Hampshire County Councils Revised Charging Proposals

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Changes to Charging for Carein Hampshire 4th
March 2006
Southampton Centre for Independent Living
Hampshire Centre for Independent Living
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Consultation on the charging policy for
non-residential services for adultsDave Ward
Hampshire County Council
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The presentation covers

• The current policy
• The proposed changes
• The reasons for them
• The consultation

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The current policy

• Chargeable services
• Services that give personal care and some other
  help at home, including sitting services
  hourly rate fixed annually
• Meals are charged at a flat rate
• Non-chargeable services
• Care management and assessment
• Help, advice and equipment from occupational
  therapists
• Day centre/service attendance
• Direct Payments
• a flat-rate deduction in Option A and one based
  on a financial assessment in Option B

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Principles

• Service users
• Pay for what they get
• Pay what they can afford
• Policy has to comply with the Governments
  mandatory guidance Fairer Charging Policies for
  Home Care and other non-residential Social
  Services, introduced in 2002

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Financial assessment

• To establish how much a service user can afford
  to pay, outgoings are subtracted from income to
  give a disposable income
• Only the income and outgoings of the person
  receiving care are taken into account
• Income includes Income Support, benefits,
  pensions and interest on savings and investments
  such as building society accounts (but not the
  principal)
• Income doesnt include earnings from paid
  employment
• Outgoings include an allowance for general living
  expenses (based on the Governments Income
  Support rules plus 25)

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Financial assessment (cont)

• Allowable outgoings also include housing costs
  (mortgage or rent), Council Tax and a range of
  disability-related expenses, including
• Special clothing
• Domestic help
• Equipment maintenance
• Gardening
• Extra heating
• Home maintenance
• Personal care arranged privately

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Financial assessment (cont)

• Disposable income equals assessable income minus
  allowable outgoings and is the basis for any
  weekly charge
• No disposable income
• no charge
• Some disposable income
• weekly charge is the hourly rate x number of
  hours received in the week up to a maximum of ¾
  of disposable income

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An example

• Income of 150 a week minus outgoings of 130 a
  week gives a disposable income of 20 a week
• 6 hours of care received each week at the current
  hourly rate of 11.36 an hour costs 68.16
• Charge 15

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Added value

• Financial assessments carried out by Financial
  Assessments and Benefits Team
• In addition to working out the weekly charge,
  they give advice on benefits and help in making
  claims
• Around a third of all the visits they make are
  follow-up visits to progress claims

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In total..

• Around 50 of people receiving chargeable
  services contribute towards their cost
• Charges raise about 4m each year
• Total spend on domiciliary services in Hampshire
  is around 55m a year
• Income from charges, therefore, pays for around
  7 of their cost

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The proposed changes

• The first four weeks of care would be free
• Peoples savings, investments and capital (but
  not the value of their home if they own it) would
  be taken into account
• An increase in the percentage of disposable
  income that can be used to pay for care from 75
  to 100
• Charging for day centre/services attendance
• An overall upper limit as a safeguard for people
  with a very high upper limit
• Charges for Direct Payments Option A would be
  based on a financial assessment

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The reasons

• The Council needs to raise more money to put
  towards the cost of caring for increasing numbers
  of people
• The number of people aged 85 in Hampshire is
  growing by 1,000 a year
• Government funding is low (the second worst
  funded shire county in England 12 lower than
  the average) and the Council is prevented from
  raising the extra money needed through Council
  Tax (capping)
• The gap between needs and resources is widening
  hence an expected Adult Services overspend of
  10-12m this year and major savings to find next

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The reasons (cont)

• Raising money (cont)
• Increasing the percentage of the cost of services
  paid for by charges by 1 (from 7 to 8) would
  raise around 0.5m enough to pay for 6 hours of
  domiciliary care a week for 120 people for a year
• To eliminate some unfairnesses
• At present, people with a moderate income and no
  savings pay charges but people with a low income
  and substantial capital and/or savings do not
• To bring Hampshire into line with other
  authorities
• Most of whom take capital into account and a
  larger proportion of disposable income

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The reasons (cont)

• To ensure the Council is operating lawfully
• The flat-rate deduction applied to Option A
  Direct Payments recipients does not comply with
  the Fairer Charging mandatory guidance which
• Expects charges to be based on an assessment of
  ability to pay
• Accepts flat-rate charges only in limited
  circumstances (such as meals, where charges
  substitute for ordinary living costs)
• Expects people receiving direct payments to be
  treated as they would have been treated if they
  had been receiving the equivalent services

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The reasons (cont)

• To ensure the Council is operating lawfully
  (cont)
• Or The Community Care, Services for Carers and
  Childrens Services (Direct Payments) (England)
  Regulations 2003 which expects the Council to
  have regard to the prescribed persons means

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The consultation

• All service users who might be affected by the
  proposed changes were written to at the beginning
  of January to seek their views. A questionnaire
  was provided and many have been completed and
  returned but many people have also written
  letters, sent emails or given their views over
  the telephone. All will be taken into account.
• The consultation period runs until the end of
  March
• Report to the Councils Executive Member for
  Adult Social Care at her Decision Day on 28 April
• Second consultation with users of day care and
  equivalent services May to July

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Refreshments
Southampton Centre for Independent Living
Hampshire Centre for Independent Living
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Hampshire County Councils Revised Charging
Proposals
Philip MasonHCIL
Southampton Centre for Independent Living
Hampshire Centre for Independent Living
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• What is Proposed?

