Select Committee on Health Memoranda

Memorandum by the Department of Health (continued)




  Derek Kirton, Kate Ogilvie and Jeni Beecham, University of Kent at Canterbury

  44.  The principal aim of the project is to explore in-depth the relationship between remuneration and other resources available to foster carers and the performance of fostering services. The context is set by the very wide variations in levels and systems of payment for foster carers, and differences of philosophy, ie whether foster care should be seen as an essentially voluntary activity or a job. Equally important is the perceived crisis in foster care, of recruitment and retention, placement breakdowns, and failure to meet children's needs, in education or preparation for leaving care.

  45.  The research seeks to explore different patterns of resource allocation (with particular reference to remuneration) from the perspective of carers, workers and managers and their relationship to key performance indicators for fostering services.

  46.  The research is taking place over two stages:

  Stage 1:  analysis of remuneration and performance data on foster care from all local authorities in England to identify links at the "macro" level.

  Stage 2:  detailed investigation to take place in 20 agencies (to include 3-4 independent fostering agencies), comprising:

    —  data on agency performance indicators

    —  semi-structured interviews with service managers

    —  focus group discussions with family placement workers and foster carers

    —  questionnaire for foster carers (sample c. 2000).

  Start date: September 1999

  End date: August 2002



  Jeni Beecham and Andrew Bebbington, University of Kent at Canterbury

  47.  Understanding child care costs has become increasingly important. Local issues include pressure to contain costs and the introduction of quasi-market delivery systems. At the national level there are concerns about the rising costs of child care, local authorities' different levels of spending and the costs associated with supporting children who are not formally looked after. More appropriate information could provide a better evidence base for both policy and practice decisions. The new Children in Need Data Collection has the potential to aid our understanding of child care costs as it contains integrated information on the characteristics and needs of all children who are seen by the social services department, the service responses and their associated costs.

  48.  The study builds on previous research at the PSSRU on variations in unit costs and work with the social services departments who participated in the Children in Need pilot. We are using data generated by the Children in Need Collection to contribute to improving the efficiency in the delivery of services by providing a better understanding of variations in child care costs. The study involves preliminary analyses of the first data set in the summer 2000 and then a fuller analysis in 2001, supported by data drawn in from other sources and information from interviews in a sub-sample of local authorities. (Phase I June/July 2000; Phase II June 2001—May 2002).

  Start date: June 2000

  End date: May 2002

Table 1



  49.  A brief description of the projects follows. This is intended to be purely descriptive of objectives and approach, rather than analytical of the findings or conclusions.


  50.  This project focuses on a primary care based intervention with informal carers of people with dementia. In particular, the project considers whether low-level early intervention is successful in preventing crisis, or whether it serves to increase the recognition of problems and needs and leads to an earlier breakdown of care at home. The project has compared a group of carers receiving an intervention package from a specially trained worker, with a control group receiving the usual pattern of care available.


  51.  The study focuses on different homes care services in the independent and public sectors, and explores criteria against which performance can be measured, and variation explained. Research was conducted in four northern authorities and employed both quantitative and qualitative methodologies. The study describes the problems which are found in the organisation and delivery of home care and considers different staff and organisational influences on service performance.


  52.  The primary objective of this project is to evaluate the ability of a new assessment instrument (the Minimum Date Set Home Care—MDS-HC) to capture the outcomes of social care from routine assessment information. The assessment instrument has been used in a randomised controlled trial, compared with current community care assessment instruments. The study is concerned with the extent to which an assessment instrument in routine use can detect measurable change in key domains of survival; accommodation; activities of daily living; cognitive and social functioning; mood and carer burden.


  53.  The project is developing a broad measure across a few key social care domains (food and nutrition; personal care; social participation; safety, and control over daily living). In each domain, the instrument is used to assess level of unmet need, informal/formal support, and level of need in absence of intervention. Later stages of the project involved establishing the relative importance of different domains to older people, and allocating appropriate weightings.


