INDEPENDENT FUNDING REVIEW OF FREE PERSONAL AND NURSING CARE: MEETING AT 10.00am ON FRIDAY 21 SEPTEMBER 2007, ST ANDREW'S HOUSE: NOTE OF MEETING
Present: Lord Sutherland (Chairman)
Anne Jarvie
Mary Marshall
Jim Dickie
Rory Mair
Rhona Dubery (Secretary)
In Attendance: Shaun Eales, Scottish Government: Community Care Division
Daniel Hinze, Scottish Government: Health Analytical Services
Apologies
1. Prof. David Bell was unable to attend but had offered comments on Paper IFR-FPNC(07)05 by e-mail which were tabled at the meeting.
Introductory Remarks
2. Lord Sutherland welcomed members to the second meeting of the Review Group and introduced Rhona Dubery, who would be the Secretary to the Group for the duration of the Independent Review. The Group noted that the papers for the meeting had been very late to issue and agreed that with a full time Secretary now appointed papers should in future issue a week in advance of meetings. The Group also agreed that in view of members' busy schedules, it would in future be helpful for a reminder to issue about 10 to 14 days in advance, flagging up the up and coming meeting. (Action: Rhona Dubery)
Minutes of Meeting held on 3 September 2007
3. The minutes of the first meeting held on Monday, 3 September 2007 (IFP-FPNC 07 1st Minutes) were approved.
Matters arising from the Minutes
Written Evidence: Letter to Local Authority Chief Executives
4. Lord Sutherland advised that his letter to Chief Executives inviting early views on the key issues and evidence the Group should consider in establishing a credible understanding of the financial circumstances had issued on 14 September, with an invitation to send responses to Rhona by Monday, 8 October. The Group noted the copy of the letter which had been tabled for information. Rory Mair said he had taken the opportunity to speak to SOLACE to encourage input.
5. The Group also noted that the letter recognised that the review was not going on in isolation and that the group expected to draw heavily on data from the Audit Scotland Study which had now begun. In addition, there was also the work on the broader aspects of the implementation of the Free Personal Care (FPC) policy which the 2 Scottish Government/COSLA Working Groups were pursuing - the Implementation Group and the Strategic Group - and in which there was likely to be a good deal of Stakeholder interest. The groups were following up the recommendations made in the February 2007 Hexagon research evaluation:
¨ The Implementation Group - looking to ensure that the policy was delivered consistently and equitably, no matter where people live; and
¨ The Strategic Group - looking at strategic issues which might need legislation or some other high level intervention to solve - including food preparation, waiting lists and eligibility criteria.
Overview of Funding & Spend: FPNC Resources to Local Authorities (Paper IFR-FPNC (07)05)
6. The Group considered paper IFR-FPNC(07)05 which provided further information on local authority expenditure in delivery of the FPC policy since its introduction in 2002-03, broken down to individual authority level. It built on the Scotland level data provided to the Group's first meeting. David Bell's tabled e-mail was relevant. It noted that the data on costs suggested much greater variability in costs of delivery of FPC at home by local authorities in Scotland than was the case for local authorities in Wales and that on the basis of the information available, it was difficult to understand what possible differences in the costs of delivery could be driving the huge differences between authorities.
7. In discussion the following points were made:
(a) In comparing the data on local authority delivery costs in Scotland with those in Wales it should be remembered that FPC was not free in Wales. The historic situation in each authority; the fact that FPC was still a policy in its infancy, with the teething problems which might be expected in such a transition; the quality of data in the statistical returns; and different accounting procedures used by individual local authorities also had to be borne in mind;
(b) In terms of beginning to get behind the figures on numbers receiving care and build a picture of the their expectations and those of practioners it might be helpful to pursue early discussions with BASW and with individual social work practioners;
(c) The new Care Commission regulatory framework and the assessment criteria for grading care homes was likely to have an impact on local authorities and their delivery of FPC. All care homes would be assessed next year and there were likely to be a number graded as "sub-standard". The impact was likely to add to the difficulties of some authorities, like Argyll and Bute who already experienced difficulties in finding care home places;
(d) It was not possible to rely on historic provision. It was important to recognise the shift that had taken place towards personalisation of care;
(e) The long-term sustainability of the FPC policy was an important strand of the Group's remit, yet as things stood there was little by the way of capacity planning took place in Scotland. In looking at the adequacy of FPC resources it was necessary to look at what the service would look like in the future and takc account of other developments, key challenges and opportunities. Further consideration would have to be given to how best to tackle this problem; and
(f) Some of the bigger providers in the care market would be planning well ahead and it was the same providers who were most likely to be in a position to respond to new regulations and standards in care and to local needs. However, the smaller providers could well be squeezed out of the market and that would add to local authorities' difficulties in purchasing bed space in certain areas.
8. The group agreed that:
(a) David Bell should be asked if he has anything to add to his e-mailed comments on Paper IFR-FPNC(07)05 which were tabled and what further information he considered might be useful in completing the picture on analysing current funding and spend;
(b) David Bell should also be invited to expand on point 1 of his tabled e-mail on variability between the costs of delivering PFC by local authorities in Wales (from his work on that) and the variability apparent in Scotland;
(c) In the light of David Bell's further comments the Group would give further consideration to what additional work might be necessary to better understand the variations in spend and the best way to approach this, perhaps focussing on a sample group of 6 or 7 individual authorities (possibly the same sample which Audit Scotland was focussing on in its detailed interviews following up on its data request, or those authorities who were involved in the COSLA Joint Improvement Team Peer Review of June 2007);
(d) Mary and Jim should proceed to hold discussions with BASW and with individual social work practioners in a bid to get behind the figures on numbers receiving care and the expectations of individuals and how that had shifted/was shifting as a result of the introduction of the FPC policy; and
(e) In considering the sustainability of FPC policy it may be necessary for the Group to do some work to look at the care market in terms of those requiring care in care homes (including local authority procurement issues) and capacity planning for the future.
