11 November 1994

Dear Colleague

COMMUNITY CARE PLANNING

Summary

1. This circular provides revised guidance to social work authorities and health boards on the content of community care plans. It aims to shift the balance of plans from, largely, a description of processes to management tools focusing on intended action, including expected outputs and outcomes. Plans will also incorporate the statements required under the Secretary of State's directions on consultation with the independent sector and on purchasing. The main focus of plans will, in future, be on:

- planned priorities and targets for care groups, and action to achieve them;

- statutory requirements (the directions on consultations and on purchasing);

- progress against White Paper objectives.

Previous/Other Guidance

2. This circular supercedes those parts of circular SWSG1/91 (issued also as SHHD/DGM(1991)1) dealing with the content of community care plans, ie paragraph 6 and the Annex. The principles underpinning community care planning remain as set out in that guidance, i.e. the lead responsibility of the local social work authority, the value of joint working, our expectation of joint plans with health boards, the need for the close involvement of housing, user and carer involvement and recognition of the key roles of the voluntary and private sectors. We wish to take this opportunity, however, to remind social work departments of the contribution which education can make to community care, and to re-emphasise the need to consult education authorities and further education colleges on the planning and delivery of services. The education input to community care was formally recognised in the GAE settlement for 1994-95, (a sum of £3m being identified under this heading). (For the sake of completeness the revised version of the circular refers to material issued after the original was published.)

Action

3. The guidance comes into effect in November 1994 and social work authorities and health boards should have regard to it in drawing up subsequent community care plans. All plans for at least 1995 onwards, which authorities should publish in the early part of 1995-96, should therefore be drawn up on the revised basis.

4. The guidance in this circular applies to community care plans generally. The Scottish Office has also issued guidance, SWSG’s letter of 2 February 1995 (Annex E) refers, on the disaggregation to the areas of new Councils of their plans for 1995-98, and expects to issue in Autumn 1995 new guidance on developing planning systems in the revised structure of local government. The core guidance in this circular on the expected focus of plans will not be affected by that subsequent guidance.

Introduction

5. In providing guidance on the content of community care plans, The Scottish Office recognises that plans are the property of local authorities and health boards, and should primarily meet their requirements and those of their planning partners. The Scottish Office is, however, interested in these plans and expects to receive copies, on publication. The use of plans centrally is described in paragraphs 16 and 17 below. This guidance aims to meet all these aspects.

6. Community care plans are strategic plans; they need to take a broad view of the needs of the area and how they are going to be met. They depend heavily on joint planning and joint working with, particularly, health and housing agencies. Experience of the first round of plans for 1992-1995 showed that plans produced jointly with health boards were generally better than single agency plans. The expectation remains firmly that joint plans with health boards will, in future, be the norm. The equal partnership with housing in planning for community care is one of the central themes of Scottish Office circular "Community Care - The Housing Dimension" (Env 27/94 - also issued as SWSG7/94 and NHS(MEL)79/94). This explains the need for and means of securing the housing input to community care planning from, in the main, housing authorities and Scottish Homes, but also other relevant housing providers as necessary. Housing has its own planning system (described in more detail at Annex B to this circular). Social work departments and health boards will be able to influence the content of housing plans and these plans will, in turn, figure in the wider community care plans prepared by social work departments and health boards. In due course the scope to harmonise planning timescales etc will need to be considered. Meanwhile, the annual review process provides a vehicle to incorporate changes emerging from other planning cycles.

7. The guidance on the content of plans in Circular SWSG1/91 reflected the then impending changes in the role of, particularly, local authorities under the Government's community care reforms. Plans were seen then as having to encapsulate all the new duties and responsibilities, and changes of focus and practice under the policy, but as the guidance made clear the emphasis nevertheless was on outputs and action plans. The content of plans tended to be wide-ranging and, in effect, they sought to be:-

- a source of information about services for users and carers;

- a source of information for providers;

- an account of the work of a large part of the social work department;

- a management tool.

With few exceptions, however, they tended to be too descriptive of procedures and processes and lacking clearly articulated action plans to meet specific objectives.

The New Approach

8. The Scottish Office believes that while the intended scope and coverage of plans set out in Circular SWSG1/91 was appropriate at the time, the new policy and supporting practical arrangements are now in place and the emphasis in plans should change. Providing information for the benefit of users and carers, in particular, is probably better handled in other more direct ways, eg by providing leaflets setting out the range of services available, how they can be accessed and who is eligible. This is already the practice in many areas. Similarly, the processes underpinning community care, e.g. assessment, complaints, etc, are now in place and community care plans need not dwell on these matters.

