30 October 1990

Dear Sir/Madam

NATIONAL HEALTH SERVICE AND COMMUNITY CARE ACT 1990

SPECIFIC GRANT FOR REVENUE EXPENDITURE ON NEW COMMUNITY PROJECTS IN THE MENTAL ILLNESS FIELD

Summary

1. The White Paper "Caring for People" announced the Secretary of State’s intention to introduce a specific grant to help accelerate the development of community based services for people with a mental illness and so enable more people affected by mental illness to live in the community while maintaining or improving the quality of their lives.

2. The aims of the grant scheme are to assist local authorities to provide facilities which will reduce the numbers of mentally ill people requiring admission to hospital because of the lack of resources to support them living at home; and to enable more people who are, or have been, mentally ill to leave hospital and live with suitable support in the community when they are fit to do so.

Statutory and Wider Policy Position

3. Section 58 of the National Health Service and Community Care Act 1990 adds to the Social Work (Scotland) Act 1968 a new section 92A enabling the Secretary of State, with the approval of the Treasury, to pay grants towards the expenses of local authorities in respect of their functions under Part II of the 1968 Act and sections 7 and 8 of the Mental Health (Scotland) Act 1984 in relation to persons suffering from mental illness. This section is to be brought into operation in time for grants to be paid with effect from 1 April 1991.

4. There are already arrangements operating successfully between Health Boards and local authorities for the promotion of jointly agreed community care projects in the mental illness field funded either through joint finance or support finance arrangements as described in circular SW 5/1985 (NHS 1985 (GEN) 18) of 24 April 1985 or by the Health Board at its own hand. The new grant is not intended to replace these arrangements or to reduce the existing level of local authority or Health Board expenditure on mental illness projects. It should rather stimulate new proposals and serve as a source of additional finance for programmes in this field. The grant scheme is accordingly confined to new projects or extensions to existing projects. The Health Board interest in grant assisted projects is further considered in paragraphs 5 and 6 below.

Type of Projects Eligible for Assistance

5. The main criterion in judging applications for grant will be the extent to which the proposed project(s) will assist in meeting the aims described in paragraph 2 above. Projects may however also be funded which are not directly aimed at either of these objectives but which serve, where institutional care is not necessarily in question, to produce a material improvement in the quality of life either for persons themselves or for their carers: this will bring into consideration provision which is proposed to be made for persons suffering from dementia. Consideration will be given in all cases to the extent to which projects (especially those involving discharge of patients from hospital) themselves involve a shared commitment of resources by the local authority and the Health Board. The balance between different types of project will be a matter for individual authorities to decide in putting forward their applications.

6. In order to provide encouragement for the continued development of a mixed economy of care, the grant will be paid not only on local authority expenditure on directly provided services but also on payments made for services which the local authority obtains from the voluntary or private sector. The Secretary of State is keen to see greater use made of existing community resources on behalf of the mentally ill, and local authorities are encouraged to pursue possibilities with voluntary bodies and respond positively to proposals which emerge from them.

7. Types of project which will merit consideration for grant assistance will include:

(a) programmes of day activities (including participation in employment schemes and preparation for employment);

(b) day centres (including drop-in centres and others where more structured support and other services may be available);

(c) domiciliary services (including home-makers, befrienders and visiting or day care in the home);

(d) staffing and other care-related running costs for supported accommodation which are not met by charges;

(e) respite and practical support for carers (including counselling and advice);

(f) crisis services;

(g) self-help schemes (including locally based community support schemes).

The examples above are intended as a broad guide to appropriate areas for grant assistance rather than as an exhaustive list. For example, respite provision could range from "sitter services" in a person’s own home through to temporary residential care for the person allowing the usual carer a complete break. In order to attract grant as indicated in paragraph 4 above, any project must either be entirely new or comprise an extension or expansion of an existing scheme.

Relationship with Other Projects and Services

8. Grant applications should relate particular proposals for grant assistance to a wider range of provision (actual or proposed) which is designed to achieve one or other of the objectives outlined in paragraphs 1 and 2 above. Local authorities will be required to relate their proposals to their community care plan when these are prepared. Applications should in any case provide clear evidence that the projects have been drawn up in full consultation with the Health Board and relevant voluntary organisations (including those representing service users and carers) and should confirm that inter-agency co-operation in the provision of services has been fully agreed. Great importance will be attached to evidence of collaborative working in assessing grant applications.

