Department of Health / Department for Communities and Local Government Personal budgets in social care
3: The Department, with partner organisations, should carry out further analysis of existing data from the Adult Social Care Survey as well as improving the POET survey and its take-up, to
improve evidence and understanding of both how personal budgets are used and how they lead to better outcomes for users. In its response to this report, the Department should make clear its criteria and timeframe for assessing the success of personal budgets.
3.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
3.2 The Department and NHS Digital have analysed the results of the 2015-16 Adult Social Care Survey to understand how better outcomes are achieved for users to live safely and independently in their own homes, and the impact that these services have on their quality of life. The results have influenced the drafting of the questions in the 2016-17 Adult Social Care Survey35 - the results are due to be published and will contribute to the content of the Adult Social Care Outcomes Framework (due to be published by the end of 2017)
.
363.3 Using the results of the 2014-1537 and 2015-16 Adult Social Care Surveys38, the Department determined that Personal budgets improve outcomes for users by giving them choice and control and independence but there is no correlation between different types of personal budget and outcomes (including user satisfaction and the user quality of life measures, such as having more control over their daily life). In general, the user survey results were positive - in 2015-16, 90.3% of users were satisfied with the service they were receiving; of those, 64.4% were either extremely satisfied or very satisfied.
3.4 The Department funded the publication of the 2016-17 Personal Outcomes Evaluation Tool,39 as part of the work programme commissioned from Think Local Act Personal. The Personal Outcomes Evaluation Tool is focused on user experiences of services. NHS England has supported Clinical Commissioning Groups (CCGs) to use the Personal Outcomes Evaluation Tool (POET),and is currently exploring how best to monitor quality of personal health budgets in the future.
4: Committee of Public Accounts conclusion:
The Committee shares the concerns of local authorities that funding cuts and wage pressures will make it hard to fulfil their Care Act obligations.
Recommendation:
The Department should improve its knowledge and understanding of the impact of funding reductions on the adult social care sector. It should send its review of the impact of the National Living Wage to the Committee by November 2016 and report to the Committee by then on the results of its review of the Care Act, including the current requirement on local authorities to review users’ care arrangements annually.
4.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
4.2 The impact of funding reductions on the adult social care sector was considered during the Spending Review 2015 and Spring Budget 2017. Earlier this year, the Government gave councils access to £9.25 billion more dedicated funding for social care over the next three years. This includes an additional £2 billion over the next three years provided by the Government and announced at the budget in Spring 2017. £1 billion of this has been provided in 2017-18, so that councils can start to fund more care packages immediately. This funding will allow councils to support more people and sustain a diverse
4.3 During this Parliament, the Government has taken a number of steps to help ensure a strong and sustainable system of social care in England. These include introducing the adult social care precept.
Councils have the flexibility to raise income through the adult social care precept, up to 3% over the next two years and still limited to 2% in 2019-20 and at 6% overall. 147 social care authorities used some or all of the additional flexibility for adult social care in 2017-18.
4.4 The impact of the new National Living Wage on local authority finances was considered during the Spending Review 2015 and Spring Budget 2017 as part of an overall assessment of spending pressures on local authorities.
4.5 The report following the Department’s commission for a 6th Local Government Association (LGA) stocktake of local authority implementation of the Care Act in June 2016, has been published40. The analysis asked local authorities to report on the overall impact on demand for care and support services for carers since (a year after) the introduction of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It also asked carers for their views on how well local authorities were meeting their duties towards carers.
5: Committee of Public Accounts conclusion:
The fragility of the social care market in many areas is putting people at risk. There is a real threat that many care providers will not survive.
Recommendation:
The Department should be realistic about its remit as national steward of the social care market and its resources to carry out this role. It should publish its National Market Position Statement before the summer recess, through which it should clarify: what being the ‘national steward’ of the social care market means in practice; how it will assess the impact of funding cuts and restrictions on care providers; its role in workforce management; how it will promote social care as a valued career and enable career pathways through social care and health; and under what circumstances it would take action to support the care market, and in what way.
5.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
5.2 The Department has an important stewardship role for the adult social care market. This involves oversight of the system and continued engagement with local authorities and providers to ensure the market overall is sustainable and delivers improving outcomes and quality.
5.3 The Department had initially proposed developing a National Market Position Statement.
Following discussions with stakeholders, it agreed to develop an on-line Markets Hub instead.41The Hub focusses on good practice guidance and support on commissioning, market shaping and contingency planning. The Markets Hub is now available through GOV.UK and will be kept under review. More broadly, the Department continues to work with the sector to promote best practice guidance to encourage quality services, smart commissioning and protection for people with care needs.
5.4 The impact of funding reductions on the adult social care sector was considered during the Spending Review 2015 and Spring Budget 2017. One of the purposes of the additional funding provided in the Spring Budget 2017 was to support the sustainability of the care market. The Government has attached a set of conditions to the grant which are also laid out in the Integration and Better Care Fund Policy Framework 2017-19. It may only be used towards Adult Social Care needs, to reduce pressures on the NHS and, ensuring that the local social care provider market is supported.
