CALDERDALE MBC
WARDS AFFECTED: ALL
8
CABINET
MONDAY 7TH DECEMBER 2009
IMPLEMENTATION OF INDIVIDUAL BUDGETS IN CALDERDALE
REPORT OF THE DIRECTOR OF ADULTS, HEALTH AND SOCIAL CARE
1.
ISSUE
1.1 On 6th April 2009 Cabinet agreed in principle to the implementation and piloting
of individual budgets, with a report to come back later in the year covering the
detailed policy and financial implications.
2.
NEED FOR DECISION
2.1
The implementation of individual budgets involves major changes to service
delivery and policy, which require Cabinet’s approval.
3.
RECOMMENDATION
3.1 Members are asked to approve:i.
The individual budget system described in this report (see paragraphs
5.1 to 5.4);
ii.
The new assessment process including a self assessment (see
paragraph 4.5);
iii.
The proposed method of calculating the individual budget using a
Resource Allocation System (RAS) based on costs of existing services
rather than points (see paragraph 4.6);
iv.
The proposed rates to be paid under cash IB’s (see paragraphs 4.10
and 4.11);
v.
Proposed changes to the way payments are made, including the use of
payment cards (see paragraph 7.2) and collecting charges by means of
net payments (see paragraph 7.3).
vi.
To receive a further report on charging for services in early New Year
(see paragraph 7.4).
4.
BACKGROUND
4.1 The principle behind individual budgets is to enable people in need of social
care to have greater control over the services they receive. Key features are:




An outcome-based assessment drawing on the individual’s contribution
through a self assessment
A transparent allocation of resources, giving individuals a clear cash or
notional sum for them to use on their care or support package
Giving individuals the ability to plan the care and support to best suits their
particular requirements
Support from a broker or advocate, family or friends, as the individual
desires.
4.2 As part of its Putting People First transformation programme, the Council is
committed to implementing individual budgets on a phased basis by April 2011,
with the following key milestones: 




