PERSONAL BUDGETS AND CONTRIBUTIONS POLICY … · 6. Proposal 4 - Changes to Personal Assistant Rates 12 7. Proposal 5 - Introduction of a charge for Day Centres 14 8. Proposal 6 -

ACS 11016 – App. 1

Appendix 1

London Borough of Bromley

Consultation: Changes to the Adult Social Care Personal

Budgets & Contributions Policy (non residential services)

Report: March 2011

ACS 11016 – App. 1

Contents

Section Title Page

1. Introduction 2

2. Consultation Process 3

3. Proposal 1 - Services to be included in a personal budget 5

4. Proposal 2 - Removal of service subsidies 8

5. Proposal 3 - Changes to the Homecare charges 10

6. Proposal 4 - Changes to Personal Assistant Rates 12

7. Proposal 5 - Introduction of a charge for Day Centres 14

8. Proposal 6 - Carelink, Telecare and assisted technology equipment 18

9. Proposal 7 - Allowances for Disability Related Expenditure (DRE) 21

10. Proposal 8 Introduction of a charge for ineligible day centre users 24

11 Final Thoughts 29

Appendix A – List of Organisations that made a response

Appendix B – Meetings

Angela Buchanan and Emma Maton Adult & Community Services March 2011 2

1. Introduction

The Council is facing many challenges with increasing demand for adult social care services

whilst at the same time needing to work within an increasingly tight financial envelope with

reducing budgets. The Council’s current charging policy was developed for the traditional

range of social care services, based on how much services cost. With the introduction of

personal budgets, the Council, along with other councils, is seeking to change its’ policy so

that it is consistent for everyone regardless of how they use their personal budget, in line

with government guidance.

This report describes how the Council undertook consultation, the range and methods used,

and the outcome showing the different points of views and opinions expressed.

The report has separate sections covering each of the eight proposals. The responses and

suggestions made by people who expressed a view are grouped together into different

themes. The consultation asked whether the respondents agreed or disagreed with the

proposals and were given the opportunity to explain why. For each of the proposals we draw

on the responses received through all the different consultation methods:

completed consultation forms,

comments made at meetings and

points made in separate submissions.

Charging is a complex issue and although the consultation forms sought to present the

proposals as simply as possible it was hard to cover the range of individual circumstances

for many who were unable to decide whether they agreed with the individual proposals clear.

The proposals were made more complicated by the fact that many people seemed to be

unaware of what personal budgets were or how they worked. It is against this general

background that the responses should be considered.

This report will inform the Portfolio Holder report which will set out in summary form the

Council’s response to the key issues and suggestions raised here and will also show how

the Council are adapting their approach to take account of these views and mitigate

concerns raised.


2. Consultation Process

The consultation process ran from the 8th December to the 28th February 2011 it was

designed to be as inclusive as possible and give everyone who wanted the opportunity to

express their point of view. The methods used were also designed to allow people to

express their views as fully as possible using free text in the questionnaires; an easy read

version was also produced in partnership with Bromley Sparks to ensure that people with a

learning disability were able to participate. We also ensured that for this particular group had

a range of opportunities to participate as they were less likely to complete a written

questionnaire.

A description of the methods used in the consultation is set out below:

Press release

The consultation was launched a press release to the local newspapers to help get the

widest possible coverage.

Website/ emails

A web page was made available and publicised from the start of the consultation. This

included information about the proposals and associated Executive report.

Telephone support

A senior care manager based in Bromley Social Services Direct and the Communications

Officer were available to offer telephone support throughout the consultation period. This

was put in place to provide people with reassurance, further information and clarifications on

the proposed changes and to help people to complete the questionnaires. This option was

used by approximately 180 people a number completed their questionnaire over the

telephone, a few people came in person following a telephone call and the care manager

visited 2 people in response to their call.

Service Users

A questionnaire was sent to all people currently supported with social care services in their

own homes or where appropriate to their representative. This included people aged over 65,

people with a physical, sensory or learning disability and people with mental health needs.

An easy read version was also available; where this was used people were also invited to

attend 2 specific meetings to enable them to express their concerns about the proposed

changes.

Stakeholder organisations

Over 73 key local organisations were contacted for their views and sent a copy of the

proposals and the questionnaire. We also asked that those organisations in direct contact

with service users and carers help to publicise the consultation.


Specific Meetings

Two meetings were arranged for people with a learning disability who would be affected by

the proposal to levy a charge for day centre sessions.