5.5 The majority of the social care workforce (91%) are employed by private and voluntary organisations, with the remaining 9% employed by local authorities. The Department’s role in direct workforce management is focused on the regulated professions where the Department can work with regulatory bodies to ensure government policies aide the recruitment, training and retention of their required workforce.
40 http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/stocktake 41 https://www.gov.uk/government/publications/adult-social-care-market-shaping/adult-social-care-market-shaping.
3: Committee of Public Accounts conclusion:
It is not yet clear how local authorities can implement personal budgets to maximise benefits to users and more evidence is needed.
Recommendation:
3: The Department, with partner organisations, should carry out further analysis of existing data from the Adult Social Care Survey as well as improving the POET survey and its take-up, to improve evidence and understanding of both how personal budgets are used and how they lead to better outcomes for users. In its response to this report, the Department should make clear its criteria and timeframe for assessing the success of personal budgets.
3.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
3.2 The Department and NHS Digital have analysed the results of the 2015-16 Adult Social Care Survey to understand how better outcomes are achieved for users to live safely and independently in their own homes, and the impact that these services have on their quality of life. The results have influenced the drafting of the questions in the 2016-17 Adult Social Care Survey35 - the results are due to be published and will contribute to the content of the Adult Social Care Outcomes Framework (due to be published by the end of 2017)
.
363.3 Using the results of the 2014-1537 and 2015-16 Adult Social Care Surveys38, the Department determined that Personal budgets improve outcomes for users by giving them choice and control and independence but there is no correlation between different types of personal budget and outcomes (including user satisfaction and the user quality of life measures, such as having more control over their daily life). In general, the user survey results were positive - in 2015-16, 90.3% of users were satisfied with the service they were receiving; of those, 64.4% were either extremely satisfied or very satisfied.
3.4 The Department funded the publication of the 2016-17 Personal Outcomes Evaluation Tool,39 as part of the work programme commissioned from Think Local Act Personal. The Personal Outcomes Evaluation Tool is focused on user experiences of services. NHS England has supported Clinical Commissioning Groups (CCGs) to use the Personal Outcomes Evaluation Tool (POET), and is currently exploring how best to monitor quality of personal health budgets in the future.
4: Committee of Public Accounts conclusion:
The Committee shares the concerns of local authorities that funding cuts and wage pressures will make it hard to fulfil their Care Act obligations.
Recommendation:
The Department should improve its knowledge and understanding of the impact of funding reductions on the adult social care sector. It should send its review of the impact of the National Living Wage to the Committee by November 2016 and report to the Committee by then on the results of its review of the Care Act, including the current requirement on local authorities to review users’ care arrangements annually.
4.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
4.2 The impact of funding reductions on the adult social care sector was considered during the Spending Review 2015 and Spring Budget 2017. Earlier this year, the Government gave councils access to £9.25 billion more dedicated funding for social care over the next three years. This includes an additional £2 billion over the next three years provided by the Government and announced at the budget in Spring 2017. £1 billion of this has been provided in 2017-18, so that councils can start to fund more care packages immediately. This funding will allow councils to support more people and sustain a diverse
4.3 During this Parliament, the Government has taken a number of steps to help ensure a strong and sustainable system of social care in England. These include introducing the adult social care precept.
Councils have the flexibility to raise income through the adult social care precept, up to 3% over the next two years and still limited to 2% in 2019-20 and at 6% overall. 147 social care authorities used some or all of the additional flexibility for adult social care in 2017-18.
4.4 The impact of the new National Living Wage on local authority finances was considered during the Spending Review 2015 and Spring Budget 2017 as part of an overall assessment of spending pressures on local authorities.
4.5 The report following the Department’s commission for a 6th Local Government Association (LGA) stocktake of local authority implementation of the Care Act in June 2016, has been published40. The analysis asked local authorities to report on the overall impact on demand for care and support services for carers since (a year after) the introduction of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It also asked carers for their views on how well local authorities were meeting their duties towards carers.
5: Committee of Public Accounts conclusion:
The fragility of the social care market in many areas is putting people at risk. There is a real threat that many care providers will not survive.
Recommendation:
The Department should be realistic about its remit as national steward of the social care market and its resources to carry out this role. It should publish its National Market Position Statement before the summer recess, through which it should clarify: what being the ‘national steward’ of the social care market means in practice; how it will assess the impact of funding cuts and restrictions on care providers; its role in workforce management; how it will promote social care as a valued career and enable career pathways through social care and health; and under what circumstances it would take action to support the care market, and in what way.
5.1 The Government agreed with the Committee’s recommendation.
Recommendation implemented.
5.2 The Department has an important stewardship role for the adult social care market. This involves oversight of the system and continued engagement with local authorities and providers to ensure the market overall is sustainable and delivers improving outcomes and quality.