Pilot Scheme – June 2009 to December 2009
Pilot evaluation and consultation October/November 2009
Cabinet report December 2009
Individual Budgets available to all new customers January/February 2010
Existing customers converted to an Individual Budget from March 2010
onwards.
4.3 In April 2009, Cabinet agreed to the piloting of individual budgets in order to
enable different approaches to be tested out and to identify the best solutions
for people in Calderdale. The Pilot Team has comprised a team manager, two
social workers and two care co-ordinators (support planners).
4.4
Assessments
4.4.1
Self assessment is a fundamental principle of Individual Budgets but it
does not remove the local authority’s legal responsibility to conduct a
full Community Care Assessment where necessary. Prior to starting the
Calderdale pilot scheme the Project Manager and the Team Manager
researched the different types of self assessment forms used by the
thirteen local authorities that participated in the national pilot scheme.
Eleven of the local authorities chose to use a form developed in
conjunction with ‘In Control’, an independent organisation that works
closely with the Department of Health. Officers developed a similar
form and then consulted with a small group of service users to refine
the form further. The feedback from service users demonstrated that
the forms were too long, too complicated and not sufficiently outcomefocused.
4.4.2
A new self assessment form has been developed, which is much easier
for service users to complete and forms part of the Community Care
Assessment. It focuses on outcomes and not on budget. Feedback
from service users in the pilot has been very good.
4.5 Resource Allocation System (RAS)
4.5.1
The majority of authorities within the national pilot scheme chose to
develop a self assessment form that would also calculate the amount of
the Individual Budget. Nationally, the Association of Directors of Adult
Social Services (ADASS) has recently published a Common Resource
Allocation Framework based on work undertaken in 18 councils.
Officers are in the process of evaluating whether the proposed
Framework will be an appropriate way forward for Calderdale (see
Section 5 below).
4.5.2
In the meantime officers have developed a system which is based on
the costs of existing services. This is transparent and easy for service
users to understand and is calculated by the social work staff as part of
their community care assessment. Using this approach, the
responsibility for the calculation of the budget lies with the social work
professional and not the service user. This ensures that it reflects the
agreed shortfalls in care identified in the assessment.
4.5.3
So far, this methodology has worked well within the pilot scheme but it
will be the responsibility of the Team Managers to ensure that
assessments are consistent when the teams start to calculate the
individual budgets. The basis on which these amounts will be
calculated is contained in paragraph 4.10.
4.6 Measuring Outcomes
4.6.1
To complete the self assessment form the service user simply needs to
circle on a score chart from 1 to 10 what they feel their needs are for
the ten outcomes which form the basis of the assessment. People can
complete the form on their own or with help from family, friends, carers
or social care staff. If they wish to expand on their needs, they can do
so, but that is their choice. More detailed information will be contained
in the Community Care Assessment which is produced by the Social
Worker. The scores translate into a chart, as below.
4.6.2
The chart is a visual tool that is personal to the service user but which
can be used for many purposes. The red blocks indicate where the
service user has the greatest need, the yellow blocks indicate a need
and the green blocks indicate no needs. This gives a clear indication of
service user’s priorities and where the individual budget should be
spent. A simple reassessment will be repeated at each review so that
progress can be effectively monitored and recorded.
4.6.3
From a service perspective we can look at individual charts or we can
group them together on an area basis, service user grouping or as a
whole. By grouping the charts together, we can use the data to
measure the effectiveness of teams in achieving service user
outcomes. It enables us to re-visit service users when outcomes are
not being met and take appropriate action. This action may be reworking the individual service user’s support plan or using aggregated
information to move resources or reshape the social care market in a
particular area to meet the changing demands of service users. It is a
tool that enables us to effectively monitor service user outcomes so that
we can make a really positive impact on their lives.
4.7 Managing Risks and Safeguarding
4.7.1
Increasing the service user’s choice and control inevitably increases
risks, which the Council needs to manage. Officers have taken care to
implement safeguards at each stage of the customer journey.
Wherever possible the processes form part of the social worker’s
assessment. However, more overt measures are being put in place,
including a risk panel which will consider safeguarding issues relating
to the individual budget. So far within the pilot there has been no need
to use the risk panel. The panel is most likely to be used if the service
user wants to employ a Personal Assistant, seen as unsuitable, if the
support plan contains a high level of risk or if there are concerns about
the individual’s capacity to manage their own services.
4.7.2
Service users will be paid in instalments. If there is evidence of
mismanagement then we can reduce this or take them off cash
payments.
4.8 Re-Structure of the Care Management Teams
4.8.1
The introduction of individual budgets across the locality teams
represents a major change in the organisational culture and the way
the services are commissioned and delivered. To support this change,
the current care management function needs to change, along with
certain job roles. It is proposed to separate the assessment and
support planning functions. This allows our professionally qualified staff
to spend more time on the assessment process, the calculation of the
budgets and working with more complex cases. The support planners
will concentrate on working with service users to develop their support
plans and broker services on their behalf. This is a ‘leaner’ process as
the support planner will be skilled to complete all tasks, where
previously some tasks may have been referred to either the direct
payments team or the brokerage service. The restructure is likely to
take place in September 2010. Under Council policy it will be necessary
to bring a further report to Cabinet once the plans are more clearly
formulated and formal consultation with the Staff Side has taken place.
4.8.2
Although the individual budget process can be more time consuming
for some service users, we do not envisage any increase in the staffing
establishment. The impact of the single point of access and the
reablement schemes will mean that fewer service users need to go
through an assessment process in the care management teams, thus
creating greater capacity. There may be some scope for efficiency
savings (See Paragraph 7.1.8).
4.9 Evaluation of pilot
4.9.1
Eighty six people have been assessed by the Individual Budgets pilot
team. The following table shows the referrals processed by the pilot
team as at the end of October.
Description
Referrals received
Cash IB paid
Virtual IB’s commissioned
Assessment complete but
support plan in progress
In the assessment stage
Ineligible for services as they
did not meet the FACS criteria
24 hour care commissioned
Low level services
commissioned
Total IBs
Actions
112
27
7
16 – all likely to lead to a
cash IB
22
6
1
7
86
4.9.2
. As part of the pilot Individual Budgets process, officers have
developed a tool to assist Social Workers in determining the correct
Fair Access to Care Services (FACS) eligibility banding. This is
embedded into the assessment process and less susceptible to
personal discretion. It also removes the current service-driven
approach to determining FACS.
4.9.3
Making the FACS process less service-driven will mean that people
can access support packages very different from those currently
available at different eligibility bands. This could have financial
implications if the support packages in the lower bands are dearer than
the existing menu of services that can be provided. This will be closely
monitored as individual budgets are mainstreamed during the coming
months.
4.9.4
The evaluation of the pilot has focussed on customer experience,
customer outcomes, the quality of the service and value for money.

