Report to: CARE TOGETHER SINGLE COMMISSIONING BOARD

Date: 2 August 2016

Officer of Single Commissioning Board

Sandra Whitehead – Interim Assistant Executive Director (Adults)

Subject: ELIGIBLE NEEDS BASED ALLOCATION SYSTEM FOR ADULTS IN RECEIPT OF PLANNED RESPITE CARE

Report Summary: There is a need to continue with the provision of a planned respite/short stay service to meet the eligible needs of individual service users and provide essential breaks for carers to support their ongoing caring role.

The Health economy faces significant budgetary challenges over the coming years and therefore needs to ensure that services are delivered in a fairer and equitable way by ensuring the allocation of respite/short stay is provided in the most cost effective way.

Recommendations: That approval is given to introduce eligible needs based system for the allocation of planned respite with a maximum allocation of 21 nights per annum effective from 1 October 2016. This will bring all adults in line with the system currently operated for adults with learning disabilities.

That the planned respite element of all existing and all future care packages is reviewed in line with the revised eligible needs allocation system attached as Appendix 3.

Financial Implications:(Authorised by the statutory Section 151 Officer & Chief Finance Officer)

The 2016/17 revenue savings allocation within Adult Services of the Council for respite care services is £0.100m. The proposals in this report will deliver an annual recurrent saving of £0.063m against this allocation (£0.032m part year in 2016/17). It should be acknowledged that the annual 21 nights maximum respite proposal represents a significant reduction to existing provision (average reduction of 32% per service user).

Emergency respite care services are also in the process of being reviewed. This may deliver further efficiency savings to ensure the estimated annual recurrent gap of £0.037m against the £0.100m savings allocation is addressed.

However, additional proposals will require evaluation to ensure the estimated gap of £0.068m in the current financial is delivered as it is unlikely that any part year savings from the review of emergency respite care services will address the gap entirely in this financial year.

The associated efficiency savings in 2016/17 and future years will be a saving to the Integrated Commissioning Fund (ICF) within the Section 75 pooled fund agreement of the ICF.

The ICF currently has a projected funding gap of £ 20.915m at 31 March 2017. It is essential that proposals are implemented as a matter of urgency to reduce the projected ICF funding gap for the 2016/17 financial year and on a

recurrent basis thereafter.

Legal Implications:(Authorised by the Borough Solicitor)

Any substantive change of policy or procedure requires meaningful consultation and consideration of the equalities duty, and in this whether the duties and responsibilities under the Care Act 2014 continue to be met through such change, to ensure vulnerable persons needs are met in accordance with the law.

SCB must ensure they both read and understand the implications of the Equalities Impact Assessment attached at Appendix 4, and that they are happy with the consultation process carried out, before they make their decision.

If agreed, the implementation of the system must be kept under careful review, and any concerns expressed fully investigated and responded to, as this area is highly vulnerable to challenge.

How do proposals align with Health & Wellbeing Strategy?

The proposals and strategic direction are consistent and aligned.

How do proposals align with Locality Plan?

The proposals and strategic direction are consistent and aligned.

How do proposals align with the Commissioning Strategy?

The proposals and strategic direction are consistent and aligned.

Recommendations / views of the Professional Reference Group:

PRG raised a query as to whether 21 nights is enough and a request that the average numbers are detailed within the report. Subject to the caveat of the data/numbers presented being revised, PRG accepted the recommendations within the report for onward presentation to SCB.

Following discussion at PRG the report has been slightly amended to reflect the breakdown of current respite care usage into bandings for ease of understanding. There was also a concern voiced about implications to carers and this is acknowledged within the decision tool.

Finally, there was a query raised about the effect of reducing respite care to those who are current high users. People who currently have a large number of nights respite will be reassessed against the decision tool and in appropriate cases exceptional circumstances will be recognised and allowed for. It may also be necessary to consider a shared care arrangement that would sit outside of this respite care model.

Public and Patient Implications: Should we decide to cease providing a planned respite service that is necessary to meet individual assessed need then we could be challenged legally in terms of failure to meet our statutory duty.

Quality Implications: There should be no implications in relation to the quality of provision being affected. The current provision will remain available for access.

How do the proposals help to reduce health inequalities?

The introduction of a needs based allocation system for planned respite will be based on individual assessment of a person’s health and Social Care needs. Individuals have equal access and rights when it comes to accessing healthcare and the treatment people receive when in healthcare. Although this may not always be practical when therapy is required many times daily and people need support with eating, mobility and continence.

What are the Equality and Diversity implications?

Without the approval for the introduction of the planned respite eligibility allocation criteria there will continue to be equality issues in that the allocation of respite is not determined by assessed eligible need.

There will be an impact on some individuals with a reduction in allocated planned respite nights though the Council will still comply with its statutory duty to provide Care and Support at the level the individual requires to meet their eligible assessed needs.

What are the safeguarding implications?

There are no anticipated safeguarding implications. Where this is assessed eligible needs that may result in individuals not being safeguarded the service provision of emergency unplanned respite will remain available. Where safeguarding concerns arise as a result of the actions or inactions of the provider and their staff, or concerns are raised by staff members or other professionals or members of the public, the Safeguarding Policy will be followed.

What are the Information Governance implications? Has a privacy impact assessment been conducted?

There are no known or unintended Information Governance implications.