The Bromley Link and Bromley Mencap organised a meeting for anyone with a disability who

wanted to clarify aspects of the consultation.

Similarly the Council on Ageing in partnership with Bromley Age Concern and Carers

Bromley organised a similar meeting for older people.

Using existing partnership groups and boards

In Bromley there are well established network partnership groups and boards which were

used to promote the consultation and encourage responses. These have been listed in

appendix b of this report.

Petitions

As part of the consultation process a petition was handed in to the Portfolio Holder from the

residents and carers who were opposed to the proposed charges for attendance of specialist

day centres.

Approximate numbers of people responding to the Consultation

Responses

Service User Changes to Charging Policy Consultation

Postal Returns 438

Easy Read Returns (via post) 67

On-line returns 8

Letters and emails 17

Calls to BSSD and the Communications Officer 180

Partner Organisations Changes to Charging Policy Consultation

Postal Returns 11

On-line returns 15

Letters and emails 7

No of meetings

Meetings

Service User & Carer meetings 2

Care Group and organisation specific meetings 14

No

Petitions

Carers & Residents of Specialist Day Centre Users 1

Please note that caution needs to be taken when aggregating these figures as some people responded through a number of methods


3. Services to be included in a personal budget

3.1 Proposal One

The first proposal is required to establish the range of service that will meet a person’s

assessed eligible need; which could be included within a personal budget and that the

service user’s financial contribution would be based on the total personal budget amount. It

was proposed that the calculation for a personal budget would include the following services:

Personal Care (including 2 carer support and evenings & weekends)

Personal Assistants Supported Living

Non Residential Respite Carelink

Assisted Technology Equipment Day care including Transport

This proposal means that everyone who uses these services would be asked to contribute what

they can afford towards the cost of their services.

3.2 Whether people agreed or disagreed with the proposal

The chart below shows that 60% (n= 306) of all respondents agreed with the proposal. However,

the respondents who completed the easy read versions of the consultation forms showed that

fewer than 29% (n=19) agreed with the proposal.

Whether people agreed or disagreed with the proposal Responses to postal/ email feedback forms (n=448) easy read version (n=65) Total n=513

Yes

60%No

16%

Don't know

not sure

24%

3.3 Reasons why people agreed or disagreed with the proposal

19% (n=97) of people who responded to this question also commented on the reasons why

and these are summarised in the sections below alongside the opinions received from letters

and meetings. The comments were often hard to relate to the answer given to the question

i.e. may have agreed with the proposal and then made a negative comment and vice versa.


3.3.1 Reasons given for agreeing with the proposal

Of the 306 people who answered yes to this question 16 also provided comments. A

quarter were positive about the benefits of knowing what was in the personal budget

in as much as it made it more equitable and people who needed support could

choose how their support is provided if they wished. A quarter of those who

commented would like to see a broader range of services included such as residential

respite care. A couple of people were keen to emphasis the importance of Carelink as

a low cost preventative service for people living alone. A couple were also concerned

about what the day centre charge would include.

3.3.2 Reasons given for disagreeing with the proposal

There was a general issue of fairness having paid taxes and made provision for old

age and now at the time when support is required charges are being introduced or

increased.

The consultation has highlighted that further work is required to explain clearly the

purpose of a personal budget, how direct payments can provide more choice and

control for people who want to receive them but also the option to continue to have

services managed by the Council.

A number of people who responded to the consultation have highlighted their

concerns about the impact of the changes on carers if a service user is unable to pay

for the services they require to meet their needs. They are concerned that the

changes will mean that for some people, residential care may be more cost effective

which would have an impact on the Council’s budgets.

Many of the people who disagree with this proposal have done so in relation to

specific services. The proposals to remove the subsidy from laundry/ shopping

services and the introduction of a charge for day services for people who are

assessed as being eligible for a personal budget attracted the most comment.

The main reasons seem to be a combination of a reluctance to pay for something that

has been free up until now, and the amount people will be expected to pay per day.

There was also an element of confusion as many already pay the day centres for

meals and other activities.

Day services have been described as lifelines for both people who live on their own

and for carers who are often a spouse providing the majority of care/ support. The risk

that has been described by the provider organisations is that people may decided not

to attend which may lead to isolation and more serious social care needs which will

require a higher level of support. One suggestion was made by a number of people to

separate the charge for day care and transport.

Carelink was mentioned by at least 10% of those respondents who disagreed with the

proposals as being an essential service which should be free to all as it provided

peace of mind to service users and carers alike.