9. In support of each group of projects for which grant is applied there should be a statement on local strategy for such services extending to (a) the estimated incidence in the area in question of mental illness among persons in the community; (b) the amount of requests for social care services made in the past to which the proposed facilities would be relevant; (c) any proposals for the discharge of patients from long term hospital care that the proposed facilities would be likely to assist with; (d) any projects which would prevent or minimise the need for admitting or re-admitting to hospital mentally ill people who are already in the community, and (e) schemes to support carers.

Financing Arrangements

10. Grant will be made available to local authorities within the framework of Aggregate External Finance (AEF) which is the combined level of support for local authority expenditure comprising revenue support grant, specific grants and non-domestic rate income over which central government now exercises control. The grant will be cash-limited and will be paid in support of projects involving local authority expenditure to a total value of £3m in 1991-1992. The amount for later years will be subject to review. The rate of grant in relation to the total cost of each assisted project which would otherwise be borne directly by the local authority is 70%.

11. The specific grant payable to an authority will need to be re-approved annually. However, it is not the intention that established projects should necessarily go through the whole process of application and approval each year. The aim is to develop services on a stable basis and improve the general level of provision for the mentally ill. Thus it is not expected that services which have been accepted for grant and are known to be performing satisfactorily will have grant withdrawn. The scheme will initially run for 3 years and, will be subject to review on the basis of success achieved. Projects will be monitored as described in paragraph 19 in order to ensure that the resources available for grant are used to maximise the level of new mental health provision in the community.

Allocation of Resources

12. The division of grant resources in a given year will have regard to estimates of uptake by local authorities. Provided sufficient projects are put forward which meet the criteria for approval the large regional authorities will receive a proportion of the total grant approximating to their share of the population of Scotland while islands councils and smaller authorities will be eligible to receive slightly higher amounts than their population share. Target figures for 1991-92 are given in Annex A. These allocations will be kept under review in the light of applications received and may be adjusted to ensure that the best and fullest use is made of the available resources. In the event of funds being available for further distribution additional projects as referred to in paragraph 17 would be considered against the shortfall of existing facilities in the area in question indicated in supporting submissions at paragraph 9 above.

Applications for Grant

13. Applications for grant should be made each year in the form indicated at Annex B. In many cases the most appropriate form of community care provision for mentally ill persons might be relatively small scale projects designed to serve a specific neighbourhood with an emphasis on close personal relationships, and intimate scale and a reasonably stable programme of activities and other arrangements. It is necessary however that the system of central approval of schemes and payment of grant should not have to deal with very large numbers of small applications. Equally local authorities themselves will not want to be burdened with a large number of small applications. To this end it is proposed that grant applications should either relate to single large schemes or to small schemes grouped together in accordance with geographical proximity or on some other basis.

14. Each project for which grant has not been paid previously should be subject of a separate description in the application but the relationship of individual projects with each other and with wider service provision as referred to in paragraph 8 above should be made clear. This will be particularly necessary as regards projects with an annual cost to the local authority of less than £40,000 which will be considered for grant purposes only if they form part of a coherent plan for the development of mental health services in a particular community and, in the case of larger authorities, are grouped with other projects included in the grant application.

15. Where an application relates to a project for which grant has been paid in the previous year the full description of the scheme in the original applications will not need to be repeated but certain information on service outturns will be required as indicated in the second part of Annex B.

Submission of Applicants

16. Applicants for grant should be submitted by 30 November of the year before that in which grant is due to be paid. Professional advisers within Social Work Services Group are available to offer advice on the professional aspects of any project without prejudice to the eventual outcome of any application for grants.

17. It is important that projects proposed for grant in the first year should be able to achieve as nearly as possible a full 12-month spend. With this in mind it is intended that decisions on grants for each financial year, should be notified to authorities by 31 January. Failure to achieve full spend could result in either the under use of the resources available in that year or possible distortion to the programme in subsequent years. Authorities should accordingly consider submitting with the list of projects comprising the formal grant application (or as soon as possible thereafter) an outline of any additional projects which they would wish to be considered at a later stage if funds become available for adding to their original allocation. It would be open to SWSI in such a case to increase the allocation of a given authority for the year in question so long as this could be done without the risk of funds in the subsequent year being overcommitted.

Payment of Grant

18. Grant in respect of approved schemes will be paid to authorities quarterly in arrears on the basis of the costs agreed at the beginning of the year. Where voluntary organisations have difficulty finding the initial resources to enable the project to start authorities may wish to consider providing a loan in terms of section 10(3) of the Social Work (Scotland) Act 1968. Authorities will be required to submit audited statements of outturn expenditure as soon as possible after the end of each year, to enable the total grant paid for that year to be adjusted if practical in the first possible grant instalment thereafter. It may difficult for adjustments to be made until statements of this kind come to hand.