  54.  This study focuses on whether the promotion of closer working relationships between front line practitioners in social services, primary care and community health services offers better outcomes for service users and their carers. The research compares two different models of collaboration between social services and primary care, and compares their costs and outcomes.


  55.  Focusing on residential services (staffed houses) for people with learning disabilities, this study addresses the measurement of quality of life using both objective and subjective measures, and to explore the relationships between these measures. The study also investigates variation between different types of service provider. Three key quality of life domains are assessed: choice and control; constructive activity; and social and community affiliation.


  56.  This project involved the implementation of a Goal Attainment Scaling (GAS) system. GAS involves the setting of goals with individual service users and/or their main carers; the development of a five point scale against which outcomes can be measured, and using this scale to provide a score for goal attainment. These scores can be aggregated and used to monitor and evaluate service performance in achieving outcomes with users of the service. The objective is to incorporate GAS within routine community care paperwork and systems.


  57.  The purpose of this project is to develop instruments which will measure outcomes from the perspective of service users and carers, with a focus on self-assessment. The instruments explore a number of different domains of life and services. It is intended that the instruments should enable service users and carers to inform health and care workers of their social function and outcomes from their perspective. The approach should contribute to and be a component of care management and care plans.


  58.  This study is looking at the outcomes and costs of care in the community for people with learning disabilities and mental health difficulties 10 years into a process of de-institutionalisation and the development of community care. The project allows a longitudinal evaluation using original instrumentation for comparisons over time, but also developing new measure to ensure comparisons with wider research evidence. The project has developed some innovative approaches to communication in user interviews.


  59.  Detoxification services have tended to be evaluated solely in clinical terms. This project looks at wider costs and benefits and offers an audit tool for use in service planning and measuring the indirect cost-benefits. The original intention of the study was to compare the service with a non-treatment seeking control group. This was not practical, and the study in fact compares two different types of detox services.


  60.  Using detailed analysis of three nationally representative data sets, the research relates outcomes for carers to the timing and duration of care giving episodes within the life course. Longitudinal analysis of data sets allows a better and more detailed understanding of the dynamics of providing care, and an exploration of the impact of past care episodes on current circumstances. The impact on carers' health, employment and pension arrangements, are all examined.


  61.  This study investigates the impact of the Carers (Recognition and Services) Act, 1995 in terms of changes in local policy and practice, and from the perspective of a sample of carers who have received an assessment under the Act. The effect on carers has been evaluated in terms of increased service provision; tailoring of services to needs; and improved quality of life.


  62.  This project differs from the other twelve in its approach and methodology. Rather than involving new research, this project provides a systematic review which identifies and synthesises research evidence on effectiveness and outcomes in two main areas. These are: rehabilitation for people with severe and enduring mental illness, and preventive services for older people. A further report offers reflections on the feasibility of undertaking systematic reviews in social care.

  63.  Alongside the 13 OSCA projects, a related programme of work on outcomes was commissioned from the Social Policy Research Unit at the University of York. Throughout the co-ordination of the OSCA programme this parallel work was also included.


  64.  The SPRU programme has focused on developing and testing practical ways in which purchasers and providers can obtain feedback on outcomes, and using outcome information in routine activity. Interviews and focus group work with users and carers, with front line staff and service managers, have been used to identify different types of outcome related to continuing quality of life; time limited change; and the quality of the service process.




  65.  From its establishment in 1974 at the University of Kent at Canterbury, the PSSRU has undertaken a considerable volume of analysis and research aimed at the improvement of equity and efficiency in social care (and increasingly also in health care). The move to three branches—continuing at Kent, together with new developments at the University of Manchester and the London School of Economics and Political Science—has allowed the Unit to build new institutional links and develop new empirical bases while continuing its research and analysis programmes.

