INDEPENDENT FUNDING REVIEW OF FREE PERSONAL & NURSING CARE, MINUTES OF MEETING HELD IN ST ANDREW'S HOUSE, EDINBURGH AT 10.00AM, ON FRIDAY, 29 FEBRUARY 2008.
Present: Lord Sutherland (Chairman)
Anne Jarvie
Mary Marshall
Jim Dickie
Professor David Bell
Rhona Dubery (Secretary)
In Attendance: Neil Rennick, Scottish Government: Community Care Division
Shaun Eales, Scottish Government: Community Care Division
Jenny Stevenson, Scottish Government: Community Care Division
Apologies
1. Rory Mair was on leave and unable to attend.
Introductory Remarks
2. Lord Sutherland noted that there was an additional paper/piece of information tabled in the form of the list of 52 local and national indicators that will be used to support Single Outcome Agreements.
Minutes of Meeting held on 14 February 2008
3. The minutes of the seventh meeting held on Thursday, 14 February 2008 (IFR-FPNC (08)2nd Minutes) were approved with a small amendment to paragraph 22(a).
Audit Scotland Review: Local Authorities' Expenditure Figures and Overall Shortfall Figure
4. Neil up-dated the review group on the further exchanges that had taken place with representatives of the SOLACE, ADSW, CIPFA Working Group and with individual local authorities. He said that the work to get behind the expenditure figures presented in the Audit Scotland report was still proving extremely difficult; he had met again with the working group's technical expert and further work had gone on with local authorities to re-examine some of the figures on costs and overheads they had reported. That had led to a shift towards the lower of the 2 Audit Scotland shortfall figures for 2005-06 of £46 million and it was now looking as though even that was over-stated.
5. Neil said he had hoped to be in a position to come to the meeting with a more definitive picture agreed with the working group. However, it now looked like it would be the following week at the earliest before any agreement on the figures, and therefore the potential shortfall, might be reached. It was hoped that a shared-view might be reached on a shortfall figure as at 2005-06, which might then facilitate agreement on the level of additional funding required to stabilise the policy and to address some of the implementation issues.
6. In discussion the following points were made:
(a) It was unfortunate that the difficulties with the quality and consistency of financial data was continuing to make it difficult to come to a firm view on potential shortfall and that the Group was still faced with various estimates of a funding gap, ranging from £25 million to £63 million at this stage in the review;
(b) In terms of any additional funding which may be made available to address any shortfall and stabilise the policy, an important outcome would be to remove the problems of variability in provision and standardise assessment and delivery of services. One option might be to set a level of minimum entitlement but defining that and agreeing eligibility would be difficult;
(c) In determining what any additional funding might buy, it would be important not to lose sight of the importance of investing in the preventative element, as that had an effect on how quickly individuals moved from having low level care needs to higher level needs and obviously that had both quality of life and resource implications;
(d) A standardisation of assessment of need and care management could be the best approach in seeking to address variability across local authority areas and ensuring that every client was assessed consistently and those requiring care have their care planned and managed consistently, with active management of any waiting lists to common and transparent timescales; and
(e) If it went down the road of suggesting a standard maximum waiting period the Group would need to be careful to define clearly what it meant. The 6 weeks delayed discharge timescale might offer a reasonable model. While a tighter waiting time may, on the surface, seem appealing, there was a danger that in attempting to meet it, local authorities would remove people with lower level needs from their waiting lists and these people would be lost sight of.
7. The Review Group noted the position and agreed:
(a) To return to the expenditure figures and the question of a funding shortfall for the policy at its next meeting on 14 March; ( Action: Review Group) and
(b) That in liaison with Mary and Jim, Rhona should prepare revised text on standardisation of assessment and delivery/management of services for the Group's consideration at its next meeting. ( Action: Rhona, Mary & Jim)
Draft Report: Consideration of Draft Report and Key Recommendations
8. Lord Sutherland invited the Group's comments on the first draft of the Review Group's final report that Rhona had circulated on Wednesday, 27 February. Rhona said that this was very much a first draft based on the conclusions from the group's meetings to-date. The detailed text and supporting evidence had still to be factored into the main body of the report. However, it would be useful to take the time at this point to consider the recommendations, both individually and as a package (given the interaction and interdependence between them) and to consider whether these adequately covered the remit or whether any were considered to go beyond it, or whether there were thought to be any gaps. There was also the opportunity to consider the detailed economic analyses which David had produced and which was now complete.