Risk Management: As part of the assessment process and implementation of the eligible needs based allocation system any individual and carers risk will be identified and assessed. The risk to the Council will remain in terms of budget management around planned respite spend without the introduction of a needs based allocation system.

Access to Information : The background papers relating to this report can be inspected by contacting Julie Moore, Service Unit Manager:

Telephone: 0162 342 3775

e-mail: julie.moore@tameside.gov.uk

1. INTRODUCTION

1.1 The purpose of this report is to seek permission to accept the proposed options for change to the current respite provision for Older Adults and Adults with disabilities.

1.2 This report sets out the current provision, proposed options for change and the results of consultation into that change.

1.3 An Executive Decision was approved in January 2016 that the Council consult service users, their families and the public on the future provision of planned respite/short stay support for adults 18+ with regards to the introduction of an eligible needs based system for the allocation of planned respite.

1.4 It is important to recognise that with a growing demographic of older people and adults under the age of 65 with complex and life limiting conditions and disabilities, together with continued reduction in budget, that a more controlled approach to the provision of planned respite/short stay is required in order to continue to remain in a position to meet its statutory duties under the relevant legislation.

1.5 Planned respite/short stay is provided if it is determined from an individuals’ and carers assessment that they have eligible care and support needs and that care and support can only be met by the provision of a respite care service. Eligibility is determined from the Care Act 2014 National Minimum Eligibility criteria. Meeting needs with planned respite/short stay provision contributes to prevent the breakdown of the family situation by enabling Carers to have regular breaks from their caring role.

1.6 Emergency unplanned respite/short stay is provided to eligible individuals who are in a situation of crisis where they cannot safely manage at home at that immediate time. There could be a number of reasons for this including health issues, carer breakdown and housing difficulties. Following assessment a period of emergency unplanned respite/short stay may be provided as a short term intervention. Before a decision is made for an individual to access emergency unplanned respite/short stay an assessment of the individuals’ and carers needs will take place via the Integrated Urgent Care Team.

1.7 It is important to recognise the difference between planned respite and unplanned respite care when determining eligibility via an allocation system. Clearly if someone needs care and support in an urgent or emergency situation it remains in the economy’s interest to be able to provide that short term provision rather than to look at more costly and life changing longer term/permanent residential or nursing care or possibly an unnecessary hospital admission.

1.8 Respite Care can be provided in a number of different ways but planned respite in Tameside particularly for older people and younger adults with long term conditions is usually provided in residential or nursing care homes or by the Council’s Shared Lives (adult placement) Scheme.

1.9 It is important to recognise the crucial role that informal carers have in preventing the need for additional care and support for the individual’s they care for. It is therefore incumbent upon services to prevent carers from developing needs for care and support themselves. Respite care is one intervention for carers that contribute to preventing, reducing or delaying the need for additional carers support.

2. BACKGROUND

2.1 The health and social care economy continues to face unprecedented financial pressures in terms of the year on year reductions in Government financial settlements. Since 2010 the

Council has been required to deliver efficiency savings of £104 million. Adult Services have been required to deliver £37 million to this total, with a further £5 million required in 2016/2017. This will result in a net budget for all Adult Services of £40 million at the start of the 2016/2017 a reduction of nearly half the budget it had in 2010.

2.2 In order to realise these savings, Adult Services has already made a number of significant changes in the way it provides services. This has included service redesign of a respite/short stay provision for adults with a learning disability. Following consultation, an eligible allocation system with a maximum of 21 nights stay per year was introduced. The service also reduced from providing 8 beds across 2 building to 5 bed within one building. This reduced the costs for this service by £74k per annum.

2.3 These reductions in budget have been happening at the same time as demand for social care has been rising. The increasing number of older people and younger adults with complex and life limiting conditions and disabilities has added a further pressure to the services that the Council provides. Although many people are encouraged to seek help from within their own families or communities many still require help and support from the Council and the people who are now seeking help are those with more complicated and complex care and support needs that often need more expensive packages of care to meet their assessed needs. Success in the treatment and care of adults with severe illnesses and disabling conditions has also meant that many more people in the borough are living longer; however they are living with one or more health issues that require help and support. The healthy life expectancy of people in the borough is 58 years.

2.4 Adult Services is currently providing planned respite/short stay to 84 individuals (excluding Adults with a Learning Disability which is 95) totaling 2619 nights per annum.

2.5 Last year (2015/2016) Adult Services also provided emergency unplanned respite/short stay to 232 individuals (excluding Adults with a Learning Disability) totaling 12,968 nights. Of the 232 individuals, 107 of these went on to have a permanent residential placement within the year and a further 55 individuals unfortunately died within the year. Of the 70 individuals remaining 64 returned home with no further planned or unplanned respite. There are 6 individuals of the 84 individuals receiving planned respite that have had planned and unplanned respite.

2.5 It is important to note that whilst a respite care allocation system has been in place for adults with learning disabilities since 2003 (last reviewed in 2013) limiting most users to a maximum of 21 nights respite care a year this has not been extended to older people and other younger adults with physical, sensory and mental health disabilities resulting in some people having access to an unlimited amount of planned respite care.

2.6 The Council has a statutory duty, as set out in the Care Act 2014, to carry out an assessment of need of any citizen who requests it or who requires it. Once the assessment is concluded the Council must then determine whether the person has any needs that are deemed eligible under the Care Act which introduced a new National Minimum Eligibility Criteria. If eligible needs are identified and there is no other means of meeting those needs (e.g. family are unable or unwilling to help and support or there are no voluntary or community services that are available) then the Council must provide a service that will meet those identified eligible needs.