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1. Capital 

• Anyone with capital above 20,000 will pay full
  cost of care
• Anyone with capital between 12,500 and 20,000
  will be assessed as earning 1 per week for every
  250 above 12,500. This implies an interest rate
  of 21, compared to actual interest rates of 4.
  Therefore the capital sum will be consumed
• Anyone with less than 12,500 capital will not be
  subject to the 21 income assessment but will
  presumably continue to have actual interest taken
  into account

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2. Disposable Income

• All income above an allowance of Income Support
  or Pension Guarantee Credit 25 will be
  regarded as disposable and available to pay for
  care
• Income Support with Enhanced Disability Premium
  25 114.81
• Pension Guarantee Credit (age 60) 25
  136.81
• The following cannot be regarded as disposable
  or available to pay for care
• Earnings from employment
• Disability Living Allowance Mobility Component

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• Some people may be able to add to their allowance
  by proving that they have extra Disability
  Related Expenses but these will have to be
  approved by a social worker and meticulously
  accounted for
• The reduction of disabled and elderly peoples
  income to these levels will restrict those with
  medium to high care needs to poverty levels

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• Age Concern, who are opposed to means tested
  charging, say that if local authorities insist on
  charging for services, they should
• reconsider the levels of the basic allowances
  and base them on a modest but adequate budget or
  similar standard to ensure that older and
  disabled people have enough left to live on
  after charges to remain socially included and to
  live healthily

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3. Hourly charge

• The County plan to increase their hourly charge
  from 11.36 to 13.32
• For someone receiving the average of 20 hours a
  week, for Direct Payments Option A, this could
  mean a charge of up to 266.40 per week

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4. Overall Upper Limit

• Hampshire do not currently have an upper limit
  for weekly care charges
• The highest current charge paid by a client for
  non-residential care is 383.64 per week
• The new proposals suggest there will be an upper
  limit but do not say what it will be
• It is likely to be between 200 300 per week

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5. Day Care

• The County plan to include day care and
  equivalent services in the charging policy
• Most people would not choose to go to day centres
  unless they have to
•  
• In many cases the time spent at a day centre is
  the only break available for long suffering
  caring families
• Charging for this relief may hasten family
  breakdown with all the associated extra costs to
  Social Services

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6. Direct Payments Option A

• Hampshire County Council propose that Direct
  Payments Option A will be abolished and all
  clients transferred to Option B
• In 1997 and 2002 it was established that Direct
  Payments Option A, with a flat rate charge of
  12, is acceptable within the Governments Fairer
  Charging Guidance because Option B exists for
  those who prefer to pay a means tested charge and
  receive a higher hourly payment rate

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• Direct Payments Option A is very different from
  receiving care provided by Social Services
• Users take on all the responsibilities,
  including
• staff recruitment and training
• organising rotas, including holiday sickness
  cover
• staff welfare and insurance
• payment of wages, tax and National Insurance
• record keeping
• keeping up to date with employment legislation

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• Option A currently saves Hampshire County Council
  significant sums of money
• Option A users receive a net payment of 8.17 per
  hour to organise their own care (9.28 gross
  minus a flat rate charge of 1.11)
• Based on an average of 20 hours care per week,
  the average charge paid at this flat rate by
  Option A users is 22.20 (12) per week

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• Option B is funded at a level similar to directed
  services, costing Hampshire an average of 13.18
  per hour
• As Option B currently appeals to those who have
  very low incomes, the percentage recovered by the
  County through charges can be assumed to be very
  low

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• If all Option A users were transferred to Option
  B their payment rate would have to increase to
  match
• Based on available figures, Hampshires average
  collection rate through means tested charging is
  6.9
• It could cost Hampshire County Council an extra
  3.5m per annum if they transfer all 786 Option A
  users to the more expensive Option B

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• Direct Payment users tend to have higher care
  needs than those on directed services, averaging
  20 hours per week as compared to 10 hours per
  week for directed services
• Therefore Direct Payments users would be
  particularly adversely affected by increased
  charges
• If Option A were to be abolished, there would be
  little incentive for new users to take on Direct
  Payments
• The County would then need to provide more
  expensive directed services

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• The Government state in their new white paper
  Our health, our care, our say
• we expect local authorities to set challenging
  targets for the take-up of direct payments
• Meanwhile, Hampshire County Council are seeking
  to close down the most successful Direct Payments
  scheme in the UK

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Is Means Tested Charging for Non-Residential
Care a Good Idea?
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1. Charges are a tax on disability