  66.  The logic of the transition to a three-branch Unit, which was strongly encouraged by the Department of Health, reflects a broadening of research scope and, in particular, the desire to build research alliances with other disciplines and groups. Closer links have been built with medical, health service and policy research, and empirical studies have been conducted over a wide geographical area. The Unit is also well positioned to undertake multi-centre research studies. The proposed programme builds on the strengths and expertise of current unit members and we would also see investment in training and development as an integral part of the process of delivering the work, in accordance with the Investors in People accreditation achieved by the Kent and Manchester branches.

Fields of study

  67.  The PSSRU forward programme of research is primarily concerned with studies of equity and efficiency in the organisation, financing and delivery of social and health care; with a particular focus on the definition and measurement of costs, outcomes and needs-related characteristics of users, the links between them, and how they can be improved.

Forward programme

  68.  This document sets out the forward programme proposals for PSSRU for the period beginning January 2001. These are outline proposals, and are likely to be subject to development and change in the light of Department of Health priorities and PSSRU capabilities. This is a working document and will form a platform for more detailed proposals.

  69.  As a preface to these forward programme proposals, we briefly describe here the activities at each of these three Unit branches.

University of Kent at Canterbury

  70.  Organisationally, the Kent branch is linked to the School of Social Policy, Sociology and Social Research, which has consistently achieved a high rating in the HECFE Research Assessment Exercises. Staff in the Kent branch undertake collaborative research locally, nationally and internationally. The research programme at Kent links programmes to inform and create fresh ideas for the new policy agenda. There is an emphasis on quantitative research, building on a unique range of data sources.

  71.  The proposed new programmes address policy issues relevant to social and community health care for both adults and children, including: performance assessment, inter-relationships between costs, quality, standards and outcomes; effectiveness in a variety of care settings, including intermediate care; and planning on the basis of need. Proposed research programmes to be undertaken at Kent (in some cases, jointly with other branches) include:

    —  Community Care Reform: UK and International;

    —  Costs and Outcomes;

    —  Economics of Child Social Care;

    —  Evaluating Community Care of Elderly People;

    —  Needs-Based Planning; and

    —  Roles, Quality and Costs of Care Homes.

London School of Economics and Political Science

  72.  The LSE branch of the Unit was established in January 1996 and is now part of LSE Health and Social Care in the Department of Social Policy. The Department was awarded the highest rating for social policy in the UK in the 1996 RAE assessment. Close working links have also been forged with the Centre for Civil Society and the Centre for the Analysis of Social Exclusion (both at LSE), the Centre for the Economics of Mental Health (Institute of Psychiatry) and the Nuffield Institute for Health (University of Leeds).

  73.  The future research programme at LSE would be pursued within this developing context, building on accumulated experience in a number of policy areas. Among these areas are: relationships between costs, needs and outcomes; measurement and promotion of performance; commissioning, competition and partnerships in social care "markets"; motivations and behaviour in the "mixed economy" of care; long-term care financing; economic and policy analysis in mental health care; and the voluntary or non-profit sector. Proposed research programmes at LSE (in some cases, jointly with other branches) include:

    —  Community Care Reform: UK and International;

    —  Competition and Performance (Mixed Economy of Care);

    —  Evaluating Community Care of Elderly People;

    —  Long-Term Care Finance; and

    —  Mental Health Economics and Policy.

University of Manchester

  74.  The Manchester branch of PSSRU, founded in 1996, is integrated into the Faculty of Medicine, Dentistry, Nursing and Pharmacy. The unit has received strong backing financially and organisationally from the University of Manchester in the development of its infrastructure. The unit has particularly close links in the University with the Departments of Old Age Psychiatry, Geriatric Medicine and Nursing, as well as Social Policy and Social Work, and is developing links with other relevant groups, such as the Health Services Management Unit and the University of Manchester's newly formed Institute of Health Sciences. The latter aims to bring together major groups at the University engaged in health sciences research. As a consequence of these links the unit is very well placed to tackle issues relating to the health/social care interface.

