Reviewing care plans to make savings Briefing for team managers and care managers, November 2006

Overview Why we’re doing this The process FACS – a reminder Principles Specifics Suggestions and issues…

Why we’re doing this NCC’s 2006/7 budget included 3-year target of £34.5m of savings Demographic change not fully funded – and government grants going down Large increase in LD/YPD spend last year – we don’t fully understand why Some evidence of inconsistent decision- making/eligibility creep CM budget £2m-£3m overspent

The process All non-residential plans to be reviewed by target date of mid-February Phase two in LD will be people in res care getting day care/enabling – expect to start in December General complaints about policy to be separated from specific complaints. Decisions may be frozen only for specific complaints about individual situations

Who is responsible? Care managers are responsible for not creating expectations beyond the guidance and clear critical needs Team managers can override guidance in exceptional cases but must provide written explanations in each case A reminder: all non-residential care plans costing more than £220/week must be authorised by a general manager

FACS/eligibility Eligibility based on guaranteed outcomes since update following national FACS guidance Criteria set at tightest possible level – “critical needs” only Northumberland approach prioritises problems not people…

The most fundamental needs            Very basic outcomes would not be achieved without help (staying alive, avoiding severe pain…)

Other basic needs            Basic dignity and independence would be threatened without help

Low level needs            “Quality of life” outcomes would not be achieved without help

Northumberland’s FACS criteria  ?    ?   ?  ? We only meet critical needs for health, safety, dignity and basic independence (but we also offer advice on other needs)

FACS and cuts We can’t substantially revise the criteria But we can stick to the letter of what the criteria say Not “can FACS justify this?” but “does FACS require this?” And not just “is it in FACS” but does it have to be us who pays for it?

Principles Spend the minimum to meet needs We should usually fund only care or substitutes for care that save costs – most other costs are a private responsibility Use the service with lowest cost to the care management budget that meets need Relief of poverty is not an objective for which we are funded

FACS and private arrangements Statutory duty is to provide services if they are “necessary in order to meet needs” So we don’t have a duty to pay for things that: –non-disabled people would pay for themselves, and –the particular person could arrange privately Even if disability means the person having to pay a bit extra, this may be reasonable (e.g. using disability benefits) Ask if we can discharge our duties by helping people to make their own arrangements

Meeting need vs ceilings The services provided should be the minimum necessary to meet needs Comparisons with standard costs set a maximum, not an entitlement (E.g. Jane Percy House, Milbury, day care) (And during the budget crisis we should use block-funded services where possible)

Care homes vs support at home We can’t guarantee support at home if a care home would be cheaper (and it’s the net cost that matters) For older people who we would fund in care homes up to 20 hours of home care is cheaper if no other services Limit on direct payments in lieu of res care for older people remains £210/week

Specifics: short break care Only guarantee is one week per year if carer has heavy responsibilities Anything more must be the minimum necessary to meet critical needs We should only pay the minimum cost to meet the critical need. –Use block-funded services if possible –no right to peak weeks at Calvert Trust

Specifics: direct payments Minimum needed to meet critical needs – cost of “standard” service a ceiling Pay for care in non-traditional short breaks – not the full cost of a holiday Only pay other peoples’ costs if they –provide care more cheaply than alternatives –wouldn’t be coming otherwise (e.g. we shouldn’t usually pay for spouse carers to come)

Specifics: transport For all transport we pay for, including transport provided by day services, ask: Why not public transport? Could they use mobility benefits/motability vehicle? Is there another option (e.g. sharing with another service user)?

Specifics: ILF ILF charges can be £35+ higher than social services charges But we can’t afford to treat use of ILF as voluntary, given our finances If a service user appears to be eligible (changed as well as new plans), we should make it clear that they must apply Can’t make savings on existing ILF plans

Other specifics Shopping –ask why people can’t use commercial delivery services –if we do need to do it, one weekly shop from one supermarket the norm Extra services for care home residents –very exceptional –existing services being reviewed – but individual reviews probably start December

Some final points Do contact any of the team overseeing the process for advice on emerging issues Do talk to providers about the impact of changes on them and any intelligence they can offer about potential savings Do consider peer audit between teams as well as between team members And do tell us now what issues/further suggestions you have…