Overview of Funding & Spend: Further Information on Current Funding Distribution Methodology (Paper IFR-FPNC (07)06)
9. The Group considered paper IFR-FPNC(07)06 which Daniel Hinze introduced and which looked specifically at local authority funding. It provided further information of the Scottish Government's current local government finance distribution methodology, through which the estimated cost of providing FPC was provided to Scottish local authorities, and details of the revised distribution formula proposed for the main Grant Aided Expenditure (GAE) line - Personal & Nursing Care for Older People - for the next local government finance settlement.
10. Daniel explained that GAE was not actual funding but represented a provision to spend and was the figure which the Government used as an estimate for the costs of providing the service. As such it was one of about 100 GAE lines used in calculating the amount of Revenue Support Grant provided to Scottish local authorities. He said that GAE lines normally used a formula based approach (rather than historic caseload data) and were set according to a number of indicators to take account of local circumstances, which could include factors such as population or poverty. The formula based approach was considered a fairer representation of current and future need but the move to bring the GAE line for Personal and Nursing Care for Older People onto that basis would sever the link to historical spending and make any link between allocation and actual expenditure more difficult. The formula had been endorsed by the Three Year Settlement Group in June and was likely to be used in the 2008-2011 local government finance settlement expected to be announced in the autumn, once the Government's Comprehensive Spending Review was completed.
11. In discussion the following points were made:
(a) The paper provided a good explanation of the grant distribution system, which was designed to allocate funding in a fair and equitable way and on the basis of relative need However, the equalisation which took place at the end of the process and existence of the "Floor" mechanism in the distribution - which sought to dampen re-distributive affects - had in the past 10 years resulted in year-on-year shifts for individual authorities which averaged only around 0.6%. That brought into question the need for such a complex distribution process. However, local authorities accepted that the system had its weaknesses and individually, where an authority lost in one GAE line it might gain in another. On the whole, authorities seen a value in the system having brought a certain stability in income over the past 10 years;
(b) Local authorities were likely to say that the quantum of funding for the provision of FPC was wrong, rather than the GAE system. The situation was currently very fluid though, with a fundamental review of distribution a possibility if the Government decided to move to an outcome based approach to local government funding;
(c) The original GAE allocation was made on the basis of historic caseload data on the number of self-funders in care homes at a specific date. So councils in "wealthier" areas, like Edinburgh, lost out because of their higher proportion of self-funders. Such councils would now benefit from the introduction of the index score proposed for the GAE from 2008-09 onwards; and
(d) The GAE system fostered a lack of accountability by local authorise as it muddied public perception of the adequacy of resources provided for FPC.
12. The Group agreed that it would re-visit the questions of the total level of resources; the distribution of those resources between local authorities and the cost of provision in the light of the evidence currently being gathered from local authorities, including that sought via the on-going Audit Scotland Investigation.
Developing the Work Programme (Paper IFR-FPNC (07)07)
13. The group considered the paper offering an initial outline of its work programme and its different phases. In continuing to build up the evidence basis for the initial phase, the Group agreed the following would be useful:
(a) The Social Work Inspection Agency might be invited to consider whether its recent work looking at the care market and quality of management might be useful to the Group's deliberations;
(b) The written evidence received from local authorities in response to Lord Sutherland's letter of 14 September should be analysed and a report prepared for the Group's October meeting. After consideration of that, the Review Group would decide what oral evidence it needed to take and from whom;
(c) The Public Service Ombudsman should be invited to offer a report providing an overview of the complaints cases she had received in relation to FPC payments and access problems experienced since 2002. Consideration should also be given to inviting the SPSO to attending the Group's November meeting;
(d) The Audit Scotland Study Team should be invited to offer an up-date on progress with its study/emerging findings for the Group's October meeting;
(e) A letter should be prepared inviting other stakeholders to offer evidence to the Review. Those to be consulted should be restricted to those who had offered evidence in the Parliamentary Committee's 2006 Care Inquiry. And on the basis that the review would be taking account of other recent reviews, research etc, they should be offered the opportunity to add to what they said at the time (rather than have to re-rehearse it);
(f) Papers should be prepared for the Group's October meeting on: the impact of withdrawal of Attendance Allowance; and on the work on-going through the 2 joint Working Groups established by the Government and COSLA in response to the Hexagon research;
(g) An early outline/framework of the shape of the Group's report to Ministers should be prepared for initial consideration at the Group's October meeting; and
(h) Copies of the recent Peer review by a small group of local authorities, the Joseph Rowntree Foundation research report, and the Hexagon research report should be sent to review group members.
Initial Report to the Cabinet Secretary for Health and Wellbeing
14. The Group considered the format the initial report it was expected to make in September should take. It agreed that the report should take the form of a letter from Lord Sutherland advising that work was underway and outlining what the early priorities would be. The letter should also trail the idea of a meeting with the Cabinet Secretary towards the turn of the year to discuss emerging findings.
Independent Funding Review of Free Personal & Nursing Care
Secretariat
September 2007