The people who have received an Individual Budgets process feel
that they have been fully engaged in the process, have had the
opportunity to clearly identify the difficulties they are experiencing
and be involved in determining the solutions.

Service users like the My Outcomes document and the opportunity
it provides to articulate what they consider to be their main
difficulties and that there is a visual representation of this on the
chart.

There has been positive feedback from service users that the
process has helped them to achieve their outcomes and on review
the pilot team have found that, for most people, there has been an
improvement in their outcomes score.

The numbers of people who have received an individual budget is
currently insufficient to determine the financial impact of individual
budgets.
4.10 Proposals for calculating cash IB rates
4.10.1 Members agreed rates for calculating Direct Payments in a report to
Cabinet on 25th June 2007. It is proposed to change some of these
rates in determining entitlements under cash IBs.
4.10.2 Hourly rate
The proposed hourly rate to be paid as a cash IB is £12.00 per hour.
This rate was determined by taking into consideration the current
direct payments rate and the rate at which services can be provided.
Currently the Direct Payment rate per hour is £11.60. This includes
£1.60 per hour for holiday, sickness cover and Bank Holiday
payments. The £12.00 per hour rate is sufficient to allow payment of
the on-costs associated with employing staff, including National
Insurance and holiday pay.
The current Direct Payment rate also includes an amount of money
for set up costs; however the £12.00 will cover these costs. This will
simplify the system and make it easier for recipients of a direct
payment to manage their funds. A contingency pot is currently held
centrally for emergencies and Direct Payment recipients can request
funds to meet additional costs incurred when emergencies arise. It is
proposed that this will continue for cash IB recipients.
4.10.3 Sleepover rate
A sleepover is a service where a carer sleeps in the service user’s
home overnight. Currently, the Direct Payment rate per night is
£38.33. The cost of purchasing a sleep-in service is currently £51.78
from Calderdale Care Scheme. It is proposed that the IB rate for a
sleepover will be set at £50.00 per night
4.10.4 Waking Night rate
A waking night is a service where a carer stays in the service users
home overnight. Currently the Direct Payment rate per night is £78.99.
The cost of purchasing a Waking Night service is currently £91.84
from Calderdale Care Scheme. It is proposed that the IB waking night
rate will be set at £90.00 per night.
4.10.5 Day Service rate
Currently the Direct Payment day care rate per day is a maximum of
£70.00. This is made up of a maximum of 7 hours at £10 per hour.
However in practice many people do not require or want 7 hours per
day in lieu of day services. It is proposed that the equivalent of a day
service will be paid on an hourly basis up to a maximum of 6 hours
per day at £12 per hour, giving a maximum payment of £72 per day.
4.10.6 Respite care
The current Direct Payment scheme pays a respite rate calculated
as:

Ten hours per day at the standard hourly rate of £10.00 per hour
A sleepover paid at £38.33
This provides a payment of £138.33 per day. During the pilot a
number of options for the payment of respite care have been
considered; however, officers have been unable to reach a clear
recommendation on the best approach to take. It is proposed to bring
a further report to Cabinet with detailed proposals for a revised respite
rate along with the report on changes to charging policy in the New
Year. In the meantime we will retain the current rate
4.11 In line with national advice and case law people currently receiving direct
payments will continue with their current level of support unless their needs
are assessed to have reduced
5
OPTIONS CONSIDERED
5.1. Officers have carefully considered whether to recommend to Cabinet that the
Council moves now to mainstream the processes piloted over the past six
months or whether to delay implementation in order to have time to consider
the new national approach in the ADASS Common Resource Allocation
Framework, published in early November. It should be noted that while this is a
complete system, it is not being portrayed as a required approach or one that
will necessarily be widely adopted, but it could become the de facto national
system if sufficient councils decide to adopt it.
5.2. The main benefits of proceeding with our current processes and documentation
are: 
We are at an advanced stage of developing the documentation,
procedures and ICT systems to support these processes.

