Care Act 2014

Understanding The Costs

Understanding the Costs

• Update and Context of National Work • Headlines/Early Indications of Key

Messages• National Perspective on the Surrey Tool

and modeling generally • Social Care Reform • Regional Events – Links – Support • Q&A Session

Overall Aim

• To have a common view – Each Council /Adass/LGA/DoH that best reflects what the real impact of social care and funding reform will be – locally as well as nationally.

• We need this information not only to plan nationally but also to plan locally

Context • Original impact of funding and social care

reform – ran into £ billions – see the next slide

• Preliminary results suggest impact will be much more than this – this on top of

• Huge reductions in spending – and • Growing need – yet fewer people supported • So crucial to have local and national

assessments - of what the impact will be backed up by local and national evidence

Financial Impact – DoH Estimate

Early Results

• We have results from about 20 Councils most of whom have used the Surrey Model.

• We have used these results to produce a first order of magnitude estimate of the national impact of funding reform.

• We have confidentially shared this with the DoH. • They were sufficiently alarmed that we have

started a regular dialogue and working group relooking at the costs as part of the DoH’s commitment to update the impact assessment of Social Care and Funding Reform.

Working Age Adult

• While the impact for working age adults is significant – with a cost range from £200m to £500m – it is not as significant as the Older Persons Threshold and Cap

• The biggest issue here is no one has yet decided how the arrangements for Working Age people will work.

• For the moment I would suggest putting this modelling on hold and concentrating on 65 and over.

Continuing Work• We have encouraged those who have responded to Phase

1 – to share their results to provide an opportunity to compare these with others and use this comparison to review their own results.

• We have also asked an independent social care expert from the LSE to independently review the models in use – starting with the Surrey Model and now also the Lincolnshire model - and to independently review some of the results.

• Through this review and obtaining results from as many councils as possible – we would hope to have as comprehensive and robust an estimate of total costs as possible – recognising the billion pound significance of this work.

Confidentiality & Timescales

• There is a commitment to form a common view jointly across Adass/DoH/LGA on understanding the national and local costs.

• While work is being undertaken to review the models and results we want to maintain the confidentiality of these national results.

• We hope to have a first stage common view of the likely national impact by the end of July – just 7 weeks away.

65 and Over - Modelling • Whatever model you use it is crucial that it – distinguishes between men and women– draws on relevant income and capital – recognises that the care paths vary – with some

self funders spending time being supported in the community before some move into residential care

– generates results where• the first years shows all of the impact of the threshold• costs increase each year – and – significantly as the

cap kicks in,

• The Surrey model while complicated can make these distinctions

Surrey Model Main Strengths • Care Pathways • Ability to include a number of different scenarios • Ability to input own data Potential Weaknesses • Allowing the model to generate numbers of self

funders – as it seems to over estimate these – so use own data

• ELSA Income and Wealth – so use own income and wealth – see next slides

• Allowing for differences between men and women – see next slides – so run the model twice – once for men and once for women.

65 and Over – Threshold • Threshold – the full impact of this happens in Year 1

– Key variable is the depletion of capital as a self funder uses their capital to pay for their care needs – much as it was previously

Threshold - Income and Wealth

• A lot of people wrongly assume that if your capital is below £118,000 you will qualify for support – but only if you income was zero.

• Average income for most people is close to £10k a year – so your assets need to have reduced to below £70k before you will be eligible for support – below the line in the graph.

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Calculating the Number of Self Funders

• Desk top exercise – residential care -– Identify all the care homes in a local authority from CQC Data– Identify the capacity of each home and the total capacity of the

local authority area– Apply an occupancy factor – either from CQC regional data or

local information to determine the number of occupied places– Deduct the number of people who are continuing health care in

residential care – from local or CQC data – Then deduct the number of places supported by the Local

Authority from PSSEX1 data – Should give a reasonable estimate of the number of self funders

in residential care

• Survey of care providers - is also a good way of identifying the number of self funders in residential care and probably the only way of identifying the number of self funders in the community – a number of councils have done this – so Nottinghamshire, Birmingham, Richmond, Hounslow, Lincolnshire,

Local Modelling • We would still suggest that where possible – even though it is

cumbersome to use - that as many LA’s as possible attempt to make use of the Surrey Model.

• All the LA’s in the South West are making use of the Surrey Model – where three Councils who have made extensive use of the model have been supporting others across the region with more limited resources.

• This seemed to be the conclusion of the event in the East Midlands where a number of councils are also using the The Lincolnshire model – but would hope to also make use of the Surrey Model across the region – with both models subject to independent expert from the LSE

• Once we have results from a number of councils across England – we can then develop a very simple tool to take these National results to apply at a local level using local data.

Social Care Reform

• Funding reform is only part of the Care Act • The most significant part of Social Care

Reform is the increased support available for carers – with an impact on the number of assessments and reviews and the amount of support offered

• This is expected to grow over the next three to four years see the next slide

• If you have not done so already – as a safeguard include the costs of this in your Better Care Fund plans.

Care Reform DoH Impact Assessment

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Social Care Reform • The other major component of the reform will be

the number of self funders who will come forward to have their care needs assessed and reviewed and a care account started.

• In both cases the impact will be influenced by the behaviours of carers and self funders

• To have a better handle on this our recommendation is that a dialogue/survey is undertaken with carers and self funders

• Whilst people’s actual behaviour might differ to what they may say in a survey – it is still better to have this information than none.

Regional Events – Links • Great to see the work going on here and in other

regions to have regional sessions where those working on understanding the costs - can meet and share their experience of the modeling.

• Donna Ridland from Liverpool and Leon Bergman from Wigan are the North West Regional Links for this work.

• Have started preparing at least monthly updates to go out to everyone working on the modelling

Summary • Overall Aim - common view nationally and

locally of likely impact – • We are talking about £bns - so crucial to have

local evidence - ideally surveys of self funders and carers; 

• Prioritise the work on 65 Plus - • Learn from each other and independent

expertise • Timescales - first stage common view by the

end of July – just 7 weeks away;• Don’t forget the Social Care as well as the

Funding Reforms -

Questions and Answers

Additional Slides

• Daily Living and Accommodation Costs

Daily Living/Accommodation Costs

• Useful source of national costs for older people and working age adults and occupancy information

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Daily Living/Accommodation Costs

• This work suggests: -

• Average Accommodation costs of £150 a week and

• Prepared Meal Costs of £90 a week

• Hence the average figure of

£240 a week – but

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Daily Living/Accommodation Costs

• Meals are being prepared because people are not able to prepare meals for themselves

• Meal preparation is included in care support for Daily Living Activities and funded by the LA

• If we base the costs on food costs then – average spend for those over 75 is no more than £40 a week.

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Daily Living/Accommodation Costs

• This would suggest average costs of £190 a week – close to the figure suggested in the Dilnot review.

• The major component of these costs £150 a week is accommodation costs and these vary significantly across the Country because of variations in land and building costs and values.

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Daily Living/Accommodation Costs

• Hence the suggestion to base this on a percentage of total costs – 37.5% - with a ceiling of £240 a week.

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