  75.  The future programme at Manchester is specifically designed to reflect and respond to the new policy agenda in relation to the key themes of integration and partnerships, more consistent and effective services, and improvement of service delivery, performance and efficiency. It is designed to build upon and develop from the substantial investment in the area of co-ordinated care, service integration, assessment and care management, and performance measurement undertaken by the research team. There are two interlinked programmes of activity:

    —  Assessment, Performance Measurement and User Satisfaction in Older People's Services; and

    —  Coordinated Care, Care Management, Service Integration and Partnerships.


Background and research problem

  76.  Two of the major themes running through social care policy are performance assessment and the commissioning of quality provision. Modernising Social Services sets national objectives, including the goal "to plan, commission, purchase and monitor an adequate supply of appropriate, cost-effective and safe social services for those eligible for local authority support" (p.111). Other policy proposals are pertinent. The Performance Assessment Framework (PAF), as described in A New Approach to Social Services Performance, and the "best value" initiative, as launched by the White Paper Modern Local Government: In Touch With The People, set challenging agenda for social care services.

  77.  Well-tempered commissioning is clearly going to be fundamental to the achievement of these goals, and will make a central contribution to the improvement of performance. As defined in Modernising Social Services, commissioning comprises needs analysis, strategic planning, contract setting/market management and contract monitoring. Our work to date suggests that commissioning does have a significant impact on the shaping of local social care markets, cost containment, and the promotion of quality care, but that the relationships are complex. Local authorities have been prepared to develop commissioning. What is now evident is a willingness to introduce new commissioning arrangements which have the potential to achieve more rapidly and successfully the broad national and local policy objectives set for social care.

  78.  At the same time, social care delivery is more dependent than it has been for perhaps 50 years on private and voluntary sector providers. Those providers have themselves been developing, as they learn to adapt to new patterns of association with, and dependence on local authority purchasers. They are also having to adapt to new generic labour market regulations, while operating under conditions of unsettling uncertainty about what is expected from them under the new regulatory regimes. The managed and intensively regulated markets of the early 2000s will be very different from the relatively "hands-off" environment of the 1990s. The provider side of the social care market will likely transform dramatically. Many of the small businesses which have traditionally dominated the field could be forced out by economic pressures and demanding quality standards, while contractual and regulatory burdens erode much of the autonomy and control over their own affairs which attracted them to this field in the first place. "Corporate" providers, in both the private and voluntary sectors, look set to consolidate powerful positions.

Policy questions to be addressed

  79.  The aim of the Commissioning and Performance Programme (C&PP), formerly known as the Mixed Economy of Care Programme, is to evaluate how different commissioning approaches, and different commissioned services, can enhance the performance of social care services in delivering quality care and improving user quality of life. We propose to explore the details of commissioning, and its relationship to performance, in the context of a better understanding of the motivations and behaviour of providers.

  The new programme would comprise five specific components:

    —  first, to paint a comprehensive picture of social care commissioning arrangements employed by English local authorities, especially in relation to services for older people, and the links with health care commissioning. Descriptions of commissioning to date have been limited to small samples of authorities; we aim instead to collect data nationally.

    —  to analyse the relationships between commissioning arrangements and performance, as measured by the performance indicators of the PAF, and other measures to be developed. This evaluation would be conducted at the level of the local authority, thus complementing our previous work at the "transaction" level.

    —  third, to cost different commissioning arrangements and assess the benefits for different stakeholders of improvements as measured by the performance indicators. This third component would thus build on the first two, and would amount to the specification of cost-outcome relationships for different commissioning strategies.

    —  to explore in detail how the motivations and behaviour of public purchasers and regulators is experienced and interpreted by providers. This must be a priority in understanding providers' (reciprocal) behaviour, and hence in understanding "performance".

    —  finally, to understand the motivations of providers. These motivations are intimately bound up with the character and quality of providers' relationships with purchasers and regulators. The rapidly changing policy and practice contexts, and particularly changing commissioning approaches and the changing structure of the provider side, mean that evidence on motivation and behaviour from the 1990s may no longer provide a sound guide to understanding the unfolding present, nor to anticipating future performance and events.