9. Planning is not an end in itself. Community care plans should lead to better services and better care outcomes for individuals and client groups in the area. The objective now is that community care plans should focus on intended action: action in support of the delivery of the policy, action to secure local and national service objectives, identifying the agency responsible and the source of funding, with purchasing intentions developed and clearly stated, and with expected service outputs and client outcomes identified. The plan should therefore constitute not only a vision of the future: it should state clearly how the aims and objectives are to be achieved, by what means and with what outputs and outcomes.

10. This means that some plans will require to be more far sighted than has been the case previously. Some have tended to focus on the short-term (usually the implications of decisions already taken); but this is not effective planning. Realistic judgements - against assumptions which are stated - have to be made about the pattern of services over the whole of the planning period. Plans can then be firmed up as they roll forward, in the light of changing resource or other circumstances. The objective is to plan reasonably and realistically for the whole of the planning period, not to state only action on decisions which have already been made.

11. The new style of community care plan should therefore comprise a series of statements. These would cover:

- the planning context;

- identification of each care group's needs and the action required by social work, health and housing to meet them;

- the local authority's and the health board's purchasing intentions for the services in the plan;

- action in support of the objectives of the community care policy;

- the consultations on the draft plan and their outcome.

A more detailed statement of the expected content of community care plans is to be found in Annex A to this circular.

12. A plan on the above basis should be an essential management tool. It should drive the action agenda of the local authority and its planning partners, and can be supported by planning agreements or other mechanisms to secure delivery of the intended outputs. It should also be more concise, more focused and more user-friendly than some of the current plans. The prime value, however, is that the planning agencies, providers and users and carers should have a clear picture of the existing service pattern, the long-term goals for the area, including the action in the short to medium term to secure them, and the intended levels of service provision.

Resources

13. Local authorities and health boards will require to make their own assumptions about the availability of resources for community care over the whole of the planning period. These assumptions need to be stated in the plans. Information is provided centrally, however, to assist that task.

14. The NHS Management Executive provides health boards each year with statements on NHS priorities for the following year. These statements which issue under the Accountability Review, Priorities and Planning Guidance include resource assumptions for use by health boards in forward planning. It is for health boards to assess these assumptions with regard to community care and to reach a view also on the availability of bridging finance and on sums to be made available for resource transfer under the agreed arrangements.

15. From the local authority perspective, the new resources for community care embrace both individual services and infrastructure. Within that broad spectrum the emphasis has naturally been on and will continue to be on the implications of the policy changes and to meet the policy’s objectives. In making their assumptions local authorities will therefore require to have regard to, amongst other things, the prospect of resource transfers from health boards and the incremental demand generated by persons who previously would have sought support through DSS allowances. It may be of assistance in the latter regard to be aware of the following:

15.1 The assumed distribution of the DSS transfer in 1995-96 was set out in Mr Meikle's letter of 9 February 1994 (copy attached at Annex C).

15.2 The transitional protection in the DSS transfer ceases in 1995-96 and thereafter the transfer and any equivalent further resources will be distributed on the basis of each authority's relative needs (the current measure of which, as agreed by the Distribution Committee, is set out in Column A to Tables 1 and 2 in Annex C).

15.3 The DSS transfer lasts formally until 1995-96. From 1996-97 onwards the need for additional resources for community care will be considered as part of the annual Public Expenditure negotiations. For 1996-97, the Secretary of State's 1993 Public Expenditure plan (which is subject to review in the 1994 Survey) includes, for social work services, additional resources for community care of £211.6m (as compared with the corresponding figure for 1995/96 of £172.1m). There is no increase between these years in the component which succeeded the Independent Living Fund. Re-organisation of local government apart, it may be assumed for these purposes that any addition will be distributed on the basis of "needs". An indicative distribution of the increase in 1996-97 (as applicable to Regional and Islands Councils law they continued) is attached at Annex D.

15.4 The Secretary of State has yet to reach decisions on provision beyond 1996-97. Further information will be made available to authorities when these decisions are made. Meanwhile, local authorities may find useful for service planning purposes DOH economists' assumptions, prepared prior to the DSS transfer, of the rate of decline of existing DSS cases. Their estimates of the percentage of pre 1 April 1993 cases (in GB terms) continuing to be supported by DSS in each year (mid-point) are:

RCH NH

% %

1995-96 56 43

1996-97 46 30

1997-98 35 21

The Secretary of State announced in December 1994 a provisional planning figure for 1997-98 for implementation of community care of £245m, an increase of £33.4m over the equivalent for 1996-97. Distribution would be on ‘needs’ as in Annex D.