They have been fully piloted and will work.

Staff, service users and stakeholders are now geared up to
implementation and mainstreaming of individual budgets from January
2010. Changing to the national system will require a delay of at least 3
months and we will lose the momentum for change that has been built up.

Our LAA targets for self directed support would be adversely affected by
any delay in implementation. This could impact on the Council’s
performance rating.
We would fail to meet some of the National Milestones that have been set
for transforming adult social care.

5.3 The main benefits of considering early adoption of the national system are: 
It takes away the need for staff to learn new processes if we decide to
adopt at a later stage.
We will be using a system that has already been taken up by a number of
councils and has the stamp of approval of ADASS.
The national system for calculating the Resource Allocation System is the
one that most councils are piloting or rolling out.


5.4. Officers believe that we should not change course at this stage, but should
investigate whether it would be in the Council’s interests to adopt the national
system from late 2010, when structural changes are due to be made and staff
will be working to new roles. This gives time to make any changes to
documentation, ICT systems and so on.
6
CONSULTATION
6.1 Service users and carers have been an integral part of the project decision
making process. There are service user representatives on the Project Board.
A separate group of service users and carers are contributing to the design and
development of business processes and documentation.
6.2 NHS partners and colleagues from the Children’s and Young People’s service
are represented on the Project Board.
6.3 Presentations and discussions have been given to a number of service user
groups. These include:







Calderdale Pensioners Association
Direct Payments Recipients Group
The Putting People First Disability Partnership
Calderdale Carers Project
BMA Men’s Day Service
Age Concern Asian Women’s Day Service
Older Peoples Day Services
6.4 A number of services users who attended the above groups have already
volunteered to take part in the pilot scheme. In general the concept of individual
budgets has been received with enthusiasm. However, older people have
tended to express greater reservations. Individual budgets have been
discussed at the Older People’s Delivery Partnership, where there was a
mixture of enthusiasm and caution. The Older People’s and Learning Disability
Strategies (both of which were the product of wide-ranging engagement with
stakeholders, service users and carers) embrace the development of individual
budgets and self directed support.
6.5 The development of individual budgets is likely to require significant changes to
the job roles and, potentially, numbers of staff required to undertake
assessment and care management functions. Staff have contributed to the
development of the project. Representatives from all areas of the service are
part of the project workstreams and progress is posted on the Council’s Intranet
for all staff to comment on. There have been a number of consultation and
information workshops to which all relevant staff were invited. These were well
attended. In addition, there are regular meetings with Trade Union
representatives. A copy of this report has been sent to Unison, who have
expressed some concerns about the restructure plans in the Care Management
Teams (see Paragraph 4.8.1).
6.6 Three public consultation events have taken place in Brighouse, Halifax and
Todmorden. These were widely advertised but poorly attended. Many of the
attendees represented organisations rather than being from the general public.
The feedback was supportive of the Council’s proposals, but raised issues
about some aspects. One person commented that they did not want the
responsibility involved in employing their own staff. Another person was
concerned about some of the risks of abuse. There was support for the
introduction of payment cards.
6.7 An Equality Impact Assessment is being undertaken as a part of the pilot
evaluation. This information will be used to ensure that: 

