particular services and in some exceptional circumstances a person may still be eligible for a very limited service. Many people who have high needs will continue to be eligible for services such as hygienic cleaning under the substantial band as part of their overall care package.

c) take into account the contribution of informal carers. Where the carer is providing a substantial amount of personal care and supervision then the person they look after will be eligible for a low level package of care if this supports the carer to go on caring. Similarly the carer may be entitled to a carer's service,

d) ensure that anyone who requires a hot meal only will continue to receive a service if they are unable to heat up a meal or need prompting to eat regularly,

e) ensure that clients are given information and advice about what other services are available locally using the "Dissbase" and the Purple Pages information line both run by the Care Forum and funded by Social Services.

f) Ensure that anyone who may have to purchase their own services receives advice about benefits and is referred, where appropriate, for further help

5.2 There is a risk that the re-assessments will not reduce the levels of service provision as much as is predicted because further needs will come to light during a re-assessment. Alternatively, without the provision of low level preventative services people's needs may increase more rapidly and they may then require a more intensive package of care. The impact of the proposals will therefore be carefully monitored. The level of service provision will be tracked and the impact on budgets reviewed regularly. This will ensure that any budget commitments for 2005/06 are based on the actual service provision and costs following assessments.

Most respondents recognised the financial difficulty of Social Services and appreciated that the local authority were concentrating resources on those in greatest immediate need. The key concerns raised in the responses to the consultation were as follows -

· reducing the eligibility for services would place a financial burden on pensioners on lower incomes who would have to purchase services independently, this would be particularly difficult for anyone not in receipt of disability allowances

· the reduction in low level maintenance support would adversely affect some people's ability to live independently

· the new threshold might impact adversely on people who have fluctuating conditions

· the preventative element of service provision would be lost and this may result in more people requiring heavier packages of care in the longer term

· management of people with long term chronic conditions often requires low levels of ongoing support to prevent deterioration or hospital admission, some of these people will fall outside the eligibility criteria

· failure to provide low level services could increase admissions to residential care in the longer term

· the greater clarity for carer's eligibility was welcomed

· staff felt that a clearer distinction is needed in the FACS framework between, services to the client which support a carer, and carers' services

· carers felt that the reduction in eligibility for low level services would place an increased burden on already hard-pressed carers and could lead to more caring situations breaking down

· carers felt that with the new threshold, there would be an emphasis on crisis management rather than preventative provision

· disabled people and carers felt that they were getting mixed messages, with the government promoting the independence of disabled people and recognising the rights of carers, but at a local level services were being reduced

· have alternative ways of saving money been looked at ?

· people with early onset dementia often require a low level service which is important to maintaining their independence and ensuring that they have taken medication etc. This client group would be adversely affected by the raising of the threshold

· provision of a strip wash is important to health and wellbeing and should be provided

· some clients would have difficulty arranging and managing their own service provision and would therefore not employ agencies and would not receive a service

· the lack of alternative shopping services in rural areas would put some people at risk

· many clients can afford to purchase services independently but they trust arrangements made by the local authority

· some clients with a visual impairment have specialist requirements regarding cleaning services which are better provided but care staff rather than cleaners

· provision of good up to date information about alternative services will be essential if this change is made

· clients and carers need to be given information about the complaints procedure so that they can register their dissatisfaction about the outcome of an assessment, if appropriate

· staff had concerns about the capacity to complete re-assessments within a reasonable timescale

· staff felt it should be made clear to patients being discharged from hospital that services could be withdrawn after 6 weeks