Introduction of the charge for 2 or more carers and the reduction of the PA rate was

also raised by a small number of people – these are picked up in the relevant

sections.

3.3.3 Reasons given for neither agreeing nor disagreeing with the proposal

A significant number of people 24% (n= 124) did not know or were unsure whether

they agreed with the proposal.

Again some people were concerned about the fairness. They could see that they

should make a contribution towards the cost and it could mean greater choice and

control over their services. It was also recognised that knowing the total cost of your

care package could be helpful. However this was balanced against comments that the

costs were excessive and the personal budget should ensure that people have the

time they need.

A number stated that they were unable to make an informed answer and this was due

to needing more information or having no experience of the services being mentioned.

A small number of people could not understand why anything needed to change and

would prefer it remain the same.

Some in this category were also concerned with whether they would be able to afford

to pay for Day Care and why they would need to pay for transport If they do not use it.

This is covered more fully in later sections.


4. Removal of service subsidies

4.1 Proposal Two

This section considers the responses relating to the second proposal in the personal budgets

and contributions policy. As with the previous section it draws on responses received as part

of the consultation and considers whether or not people agreed to the proposal and the

reasons they gave for agreeing or disagreeing. The proposal is that the laundry, shopping

and holiday breaks services will not be included as part of the personal budget. The Council

plans to remove the current subsidies from these services with the expectation that anyone

wanting to continue using them access and pay directly.


The chart below shows that whilst just over a third (35% n= 180) of all people responding

agreed with the proposal a larger proportion (42% n= 218) felt that the subsidies should not

be removed and these services should be included in a personal budget. A larger number of

people disagreed with the proposal than agreed. 158 out of the 218 disagreeing also made a

comment; shopping was mentioned 62 times, laundry 59 times and holiday breaks 37 times.

A summary of the comments is available in section 4.3 below.


Yes

35%

No

42%

Don't know

not sure

23%


37% (n=170) of people who responded to this question also made a comment; their reasons are summarised in the sections below alongside the opinions received from letters and meetings. This question received the highest number of comments.



In the main the people that said yes and also made a comment stated that they did

not use these services or in one case they did not realise the laundry service was

subsidised but were happy to pay more.


A fifth of respondents commented on the general principle of removing services from

the most vulnerable who may not either be able to afford or be able to organise them

for themselves as they did not have the support of family and or friends.

A small number of respondents were concerned about how they could pay on top of

their other support needs.

Over 70 people made a specific comment about one or more of the 3 services. Again

they were concerned that these were essential services which they may not be able to

afford or organise. Shopping and laundry were often described as activities of daily

living. The concern is that if the most vulnerable find it too difficult to access or too

expensive they may be unable to cope with their daily lives. Holiday breaks were

described by many as respite for a carer and being the only way someone with

multiple disabilities could access or afford a specialist holiday on the income that they

had.

A small number felt that perhaps instead of stopping the subsidy for everyone that an

assessment of need and financial position should identify the most needy who should

then continue to be subsidised.

For holidays a couple of people who currently use the BATH scheme stated that they

would be happy to contribute towards the total cost but would be unable to pay the

whole amount.


Just under a quarter of people responding (n= 117) did not know or were unsure

whether they agreed with the proposal. 23 of these people took the opportunity to

comment on the question.

Over a third stated that they were unable to make an informed answer as they had no

experience of the services being mentioned. A quarter felt that the need for these

services should be based on an individual assessment and not a blanket approach.

Another 3 thought that they may stop using these services. One person suggested

that benefits should be used to pay for shopping and laundry but holidays should be

free.


5. Changes to the Homecare Charges

5.1 Proposal Three

This section considers the responses relating to the third proposal in the consultation on the

personal budgets and contributions policy. It considers whether or not people agreed to the

proposal and the reasons they gave for agreeing or disagreeing.

The following areas will be included within a personal budget and will therefore be part of the

financial assessment: new rates for ½ hour and 1 hour personal care visits, introduction of

an additional charge for where a second carer is required for personal care visits and a

supplement for evening and weekend personal care visits. It is important that the personal

care rates enable people to be able to purchase the support and the care they require using

a direct payment. The hourly rate will also be reduced from £16.20 to £14.00 to bring it in

line with the market agency rate.


The chart below shows that 39% (n=195) of all people responding agreed with the proposal

compared to 28% (n=18) by the people completing the easy read version. 148 people felt

that they could neither agree nor disagree with the proposal. A summary of the comments is

available in section 5.3. below.