The Scottish Office's Use of Plans

16. The Scottish Office expects to use community care plans for monitoring and to aid the determination of global resources devoted to community care in Scotland. It will continue to examine community care plans to ensure that national objectives and priorities are being met and that plans contain firm statements of planned action to secure them. Community care plans, together with local health strategies and housing plans, will also help inform both the provision of programme resources nationally and, in some instances, their use. In particular applications for directly provided resources such as bridging finance and Mental Illness Specific Grant will require to show that they have their roots in community care plans and are consistent with their objectives.

17. The Community Care Implementation Unit will continue to work with health boards and local authorities to ensure that areas of intended action are identified and that progress is taking place.

Contact Point

18. Enquiries about this circular should be addressed in the first instance to Mrs Lorna Malcolm, Social Work Services Group, Room 48c, James Craig Walk, Edinburgh, EH1 (telephone 0131 244 5424).

Yours sincerely

GAVIN ANDERSON JOHN ALDRIDGE DAVID MIDDLETON

Social Work Services Group NHS Management Executive SOEnv

ANNEX A

CONTENT OF COMMUNITY CARE PLANS

1. A community care plan should for the most part be a series of statements of proposed action - across the whole of the planning period - in support of national and local objectives and targets. It will also contain statements required under directions of the Secretary of State.

2. Paragraph 11 of the circular suggests that the plan should comprise statements of:

- the planning context;

- for each care group, the needs in the area and how they are to be met by social work, health and housing;

- the authority's and health board's purchasing intentions for services covered by the plan.

- action in support of the community care policy;

- the consultations on the draft plan (ie those consulted, the views expressed and their influence on the final plan);

These elements are addressed more fully in the remainder of the annex.

Statement of the Planning Context

3. This statement should briefly set out the planning context, identifying the joint planning framework for the area and any planning agreements or other statements (e.g. hospital admission/discharge protocols, joint purchasing arrangements) in support of the strategic framework. It should identify the parties to joint planning including housing bodies, education and recreation, transport, as well as the voluntary and private sectors and service users and carers. This section should therefore be the focus for pulling together the various strands of the planning framework, however constructed and led, for the individual client groups.

Care Group Sections

4. This section of the plan should spell out the needs for each care group and how they are to be met by social work, health and housing. Relevant groups would include:

- Frail elderly people

- Elderly people with dementia

- People with mental illness

- People with learning difficulties

- Drug misusers.

- Alcohol misusers

- People with HIV/AIDS

- People with physical disabilities

- Carers

- Young disabled people

5. The list is not exhaustive. It does not, for example, include homeless people as such, although it is recognised that some homeless people will require social or health care support. The essence is not whether individuals have a particular care group label, rather whether or not they have needs for community care. Conversely, many people requiring care in the community are vulnerable and therefore susceptible to homelessness. These elements would be expected to be covered within the relevant care groups. Social work authorities and their planning partners equally have to have regard to the particular needs of cultural and ethnic minority groups; again this should be addressed within the care groups above. This also applies to persons suffering from progressive illnesses who under previous guidance were included with persons with HIV/AIDS.

The care group sections are probably the most important element of the plan. They need to spell out the perceived aggregate needs for each group and the planned action across the planning period to meet them. They need not be lengthy: it should be possible to incorporate the expected coverage in a few pages of text and tables. Each care group section would need to cover:

- a brief assessment of the aggregate needs, incorporating levels of severity/dependency and how these may change over time. Identifying the needs of the area is the first, critical step in planning. Aggregate needs should concentrate on social and health care and housing, but should also touch on wider fields such as transport, leisure and recreation, training and employment, especially for those with special needs. The requirement in this section is to reach a conclusion about aggregate needs using the most appropriate sources available, not to describe the theory of needs assessment. This may draw on national prevalence rates, local surveys, research studies etc together with aggregation of individual assessments. A hand book for planners and practitioners on population needs assessment for community care has been commissioned by The Scottish Office and this will be published in the Autumn of 1995. Needs mapping is not an exact science, nor is it fully developed at present; but the work in the plan should result in the best estimates of need, classified according to broad service categories within health, housing and social work. A brief introduction and tabular presentation may be a satisfactory way to meet the requirements of this section.

- A concise analysis and evaluation of current service provision. This element should quantify current services in social work, health and housing (plus other relevant fields such as employment, transport etc as appropriate) by providing sector. Again, a tabular presentation seems appropriate. No description of individual services is necessary. The crux, however, is to evaluate the extent to which these services meet current needs and to quantify gaps and deficiencies. Such gaps can be in volume, quality, range or service outcomes, and should be prioritised.