5.3 The Department had initially proposed developing a National Market Position Statement.
Following discussions with stakeholders, it agreed to develop an on-line Markets Hub instead.41The Hub focusses on good practice guidance and support on commissioning, market shaping and contingency planning. The Markets Hub is now available through GOV.UK and will be kept under review. More broadly, the Department continues to work with the sector to promote best practice guidance to encourage quality services, smart commissioning and protection for people with care needs.
5.4 The impact of funding reductions on the adult social care sector was considered during the Spending Review 2015 and Spring Budget 2017. One of the purposes of the additional funding provided in the Spring Budget 2017 was to support the sustainability of the care market. The Government has attached a set of conditions to the grant which are also laid out in the Integration and Better Care Fund Policy Framework 2017-19. It may only be used towards Adult Social Care needs, to reduce pressures on the NHS and, ensuring that the local social care provider market is supported.
5.5 The majority of the social care workforce (91%) are employed by private and voluntary organisations, with the remaining 9% employed by local authorities. The Department’s role in direct workforce management is focused on the regulated professions where the Department can work with regulatory bodies to ensure government policies aide the recruitment, training and retention of their required workforce.
40 http://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/stocktake 41 https://www.gov.uk/government/publications/adult-social-care-market-shaping/adult-social-care-market-shaping.
5.6 The Department funds Skills for Care to provide practical tools and support to help adult social care organisations and individual employers in England recruit, develop and lead their workforce. This includes the Think Care Careers website42 and information on apprenticeships, the national graduate management training scheme and information promoting social care career pathways and opportunities.
6: Committee of Public Accounts conclusion:
The health sector faces an even greater challenge in rolling out personal health budgets and integrated health and social care budgets than the social care sector did in rolling out personal budgets in social care.
Recommendation:
The Department should put in place a robust regime to monitor the effectiveness of personal health budgets and of integrated health and social care budgets as it rolls them out, applying relevant lessons from the rolling out of adult social care personal budgets.
6.1 The Government agreed with the Committee‘s recommendation.
Target implementation date: Spring 2019.
6.2. The NHS is undertaking a significant shift towards personalisation, which is at the heart of the vision of the Five Year Forward View (FYFV) and will help meet these challenges. The FYFV sets the expectation that by the end of 2018-19 the Integrated Personal Commissioning model will reach over 300,000 people and over 20,000 people will have a personal health budget in 2017-18 rising to 40,000 in 2018-19.
6.3 NHS England is supporting the roll-out of personal health budgets with a comprehensive programme of national and regional delivery support.43 Good progress is being made, with over 15,800 people benefiting from a personal health budget in 2016-17. NHS England is also exploring how to measure people’s experience of receiving a personal health budget, building on work already underway as part of the Integrated Personal Commissioning Programme (IPC Programme) evaluation.
6.4 The Department has commissioned a formal evaluation of the IPC Programme, which will report in Spring 2019. In addition, local progress in IPC areas is being monitored quarterly by the IPC programme board.
6.5 Looking at local authorities’ experience of introducing and delivering personal budgets in social care at scale has always formed a key part of NHS England’s personal health budget policy development and informed the national delivery programme and implementation on the ground. The personal health budget pilot used the framework and learning from personal budgets in social care and tested how these could improve people’s choice and control within the NHS. Examples of specific lessons learnt that have informed the development include how personal health budgets can improve people’s quality of life, well-being and feeling of well-being in control; work best when there are fewer restrictions in place around what people could spend the money on; and work best when people have choice of how to receive the budget, including the choice of a direct payment for healthcare.
8: Committee of Public Accounts conclusion:
Many users with complex and long term care needs receive money and benefits from several different sources, which is confusing for them and potentially an inefficient way to support people.
Recommendation:
The Department should write to the Committee in a year setting out the progress made in ensuring that people who qualify for different pots of money for similar or overlapping purposes can spend it in a way which represents good value for money. The Committee would also like to know from the Department how the different bodies issuing the payments are working jointly to provide a clearer, more efficient process.
8.1 The Government agreed with the Committee‘s recommendation.
Recommendation Implemented.
42 http://www.skillsforcare.org.uk/Care-careers/Think-Care-Careers
43 https://www.england.nhs.uk/healthbudgets/resources/support-professionals).
8.2 The Department has provided a range of support and guidance for local authorities on commissioning for adult social care. This includes a route map on commissioning for better outcomes.
The Integrated Personal Commissioning Programme is also developing a single robust administrative process to enable streamlined implementation of personal budgets, combining funding streams for people with the most complex needs. The Personalised Health and Care Framework44 was published in June 2017 and provides detailed advice and practical tools to support local implementation of IPC.
8.3 The Department has improved the information and advice on care and support available to the public through NHS Choices web services.45 Applications for different funding streams can also be accessed and completed online through GOV.UK. As part of the digital development of NHS Choices a redesign of the service is being undertaken over the next few years. The purpose is to provide a more transactional and individual approach to the digital services.
44 https://www.england.nhs.uk/personalised-health-and-care-framework/
45 http://www.nhs.uk/pages/home.aspx