2.7 It is incumbent upon the Council to ensure that adequate service provision is available to meet the assessed needs of its citizens and over the years Adult Services have worked with a number of agencies including statutory, voluntary and independent agencies to ensure that there is adequate provision in the borough. Where possible this service provision can be of a universal nature and offered to the whole population, but often more specialist service

provision is required and this has to be either provided by the Council directly or commissioned by the Council from other providers.

3. CURRENT SITUATION

3.1 The Care Act 2014 was implemented from April 2015 and pulls together all the salient points of previous legislation for adult social care within one piece of legislation. The duty on Councils to assess any citizen who requests an assessment of their social care needs remains as a fundamental part of the Care Act as does the introduction of a new national minimum eligibility criteria for receiving adult social care services.

3.2 Once an assessment is completed the Council must determine whether a person is eligible to receive services provided by or commissioned by the Council. Previous to the Care Act local councils had discretion regarding the level of need they deemed eligible using the Fairer Access to Care Services (FACS) eligibility criteria. In Tameside services have always been provided to those people meeting category 1 and 2 of the FACS criteria, that is those people with critical and substantial needs.

3.3 The FACS eligibility criteria was replaced with the introduction of the Care Act’s national minimum eligibility criteria which means that all councils must now assess people and provide services to those people who meet the national criteria.

3.4 The Care Act says that an adult meets the eligibility criteria if:

Their needs are caused by physical or mental impairment or illness; As a result of the adults needs they are unable to achieve two or more of the specified

outcomes; As a consequence there is likely to be a significant impact on the person’s wellbeing.

3.5 The specified outcomes are:

Managing and maintain nutrition; Maintaining personal hygiene; Managing toilet needs; Being appropriately clothed; Being able to make use of the home safely; Maintaining a habitable home environment; Developing and maintaining family or other personal relationships; Accessing and engaging in work, training, education or volunteering; Making use of necessary facilities or services in the local community including public

transport and recreational facilities or services; Carrying out any caring responsibilities the adult has for a child.

3.6 These outcomes are much broader than previously within the FACS criteria and have the potential for more people becoming eligible for adult social care services.

3.7 As well as service user eligibility, the new Care Act also extends the duty that the Council has beyond people who need help and support to include their carers.

3.8 The Act introduces new carer’s eligibility criteria which are met if:

The carer’s needs are caused by providing necessary care for an adult. As a result their health is at risk;

Or they are unable to achieve specified outcomes; As a consequence there is likely to be a significant impact on the carers wellbeing.

3.9 The specified outcomes for carer’s are:

Carrying out any caring responsibilities the carer has for a child; Providing care to other persons for whom the carer provides care; Maintaining a habitable home environment; Managing and maintaining nutrition; Developing and maintaining family or other personal relationships; Engaging in work, training, education or volunteering; Making use of necessary facilities or services in the local community including public

transport and recreational facilities or services; Engaging in recreational activities.

3.10 All of these new criteria and outcomes require skilled assessment to determine appropriate levels of need and more importantly how those identified needs can best be met. It is important that people are encouraged to remain as independent as possible and wherever possible family or community solutions should be sought for meeting the majority of needs. Where this is not possible the Council then has a duty to meet any residual needs and steps have been taken over the years to try to ensure that this is done in the most efficient, cost effective way that represents value for money for the people of Tameside.

3.11 The current planned respite/short stay service is provided across a number of residential homes across the borough and with the Council’s Shared Lives (adult placement) Scheme. It provides a break away from home for individuals and allows respite for their carers. Individuals and carers have the choice of which residential care home they wish to receive their planned respite /short stay from.

3.12 The key aims and objectives of the service are to provide personal support to individuals who for the majority of the time reside alone with family support or reside with their family. There are currently 84 individuals who access planned respite/short stay (excluding Learning Disability) and do so with varying allocations for their number of nights stay per year. This ranges from 1 night to 200+ nights per individual user. The total nights used for planned respite are 2,619 nights per year.

3.13 The approximate current spend for planned respite is £186,323 per annum based on an enhanced residential EMI placement. This does not take into account any placements that are part Continuing Health Care/part Council funded. There are currently 39 residential and nursing homes on the Council’s on/off framework, any of which an individual may access for their planned respite/short stay nights.

3.14 The Council currently has a criteria for the allocation of planned respite / short stay for Adults with a Learning Disability. This was introduced in 2012 following a Key Decision. The allocation criteria has a set maximum number of nights or equivalent and forms part of the users personal budget. Users can choose to take their personal budget as a Direct Payment and arrange their care and support from wherever they choose. There are instances when an individual will receive more than the maximum allocation, should exceptional circumstances be determined.

3.15 The Council does not currently have a criteria for the allocation of an individuals planned respite /short stay allocation for all other Adults 18+. This results in a system of allocation that does not deliver a fair and equitable service across all residents of Tameside and gives little control of costs as there is currently no ceiling on the number of nights that can be allocated. Without eligibility criteria we cannot align the level of provision to the level of need as detailed in the Care Act 2014 above.

4. OPTIONS APPRAISAL

4.1 It is clear that there are three main options moving forward with this service redesign project:

Close the service down; Continue with existing service and uncontrollable spend; Introduce a fair and equitable cost effective provision that aligns with other adults

receiving planned respite/ short stay.