- a brief statement of the key objectives, suitably prioritised, including local action under the wider policy objectives in paragraph 11 below.

- concise action plans for service provision generally and particular developments contributing to the achievement of the objectives. This section of the plan is the product of the preceding sections and planned action should, therefore, be transparently consistent with the needs, gaps and objectives of the area, across the social work, health and housing sectors. The essentials here are to set out clearly the expected levels of service over the planning period as a whole, the priority and the timing of particular developments, agency responsibility for service provision, costs and the sources of finance. Plans should also begin to address outcomes by setting out the likely outcomes at individual client and client group levels which in the view of local authorities and their partners would be relevant measures of success under the policy. Throughout this whole section of the plan the emphasis needs to be on producing objectives and targets which are measurable. Targets therefore need to be quantified if they are to be meaningful. Subsequent reviews and revised plans should address the extent to which previous targets have been achieved.

The latter part of this section also lends itself to tabular presentation in support of an introductory or summary narrative. Such a schedule would identify:

- the long-term objectives.

- the long-term targets.

- the planned action over the planning period (prioritised).

- agency responsibility and sources of finance.

7. In order to secure achievement of the objectives and targets, the care group section should be underpinned by local planning agreements setting out the precise action expected of an agency, its financial inputs and the outputs for services and clients.

8. The care group section of the plan looks at needs and services in the round. There is considerable advantage, as recognised in the plans of some Regional Councils, in identifying needs, current services and planned provision on a locality basis. This approach is particularly commended to new authorities: their territorial spread may cover a number of distinct localities with internally different circumstances and characteristics which planning in aggregate terms masks. Providing locality based information can also convey more meaning to the reader seeking to assess the implications of the plan for a particular area.

Statement of Purchasing Intentions

9. The Secretary of State has made Directions entitled the Community Care Plans (Purchasing) Directions 1994 issued under cover of Circular SWSG13/94 of 2 November 1994, which require local authorities to set out in their community care plans their intended levels of services and the sources from which they are likely to be purchased. It is not necessary to elaborate on the requirements here. As plans become increasingly purchasing orientated, health boards should, for the sake of completeness, provide similar details of their overall service plans and purchasing intentions.

Statement of Action in Support of the Policy Objectives

10. The community care policy and its objectives are set out in the White Paper 'Caring for People'. It aims to change the way in which community care services are provided by:

- changing the balance of provision from being service-led to needs-led.

- changing the balance of care by reducing that in institutional settings and providing alternatives in the community.

- altering the way local authorities operate by making them enablers, rather than providers of services.

11. This statement should identify the action by the local authority and health board to secure the changes required under the policy. The objectives extend to the provision of community care in the round and this section should provide an overview of the action which local authorities and their partners are taking to achieve them. The extent to which that is taking place may or may not be fully discerned from other parts of the plan and this statement therefore seeks to crystallise and summarise action by identifying in bullet point format the aims and the key steps (about 3 or 4 at the most) by which each of the main objectives identified below is being and will be addressed over the period of the plan:

(a) to promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible;

(b) to ensure that service providers make practical support for carers a high priority;

(c) to make proper assessment of need and good care management the cornerstone of high quality care;

(d) to promote the development of a flourishing independent sector alongside good quality public services;

(e) to clarify the responsibilities of agencies and so make it easier to hold them to account for their performance;

(f) to secure better value for money;

(g) to provide choice;

(h) to transfer from long-stay hospitals those patients whose care needs can best be met in a community setting and the establishment of a mechanism, such as hospital admission and discharge criteria and joint commissioning arrangements to support and deliver change.

(i) to prevent inappropriate admissions to hospital.

This element of the plan also lends itself to the tabular form of presentation identified for action plans in the care group section.

Statement on Consultations

12. Circular SWSG1/91 identified the bodies who, under statute, must be consulted on plans and provided guidance on consultation on community care plans generally. These requirements were subsequently extended by the Directions on Consultation issued under cover of Circular SWSG4/93, under which local authorities have to state in their plans the arrangements for consultation with organisations representing providers in the private and voluntary sectors. As indicated in the circular, we would also expect the statement to encompass the views of other consultees, including users and carers. The statement should therefore cover these aspects together with identifying those consulted, their views and how they were taken into account in the final plan.