Yes

39%

No

31%

Don't know

not sure

30%


28% (n=142) of people who responded to this question also made a comment the reasons

are summarised in the sections below alongside the opinions received from letters and

meetings.



195 people responded yes to this proposal with 14 also making a comment. The

views expressed were very similar, “that the personal budget needed to reflect the

actual cost and that as long as the contribution was based on a person’s ability to pay

then it would be fair”. It is important that the cost of services outside core hours and

for 2 carers is needed to be reflected in the personal budget to enable the true

support costs to be shown.


156 people disagreed with this proposal, 105 people also provided a comment to

explain their answers. These have been grouped and summarised into 4 main

themes:

Nearly a third expressed a view on the unfairness of penalising the most vulnerable

as in many cases the need for 2 carers and carers outside core hours could not be

helped and had been assessed by the Council as what was required. A number felt

that health and safety issues often decided whether someone needed 2 carers and

therefore is it right that the service user be expected to pay.

17 respondents were specifically unhappy with the introduction of a charge for 2

carers the amount of the charge was seen as too high and the risk is that service

users may withdraw from services which could increase risk and vulnerability.

14 people made a comment in relation a broader principle where they had paid their

taxes and that the council had a duty to provide free care. They felt that the Council

was penalising the most vulnerable and in the longer term could cost more as

residential care is a more expensive option.

14 respondents stated that evening and weekend supplements were unfair

A small number of people wanted to leave everything as it is now.


Just under a third of people responding (n= 148) did not know or were unsure whether

they agreed with the proposal. 23 of these people took the opportunity to comment

on the question.

A third stated that they were unable to make an informed answer as they had no

experience of the services being mentioned. Some felt that they needed more

information. The remainder made a statement such as “my mother doesn’t want a

direct payment” or “I don’t agree with this”.


6. Changes to the Personal Assistant Rates

6.1 Proposal Four

This section considers the responses relating to the fourth proposal in the consultation on

the personal budgets and contributions policy. It considers whether or not people agreed to

the proposal and the reasons they gave for agreeing or disagreeing to directly employed

personal assistants being part of a personal budget forming part of the financial assessment.

This means that the service user’s contribution will be deducted from the amount received as

a direct payment. The consultation also covers the reduction in the hourly rate paid as a

direct payment from £14 to £11.



compared to 28% (n=17) by the people completing the easy read version. However, the 193

people who felt that they could neither agree nor disagree was the most popular answer. The

reasons for this are considered in the summary of the comments in section 6.3 below.

Whether people agreed or disagreed with the proposal Responses to postal/ email feedback forms (n=431) easy read version (n=61) Total n= 492

Yes

39%

No

22%

Don't know

not sure

39%


20% (n=96) of people who responded to this question also made a comment the reasons are

summarised in the sections below alongside the opinions received from letters and

meetings.


191 people responded yes to this proposal and 10 also made comment.

A couple of the comments related to the fairness of the rate; the views were split

between whether you can get the quality of support required and whether the Council

monitored the quality.



108 people disagreed with this proposal and 65 people also provided a comment to

explain their answers. These have been grouped and summarised into 5 main

themes:

17 people thought that the reduction in the amount paid for a personal

assistant as part of a direct payment was unfair. They described how they

would find it hard to make up the difference in the amount and were worried

about losing their personal assistant. They also highlighted that if the rates

were too low it may be hard to employ good quality personal assistants.

Similar to the previous responses some people felt that the change to this rate

was being unfair to the most vulnerable people who can least afford to pay

more.

10 people were concerned that they did not know about being able to access a

personal assistant or the new costs.

A small number of people commented that employing a personal assistant was

nothing to do with the council (they may not be referring to people using a

direct payment).

A few of the comments made were not related to the change in rate but more

statements that they thought that having a personal assistant may offer more

flexibility and choice.

There seemed to be a lack of clarity about how contributions will be deducted from the

direct payment is paid. This will need to be addressed when implementing the revised

policy.


The same proportion (39%) of people that agreed to this proposal did not know or

were unsure whether they agreed with the proposal. 21also took the opportunity to

comment on the question. Eighteen related to the respondent either not having or

understanding what a directly employed personal assistant (through a direct payment)

is. The other 3 comments related to how the process would work and whether the

new rate was affordable.


7. Introduction of a charge for Day Centres

7.1 Proposal Five

This section considers the responses relating to the fifth proposal in the consultation on the



Day centres and transport will be calculated as part of a personal budget and will therefore

be part of the financial assessment, which means a charge may be applied. This proposal

involves moving away from the current system so that just as everyone who receives a

personal budget would be asked to make a contribution to their budget if they can afford it,

so everyone who uses day services would be asked to contribute towards the cost of their

day services, if they use them and if they can afford it.