9. In discussion of the draft, the Review Group agreed the package or recommendations was the right one and that it offered a constructive and coherent way forward for the Government and local authorities. The Group offered a number of drafting points on the text, including the following key points:
(a) It was disappointing that the wellbeing of older people did not feature in the Government's 15 National Outcomes (that will be supported by the 32 Single Outcome Agreements (SOAs) agreed with each local authority) in its National Performance framework. The Group's disappointment in that should be recorded and a review of the position called for;
(b) Just as users of the NHS had an "entitlement" to care, FPC was an "entitlement" for those assessed as requiring it and the "Rationing" prevalent in some areas was clearly unacceptable. Waiting lists could not be eradicated completely, as clearly no service could be provided instantly and there would always be more complex cases outwith the norm. But waiting lists had to be reasonable and actively managed and establishing a 6 week period as the maximum standard waiting time, or "norm" would compare favourably with other services;
(c) It may be more appropriate to invite local authorities to agree and "buy-into" an appropriate maximum waiting period, after all, the period agreed would need to be incorporated in each authority's SOA. It was too late to do that for 2008-09 but it may be possible to incorporate such a target in the National Outcomes Framework for Community Care, which was currently being discussed (which included the 6 week delayed discharge measure);
(d) The standardisation approach being recommended should be extended beyond assessment - and as currently drafted - to the management of care and provision of services. The Single Shared Assessment model already provided a framework for the first half of the process but a consolidation of that work was required. Greater use of the Indicator of Relative Need (IoRN) should also be advocated in terms of grading and allocation of services;
(e) Although the group had still to come to a final view on a Scotland level funding shortfall, whatever the final position it was difficult to reconcile that against the situation at individual local authority expenditure level, where the Audit Scotland report and other evidence showed 27 out of 32 authorities spending less than their indicative GAE allocations for older people's services. Clearly the situation was a complex one and there were other factors at play - and a high spend did not in itself equate to high quality services - but the report ought to bring out the spend/GAE comparison ;
(f) In terms of the total cost of care, the balance between state funding and individual/personal funding of long-term care should be brought out more clearly. Also, the message on the escalation of total costs should be drawn out more, i.e. as at 2005-06 total costs at UK level amounted to £2.2 billion or about 2.3% of GDP, but if nothing changed, by 2031 that cost is likely to have at least doubled;
(g) Greater emphasis should be put on: the importance of reviewing and re-modelling regularly; on considering the costs of care in the round, including factoring-in savings which might be accrued elsewhere (e.g. savings in the costs of education because of the falling birthrate); and the importance of " mainstreaming" FPNC; and
(h) The factors of uncertainty which might be taken into account in modelling the future costs of long-term care should be explained in more detail in the chapter on the cost of long-term care in Scotland.
10. The Review Group agreed that Rhona should take on board the comments offered and provide a full draft of the report to its next meeting in 2 weeks time. ( Action: Rhona)
Presentation and Publication of the Final Report
11. Lord Sutherland said he had been giving some thought to the options on presentation and publication of the Review Group's final report to Ministers, including the timing. The Group was obliged to report to Ministers by the end of March. Timing considerations would obviously need to take account of the work in progress and time still needed to finalise conclusions and the overall shape of the report but the aim at the moment was to publish and hold a news conference in the last week of March.
12. Rhona said that a dedicated Senior Communications Officer had now been identified to support the Review in its final stages and would be preparing an options paper with detailed proposals on presentation and publication for Lord Sutherland's consideration over the next few weeks. She should also handle any media enquiries in relation to the review, in the run up to and at the time of publication. Media interest was likely to be high and the subject matter complex. Also, the report was being published against a background of past mis-understanding about the policy, so some careful communications planning was required. The Review Group noted the position.
Independent Funding Review of Free Personal & Nursing Care
Secretariat
March 2008