Day Services: the changing context and challenges Paul Kelly LB Camden Monday 11 July 2011

The context for changes to day services Changes to date Customers who can afford to, will now pay contributions for day services A clear focus on people with critical and substantial needs A reduction in funding for services for people with moderate and low level needs Moving forward Increasing numbers of people with direct payments and personal budgets Investing in modern day opportunities for people in Camden A new offer from community centres in Camden Supporting the development of small providers in Camden

National facts and figures - March 2011 Number of personal budgets has doubled to 338,000 – more than half go to older people More than 1 in 3 of eligible users The total amount of money delivered through personal budgets is over £1.5 billion A fifth of personal budgets have a value of less than £1k per annum, but a quarter are for £10k or more Of the total number of personal budgets (excluding carers): Direct Payments = 26% Mixed = 7% Managed = 67%

Some key figures for Camden Estimated numbers using day services – 1040 (Cavaet: Estimate only as data from the Grant Funded Services Survey 2010) are not currently care managed 38% using self directed support About one third have a direct payment Day Service Banding for Resource Allocation: –High - £80 –Medium - £40 –Low - £25

What does this mean for customers?

Personal budgets and contributions in Camden – Fact Sheet What can a personal budget be spent on? How is the personal budget amount decided? How are personal budgets funded – council and customer contributions? How is the personal budget managed?

Customer undertakes Supported Self-Assessment and receives an indicative budget allocation from the Council Customer draws up support plan to meet care and support needs Council undertakes Financial Assessment of Customer to determine how much they can afford to contribute to their personal budget. Council approves support plan and notifies Customer of how much they need to contribute to the cost and how much subsidy the Council will contribute Customer opts for the Council to manage the personal budget Customer opts to receive the Council subsidy as a Direct Payment Council procures the services required in the support plan and enters a contract with the chosen provider(s) Customer procures the services required in the support plan and enters a contract with the chosen provider(s) Council collects the customer’s contribution Customer tops up their Direct Payment with their assessed contribution Council pays provider(s)Customer pays provider(s). Personal Budget Flowchart

Example – Customer with Critical and Substantial needs Mr S currently attends Charlie Ratchford Resource Centre three days a week and is assessed as having FACS eligible needs. He is allocated a personal budget that includes £75 a week for day support in his personal budget. His new support plan includes: –attendance at a local community centre Castlehaven once a week (currently free) –attendance at Charlie Ratchfords twice a week (£50) –Meets with group of friends for day trip or visit to local café / pub - £25 for transport or for personal assistant / companions expenses

Case study – Customer not eligible for council funded care Mrs J currently attends the drop in at Kingsgate Resource Centre two days a week where she purchases lunch. She receives an assessment and is found not to have eligible needs. Mrs J is signposted to other community resources: –She chooses to go to a local Community Centre one day a week which is currently free and purchases lunch –Attends exercise class at Kingsgate Resource Centre at a current charge £1.50 –Mrs Smith also has the option of attending an existing day centre paying for example £25 per day

Current issues Need to complete assessments and reviews of all customers How should services account and charge for non attendance – holiday, sickness, hospital appointments? How can we give all customers maximum choice and flexibility over services? How can we personalise transport? How should we resource services for people in crisis and fluctuating needs? How do we ensure ongoing monitoring and contact of people – for instance people disengaging from services?

What will this mean for providers?

Business model and financial risk Scenario A) The Council guarantees 100% block funding to the provider: –The service is secured for the duration of the contract –The Council takes 100% of the risk –However, if customers exercise their choice to spend their personal budget on services outside the block contract, the service is under-utilised –The Council would need to identify a budget to pay for this double-funding

Business model and financial risk Scenario B) The provider contract is directly with customers and income is solely from personal budgets / self funders: –The provider takes 100% of the risk –The service is less secure as income is dependent on demand that may fluctuate –The business model will need to minimise fixed costs and maximise flexibility of staffing input –Providers may opt to increase prices to mitigate against risks

Business model and financial risk Scenario C) – Risk sharing agreement that could change over time and responds to shifts in demand –Small block element that could change over time as the business model stabilises –Provides a degree of stability for the provider and secures local provision –Can build in incentives for the provider to respond to customer demand and bring in additional funding

Provider Case Study Day Service – A small day service with annual running costs of £130,000 For the service to break even it would need to operate at full capacity and generate income of £130,000+ With people paying per visit this would require 100 sessions a week at £25 a session eg. 50 service users each accessing 2 sessions a week. This could also be paid as a block or through a “membership”. However if demand reduces by 25% due to people using their personal budget elsewhere then income will reduce to £97,500 –With scenario A) the provider taking the risk, this will equate to a £32,500 provider budget deficit –With scenario B) the council taking the risk, this would equate to a £32,500 annual double running cost or 1300 lost day sessions that could have been commissioned from elsewhere –In either case there would be an increase in unit cost from £25 to £33

The challenges Developing sustainable business models Providing a sustainable service offer that delivers choice and control Designing service / business models that can cope with fluctuations in demand– eg. keeping fixed costs to a minimum Using assets and resources creatively to maximise income Identifying a range of funding and resources Attracting self funders and charging a wider range of people than at present A sustainable market Developing a risk sharing model that secures provision and mitigates financial risk Maximising the use of community based facilities for people with low / moderate needs and in support planning for people with PBs Ensuring there are a variety of flexible locally based options for people with budgets