4.2 Service closure - It is clear that there is a demand which given demographic projections will increase in the coming years for planned respite/short stay support for adults aged 18 and above. Not retaining a service will lead to the Council having to make alternative provision for the current and new users of the service and their carers in potentially less appropriate and/or more costly ways. Not delivering planned respite/short stay service would be severely at odds with projected increasing levels of need in the population. If this was not available there would be a potential impact on the carer’s ability to care for their loved ones, without the option of an occasional break from their caring duties could result in the breakdown of the caring relationship resulting in more people requiring admission to permanent residential care or hospital at considerably increased costs than at present.

4.3 Continue with the existing provision - Current provision meets the needs of both individuals and their carer and reduces the risk of carer breakdown which could result in the need for more long term admission to permanent residential care for the individual. However the delivery of the service gives little control of costs as there are currently no allocation criteria or ceiling on the number of nights that can be allocated. This does not promote fairness and equity.

4.4 Introduce a fair and equitable cost effective provision that aligns with other adults receiving planned respite/ short stay - In order to effectively meet the current and future demand of planned respite/short stay within budgetary limits it is crucial that all adults are assessed fairly and equitably to receive planned respite/ short stay provision. The introduction of a planned respite/short stay allocation criteria (effective from 1 October 2016) will ensure the Council meets eligible care and support needs for both the individual and the carer in the most cost effective way.

5. ELIGIBLE NEEDS BASED ALLOCATION SYSTEM

5.1 A needs based allocation system for respite was first introduced in 2003 for all adults with a learning disability to be able to fully capture the level of need of individuals and carers to ensure fair and equitable allocation of respite nights. The allocation was based on an annual assessment of respite needs determined by bandings of low, medium and high needs. The allocation had a ceiling of 21 maximum respite nights per year. This was implemented between 2003 and the end of the previous contract of 2008. During that period there was a significant demand for building based respite/short stay support and the implementation of the ceiling of 21 nights faced considerable challenge and the application of this was not, in the view of officers, consistently implemented. Following the retender of 2008 the respite criteria and needs based allocation system was once again implemented at a ceiling of 21 nights; however the process of achieving 21 nights was based on a year on year reduction of allocated nights in order to still meet assessed needs and demand and manage budgetary pressures. There remained a number of individuals who were considered to have exceptional needs and circumstances who continued to receive more than 21 nights. From 2011 a full comprehensive reassessment of need for all services was implemented across Adult Services, improving the quality of assessment and focused on achieving outcomes rather than demand. This identified that the implementation of the criteria and allocation required reviewing due to the continued perception of inequity. The revised eligible needs

based allocation system was approved via a Key Decision 27 March 2013 and implemented fully since this date.

5.2 Alongside this consultation process, a review of the current eligible needs based allocation system has also been completed. The initial basis for this review was to establish criteria that would support equitable allocations for all adults receiving a respite /short stay service, not just for adults with a Learning Disability.

5.3 The proposed revised needs based allocation system scores applications on a points system resulting in needs being assessed as high, medium or low with the maximum number of nights at 21 per annum. The implementation of the revised allocation system will have an impact for many of those who currently receive over a maximum of 21 nights. The impact of this has been reflected within the Equality Impact Assessment. It should be noted that whilst the 21 nights is in principle a ceiling, it is recognised that there will be exceptional cases where it is appropriate to provide more support. An analysis of the allocated nights that have been increased above the 21 nights due to exceptional circumstances identifies there are 19 individuals out of a total of 95 who use the Learning Disability Service that are in receipt of additional nights above 30 nights per annum. The majority of these individuals have met the criteria for additional exceptional circumstances based on their needs and the needs of the carers due to more than 1 individual being cared for at home and or the main carer being elderly. Without these exceptional circumstances being taken into consideration and the nights allocated increased above the 21 nights these individuals would otherwise need to rely on a much higher cost level of provision. Any allocation that exceeds 21 nights is meeting the individual and carers needs in the most appropriate and cost effective way.

5.4 There are 84 (excluding learning disabilities) individuals currently in receipt of planned respite/ short stay support. The revised needs based allocation system will impact across all users as assessed needs will determine the level of nights in terms of the banding across high, medium and low. The allocation model asks a number of questions around the needs and risk of the individual and those of his or her carers circumstances which are then scored against criteria. This score then determines the level of nights that will be allocated. Where there are exceptional circumstances additional descriptors have been considered and included within the criteria. The criteria are set out at Appendix 3.

5.5 A desk top exercise was completed where the proposed system was hypothetically applied to a number of cases. Those undertaking the exercise felt that the prioritisation of the cases was fair and appropriate.

5.6 The assessment tool takes the carer’s age into account, giving credit to carers who are above state pension age and those above 75. Whilst the carer’s health is also separately taken into account, the age criterion recognizes the fact that older people tend to find it harder to provide care and that society has recognized that people above state pension age will not generally work. This is considered to be a proportionate way of meeting a legitimate aim – namely to ensure that people are allocated fair resources according to need.

5.7 Where an individual provides care for another individual, the carer may have needs of their own. A carer’s assessment would be carried out to determine the carer’s needs for support and the sustainability of the caring role. There will be some circumstances where the needs of both the carer and the cared for are above and beyond exceptional circumstances and this may result in the need for a shared care and support arrangement being put in place.