The chart below shows that 42% (n=209) of people responding agreed with the proposal

compared to 33% (n=22) by the people completing the easy read version. More people

answered yes or no to this question than previous questions. The reasons for this are

considered in the summary of the comments in section 4.5.4 below.

Whether people agreed or disagreed with the proposal Combined responses to postal/ email feedback forms (n=437) easy read version (n=66) total n=503

Yes

42%

No

38%

Don't know

not sure

20%


30% (n=151) of people responding to this question also made a comment, these are


meetings. This question received the second highest number of comments.

We also received a petition from residents on behalf of people who attend the

specialist older people’s day centres. They were protesting against the unfairness to

most vulnerable being let down by the state having already contributed through their


taxes. The petition indicated that people are concerned about both the principle and

the proposed level of the contribution. They highlighted a case where a person with

dementia who currently pays the full cost of their services (including homecare) would

see an increase of over £10, 000 pa.

We also had a number of letters from people in similar circumstances who felt that the

proposed level of contribution would impact negatively on both the service user and in

many cases an informal carer (often an aged spouse) who was struggling to cope

already.

The meeting held at the learning disability day centre also raised some issues about

the proposed costs and how these would be managed alongside other commitments

people attending the day centres already have. They were also concerned about how

the review of welfare benefits would affect the amount of money they had. They also

asked questions about what day services would be chargeable.

They went on to ask questions about the process including the assessments that

would need to be undertaken and the appeals process. They seemed to agree with

the principle of making an affordable contribution, but were less clear about whether

they would be able to afford the proposed contributions.

We met with people attending the work based projects (Shaw Trust, Thyme Out) who

were interested in how the proposed changes would affect them attending their work

based activities. We were able to reassure them that at this stage these type of

projects are not going to be subject to a charge. However, if they also attended one of

the learning disability day centres then they would be asked to contribute towards the

cost of this service. We also discussed how the financial assessment process worked.


17 of the 209 people who responded yes to this proposal also made a comment.

These comments were grouped and summarised into 5 themes:

10 people agreed but felt that the proposed costs were too high.

1 person felt that the charge should be applied even if a person didn’t attend as

the centre needed to be open regardless. A couple were concerned that level

of attendance matched the cost.

Another 2 felt that it could offer more choice but would need to reflect the

person’s needs.

2 people were concerned that the changes to specific benefits may impact on

their ability to pay in the future.

Another person was keen to split the day centre and transport charges.



193 people disagreed with this proposal 110 people made a comment to explain their

answers. These have been grouped and summarised into 3 themes below:

The areas that had the most comments were the affordability of the proposed

charges, the impact these charges would have on the most vulnerable and the

potential impact on future more expensive services. These 3 areas accounted for 94

of the comments.

The suggested charges were cited as too high for many people on pensions

and benefits. What the consultation appeared unable to do was reassure these

people that the financial assessment process would ensure that people are

only asked to contribute the amount that they can afford. There were also a

number of people who thought it was unfair that they did have savings and so

would have to pay the full cost which could potentially run into hundreds of

pounds per week. This was particularly acute for people who also had personal

care visits from 2 carers. Another 6 stated that they were already paying

towards the time they spend in the day centres and did not think it was fair that

they pay for anything else.

A significant proportion felt that the introduction of a charge for day centres was

hitting the most vulnerable who could least afford not to attend these services.

They felt that it would restrict a person’s quality of life and ability to take part in

society that could lead to social isolation and potentially other problems. A

couple felt that the community had a responsibility for providing these services

free to the most vulnerable (not based on income). Day centres were seen as

part of preventing risk and ensuing that people were safe.

The final area relates quite closely to the previous one; the impact on people

not attending (6 people stated they would stop attending if these proposals are

implemented) which could mean that people require more intensive and

expensive support services sooner. 4 people also commented on the impact

on carers if people stopped attending the centres due to being unable to afford

the proposed charges. Again some respondents who currently pay for the full

cost of their services felt that residential care would turn out to be a more

affordable option. A number of respondents felt that this could also lead to day

centre closures with the outcome that even more people will become socially

isolated.

The remainder of the comments were either a direct statement “I don’t agree

with the proposal” or a statement about an individual situation.



A fifth of people responding (n= 101) did not know or were unsure whether they

agreed with the proposal. 24 of these people took the opportunity to comment on the

question.