• Hampshire County Council collect Council Tax to
  pay for social services
• They then charge disabled people again for
  essential services such as washing, getting out
  of bed, using the bathroom and eating

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Charging enforces poverty andundermines
independence

• Hampshire propose to levy the maximum charges
  permitted by Government guidance
• This would ensure that clients who need a lot of
  care would be reduced to the lowest income
  permitted by the Government
• This is not compatible with the stated purpose of
  social care to promote independence and social
  inclusion

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Charges discourage disabledpeople from saving
for a pension

• Although earnings from employment are not allowed
  to be taken into account for charging, Hampshire
  regard pensions or savings people may have put by
  when they were working as available to pay for
  care
• The Government is keen to encourage people to
  save for retirement but Hampshire plan to
  penalise anyone who does so

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Charging causes people to go without the help
they need

• Many, faced with the indignity of a means test
  and enforced poverty, will try to get by without
  help
•  
• The loss of essential care undermines quality of
  life and health and may ultimately necessitate
  expensive remedial action by both Health and
  Social Services
• Hampshire Social Services calculations imply
  that they hope to achieve a 30 saving from
  cancellation of services

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Charging increases the burdenon family and
friends

• Much the greater part of care support for elderly
  and disabled people is supplied unpaid by family
  and friends
• Reductions in support for families who are faced
  with heavy charges will place a much greater
  burden on these family carers

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• Many carers are not free to go out and work and
  will therefore suffer the effects of charging
  alongside the disabled family members they care
  for
• High charges will drive some carers to give up
  the relief they need in order to avoid poverty
• Others will stop providing care so they can go
  out to work to maintain a reasonable living
  standard
• This will force Social Services to greatly
  increase their support to the disabled family
  member

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Some may give up and move into residential care

• Heavy charges will make it increasingly difficult
  for disabled and elderly people to cope in their
  own homes
• As a result of lack of care support and general
  poverty, some will decide to give up and go into
  expensive residential care

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Why are Hampshire suggesting these changes?
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1. They claim it would be fairer

• Hampshire claim that it is fairer if they apply
  the same high charges to all disabled and elderly
  people regardless of differences between the
  services provided
• However, legal advice in 2002 pointed out
• you cannot treat different people in the same
  way and still have a 'fair and equitable' policy.
  
• To treat different people in the same way can be
  discriminatory under article 14 of the European
  Convention on Human Rights

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• Hampshire suggest that disabled and elderly
  people have a special responsibility over and
  above that of able-bodied citizens to provide
  funding for Adult Social Services
• This means that service users should pay their
  taxes and community charges and then, so that the
  general population should not have to bear the
  burden, they should provide extra funding to meet
  the costs of care for other disabled people

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• Hampshire also claim that, to be fair, all users
  of services should be left as badly off
  financially as the poorest
• However, Francesca Klug of the Centre for the
  Study of Human Rights, writes regarding European
  Human Rights legislation
• the value human rights law puts on equality is
  not entirely neutral. Everyone being treated
  equally badly is not a human rights concept. It
  is not sufficient to ensure that no-one is being
  discriminated against if the consequence is that
  all groups are treated with an equal lack of
  respect or lack of opportunity to participate in
  social and civic life.

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Hampshire County Council Want to Obtain More
Money

• Ken Thornber, Leader of the County Council says
  Hampshire will need to find 11m over the next
  two years in order to balance its books
• However, the suggested measures will not achieve
  the necessary funding increase

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• According to County figures the anticipated extra
  income obtained from treating all of a clients
  income above Income Support 25 as available to
  pay for care and increasing care charges to
  13.32 per hour is estimated at approximately
  500,000
• No estimates are given for any of the other
  proposed changes to charging policy
• Rather than saving money, the proposal to close
  down Direct Payments Option A is likely to incur
  a deficit in the region of 3.5m

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• In 2002, Social Services officers confirmed that
  the County Council would lose money if they
  applied means tested charging to Direct Payments
  Option A
• The Audit Commission Report Charging with Care
  has shown that it is not a useful source of
  revenue for local authorities as an average of 25
  40 of revenue raised is swallowed up in
  administrative costs

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How could Hampshire save money?

• The best way Hampshire could save money would be
  to retain Direct Payments Option A and encourage
  many more people to use it
• In addition, if means tested charging were not
  applied to Option A there would be no need to
  take on additional staff in the Financial
  Assessment team, as proposed in the Report to the
  Executive Member, Adult Services

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• Other ways of saving money could include
• Better management of services provided directly
  by Social Services at a cost of 26.08 per hour
• Monitoring of bills from care agencies, who
  currently charge for many hours of care which
  have not actually been supplied
• Improvement in the Countys poor rate of moving
  people out of expensive hospital beds

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• Finally, Age Concern are representative of most
  organisations representing elderly and disabled
  people when they say
• Charges for personal care and carers
• services should be abolished

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Resolution
Ian LoynesSCIL
Southampton Centre for Independent Living
Hampshire Centre for Independent Living