  80.  One focus for much of this work, at least in the short term, is to examine the economics of care home closures.

Research approach

  81.  As with our previous work, we will meld a range of approaches and data sources, continuing to build on other PSSRU data collections (for example, those being gathered in the Care Homes programme led by Ann Netten, and which are already being used in the Commissioning and Performance programme). We would also collect new data from commissioners and providers. A new departure would be to conduct a national data collection from all English authorities (in collaboration with appropriate national bodies).

  82.  Again, as in our current and previous work, we would build multidisciplinary conceptual structures and empirical collections, drawing on economics, social psychology, public administration, social policy and other bases. We would build upon the combination of quantitative and qualitative data-gathering strategies in our current programme. "Performance" would be defined not only in terms of the elements of the current PAF, but also so as to embrace such contributions to ultimate performance as the building of trust and social capital. A wide range of factors would need to be examined in understanding variations in performance so as to reflect the unprecedented degree to which private and voluntary providers and public authorities are now interdependent.

  83.  It is hoped that the PSSRU programme can continue to be pursued in collaboration with researchers at the Nuffield Institute for Health, University of Leeds.

Programme management and branch

  84.  This research programme is managed by Professor Martin Knapp and conducted at the LSE branch of the PSSRU.



  85.  During the previous quinquennial period, the Unit Costs programme drew together information about unit costs of a wide variety of services in a format that is transparent and easily adapted to particular circumstances. This has fed into many other programmes of research both within and outside the unit, nationally and internationally. The demand for the work is therefore both direct, for those who need information about unit costs for specific purposes, and indirect, through the results of research which has drawn on the work.

  86.  For the most part the programme has drawn on costing undertaken as part of other, unrelated studies. However, two pieces of specific costs research have been commissioned during recent years. First, a study developing a Ready Reckoner for health service staff costs has contributed to our understanding about the costs of initial training of health service professionals, and about incorporating these in unit costs in a way that reflects the expected working life of these professionals. Second, research has been undertaken into the costs of regulation under the current arrangements. Related work within the Unit has examined trends and variations in unit costs across services, and their implications for efficiency.

  87.  For the most part PSSRU studies have drawn on previously developed scales of general welfare or particular aspects of people's lives when investigating outcomes. In a new development, as part of the OSCA initiative, a project underway is developing an innovative measure of social care outcome for older people (SCOOP). This measure is designed to reflect the core objectives of social care and the preferences of older people in a way that measures such as EQ5D do for health services and the general population.

The policy questions

  88.  The current policy drives for Best Value and raising standards have as a key component the national Performance Assessment Framework (PAF) with associated Performance Indicators (PI). Ideally the PAF, together with the arrangements designed to encourage partnerships with health services, would provide incentives for authorities to improve efficiency, encourage independence and improve the quality of care provided. In order to do this PIs should include indicators of cost and outcome that together could provide clear messages about relative efficiency. In practice the initial PIs have had to be based pragmatically on data collections designed for other purposes. As a result, the initial PIs are very much proxy indicators. For example, the majority of indicators of "Effectiveness of service delivery and outcome" are focused on process, rather than the ultimate objective: outcome. In addition to measurement concerns there is a temptation to assume that variations in unit costs are explained more easily than they actually are. Over-simplistic interpretation could mean that in the drive to improve efficiency, policies adopted to reduce PIs may result in unmeasured drops in quality, while genuine efficiency gains are missed.

  89.  The drive to improve the efficiency and effectiveness of health and social care partnerships in practice raises important issues about the composition of the workforce. Any initiatives that have implications for the long-term composition of the workforce need to be evaluated in a way that reflects the costs of training and educating the relevant professionals. The work undertaken to date takes us some way towards achieving this for many health service professionals. However, there is insufficient information at present about training costs and expected working lives of social care professionals.

