MIDDLESBROUGH COUNCIL

EXECUTIVE REPORT

Review of the Care Link / Telecare Service

Executive Member for Adult Social Care: Barry Coppinger

Director for Adult Social Care and Environment: Mike Robinson

24th April 2012

PURPOSE OF THE REPORT

  1. To seek Executive approval to a number of changes to the Care Link Service following a period of public consultation.
SUMMARY OF RECOMMENDATIONS
  1. That Executive approves the following:

a) That there should be a single service charge for the Care Link service of £3.99 per week.

b) That telephone calls and visits are no longer provided and the service provides only monitoring and response.

c) That a full subsidy is provided for all people in receipt of pension credit – guarantee credit.

d) That transitional funding is provided for two years for current claimants receiving Care Link free of charge due to their housing situation.

e) That where additional telecare sensors are provided as part of a Social Care package of support the charge paid by an individual will be determined by the Council’s Adult Social Care Fairer Charging process.

f) There is a service option introduced to purchase a keysafe at a one off charge.

g) That the keyholding charge be £30.00 per annum with the option to spread payments.

IF THIS IS A KEY DECISION WHICH KEY DECISION TEST APPLIES?

3. / It is over the financial threshold (£75,000)
It has a significant impact on 2 or more wards / x
Non Key

DECISION IMPLEMENTATION DEADLINE

  1. For the purposes of the scrutiny call in procedure this report is

Non-urgent / x
Urgent report

BACKGROUND AND EXTERNAL CONSULTATION

  1. Care Link is a 24hr 365 day a year service delivered to over 3600 people. It provides a response when alarms within peoples homes are activated. The response is provided by the Care Link contact centre which assesses whether a physical response is required. Physical responses can include the Care Link response team, emergency services or family and friends.
  1. Telecare is additional sensors in people’s homes such as smoke, gas, bed sensors which alert the contact centre when activated and provide additional support and protection for the most vulnerable and those with health conditions.
  1. The Adult Social Care Scrutiny Panel conducted an investigation of the Care Link / Telecare service and in February 2011 and recommended that:-
  • An optimum pricing strategy for increasing take up of the Care Link service and Telecare by an additional 1500-2000 service users over the next 2/3 year period should be developed.
  • The Council review options for the future funding and structure of the Care Link service to ensure its continued viability.
  1. The Care Link service is currently provided free to approximately 2166 people living in social rented accommodation in receipt of housing benefit, this was historically funded by the ringfened Supporting People grant, which is now mainstream funding. The current Supporting People contribution to the Care Link service is £406,149 per annum.
  1. The primary beneficiaries of the Care Link service are older people. Those older people least able to pay for the Care Link service are those who receive Pension Credit – Guaranteed Credit, which is a benefit for those in most financial hardship.
  1. In November 2011, Executive approved the recommendation to proceed to formal consultation on proposed changes to the Care Link service including charges.

The proposed changes consulted upon where:-

a) Whether there should be a single service charge of £3.99 per week for everyone. This would be monitor and response service only. Telephone calls and visits would no longer be available.

b) Whether a contribution of £1.50 to help meet the costs of the service should be provided for

  • People aged 70 and over
  • People over 60 who currently have their service funded by Supporting People

c) Whether the service should be provided free of charge to people who meet social care eligibility criteria at the critical level and people who are over 70 and in receipt of Pension Credit - Guarantee Credit.

d) Whether the charge for the key holding service should be increased to £30.00 per year. In addition, that an additional option to purchase a key safe at a one off cost including installation should be provided.

  1. A comprehensive consultation exercise was undertaken, the outcome of which is summarised below. 1624 individual responses were received, a 44% response rate. The questionnaire and information sheets which detail the proposals that were consulted on are attached at Appendix 1 & 2, the headline findings and the age, gender, race and demographic breakdown of respondents at Appendix 3 and a representative sample of individual comments are attached at Appendix 4.

IMPACT ASSESSMENT (IA)

  1. The findings of the Equality Impact assessment are summarised in this report.
  1. A stage one Equality Impact Assessment indicated that amendments would be required to the proposals as they disadvantaged some groups in particular:
  • People aged under 70 who were in receipt of Pension Credit – Guarantee Credit.
  • Social Care Users who were assessed as meeting the “substantial” eligibility criteria.
  1. As a result the proposals were amended to allow for:-
  • Any person in receipt of Pension Credit – Guarantee Credit to qualify for a subsidy.
  • Any individual qualifying for Social Care support (substantial or critical level) to be able to have the service funded as part of their Social Care Package if the provision of Telecare was evidenced to meet their needs.
  1. Those people meeting the FACS criteria at both substantial and critical level assessed as requiring telecare would be subject to financial assessment in line with the Council’s Fairer Charging Policy would pay according to their means.
  1. A stage two Equality Impact Assessment identified that the amended proposals, mitigated the impact on the age and disability characteristics.

OPTION APPRAISAL/RISK ASSESSMENT

  1. Outlined below is a summary of the consultation proposals and responses.
  1. A single service charge of £3.99 per week for everyone, for a monitor and response service only.
  • 75% of responses received through the consultation portal either strongly agreed or agreed with the proposal for a single charge regardless of housing situation.
  • 58.34% strongly agreed or agreed with the proposal to become a monitor and response service only.
  • The majority of people in all groups either agree or strongly agree that the charges for the service should be the same regardless of housing situation and that the service becomes a monitoring and response only service.