6. CONSULTATION ON RECOMMENDED MODEL

6.1 Consultation on the proposal was launched on Monday 1 February 2016 and closed on Friday 18 March 2016 following the Executive Decision approval of 20 January 2016. The

consultation was conducted via the Council’s Big Conversation website and also individual letters were sent to all service users of planned respite and their families.

6.2 The consultation focused on the introduction of an eligible need based system for the allocation of planned respite with a maximum number of 21 allocated nights.

6.3 Some consultation had already taken place as part of a wider public consultation for Adult Social Care services financial position.

6.4 A total of 12 responses were received by the Council, 8 responses via the Council’s Big and 4 responses via return letter.

6.5 The consultation letter is detailed in Appendix 1.

6.6 The Big Conversation questions and responses via the Council’s website is detailed in Appendix 2, this includes the responses received from the consultation letter.

6.7 Although a limited response the general consensus was one of recognising the important role that respite care plays allowing users and carers to remain at home. Nearly all the respondents commented that if respite wasn’t available that they would have to consider longer term care solutions.

6.8 A few people, all carers, commented on the proposal to limit planned respite to 21 nights a year and they felt that this wouldn’t be sufficient for them in allowing them to have enough of a break from their caring role. Given their circumstances it may be possible that these carers and the people they care for meet the exceptional circumstances conditions and even if this isn’t the case then unplanned and urgent care will continue to be available for people who need help and support in a crisis.

7. FINANCE

7.1 An analysis of a 12 month period identified 84 (excluding adults with a learning disability) individuals received planned respite /short stay, this equated to 2,619 respite nights taken. If of the 84 individuals reduced to 21 nights each per annum this equates to 1,764 nights per annum and realizes a saving of £63,000 per annum when taking account of the 2016-17 care home fees (£31,500 part year with an implementation date of 1 October 2016). It is acknowledged, however that some people may have exceptional circumstances and warrant more than the prescribed 21 nights maximum, thus reducing the size of any anticipated saving on the current planned respite care spend.

7.2 The current spend for planned respite is approximately £186,323 gross costs per annum with costs incurred against the on/off framework rates charged by each residential home for an individual’s stay. There are currently 26 on framework and 13 off framework residential and nursing homes on the Council’s approved list.

7.3 Individuals may currently access their planned respite/short stay from any residential or nursing home on the approved list or from the Shared Lives Scheme. The Council pays the following rates and individuals are subject to a Care Act eligible needs assessment to establish their contribution to this cost.

7.4 The current spend for respite that has not been planned and is urgent or emergency in nature is approximately £907,760 gross costs per annum.

Table 3

Residential £

Dementia£

Nursing (incl FNC)

£

Nursing + Dementia(incl FNC)

£ Residential Dementia Nursing Nursing + Dementia

Proposed RatesOff Framework 432.90 468.90 574.40 611.40 3.32% 17.23% 11.75% 14.49%On Framework 468.00 507.00 621.00 661.00 -3.11% 15.23% 6.88% 9.80%Enhanced 503.10 545.00 667.50 710.50 2.26% 9.44% 3.33% 6.84%

Proposed Fees 2016/17 Movement in Fees 2015/16 to 2016/17

8. EQUALITY IMPACT ASSESSMENT AND CONSULTATION EQUALITY ISSUES

8.1 Section 149 of the Equality Act 2010 creates a legal duty called “the public sector equality duty”. The act defines a number of equality groups:

Age; Disability; Gender reassignment; Pregnancy and maternity; Race; Sex; Sexual orientation; Religion or belief.

8.2 The equality duty says that the Council must, in the exercise of its functions, have due regard to the need to:

(a) eliminate unlawful discrimination, harassment and victimisation;(b) advance equality of opportunity between members of different equality groups;(c) foster good relations between members of equality groups;(d) remove or minimise disadvantages suffered by members of an equality group;(e) take steps to meet the different needs of people in particular equality groups;(f) take steps to encourage members of equality groups to participate in public life or in

any other activity in which participation by such persons is disproportionately low;(g) tackle prejudice and promote understanding.

8.3 With respect to disabled people, the steps involved in meeting the needs of disabled persons that are different from the needs of persons who are not disabled include, in particular, steps to take account of a person’s disabilities.

8.4 The Act notes that compliance with the duties in this section may involve treating some persons more favourably than others; but that is not to be taken as allowing unlawful discrimination. It is clear from court decisions on the equality duty that Judges expect the duty to be discharged rigorously and that public bodies are under a higher duty than other types of organisations.

8.5 An Equality Impact Assessment (EIA) has been undertaken which considered a number of issues. The EIA reflects the impact of the implementation of a needs based allocation system that has a maximum number of nights provision for an individual as 21 nights per annum. There will be an impact on 27 individuals who currently receive a planned allocation above 21 nights. As part of the implementation, there will need to be a reassessment of the respite

needs of all service users, with a view to ensuring that respite is fairly allocated according to need. Although it is recognised that there may be some wholly exceptional cases where more than 21 nights are required, it should be noted that whilst the 21 nights is in principle a ceiling, it is recognised that there will be exceptional cases where it is appropriate to provide more support.

8.6 The revised needs based allocation system will impact across all users as assessed needs will determine the level of nights in terms of the banding across high, medium and low. The allocation model asks a number of questions around the needs and risk of the individual and those of his or her carers circumstances which are then scored against criteria. This score then determines the level of nights that will be allocated. There are clear descriptors to determine exceptional circumstances that where it is appropriate to allocate more than 21 nights.