Monitoring and Review

19. Local authorities will be responsible for the monitoring and evaluation of their own grant assisted projects in order to satisfy themselves that the continuation of funding is justified. Central monitoring will be arranged selectively to validate particular developments, to assess the general efficiency of grant arrangements and to make it possible for lessons learned in one area to be made available for wider application. Detailed monitoring arrangements will be indicated in the grant application form (see Annex B) and these will also be included as conditions of grant: additional requirements may be included where the project appears to involve a novel approach to service delivery, or where there seem to be uncertain factors inherent in a project which nevertheless appears to warrant grant aid.

20. The intention is that the grant should have a pump-priming role in the development of community care services for the mentally ill. Consideration will be given as part of the review referred to at paragraph 11 above to whether facilities created through the grant arrangements should be funded in future in the same way as other parts of the social work programme. In this event the intention would be that the annual needs calculation for the purpose of fixing the level of Exchequer assistance to each local authority should take into account the facilities brought into existence through the specific grant.

Enquiries

21. Any enquiries about the terms of this circular or requests for advice on procedural matters in respect of grant applications should be directed in the first instance to Mr F Stewart, Social Work Services Group, Room 52, James Craig Walk, Edinburgh EH1 3BA (telephone 0131 244 5460): enquiries on professional issues should be directed to

Mr T Leckie, James Craig Walk, Edinburgh EH1 3BA (telephone 0131 556 8400).

Yours faithfully

GAVIN ANDERSON

ANNEX A

MENTAL ILLNESS SPECIFIC GRANT

Note

The column headed Grant Share shows the amount of grant an authority can expect to receive provided it submits satisfactory projects. For the islands and smaller authorities a round figure has been set which takes account of population and the need to provide a realistic figure. For the larger authorities the figure is directly related to population and distributes the remainder of the grant after the share of the smaller authorities has been deducted . The column headed "local authority expenditure" shows the grant figure translated into the total local authority expenditure figure against which the 70% specific grant in the previous column would be payable.

ANNEX B

MENTAL ILLNESS SPECIFIC GRANT

NOTES ON COMPLETING THE APPLICATION FORMS

General Points

1. A description of the kind of projects to which the grants scheme will apply and a note of the criteria which must be met if projects are to attract grant is provided in Circular No SW/10/1990. Projects may be submitted on an individual and free-standing basis or in groups where collectively they will improve the availability of services in a particular area. Either way the application should explain the extent to which an assessment of need for the area has been made, the degree of inter-agency co-operation in drawing up projects, and the way in which the proposed projects will, along with existing facilities, address the service requirements identified.

2. Applications for grant will involve the use of three separate forms, copies of which are attached. Form A will require an indication to be given of the strategy to be followed in meeting the need for community care services in this field as well as providing a list of projects for which grant is sought. It is important that details of existing services available to people in the area should be given, including an analysis of the strengths and weaknesses of existing provision.

3. Form B is project specific. It contains a one page summary sheet which must be completed in all cases; it also includes a range of questions, which must all be answered, but for which a pro-forma is not provided. This allows freedom to offer as much information as is considered necessary to describe the project; the numbered sequence should however be followed and the item given the heading shown.

4. Form C will provide the information which is required before second and subsequent year funding can be approved (see paragraph 15 below).

Particular Sections of Form B

5. Name and Location of Project (Items 1 and 2): The name should be unique to enable the project to be easily identified. The location may be specific where it is known or simply a district where accommodation has yet to be found.

6. Type of Project (Item 8a): A number of suggestions are made. Insofar as a project might involve more than one activity a number of boxed may require to be ticked. Explanations can be offered at item 17.

7. Functions (Item 9 and 17): A number of suggestions are made. These are not mutually exclusive and insofar as a project might involve more than one activity a number of boxes may require to be ticked. Explanations can be offered at item 17.

8. Financial Details (Items 13, 14, 15, 21 and 22): The grant meets 70% of the local authority’s revenue expenditure on the project. Contributions may be made from other quarters, eg the Health Board or voluntary agencies, but only the local authority expenditure will qualify for grant. Items 13 and 14 differentiate between the total cost of the project and that which is to be met by the local authority. Items 21 and 22 allow further information to be given.