It is therefore recommended that this proposal is implemented.

  1. A number of people (38%) who currently receive their service free have indicated that they may not continue with the service if this proposal is implemented. Analysis has shown that the majority of these people do not need the service and historically received it as part of their housing package. The reduction in service user numbers will have an initial impact on service funding, that has been factored into the financial calculations.
  1. Whether financial help with meeting the costs of the service should be provided for
  • People aged 70 and over
  • People over 60 who currently have their service funded by Supporting People
  • People over 70 in receipt of Pension Credit –Guarantee Credit.
  • People assessed by Adult Social Care as critical

The responses identified that this proposal received significant support with over 75% of responses in support of the provision of financial assistance. However the Equality Impact assessment has resulted in some amendments to the original subsidy proposal. Given the strong support from the consultation subsidy has been provided on amore equal basis:

  • Service free to individuals in receipt of Pension Credit Guarantee Credit – i.e those in the greatest financial hardship
  • Time limited transition subsidy for those currently receiving the service free. It is therefore recommended that a transitional subsidy of £1.50 in year one and £0.75 in year two is provided.
  1. Again as a result of the impact assessment subsidy could not be provided to those assessed as critical only. Where people with substantial or critical needs are assessed as requiring Telecare sensors they will have a financial assessment in line with the Adult Social Care Fairer Charging Policy and pay according to their means.
  1. Whether the charge for the key holding service should be increased to £30.00 per year. And an additional option to purchase a key safe at a one off cost including installation should be provided.
  1. The current charge is 30p per week, over 1,500 keys are held. The responses highlighted that the majority of clients would make their own arrangements, just over 15% of the respondents would opt for a keysafe, the majority of which would purchase one from the Council. It is therefore recommended that this becomes a service option.
  1. Comments received during the consultation suggest that many people may find it difficult to pay a yearly charge of £30.00. We have listened to these concerns and recommend that the keyholding charge be £30.00 with the option to spread payments.

FINANCIAL, LEGAL AND WARD IMPLICATIONS

Financial
  1. The current Care Link Service creates a surplus of some £147,200 within the Social Care budget, however this is £95,500 less than budgeted. The proposals seek to bring the service to at least the budgeted levels. It is expected there will be an initial significant reduction in numbers, due to fall out from Supporting People claimants, however a targeted growth rate of 1300 clients is in place as part of a marketing drive to attract new claimants. A growth in paying members is therefore anticipated that will address the shortfall by 2013/14.
  1. Supporting People Funds currently pay for up to 2635 people to receive the service at a budgeted cost of £437,000. The proposals include a transitional arrangement for existing Supporting People claimants for the first two years, the costs of this in 2012/12 is £60k and £30k in 13/14. A drop out rate based on the consultation responses has been assumed in this calculation. The Supporting People fund however will continue with its current budget for the Care Link service of £437k for the next two years to alleviate pressures caused by the change in the Supporting People policy. This will facilitate time for a full marketing strategy to be fully implemented; however as numbers of paying customers increase, savings will be made. Through successful implementation of the marketing strategy it is projected by 2014/15 the Supporting People investment will be reduced to £364k, a saving of £73k. Supporting People will continue to offer financial support for those older people most in hardship through the provision of a full subsidy for those in receipt of pension credit –guarantee credit, however the budget will be capped at £364k.
  1. Furthermore in the interim, one-off PCT funding of £75,000 has been secured to address the funding gap in 2012/13. The price change does impact upon Fairer Charging income, a loss of £14k per annum. The Supporting People fund can address the gap in the short term, however as individuals will pay a lower contribution the number of assessed clients is projected to increase.
  1. Currently capital funding is available to fund the Telecare equipment for 2012/13, however the change in charging policy will encourage more users of Telecare placing additional burdens on the capital fund. Further consideration for capital resources or potential policy changes will be required to fund the telecare equipment post 2012/13.
  1. The Supporting People fund, and the PCT income will result in no projected impact on the Care Link budget, however savings are projected from 2014/15 onwards.

Ward Implications

  1. The proposals will make the service more accessible to potential customers from all Wards.

Legal Implications

  1. There are no legal implications.

SCRUTINY CONSULTATION

  1. Scrutiny recommended a review of the Care Link service including charges in 2011.
RECOMMENDATIONS
  1. That Executive approve the following recommendations:

a) That there should be a single service charge for the Care Link service of £3.99 per week.

b) That telephone calls and visits are no longer provided and the service provides only monitoring and response.

c) That a full subsidy is provided for all people in receipt of pension credit – guarantee credit.

d) That transitional funding is provided for two years for current claimants receiving Care Link free of charge due to their housing situation.

e) That where Telecare is provided as part of a Social Care package of support the charge will be determined by the Council’s Fairer Charging process.

f) There is a service option introduced to purchase a keysafe at a one off charge.

g) That the keyholding charge be £30.00 per annum with the option to spread payments.

REASONS
  1. The proposals provide a simple, fair and equitable charging structure for Care Link and Telecare enabling planning for future business growth and development.
BACKGROUND PAPERS

Social Care Scrutiny Panel Report - 13th January 2011

AUTHOR: Tony Parkinson

TEL NO: 729458

______

Address: 3rd Floor, Civic Centre

Website: http://www.middlesbrough.gov.uk

1