INDEPENDENT FUNDING REVIEW OF FREE PERSONAL AND NURSING CARE: MEETING AT 1.00pm ON MONDAY 3 SEPTEMBER 2007, ST ANDREW'S HOUSE: NOTE OF MEETING
Present: Lord Sutherland (Chairman)
Anne Jarvie
Mary Marshall
Jim Dickie
Professor David Bell
Rory Mair
In Attendance: Neil Rennick, Scottish Government: Community Care Division
Shaun Eales, Scottish Government: Community Care Division
Julie Rintoul, Scottish Government: Health Analytical Services
Welcome and introductions
1. Lord Sutherland welcomed those attending the first meeting of the independent Review Group.
Terms of reference
2. The terms of reference were agreed. A copy is attached at Annex A.
Ways of working
3. Shaun Eales confirmed that Rhona Dubery, currently a member of the Scottish Government's Cabinet Secretariat, had agreed to act as Independent Secretary to the Group, on a period of secondment for 6 months. She was expected to take up post from 18 September.
4. Shaun outlined 3 strands of related work that could have an impact on the work of the Review Group:
- Following the recommendations made in the Hexagon evaluation of the operation of the policy published in February 2007, the Scottish Government and COSLA have jointly established 2 working groups to look at some of the issues highlighted in the report.
- An Implementation Group would look at issues arising from the implementation of the policy. It would ensure that the policy is delivered consistently and equitably, no matter where people live.
- The Strategic Group would look at strategic issues that might need legislation or some other high level intervention to solve, including food preparation, waiting lists and eligibility criteria. A joint paper with options and recommendations on the way forward would be produced and presented to the President of COSLA and the Minister for Public Health by September.
- Audit Scotland is currently undertaking an investigation of free personal care finances. They are due to report their findings in January 2008. The study will consider the implementation and the financial implications of the free personal care policy and assess the impact of the policy on older people, carers, local authorities and NHS Scotland. Though there may inevitably be some overlap, the scope and terms of reference for these studies have been kept as distinct from each other as possible. Lord Sutherland had met with the Auditor General and agreed an approach for the two projects to co-operate, including shared access to the Audit Scotland data returns and economic analysis, regular meetings between the secretariat and Audit Scotland officials and early sight of Audit Scotland's initial findings.
5. The Review Group noted these initiatives and agreed that regular updates from officials should be offered via the Secretary to help inform the context of the Group's work and ensure that duplication of effort was avoided. Action: Secretariat
6. Members recognised that the press was bound to take an interest in the work of the Group. Lord Sutherland suggested and the Group agreed that all press bids should be submitted to via the Secretariat. This would ensure that a consistent and agreed line was adopted in dealing with media enquiries. Action: All Members.
7. Any papers for consideration by the Group should be submitted electronically via the Secretariat. Details of individual contact numbers and e-mailing addresses should be circulated to members. Action: Secretariat.
8. On evidence gathering, the Group indicated that they were keen on receiving written evidence. That evidence would be published at some future date and must, of course, be in accordance with the Freedom of Information Act. Minutes recording meetings of the Group would also be made publicly available once deliberations were complete. Action: Secretariat.
Overview on funding and spend
9. The Group considered a paper which had been circulated in advance about free personal and nursing care costs. The paper considered how much money local authorities had spent each year since the introduction of the policy and how much local authorities had been allocated to deliver it. .
10. Julie Rintoul from the Scottish Government's Analytical Services Division presented the paper. The main conclusions from the paper follow.
- The figures in the report allowed the reader to compare allocations with estimated spend, but care should be taken in attempting to do this as allocations are not budgets and local authorities are free to allocate resources as best fits local policy, whilst meeting their statutory requirements.
- Current policy is to shift the balance of care away from care homes towards more care at home.
- Since the introduction of the policy, the proportion of care home clients who receive personal care services has increased significantly and the proportion of clients who receive only domestic help has decreased.
- Expenditure on FPNC in Care Homes has risen each year since the introduction of the policy. This is due to increasing numbers of self-funding residents in Care Homes.
- FPNC payments have not changed since the policy was introduced. Care home fees have however increased substantially over this period resulting in higher "hotel costs" for self-funders.
- Overall the number of older people in care homes has remained level since 2002-03 at around 32,000 people. So while the number of self-funders have been increasing, the number of LA funded residents have been decreasing from 24,600 in 2002-03 to 22,200 in 2006-07.
- We have seen an increasing proportion of home care clients receiving personal care services. This is likely to be a consequence of the FPC policy as people only want the "free" services but should also be a consequence of the shifting balance of care towards more care at home.
11. Members thanked Julie Rintoul for her presentation and in discussion, the following points were made:
- It was important to be clear when collecting data from local authorities in relation to comparisons made between net and gross expenditure. The differentials here could be significant and steps should be taken to ensure that local authorities were being asked to provide like for like information.
- The Group would need to consider a piece of work to measure unmet need.
- There were significant variations in LAs charging policies outwith free personal care and the costs of providing care at home services. The Group agreed that this was an area that would need closer investigation.
- The Group agreed that it could not consider FPC funding in isolation. Funding streams for care at home and care homes would need to be taken into consideration too.
Forward look
12. In terms of next steps, the Review Group agreed that more work was needed to gain a clearer picture from the local authority perspective of the financial circumstances and impact of free personal care policy. A greater understanding of how demographic changes might impact upon the policy would also need to be considered. More detailed consideration would also need to be given to issues surrounding quality of life, rurality and areas of deprivation.
13. As a first step, the Group agreed that they should seek, as an immediate priority, an early view from local authorities on the key issues and evidence that the Group should consider to establish a coherent and credible understanding of the financial circumstances and impact of the free personal care policy. They were interested not just in the specific resource allocations to and expenditure on free personal care, but in the wider impact across social care, local authority, health and housing support finances and on the quality and effectiveness of overall services provided to older people in need and other vulnerable groups. The Group agreed that each local authority Chief Executive should be given the opportunity to set out views on how the Review Group might move forward in considering this issue, within its agreed terms of reference. The responses should help inform the Group's work programme and evidence gathering over the coming months. Action: Secretariat.
14. The Group also agreed that it should seek oral evidence from a selection of local authority representatives when returns had been made. Action: Secretariat.
Future meetings
15. The Review Group agreed to meet in Edinburgh on the following dates:
September 21, 2007 10.00am
October 22, 2007 2.00pm
November 23, 2007 10.00am
December 14, 2007 10.00am
January 18, 2008 10.00am
February 15, 2008 10.00am
Independent Funding Review of Free Personal and Nursing Care
Secretariat
September 13, 2007