  90.  The programme aims to contribute to the derivation, interpretation and development of PIs and more generally improve the measurement and wider understanding of cost and outcome measures in research, policy and practice. Some of this work will be directly undertaken as part of the core programme, but where there are large scale fieldwork implications the programme will provide a base from which to seek competitive funding.

Costs research

  91.  The aims of the costs element of the programme would be to investigate:

    —  reasons for variation between areas in the proposed cost-based performance indicators and their constituent elements;

    —  trends in costs;

    —  the relationship between cost and performance;

    —  the relevance, availability and use made of cost data within local authorities as a means of monitoring efficiency, and barriers to that use;

    —  other indicators (or existing indicators) that might contribute to interpretation of cost PIs.

  92.  The programme would also:

    —  continue to provide estimated unit cost information for a wide variety of services;

    —  provide a source of information and advice on costing issues;

    —  seek funding to investigate issues such as costs of training the social care workforce and changing costs of regulation.

  93.  The work would ensure close links with the planned Economics of Child Social Care and Commissioning and Performance programmes. Links would be maintained with other bodies with interests in the area, such as the Audit Commission and other research organisations.

  94.  The annual publication Unit Costs of Health and Social Care would continue, disseminating information about unit costs from a variety of sources, identifying gaps and informing unit cost estimation. A key element in this would be to identify sources of information on the costs of intermediate care in a variety of settings.

  95.  Data that have already been gathered by the Unit (for example from the residential care surveys and MEOC) would continue to provide evidence about what we can say about expected variations in unit costs and prices.

  96.  Where information is limited, specific data collection(s) would be undertaken to investigate trends and variations in unit costs and performance indicators. It is anticipated that this would include a survey of provider organisations for home care. In these data collection(s) the aim would be to investigate causes of variation in costs and prices. These would include factors both beyond the control of the authority and those within control that are associated with both quality and efficiency, and factors affecting income as well as expenditure.

  97.  It is anticipated that data collections would include views of purchasers and providers within local and health authorities and, if possible, those receiving the services, in order to establish the degree to which the information that can be collected directly from provider organisations matches client perceptions.

Outcomes research

  98.  Specific developments depend largely on the outcome of the SCOOP project (see above), which is due to be completed early in the new core programme period.

  99.  The programme would aim to:

    —  Test out the use of the measure of outcome for social care of adults in conjunction with other fieldwork undertaken as part of the Coordinated Care programme;

    —   To seek out opportunities to contribute to performance measurement through the use of outcome measurement. For example, incorporating indicators from the SCOOP project in client satisfaction surveys undertaken by local authorities.

    —   To seek funding to develop the approach further. Potential areas to be considered are:

    —  A large scale survey to develop the utility weightings for older people;

    —  Domains of outcome and their relevant importance to different ethnic groups;

    —  Linking the measure to other utility based measures of health related quality of life.

    —  Developing a linked utility-based measure of outcome for carers.

  100.  This is clearly a very broad programme, so priorities will need to be discussed with the Department.

Programme management and branch

  101.  This research programme will be managed by Dr Ann Netten and conducted at the Kent branch of the PSSRU.

5.12  Fees and Charges

  5.12a  Could the Department update Tables 5.12 providing separate figures on residential care for each client group? Could the Department quantify the degree of variation in domiciliary charges between authorities? Could the Department provide a commentary?

  5.12b  Could the Department provide an analysis, to include chart, tables and commentary, of (i) the recent national trend in the percentage of gross expenditure on residential accommodation for older people recouped through fees and charges and (ii) the recent national trend in the percentage of gross expenditure on home care/home help for all client groups recouped through fees and charges?

  5.12c  Could the Department provide an analysis, to include chart, tables and commentary, of (i) the local authority variations in the latest year in the percentage of gross expenditure on residential accommodation for older people recouped through fees and charges and (ii) the local authority variations in the latest year in the percentage of gross expenditure on home care/home help for all client groups recouped through fees and charges?