10 people agreed in principle but felt that it did depend on the actual cost,

wanted more information about the full impact and the quality of the services

being provided.

7 people felt that it was unfair to be imposing a charge on the most vulnerable

and was there another way. The issue of splitting the day centre and transport

costs were raised again. A couple of respondents felt that this was a cost

cutting/ service closure proposal.

The remainder of comments related to a statement such as “I don’t use this

service”.


8. Carelink, Telecare and assisted technology equipment

8.1 Proposal Six

This section considers the responses relating to the sixth proposal in the consultation on the



The proposal is that Carelink (community alarm); Telecare and other assisted technology

equipment will be calculated as part of a personal budget and will therefore be part of the

financial assessment, which means a charge may be applied. This proposal relates to

formalising theses services as part of the personal budget and making them subject to a

contribution. These services are already subject to the non residential services charging

policy and within the consultation the new policy also covers the increase in the charges for

these services.


The chart below shows that 46% (n=191) of people responding agreed with the proposal

compared to 10% (n=3) by the people completing the easy read version. This is a significant

variation between the 2 formats but could be down to fewer people completing the easy read

version are using these services.

The reasons for this are considered in the summary of the comments in section 4.6.4 below

Whether people agreed or disagreed with the proposal Responses to postal/ email feedback forms (n=384) easy read version (n=29) Total n=

Yes

46%

No

29%

Don't know

not sure

25%




meetings.



24 of the 226 people who responded yes to this proposal also made a comment. The

comments were grouped and summarised into 3 main themes:

8 people stated that they were already making a payment for Carelink

12 more people felt that Carelink was such an essential service it should be

provided to anyone living at home and so the cost needed to be affordable.

4 people agreed that charges needed to be made and that these charges

should be applied fairly.


85 of the 146 people who disagreed with this proposal also made a comment. These

have been grouped and summarised into 4 main themes:

28 people felt that if Carelink or specialist equipment was required then the

Council should fully subsidise the provision as it was a low cost way of maintaining

some of the most vulnerable people’s independence as well providing peace of

mind should someone have a fall or need help with a medical condition. A further

10 echoed this in their concerns that someone may stop using this service

because they could no longer afford to pay for it, putting themselves at risk. They

expressed the view that it was a necessity not a luxury. 6 people also stated that

the cost of Carelink was relatively low compared to more expensive residential

services which could impact on the Council’s future budgets.

21 people made clear statements relating to Carelink being a “lifeline”, “the only

real security some might have” and “don’t change it”.

10 comments related specifically to the proposed increases in charges and how

they would not be affordable on a low income or pension.

10 people commented that they or their relative paid already.


A quarter of people responding (n= 124) did not know or were unsure whether they

agreed with the proposal. 21 took the opportunity to comment on the question. These


11 people stated that they are already paying for Carelink some of these wanted to

know whether they would be paying more (this would depend on their individual

financial circumstances which will be reassessed during April 2011).

7 people felt that as this was going to affect the most vulnerable and the

assessment process needed to ensure that any charges were fair.


3 people made a statement or suggestion e.g. “I think Carelink is a necessity and

assisted equipment for everyday living. Perhaps Carelink should only be given free

to elderly people living alone where no one is visiting”.


9. Allowances for Disability Related Expenditure (DRE)

9.1 Proposal Seven

This section considers the responses relating to the seventh proposal in the consultation on

the personal budgets and contributions policy. It considers whether or not people agreed to

the proposal and the reasons they gave for agreeing or disagreeing.

We are proposing to introduce standard amounts for disability related expenses; there would

be 3 levels (£5 - £15) based on the welfare benefits receipts. This system would be a fairer,

simpler and more consistent way of allowing for the extra costs of having a disability,

meaning that a service user would not have to supply receipts as evidence of the extra

costs.



compared to 33% (n=21) by the people completing the easy read version. A third of people

used the don’t know/ not sure option.

The reasons for this are considered in the summary of the comments in section 4.7.4 below


Yes

44%

No

23%

Don't know

not sure

33%




meetings.



7 out of the 216 people who responded yes to this proposal also made comment. The

comments were summarised and grouped into 3 main themes:

3 people felt that the proposal was fair as it would be targeted at the people

who have the greatest need.

2 people commented on the reduction in paperwork as being welcomed

2 people felt that the policy should allow for some exceptions for people who

may have additional needs.