8.7 The table below shows the number of allocated nights in blocks of 10 nights for the 70 individuals referred to in section 2.5. There are 6 individuals who receive over 100 nights a year respite which more a kin to shared care and support due to their high level of need and risk.

8.8 The majority of individuals choose to take their planned respite/short stay within a residential home setting, however all individuals have the opportunity and choice to access other forms of planned respite/short stay once they have received their eligible needs based allocation. This could be via a Direct Payment, holiday respite, and respite at home. This allows greater choice and control rather than individuals fitting into one form of provision.

8.9 It is identified there is a need to continue to deliver planned respite. A number of fundamental principles that are inherent in all the savings proposals for Adult Services will be taken into consideration as follows:

The receipt of social care services is based on eligibility. All adults over the age of 18 have the right to request an assessment of their need either as a potential service user or as a carer of someone who needs care and support. Once an assessment has been completed a decision will be made as to which needs someone has that are eligible to be met according to the National Eligibility criteria laid out in the Care Act 2014.

That wherever possible identified eligible needs are met by family, friends, neighbours and the wider community.

That whatever eligible needs are left unmet by other parties must be met by the Council by either providing services directly to meet the need or by commissioning services from elsewhere. In doing so every effort should be made to use the most cost efficient service available to meet the eligible needs identified including the use of assistive technology and appropriate equipment.

That people are expected to pay what they can afford to pay for the services that they are in receipt of taking full account of any income, savings and assets that they have.

8.10 Applying the National Minimum Eligibility Criteria robustly will ensure that only those people who have identifiable needs will receive help and support from the Council. This will ensure

Number of people banded against Respite Care Nights used in 2015/16

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 Over 100

22 25 5 6 1 2 3 0 0 0 6

that all people will be treated fairly and equitably according to the needs that they have. People who have needs that are not deemed eligible will be offered other advice and signposted to other organisations who may be able to help.

8.11 The Council has a responsibility to ensure that the public purse is spent efficiently and effectively and all services that are provided to meet identified eligible needs should represent the most cost effective solution possible. In doing this the way that services are identified to meet individual needs should be done in as transparent and equitable way as possible.

9. RISK

9.1 A risk appraisal has been undertaken to ensure that risks, their consequences and impact are considered.

9.2 The project group working on this proposal has been keen to ensure that the process is fair and transparent. It is believed that the process we have followed to date and intend to use is fair and transparent and will minimise the risk of a successful legal challenge should any challenge be made relating to the change of a service.

9.3 The following table sets out the risk considerations.

Risk Consequence Impact Likelihood Action to mitigate against risk

The Council is unable to fulfil its statutory duties

Potential for Judicial Review and involvement of Local Government Ombudsman

4 4 Ensure that assessment function remains and that appropriate services are available to meet identified eligible needs

People being left without necessary services

People will have to receive services from elsewhere or go into crisis resulting in higher level services being needed

4 3 Discuss and redesign different service delivery models with health service colleagues

Not being able to meet the Services financial targets

Inability to make the necessary savings will impact elsewhere on Council services at a time when all services are being drastically reduced

4 3 Ensure that budget plan is realistic and recognises the optimum cost of an effective respite care service that ensures that the Council continues to meet its statutory obligations

The level of respite care offered results in carers not being able to cope resulting in people needing to move to residential care

Potential for more people requiring permanent residential or nursing care prematurely

4 2 The decision tool will be able to acknowledge exceptional circumstances and offer more care if necessary to prevent care breakdown.

Challenge to the allocation policy

The policy could be deemed incorrect impacting on resource allocation and finances.

4 2 Ensure appropriate communication and support offered to users and carers

10. CONCLUSION

10.1 The Care Act requires the Council to provide services that meet assessed eligible needs. Planned Respite care is a service that allows users and their families to have a break from each other in order to allow users to remain at home being cared for by their families for as long as possible.

10.2 Consultation with the public and more specifically with users and carers of planned respite has clearly identified the importance of providing a respite service and the impact on carer’s ability to continue if it was felt necessary to stop providing the service.

11. RECOMMENDATIONS

11.1 As stated on the report cover.

APPENDIX 1

Dear Sir/Madam

Re: Tameside Council’s Respite Care Allocation Criteria

I am writing to you as someone who has used respite care organised by Tameside Council. This may have been in a residential or nursing home, with a Shared Lives family carer or in a specialist facility for respite care.

The Council is currently consulting the public and in particular those people who have used respite care services in the past on the introduction of an allocation criteria based on people’s needs and individual circumstances.

Tameside Council is facing unprecedented reductions in its current budget due to ongoing Government cuts to local authorities. Since 2010 the Council has had £104million less to spend on its services. Over the next 5 years we know the Government will continue to make further cuts to our funding. We expect that will mean a further £90 million less to spend on services. That equates to almost £200 million over the 10 year period.

By the end of March 2017 Adult Services will have reduced its budget by just over 50%. Over the next 18 months a further reduction of £19.7 million has got to be made from the services which Adult Services currently provides. The level of reduction needed inevitably means that many services that the Council has provided in the past will either have to stop or be provided in different ways.

The Council currently provides respite care for older people and younger adults with disabilities or life limiting health conditions. This is provided in a number of settings including residential and nursing homes, Shared Lives family carers and in specific respite care facilities. The Council wants to continue to provide respite care but now needs to ensure that the service is offered in a fair and equitable way to all adults who need to use the service.

