Commissioning Community Care Services for Older People
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Commissioning community care services for older people Prepared for the Accounts Commission and the Auditor General for Scotland July 2004 Commissioning community care services for older people Prepared by Audit Scotland on behalf of the Accounts Commission and the Auditor General. The Accounts Commission The Accounts Commission is a statutory, independent body, which through, the audit process, assists local authorities in Scotland to achieve the highest standards of financial stewardship and the economic, efficient and effective use of their resources. The Commission has five main responsibilities: • securing the external audit • following up issues of concern identified through the audit, to ensure satisfactory resolutions • reviewing the management arrangements which audited bodies have in place to achieve value for money • carrying out national value for money studies to improve economy, efficiency and effectiveness in local government • issuing an annual direction to local authorities which sets out the range of performance information which they are required to publish. The Commission secures the audit of 32 councils and 34 joint boards (including police and fire services). Local authorities spend over £9 billion of public funds a year. Auditor General for Scotland The Auditor General for Scotland is the Parliament’s watchdog for ensuring propriety and value for money in the spending of public funds. He is responsible for investigating whether public spending bodies achieve the best possible value for money and adhere to the highest standards of financial management. He is independent and not subject to the control of any member of the Scottish Executive or the Parliament. The Auditor General is responsible for securing the audit of the Scottish Executive and most other public sector bodies except local authorities and fire and police boards. The following bodies fall within the remit of the Auditor General: • departments of the Scottish Executive eg the Health Department • executive agencies eg the Prison Service, Historic Scotland • NHS boards • further education colleges • Scottish Water • NDPBs and others eg Scottish Enterprise. Acknowledgements Audit Scotland gratefully acknowledges the support from councils in devoting time and contributing to the study. We are also grateful those who commented on drafts of this report and to councils’ external auditors for their contribution to this study. Thanks also go to staff in the Scottish Executive Health Department’s Social Work Statistics Branch for providing analyses of national data. Jane Kennedy managed the study, under the general direction of Angela Canning. Andrew Reid provided consultancy services. Audit Scotland is a statutory body set up in April 2000 under the Public Finance and Accountability (Scotland) Act 2000. It provides services to the Auditor General for Scotland and the Accounts Commission. Together they ensure that the Scottish Executive and public sector bodies in Scotland are held to account for the proper, efficient and effective use of public funds. 1 Contents Part 1. Introduction Summary of recommendations Page 2 Page 35 Background Appendix 1: Summary of Our study information collected and used Page 3 by councils Page 36 Study methodology Page 4 Appendix 2: Definitions of best value terms Part 2. Community care services Page 38 for older people Population projections Appendix 3: JPIAF indicators Page 5 Page 39 Balance of care Page 7 Community care policies Page 9 Part 3. Planning for commissioning Assessing need Page 18 Consulting older people and their carers Page 19 Part 4. Commissioning Contracting services Page 23 Part 5. Reviewing performance Monitoring waiting times and lists Page 28 Best value reviews Page 29 Reviewing joint working Page 31 2 Part 1. Introduction The environment for providing community care services to older people is challenging. Part 1. Introduction 3 with the introduction of free personal “Our aim is clear. Care delivered care, direct payments and rapid • Councils and their NHS partners 2 at home, not just in care homes. response services. need to plan now for the likely A fundamental shift in increase in demand for emphasis in community care. 3. Councils have to consider the community care services for Care based on individuals sustainability of the care services older people and the expected receiving continuous support they commission for older people. shortage of carers. that reflects their changing Not only do services have to meet circumstances – but also the needs of individuals now, they • There has been some shift in reflects their rights, their also have to be commissioned with the balance of care for older feelings, their homes and their the future needs of the older people from care home families.” population in mind. Councils and their provision to more intensive care (Deputy Minister for Health and partners therefore need to know packages delivered in their own 1 Community Care, 2000) what type and level of services they homes. must have in place now for their local older population, what services they • The Scottish Executive needs to Background will need to meet the needs of older ensure it collects information people in the future, and then jointly about the implementation of 1. As people get older their health plan how to work towards meeting policy. This is essential to may deteriorate and they may future capacity. enable the impact of its policies become more frail. Living to be monitored and evaluated. independently can then become 4. Spending on community care difficult. Many older people depend services for older people in Scotland • Almost every council has a 3 on support provided or organised by was around £558 million in 2001/02. waiting list for care home places their council and its local partners to This represents about 64% of and two-thirds have one for help them live in their own homes. total community care expenditure home care. But monitoring how This can be anything from help with (£876 million) and about 41% of total long older people wait for getting dressed and washing, to expenditure on social work services services to be provided is patchy 4 cooking meals, shopping and taking (£1.3 billion). It is difficult to quantify and inconsistent. medication. Often this support is health expenditure as older people bought from the voluntary or private use services across the NHS both in • Councils and their partners need sectors rather than provided directly the community and in hospitals. to use the information they have by a statutory body like a council or on older people’s needs when the NHS. Councils and their partners Our study planning services. The balance also provide support services aimed of contracts needs to support at preventing older people being 5. This report sets out the findings of strategic planning to ensure admitted to hospital or remaining in our national review of how councils value for money and the hospital longer than necessary. commission community care sustainability of services. services for older people in 2. Current community care policy partnership with the NHS (aged 65 promotes independent living for older and over). The key messages from 6. Our review follows up the people. Councils are encouraged to our review are: Accounts Commission self- work with their partners to provide assessment handbook on services to older people in or close to commissioning services for older 5 their own homes, and to move away people. We focused on councils as from an over-reliance on care homes. they have the lead role in planning Policies to support this balance of community care services for older care in favour of more care at home people. Recognising the increasing have increased in the last five years involvement of health bodies in this 1 Scottish Executive news release SE2645/2000, October 5 2000. 2 Rapid response services are multi-disciplinary teams which work to support older people either to stay out of hospital after a fall or illness or to support their discharge from hospital as soon as possible after they are well enough to leave. For further information see www.scotland.gov.uk/health/jointfutureunit 3 This is an estimate because national statistics on expenditure do not provide an overall figure for expenditure on older people’s services. 4 Scottish Community Care Statistics 2002, Scottish Executive, 2003. These figures relate to net expenditure. 5 Commissioning community care services for older people: applying a best value framework, Accounts Commission, 2000. 4 role, through community planning Reviewing performance and the Joint Future Agenda, we In order to meet the needs of older also comment on how councils are people, service performance should working with their local health be monitored and reviewed, and partners when considering future changes made where necessary. demand, capacity and models of service delivery. Part 5 looks at waiting times for community care services, best value 7. We looked at the performance of reviews and ways in which service all 32 Scottish councils in three key performance is monitored. We also elements of commissioning: look at how councils and their partners are working together to Planning manage community care services for To plan community care services older people. effectively, councils need to know the needs and expectations of older Study methodology 6 people and their carers, and involve them in the planning process. Each 8. The review was developed and led council should also be aware of its by a team from Audit Scotland’s current levels of unmet need and the Performance Audit Group. We potential future needs and collected data from 32 councils about expectations of older people. This how they commission services. should be undertaken jointly with Councils’ external auditors then local health partners. validated these data through interviews with key council staff and We looked at the information reviewing local documentation. councils gather on their older service users and the older population in 9.