9. Consultations (Items 6 and 16): Please say at item 16 what consultations were held with other agencies and the extent to which they agree with, and will participate in, the project. State whether the agreement is one in principle or represents a firm commitment.

10. Type of Project and Functions (Item 17): Please provide a description of the project and the services or facilities which it will provide. If it is an extension of an existing project explain what new or additional services will be provided.

11. Staffing (Item 18): Full details should be given to all the staff involved, including designations and grades. It may be necessary to show separately staff whose salaries will be met by the local authority and grant-aided and those who may be funded through the Health Board, the voluntary sector or other agencies. Mention should be made of likely numbers of volunteers.

12. Management (Item 19): In co-operative or jointly run projects the management arrangements may be complex. It is important that there should be proper lines of accountability and responsibility. Please say who will be responsible for the oversight of the project and its successful implementation.

13. Accommodation (Item 20): Say whether suitable accommodation has been identified and whether it is available. Are resources available to meet any costs involved? Will any refurbishment or other modifications which might be necessary jeopardise the start or running of the project?

14. Proposed Outcomes (Item 23): The aims of projects should be clearly identified from the start and measurable outcomes stated. Numbers of persons expected to receive the service provided by the project should be given. Increases in service provision should be measurable in terms of numbers, length of time, etc. Other indicators such as reductions in hospital admissions, reductions in the length of stay in hospital, the increase in numbers of people supported at home and in the number of people able to secure employment should also be mentioned, where possible, although the extent to which these figures have been influenced by the grant alone might be difficult to measure. Similarly it might be possible to measure changes experienced by individuals in independent living and social functioning.

Grant in the Second and Subsequent Years

15. In order to minimise the amount of work necessary once projects have been approved for grant, subsequent applications can be made using only the summary from Form B and Form C. It is important, however, to identify any changes which might have to be made to the project since the previous grant application. If minor these can be dealt with at item 3 in Form C. If major alterations to the project are involved Form B should be completed.

MENTAL ILLNESS SPECIFIC GRANT APPLICATION

FORM A: GENERAL

MENTAL ILLNESS SPECIFIC GRANT APPLICATION

FORM B: INDIVIDUAL PROJECT

SUMMARY SHEET

1. Name

2. Location of Project

3. Managing Agency

4. Contact for Information

5. Voluntary Sector involvement

(if different from 3 above)

6. Consultation with other agencies: Health Board 

Housing 

Education 

Voluntary Sector 

Other (specify below) 

7. AREA SERVED - Geographical

Population

8a. TYPE OF PROJECT Community Development 

Day Centre 

Domiciliary 

Drop-In 

Housing 

Residential Care 

Resource Centre 

Self-Help 

b. IS THE PROJECT NEW OR AN EXTENSION

c. IS THE PROJECT REGISTERED, OR TO BE REGISTERED, UNDER SECTION 62 OF THE 1968 ACT?

9. FUNCTIONS Accommodation and Support 

Advice 

Advocacy 

Casework 

Education 

Employment Training 

Leisure 

Occupation 

Respite for Carers 

Social Skills Training 

Social Support 

Treatment 

Other (specify below) 

10. USER GROUPS TARGETED

11. NUMBER OF PEOPLE HELPED

12. NUMBER OF PAID STAFF

13. TOTAL REVENUE COST OF PROJECT

14. COST OF PROJECT TO LOCAL AUTHORITY

15. AMOUNT OF GRANT REQUESTED

16. CONSULTATION

17. TYPE OF PROJECT AND FUNCTIONS

18a. NUMBERS AND GRADES OR STAFF: LA

Health Board

Voluntary Agencies

Others

18b. NUMBER AND ROLE OF VOLUNTEERS

19. MANAGEMENT

20. ACCOMMODATION REQUIREMENTS

21. TOTAL PROJECT COSTS: Health Board Staff

Voluntary Sector Staff

Other Staff

Accommodation Costs

Other Revenue Costs

Local Authority Costs

22. LOCAL AUTHORITY COSTS

23. PROPOSED OUTCOMES

FORM C

SECOND AND SUBSEQUENT YEAR FUNDING

1. STATEMENT OF EXPECTED OUTCOMES

(from previous year’s application)

2. EXTENT TO WHICH OUTCOMES MET

(with explanation for any difficulties experienced)

3. CHANGES REQUIRED TO MEET ANY MINOR DIFFICULTIES WHICH EMERGED DURING THE YEAR

4. STATEMENT OF EXPECTED OUTCOMES FOR FORTHCOMING YEAR