111 people disagreed with this proposal and 72 also provided a comment. These


52 comments related to people’s disability needs and expenses being

individual (all different) and the application of a standard rate would not reflect

the diversity of expense incurred. Concern was expressed that the level of

benefits someone is receiving does not accurately reflect their disability needs

or expense.

15 people were concerned that even the highest level would not sufficiently

cover their current expenses which would lead to hardship. 8 people’s

comments related to the unfairness of introducing a standard rate as it could

have a negative impact on people who are already suffering hardship due to

their disability and the additional expenses that it incurs.

5 people commented that the new system would be open to fraud if receipts

were not shown.

21 people’s comments were statements such as “none of it will be fair”, “why

change it” and “linking the allowance to usage would be fairer”.


A third of people responding (n= 163) did not know or were unsure whether they

agreed with the proposal. 34 took the opportunity to comment on the question. These


7 people made the same point as in the previous section stating that everyone

needs are different and their expenses would therefore be different and should

be assessed individually

10 people made a statement such as “receipts make no difference”, “depends

on the situation” and “depends on what you assess as a standard amount for

the disabled person”.


7 people wanted more information to increase understanding of the proposal

6 people stated that expenses may be significantly more than the proposed

rates which could mean that there are winners and losers, which could lead to

financial difficulties.

4 people felt that this question did not apply to their current circumstances


10. Introduction of a charge for ineligible day centre users

10.1 Proposal Eight

This section considers the responses relating to the eighth and final proposal in the

consultation on the personal budgets and contributions policy. This proposal has two parts

and gave respondents the opportunity to comment on both parts.

This considers whether people using day services whose social care needs do not qualify(

FACS criteria substantial and critical) for the council’s support will be expected to pay £10

per session for using this service.


The first chart below shows that 44% (n=217) of people responding agreed with the proposal

compared to 17% (n=3) by the people completing the easy read version. This question

shows the greatest variation in the responses; this could be due to the high number of day

centre service users who completed the easy read version. During the meetings it was

apparent that many people were unaware as to whether they met the eligibility criteria or not.


Yes

44%

No

32%

Don't know

not sure

24%

The second chart (top of next page) shows that the response to the question was inclusive

with a third (n=143) of people responding that they agreed with the proposed £10 charge

compared to 11% (n=7) by the people completing the easy read version. Again the variation

is apparent here between the 2 formats. The reasons for both of these are considered in the

following sections.



Yes

33%

No

36%

Don't know

not sure

31%


Part 1: 26% (n=119) of people who responded to the first part of the question also made a

comment; their reasons are summarised in the sections below alongside the opinions

received from letters and meetings.

Part 2: 20% (n=87) of people who responded to the second part of the question suggested

an amount if they disagreed or provided a comment on why they couldn’t decide; these are


meetings.


Part 1: 24 of the 217 people who responded yes to this proposal also made a

comment. The comments were grouped into 4 main themes:

9 of the comment made in agreement with this proposal were either a statement

like” I agree” and “if day services are free they may not be able to stay open as

everyone is making cuts,” or a description of a personal situation “my own mother

would be one”.

6 people who agreed with the proposal in principle stated that the proposed

amount £10 per day may be too much they suggested an amount between £5 - £6

per day including transport

6 people agreed that it was fair that ineligible service users pay towards the

services that they use, but also stated that this should be based on whether they

could afford to pay.

3 people’s comments related to service users stopping the service due to the cost

and then requiring more intensive services in the future, which would cost more.

Part 2: 15 of the 143 people who agreed with the £10 charge made a comment to this

effect.



Part 1: 157 people disagreed with this proposal 81 people also provided a comment to

explain their answers. These have been grouped and summarised into 8 main areas:

18 people made a statement such as “don’t agree with means testing” or “its

unfair”

24 people felt that the proposed £10 cost was too high and which could mean

that people withdraw from the service which could lead to social isolation and

deterioration in their well being. They also wanted confirmation on what would

be included for the charge

16 people felt that the changes would lead to vulnerable adults becoming more

isolated they also linked this to discrimination and that everyone should be

treated the same especially as they had already paid their taxes.

7 people felt that day centres should be free to all as it provided social activity

for the elderly

7 people were unclear as to how the eligibility criteria works and which rates

would apply to whom.

2 people felt it could lead to services closing if people opted not to attend

5 comments were about ineligible people not having the income to pay for

service

2 people commented on the potential impact on informal carers if people

stopped attending the day centre

Part 2: 157 people disagreed with the £10 amount proposed 52 people suggested an

alternative amount.