Respite Care can only be provided once an assessment of a person’s needs has taken place and it has been determined that the person is eligible under the Care Act 2014. In determining that respite care is required and is appropriate the Council must look at all possible ways to meet the assessed needs taking into account family and community resources.

Respite care for adults with learning disabilities has been assessed for and allocated using a set criteria for many years. The Council now wants to consult on extending that criteria for all adults who have been assessed as requiring a respite care service.

The criteria takes into account a number of things that together allow the person carrying out the assessment to decide on an appropriate number of nights respite care for the year. These include what other support the person receives (such as day care or homecare), the level of physical care a person needs, the level of complex health and behavioural needs, and the age and health of any carers.

The maximum amount of respite care an adult with learning disabilities can have is 21 nights per year. In some exceptional situations this can be a little more.

The Council now proposes to use the same criteria for all adults to ensure a fair and equitable service is provided to everyone that is assessed as being eligible.

You are invited to make any comments you may have on the new proposals as part of the Council’s consultation which ends on 18 March 2016.

You can do this in one of two ways either by answering the electronic questionnaire which can be found on the Council’s Big Conversation Website the link for which is:

http://www.tameside.gov.uk/tbc/TamesideCouncilAdultRespiteCareConsultation

or if you would prefer a paper version of the questionnaire you can request one via the contact details below which is also the address to return completed paper copies to.

Telephone: 0161 342 3493

Tameside MBCAdult ServicesDenton Festival HallPeel StreetDentonTamesideM34 3JY

Once the consultation has been completed a further report will be presented to Councillors for a decision to be taken about the future allocation of respite care.

Thank you for your interest in this matter and for taking part in the consultation if you choose to do so.

Yours sincerely

Paul DulsonHead of Adult Services Transformation

APPENDIX 2

Respite Consultation Responses

Questions 1 to 5 were all quantitative questions as follows;

Q1. Name and address.

Q2. Please tick the box that describes your interest in this issueAnswers to Q1. - 6 relatives of individuals who use respite/3 members of the public/1 Tameside Council employee.

Q3. On average how much respite care do you or your family member have in a year?Answers to Q3. 1 person up to 7 nights per year/1 person 15-21 nights per year/1 person 22-28 nights per year/3 people 29 nights and above.

Q4. If respite care was allocated according to need which of the following factors should be taken into consideration?

Answers to Q4. From 7 responses to this question the following were considered the most important factors in order of priority;

1) The person needs a great deal of physical support

2) The person lives with one carer and the carer has health problems

3) The person lives alone

4) The person has sever and complex behavioural needs and the person has a number of carers

Q5. The criteria applied to respite care for adults with a learning disability includes what other support the person receives (such as day care or homecare), the level of physical care a person needs, the level of complex health and behavioural needs, and the age and health of any carers.If the Council applies this criteria to all adults who apply for respite care how would this impact on you and your family members / the person you care for? (Please state below)

Answers to Q5. - My husband has day care at Wilshaw house. I don't really understand this question. my husband as well as dementia also has heart disease if the council were to apply this criteria to all, it would impact greatly on xxx's welfare. He goes to Loxley Day Care Centre three days a week, if he is fit enough. if he were to lose his allocation of 5 weeks respite care it would affect me greatly as I do not have any other help as my family live away so I need to have this time for a break and a well-earned rest as I am coming up to 70 years old myself. Physically my husband’s needs require a lot of care.

Both my sons have complex physical needs both suffering from Ataxia Telangiertasia. Both are confined to wheelchairs and use a hoist to transfer. They need to be fed and help with all aspects of daily living This service is a service life and death. This is very confusing. By respite care I think you mean overnight care, and not day care provision which I also think is respite. The less respite care my husband has the more significant and devasting will be the impact on my physical and mental health, meaning I will no longer be able to care for my husband and he will have to go into full time residential care. Don't think they would agree to respite as would say needs too great

Q6. If the proposal to introduce a maximum amount of 21 days respite care per year was introduced, what impact would this have on you and your family members / the person you care for? (Please state below)

Answers to Q6. - Both of us would suffer as my health would be affected as for question 5. both sons are looked after solely by myself as my husband has had a stroke and cannot help. Cutting back on respite would not be an option for this family. Respite is essential. Totally inappropriate care is 365 days a year

See above. Caring for an elderly person with dementia is physically and mentally demanding, especially when the carer (me) is 74. I need breaks to refresh and exercise. 21 days is not sufficient.

Q7. Do you have any other comments you would like to make on the proposed changes to adult respite care? (Please include these in the box below)

Answers to Q7. Sometimes I need respite for my husband when I can no longer cope so it is a two way benefit as I can relax for a few days whilst he is away by trying to keep family at home in their own environment instead of care or nursing home carers are saving the government billions of pounds per year.

We know the cuts have a huge impact on local services but we need to prioritise essential services

I feel it is only fair that all respite care is given equal criteria no matter what the health issue/disability is.

To cut down on respite care seems like a short term saving at the expense of the most vulnerable in our society. This is a very valuable service as when you are a carer you need the chance to have time away and know that your loved ones are well looked after. We did not take up because my mother needs nursing care and the respite offered in the past was just residential

APPENDIX 3

Planned respite/short stay is provided if it is determined from an individuals’ and carers assessment that they have eligible care and support needs that can only be met by the provision of planned respite/short stay. Eligibility is determined from the Care Act 2014 National Minimum Eligibility criteria. By meeting needs with planned respite/short stay provision this contributes to prevent the breakdown of the family situation by enabling Carers to have regular breaks from their caring role.