SWSG

November 1994

ANNEX B

HOUSING PLANS AND COMMUNITY CARE PLANS

1. At strategic level, housing plans are produced by housing authorities, and community care plans by health boards and social work authorities (preferably health boards and social work authorities should produce joint plans with a housing input to ensure housing requirements are quantified). Since addressees for this circular cover all 3 types of body, it may be helpful to summarise the main features of each.

2. A new housing plans system was introduced in 1993, with the following features:

- The housing plans normally look 5 years ahead, eg 1995-1996 to 1999-2000 for the 1994 plans. They are due in September. For 1994 plans, housing authorities have the option of looking only 3 years ahead because of local government re-organisation.

- Housing plans should be strategic in character, and set out priorities, and also key issues which should be addressed in all housing plans (community care, homelessness, houses below the tolerable standard, and condensation and dampness), but housing authorities can develop other key issues for their area based on local needs and priorities. Health Boards and social work authorities will wish to ensure that relevant community care issues are brought to the attention of housing authorities.

- Housing plans, and the capital programmes for future years which they contain, should be realistic, ie consistent with the resource planning assumptions issued to each authority for the next 3 years (1995-96 to 1997-98 for 1994 plans); although these assumptions should not be seen as guarantees of capital allocations at this level.

- Housing plans must take full account of the linkage between housing investment planning and housing management planning. This linkage is particularly important for community care which may consist of a package of housing and services. The Scottish Office Environment Department wrote to local housing authorities on 1 July 1994 requesting submission by 30 September 1994 of their first Housing Management Plans, covering the years 1995-1999. Authorities have been asked to describe in these plans the arrangements for their involvement in the assessment, planning and delivery of community care.

- Authorities submit full housing plans only every 4 years (every 2 years for Glasgow) under a rota system. In 1994, full plans have been submitted by districts within Dumfries and Galloway and Grampian; and for Clydesdale, Cumbernauld and Kilsyth, East Kilbride, Hamilton, Monklands, Motherwell and Strathkelvin in Strathclyde Region; and Orkney and Western Isles Islands authorities.

- However all authorities will submit to the Department every year:

- Capital Programmes: normally for the next 5 years, including details of planned investment in community care. For 1995-96 housing authorities have only been asked to prepare programmes for the next 3 years because of local government reorganisation.

- Annual Policy Statements: which comment on the capital programmes (including changes from the previous years) set quantified output targets for priorities including community care and review progress against previous targets.

Capital allocations were issued to authorities in February, 1995 for 1995-96 onward programmes.

3. More detailed guidance on the 1994 housing plans is given in circular Env 9/94, which was sent to housing authorities and various relevant housing bodies and interested parties. Guidance on housing management plans was given in circular Env 23/94, sent to the same addressees.

Directors of Social Work

Our Ref: GKE/2/2

9 February, 1994

Dear Director

DSS TRANSFER: DISTRIBUTIONS FOR 1994-95 AND 1995-96

This letter updates the illustrations of the distribution of the DSS transfer issued under cover of Mr Campbell's letter of 2 October 1992. I attach tables showing the detailed calculations underpinning the distribution of the transfer in 1994-95 and an illustration of the possible distribution in 1995-96.

The illustrations in Mr Campbell's letter were based on the most up-to-date information at that time. The main components were the size of the DSS transfer in each year, the calculation of each authority's relative needs, its share of DSS expenditure and assumptions about the level of transitional protection. As is customary, the distribution of resources in RSG uses the latest information available. This has had implications for some authorities' shares of the transfer.

The aggregate levels of DSS transfer remain fixed at £40.6m in 1993-94, £106.2m in 1994-95 and £158.3m in 1995-96. The rates of transitional protection have remained, as in the illustration, at 75% in 1993-94 and 50% in 1994-95 and it can be assumed for these purposes that the 25% rate envisaged for 1995-96 will materialise. The calculation of an individual authority's relative needs is, however, changing in some instances, as a result of revised population and other data; and the pattern of DSS expenditure used originally (July 1992) has been superseded by that in the final DSS survey of claimants under the previous arrangements as at March 1993. In the tables attached the current figures for relative needs are to be found in column A and the final figures for DSS spend in column C.

As a consequence of these changes some authorities may have noticed differences between the illustrative figures for 1994-95 and those in the actual distribution as set out the 'Green Book'. I trust that the information in Table 1 below, together with the description in this letter, clarifies the position. As regards the illustration for 1995-96 in Table 2, this uses the same base data but incorporates the lower level of transitional protection assumed for the final year, and I trust that this will be helpful to authorities in their financial planning.

Yours sincerely

D K MEIKLE