Free service = 12 £6 = 1

£1= 2 £10 = 1

£2 = 2 £5 - 7 = 1

£5 = 28 (2 include transport) £8 = 1

£10 per day too much low income = 4


Part 1: Just under a third of people responding (n= 117) did not know or were unsure

whether they agreed with the proposal. 19 of these people took the opportunity to


comment on the question. These have been grouped and summarised into 4 main

areas:

8 people were unclear as to how the eligibility criteria works and which rates

would apply to whom.

2 people thought that people may stop attending leading to social isolation and

potentially more serious needs.

3 people making a comment stated that they needed more information as to

what the £10 included before they could decide on whether they agreed with

this proposal.

6 people made a direct statement about their personal situation

Part 2: A third of people responding (n= 123) couldn’t decided whether the proposed

£10 rate was a good idea. 21 of these people took the opportunity to comment and or

suggest an alternative rate. These have been grouped and summarised below.

One comment reflected that compared to homecare £10 was a reasonable

charge

7 people felt that £10 was too much money and many people may not be able

to afford this amount.

6 people made a direct statement about their personal situation

4 people making a comment stated that they needed more information as to

what the £10 included before they could decide on whether they agreed with

this proposal.

3 people comments indicated that they had misunderstood that this question

related to people who did not meet the Council’s eligibility criteria.


11. Final Thoughts

There were 539 questionnaires returned and just under half (n=261) chose to write a final

thought.

All the comments received have been grouped into themes and summarised below. In the

main these reflect the views already expressed in the previous sections.

A number of the final comments expressed agreement with the proposed changes

particularly in relation to people contributing what they can afford towards the cost of their

care. Some went on to express that whilst they agreed in recognition of the current economic

climate they felt that the proposed changes should not lead to hardship.

Several of the people making a comment felt that the proposed changes would unfairly

impact on the most vulnerable who may not be able to afford pay for the services that they

need. For some the negative impact on the preventative agenda by reducing people’s

ability to remain independent for longer if they stopped using services and could therefore

increase demand for more expensive services in the longer term.

A number of people commented that they may stop using the services if they felt they were

unaffordable. The proposed cost of day care particularly the £40 rate was mentioned as the

main concern.

A few felt that it was such a complex area and that they may not have the whole picture to

enable them to understand the total impact.


Appendix A Responses from Organisations

During the consultation period the following organisations made a submission about the

proposed changes to personal; budgets and contributions policy for adult social care. These

took a variety of forms: completed questionnaires, stand alone reports, letters, emails and a

petition from carers and residents on behalf of people attending specialist older people’s day

centres.

In a number of cases the submissions were based on discussions or consultations with

service users, carers, staff or community groups. In addition to these submissions a number

of elected members received letters about the proposals from individual residents.

Name of Organisation

Anonymous (7)

Age Concern Bromley

Age Concern Ravensbourne

Biggin Hill Community Care

Bromley Council on Ageing

Bromley Link

Bromley Mencap

Bromley Mind

Burgess Autistic Trust

Carers Bromley

Carers Partnership Group

Chrisites Care

Elmstead Friends and Neighbours

Keniston Housing Association

Keyring

LBB - Older People's Commissioning Team

Older Peoples Partnership Group

Shaw Trust

Southside Partnership

White Gables

Whittington Consultants


Appendix B Meetings where the consultation was discussed

The consultation materials were distributed to a broad range of existing networks including

all the main partnership boards and groups. The table below lists the main meetings that

considered the consultation materials. In some cases the consultation lead and members of

the fairer charging team attended these meetings to offer further clarification on the

proposals.

Group or Forum Name – attended by the fairer charging team and/or the consultation lead

Older People's Day Service Providers (Forum)

Bertha James Day Centre (management committee)

Experts by Experience

Astley Day Centre - Meeting for people with a Learning Disability

Oakfield Centre - Shaw Trust

Bromley Link & Bromley Mencap (special meeting)

Council on Ageing (AC Bromley & Carers Bromley special meeting)

HSCH Partnership Board

Adult & Community PDS Meeting

Learning Disability Partnership Board

LBB Senior Managers Meeting

LBB Care Service Managers Meeting

Group or Forum Name – where the consultation was discussed

Older People's Partnership Group

PDSI Partnership Group

Carers Partnership Group

Mental Health Partnership Board

Documents

PERSONAL BUDGETS AND CONTRIBUTIONS POLICY … · 6. Proposal 4 - Changes to Personal Assistant Rates 12 7. Proposal 5 - Introduction of a charge for Day Centres 14 8. Proposal 6 -