CHAPTER EIGHT CONCLUSION and RECOMMENDATIONS
Conclusion
8.1 The primary aim of FPC is to remove discrimination against older people who have chronic or degenerative illnesses and need personal care by bringing their care into line with medical and nursing care in the NHS, where the principle of free care based on need is almost universally applied and accepted.
8.2 FPC has achieved that aim. Around 9,000 self funders aged 65 or over are currently receiving £145 per week as a contribution to meeting their care home costs without means testing, and around 6,000 of these self funders are also receiving £65 per week towards their nursing care costs. Over 42,000 people are now receiving personal care services at home at no charge and without being means tested.
8.3 The evaluation found strong public support for both personal and non-personal care services being provided free to all older people who need help, and a majority of people (over 60%) believe that frail older people should be "offered FPC to help them continue living in their own home, as long as they choose, whatever the cost to the public purse."
8.4 The vast majority of people receiving FPC under the Community Care and Health (Scotland) Act 2002 have received their FPC payments or personal care services without undue delay or complication. FPC has helped to support unpaid carers in their caring role and has made a positive difference to both the lives of the carer and the person for whom they care.
8.5 The process through which an individual moves through the community care system from first contact with the local authority (referral) through to assessment, and delivery of services (or payments) is well defined within the legislation and guidance that governs the delivery of Community Care, and the system works well in the vast majority of cases.
8.6 However, the evaluation did identify some problems in relation to the operation of the policy which need to be addressed. It was clear from the evaluation that there was variation across Scotland in relation to the implementation and operation of FPC.
8.7 Around half of Scotland's local authorities reported having people waiting for assessments due to staff shortages or vacancies. Two thirds of local authorities reported that they have people waiting for a care home place and FPC payments because of a lack of care home vacancies or people waiting for a vacancy to become available in a care home of their choice.
8.8 Just under a third of local authorities reported that they have people waiting for all or part of their care package at home due to problems purchasing or providing services (particularly in some rural areas and at evenings and weekends). People waiting for a local authority service were currently having their needs met by informal carers or other service providers.
8.9 Four local authorities directly attributed delays in service provision/ payments at the time the latest survey was carried out to a lack of available funding
8.10 Only five local authorities did not report anyone waiting for FPC payments or services. However, most local authorities reported only one or two people waiting in any category and only nine local authorities reported more than 12 people waiting for either FPC payments or services.
8.11 The different interpretations by local authorities of what is meant by 'assisting with the preparation of food' have led to local authorities adopting different policies on charging for food preparation. Despite the clarification provided by the Scottish Executive most local authorities still believe there is ambiguity about what services should be provided free of charge.
8.12 Very little, if any, systematic research has been carried out by local authorities to assess unmet need/ demand for care services, either among the general older population or within specific vulnerable groups such as black and minority ethnic groups. A significant proportion of unpaid carers provide personal care services for older people who do not receive FPC, suggesting that there may be some hidden unmet need for FPC amongst older people who receive support from unpaid carers.
8.13 The recommendations detailed below outline measures to address these and other concerns that have been raised through the evaluation in order to ensure the continued sustainability of FPC.
8.14 As with any other policy which involves public expenditure, the future sustainability of FPC depends on ensuring it is adequately funded. However, the funding and cost of FPC was not within the remit of this evaluation as the Scottish Executive has established a working group to analyse the cost FPC and the wider costs of care for older people at a national level.
8.15 A fundamental issue that needs to be resolved by policy makers is whether FPC is a national policy that aims to deliver the same range and quality of services across Scotland or whether local authorities should continue to be given discretion in how they deliver FPC, taking into account their financial resources.
8.16 If it is to be the former, this will require the establishment of national criteria for prioritising access to services, national target times for assessments to be completed and services to be delivered, and national guidance on whether the cost of home care packages can be capped.
8.17 If it is the latter then there will have to be an acceptance by policy makers and the general public that access to care services and FPC may differ across Scotland depending on local policies and priorities and the level of resources available in individual local authorities.
Recommendations
Public Awareness and Understanding of FPC
R2.1 The Scottish Executive and local authorities should attempt to improve awareness and understanding of FPC amongst the public, service users and carers. All publicity material on FPC and community care services, including information provided to people undergoing needs assessments, should be reviewed to ensure that they provide clear and unambiguous information about FPC and people's access to it. GP surgeries, Day Care Centres and other facilities used by older people and their carers should be targeted for information about community care and FPC.