PLEASE COMPLETE ALL SECTIONS TO ENSURE AN APPROPRIATE DECISION CAN BE MADE FROM THE INFORMATION ON THIS FORM.

Short-Term Break Provision:

1. Have you had to access respite in an emergency this year so far?

2. If yes, please give details. (Number of nights and reason etc)

3. Additional Information

Service User:

Does the service user receive any other provision?Please specify number of days and hours0-3 hours = ½ day3-6 hours= 1 day

Day Services Number of DaysSitting/Support Number of HoursDirect Payment Number of HoursHome care support Number of Hours

4. What level of physical care do you provide to meet the service users personal care and daily living needs?

RESPITE ALLOCATION ASSESSMENT

IAS NUMBER:

Personal Details

Name: D.O.B:

Address:

Ethnic Origin:

Tel:

Carers Name/s:

Very High (Service user is completely dependent in all areas of personal care and daily living and needs moving and handling)

High (Service user is dependent in many areas of personal care and daily living tasks, but can complete some with support or supervision)

Medium (Service user is independent in most areas with verbal prompts and support)

Low Service user is independent in all areas with minimal support)

5. Does the service user have any complex medical needs that require medical intervention or supervision?

Very Complex Any medical condition that requires specialist medical intervention.

Complex Any medical condition that requires specialist medical training to manage the condition.

Low Some level of medical supervision is required.

None No health issues, but may need prompts/support with medication

6. Does the service user display any behaviour that you find difficult to manage or that is very disruptive to you or your family?

Do you receive any support to manage these behaviours?

HighBehaviour’s that pose a predictable risk to self or others. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions.

Medium Behaviour’s that follow a predictable pattern. The risk assessment indicates a pattern of behaviour that can be managed that does not pose a risk to self or others. The person is nearly always compliant with care.

Low Some incidents of behaviour. The person is compliant with all aspects of their care.

None No evidence of behaviours.

Carers Details:

7. How many people care for the service user in the household?

Lone CarerTwo CarersOther (Please Specify)

8. Age of main carer/s?

75+ Above state pension age (As applying to women)

Below state pension age.(As applying to women)

9. Do you care for anybody else in the household who has a disability or serious illness?

10. Do you have any health related problems that impact on your ability to carry out your caring role?

YESNO

EXCEPTIONAL CIRCUMSTANCES:

This should include additional information from question 10 and 11 and any frequent complex night time support needs.

Q11. Do you care for anyone else in the household who has a disability or serious illness?If yes please provide details

Q12. Do you have any health related problems that impact on your ability to carry out your caring role?If yes please provide details;

Q13. Night time support needs?If yes please provide details:

Signature of Reviewer: Date:

ScoreBanding: High Medium LowAllocated Nights

ADULT SERVICES RESPITE/ SHORT TERM BREAK SCORING:

Questions 1-3 are not scored as this is demographic information.

Q4. Does the service user receive any other provision?

In receipt of:

0 days – 31-2 days – 23-4 days – 15+ days – 0

Q5. What level of physical care do you provide to meet the service users personal care and daily living needs?

Very high support needs – 3High support needs – 2Medium support needs – 1Low – 0

Q6. Does the service user have any complex medical needs that require medical intervention or supervision?

V Complex needs – 3Complex needs – 2Low – 1No needs – 0

Q7. Does the service user display any behaviour that you find difficult to manage or that is very disruptive to you or your family?

High – 3Medium – 2Low – 1None – 0

Carers Details:

Q8. How many people care for the service user in the household?Lone carer – 2Two carers – 1Plus two – 0

Q9. Age of main carer/s at pensionable age

Above - 4 Below - 3

Q10. Do you care for anybody else in the household who has a disability or serious illness?

Yes -1No – 0

Q11. Do you have any health related problems that impact on your ability to carry your caring role?

Yes – 1No – 0

Scoring allocation –Maximum score is 20 points.

Low – up to 6 points = 7 nightsMedium – 7-13 points = 14 nightsHigh – 14 – 20 points = 21 nights

Exceptional circumstances:

Q10. Do you care for anyone else in the household who has a disability or serious illness.

Low low level of care/supervision to another person,Score 1 point

Medium carer provides care to another person (s).Other person requires moderate level of care.Score 2 points

High carer provides high level of support to another person (s).This will include the other person having complex medical health conditions that require a high level of intervention. Score 3 points

Q11. Do you have any health related problems that impact on your ability to carry out your caring role.

Low carer has low level health conditions that have low impact on their caring role.Score 1 point

Medium carer has more complex health related conditions that will have some impact on their caring role. Score 2 points

High carer has a high level of health conditions that will have great impact on their caring role.

Q12. Night time support needs

Low Cared for has low level night time support needs that require little intervention.Score- 1 point

Medium Cared for has moderate night time support needs that require some intervention or support.Score 2 points

High cared for has complex night time support needs that require regular intervention during the Night time. Score - 3 points.

From the exceptional circumstances:

Low- score between 1-3 points= 3 extra nightsMedium-score between 4-6 points= 10 extra nightsHigh score between 7-9 points = 19 extra nights.