  1.  Table 5.12.1 updates last year's information and provides separate figures on residential care for each client group. Figures 5.12.1 and 5.12.2 illustrate the recent national trends in the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges and the percentage of gross expenditure on home care/home help for all client groups recouped through sales, fees and charges.

  2.  The table shows that the percentage of gross expenditure recouped in sales, fees and charges for residential care for the elderly rose from 35 per cent in 1997-98 to 38 per cent in 1999-2000 (mainly as a result of increased use of the independent sector where councils are able to recoup a higher proportion of their recorded expenditure from charges) ; in absolute terms the amount recouped rose from £958 million in 1997-98 to £1,243 million in 1999-2000. The amount recouped for home care and home help service also rose from £129 million in 1997-98 (representing 10 per cent of gross expenditure) to £187 million (13 per cent of gross expenditure) in 1999-2000.


  3.  Figures 5.12.3 and 5.12.4 illustrate the percentage of gross expenditure recovered in charges by each local authority for home help/home care and meals on wheels services, the two main items of service provided in a domiciliary setting. Table 5.12.2 sets out in tabular form the percentage of gross expenditure on home care/ home help recouped through sales, fees and charges.

  4.  At the Local Authority level, there is a wide variation in the amounts raised in sales, fees and charges made from domiciliary provision. Local Authorities are free to decide upon the level of charges to raise on domiciliary services in the light of what it is reasonable to expect the client to pay. A wide range of charging policies are in operation ranging from flat rate charges to income-related charges. The Government believes that the scale of variation in the discretionary charging system, including the differences in how ability to pay is assessed, are unacceptable. We have considered how best to improve the system in the light of both the Royal Commission's report on the funding of long term care, and the Audit Commission's study of local authority charging practices (published as "Charging with Care" in May 2000). We took new powers through the Care Standards Act, 2000 to issue statutory guidance to councils in respect of these discretionary charging functions. On 3 January 2001, we issued for consultation draft guidance, "Fairer Charging Policies for Home Care and other non-residential Social Services". We intend to issue guidance in light of the consultation shortly. Our aim is to establish greater consistency and fairness in charging.

  5.  There are a number of instances where Local Authorities have reported that they raised no sales, fees and charges income for home care/home help services provided; at the other extreme, some authorities reported recouping in excess of 30 per cent. Such wide variability of individual authority figures points to issues of data quality and there is a risk that misreporting of data by local authorities has had an effect. The current Performance Management Framework for Best Value in Personal Social Services will help to reinforce the message to Local Authorities that it is important they report their PSS financial data accurately on the central returns.

  6.  For England as a whole, 13 per cent of the direct cost of the home care/home help service was recouped in sales, fees and charges to clients. Within authorities, the actual figures reported varied from zero in the case of five authorities to 30 per cent or more in three authorities. The middle 50 per cent of authorities had recoupment rates between 9 per cent and 17 per cent compared to rates between 8 per cent and 16 per cent for the previous year.

  7.  For meals on wheels services the overall England recoupment rate was 44 per cent: LA figures range from zero in 22 authorities to over 100 per cent in two authorities (8 authorities reported no expenditure). The middle 50 per cent of authorities had recoupment rates between 29 per cent and 64 per cent compared to rates between 35 per cent and 64 per cent for the previous year.


  8.  Figure 5.12.5 illustrates the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges. Table 5.12.3 tabulates these figures.

  9.  The charges levied to individual residents in care homes are determined nationally. The overall recoupment rate for residential provision for the elderly in England was 38 per cent. LA figures varied between 2 per cent in one authority and 59 per cent in another authority. This may again just reflect misreporting by local authorities. The middle 50 per cent of authorities had recoupment rates between 33 per cent and 44 per cent compared to rates between 31 per cent and 43 per cent for the previous year.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 17 January 2002