R2.2 The Scottish Executive and local authorities should consult with older people's and carers' representative groups on the wording and content of information and publicity material about community care and FPC.
R2.3 Local authorities should work with black and minority ethnic groups to ensure that older members of these groups and their families are aware of their entitlement to an assessment for care that may lead to the provision of FPC.
Assessment
R3.1 Local authorities and their Joint Future partners should address concerns in some areas about delays in completing assessments by developing challenging Local Improvement Targets ( LITs) for assessments and ensuring that they have the organisational capacity to meet the demand for community care assessments and their LITs.
R3.2 Local authorities and their Joint Future Partnerships should provide clear and easily understood information about the assessment process, including target times for completion of the assessment to clients and their relatives.
Provision of FPC and Care Services
R4.1 All local authorities should publish easily understood statements of their policies and their processes for prioritising access to services and ensure that users and carers are made aware of them.
R4.2 Local authorities should be open and transparent about waiting times for care services and payments following assessment. Local authorities should provide information to people who are waiting for services/ payments on the reason for the wait and an indication of the timescale before the service will be delivered.
R4.3 The guidance on Free Personal and Nursing Care should be reviewed and revised to clarify the basis on which local authorities can legitimately operate waiting lists for personal care, and whether/ in what circumstances local authorities can adopt and operate a cap on the size of personal care packages delivered at home.
R4.4 Local authorities should have systems in place to record, monitor and analyse unmet need and use the information to develop strategies for reducing unmet need. This should be reported either through the JPIAF or in annual reporting on FPC to the Scottish Executive.
R4.5 The Scottish Executive should consider producing an accessible, easily understood explanatory leaflet on the advantages and disadvantages of the various care home contractual arrangements for self funders. Local authorities should ensure that all self funders and their relatives receive adequate information on the contractual options to enable them to make an informed choice
Reviewing and Monitoring of FPC
R5.1 Local authorities should report on their performance in undertaking reviews of cases. This could be done via the same arrangements that are in place for reporting on progress in implementing SSA through JPIAF and Local Improvement Targets.
R5.2 The Scottish Executive should be clear about the outcomes it expects to monitor in relation to FPC and these should be used as the basis for a set of performance indicators which local authorities should report on.
R5.3 The development of a common framework for recording social care data and the implementation of systems to allow for the collection and analysis of information through the full implementation and operation of e-care should be a national and local priority and should be implemented without delay.
The Impact of FPC
R6.1 Local authorities should use the assessment and review process to record the level and type of care provided by unpaid carers and use the information to assist in reviewing and planning to meet carers' needs (e.g. respite care).
R.6.2 A more holistic measure of the shift in the balance of care from residential to home care is needed than the current "10+ hours of home care" measure. It should take account of the criteria by which assessments of needs determine whether a care home placement is required, including factors such as the complexity of the care package and the hours at which services are required.
R.6.3 The FPC/ FNC rates paid to older people requiring personal and nursing care in care homes should take account of the real costs of providing augmented care for older people with special needs which may be higher than personal care but fall short of nursing care.
R.6.4 Local authorities should take a systematic approach to planning to meet the demand for home care services by working with independent sector providers and representatives of users and carers to better meet the changing needs and demands for person centred home care services. Best Value Reviews of home care services and workforce development planning should be used to ensure the most effective and efficient deployment of home care staff to provide high quality, person centred care services that meet national quality standards.
Continued Sustainability of FPC
R7.1 The Scottish Executive should establish a short life working group with representatives from local government and other stakeholders to review and clarify the guidance on FPC especially in relation to 'assistance with food preparation', 'assistance with medication' and the extent to which local authorities can take resources into account when making decisions regarding the delivery of FPC.
R7.2 Local authorities should be asked to report to the Scottish Executive on how they have tackled or are intending to tackle the workforce issues that have constrained or may constrain their delivery of FPC.
R7.3 Joint Future Partnerships should report (to the Scottish Executive) on how they will support the implementation and operation of FPC with particular reference to the interface between personal and nursing care, the implementation of Single Shared Assessment (to reduce delays in assessments) and funding of care services through resource transfer and other joint funding initiatives.