7
Our services are accessible and appropriate to all members of the
community and do not discriminate against any groups
Our policies and procedures are customer focused and fit for purpose.
FINANCIAL IMPLICATIONS
7.1 Revenue implications
7.1.1
One of the key objectives in implementing individual budgets is that this
will be ‘cost neutral’. Officers are currently modelling the financial
impact of individual budgets as part of the pilot process.
7.1.2
Officers have conducted an exercise to compare the global cost of
home care services taken as cash IBs with the cost of current in-house
and block contracted home care – see the table below. This shows
that if half of service users converted to cash IBs as a way of obtaining
home care, there would be a substantial saving (£623,000). However,
more realistically it is anticipated that a large proportion of service users
will decide to retain their existing home care services. If only 20% of
service users convert to cash IBs, this will potentially yield a saving of
£250,000. Any saving would be marginally reduced by additional IB
transactional costs and potential loss of income from client
contributions.
Conversion rate
to IBs
Potential Annual
Saving
50%
£622,983
40%
£498,386
30%
£373,790
25%
£311,491
20%
£249,193
10%
£124,597
7.1.3
In relation to day services, under a cash IB, a person could have up to
a maximum of six hours support a day in lieu of a day service.
However, typically a person may be awarded four hours, at a cost £48.
Current day care costs vary from £28 to £104 per day If the cash IB is
an alternative to a low cost service, it will be more costly to the Council.
Conversely, it will be less costly if it replaces a high cost service. The
broad impact is likely to be cost neutral. Officers do not know how
many people will decide to switch to cash IBs, but it is likely that some
people will choose to take at least part of the service as a cash IB.
7.1.4
It should be pointed out that it is not intended at this stage to limit
people to the amount indicated by their Resource Allocation if they
decided they would prefer the council to manage their care rather than
take it as a cash IB.
7.1.5
The numbers going through the pilot process have not been sufficiently
large to provide a reliable sample for the purposes of modelling the
financial impact of individual budgets. Spending levels will be closely
monitored as individual budgets are mainstreamed over the coming
months and action will be taken if necessary to control spend.
7.1.6
If, as anticipated, there is a reduced demand for some services, such
as centre-based day care and overnight respite care, this will impact on
the unit cost of those services in the medium term, given that it takes
time to decommission in-house and block contracted services. This
could put pressure on budgets. We will be able to model the impact
this will have when individual budgets are mainstreamed during
early/mid 2010, but it is clear that there will be double running costs
and some providers – particularly those offering day care - may have to
adapt their services
7.2
7.1.7
A sum of £250,000 has been allocated from the Social Care Reform
Grant in 2010/11 to cover these costs, but this may not be sufficient.
For future years there will be more time to decommission services and
change the way these are delivered.
7.1.8
The business processes in adult care management and associated
back office functions are being significantly changed by the
implementation of individual budgets. Early indications are that these
will be leaner and more efficient and should generate efficiency
savings. In May 2010, the staffing levels of the new functions will be
decided, with a view to implementing new structures from September
2010. There is already a Budget Council saving of £105,000 from April
2010 to be achieved against these efficiencies. Modelling work on
different options suggests that an additional saving of £45,000 per
annum could be achieved (after allowing for the additional staff required
in the new single point of access).
Payment Cards
7.2.1
Officers know from service users who receive a direct payment that
they find it difficult to keep accurate auditable records and often this
puts them off managing their own service. A possible solution to this
problem is the use of a payment card. This is a bank card that we can
allocate to service users to pay their individual budget. The card is not
a credit card and therefore the service user can only spend the money
that we have allocated on to the card and cannot overdraw. Since the
Council can maintain control over the payment card and access to the
statement on-line, it can carry out audits without the service user
having to keep receipts and can create ‘merchant blocks’ to prevent
spending on unauthorised goods and services. Detailed procedural
guidance is being produced in order to reduce any risk of misuse or
fraud and covering situations such as appointing another person to use
the card if the service user cannot do so themselves.
7.2.2
Officers have reached agreements to trial a payment card through
RBS, which will enable an informed decision to be made whether to roll
this out widely as part of the mainstreaming of individual budgets. If the
piloting is successful over the next three months, it is intended to go to
full procurement of a payment card solution.
7.3 How charges are paid
7.3.1
Currently people pay their charges under the Fairer Charging Policy
either through a weekly payment or by Standing Order from their bank.
If the Council continues to give people their Direct Payment gross, then
we will be giving them cash in their Direct Payment account, part of
which they then have to repay to us as a charge from their own bank
account. The Department of Health recommends that the cash is
provided net of the charge. Any shortfall between the cash amount and
the cost of the service due to the charge having been deducted would
be made up by the service user from their own resources.
7.3.2
7.4
8
This approach has been successfully piloted and is felt by service users
to be more logical and easier to manage. From the Council’s viewpoint,
it significantly reduces the cost of collecting these charges. It would not
apply to people still having services arranged by the Council.
Fairer Charging Policy
7.4.1
In July 2009 the Department of Health introduced new guidance for
calculating an individual’s contribution to their individual budget.
Councils are expected to implement this guidance at the latest by
March 2010. The guidance has been issued to simplify the contribution
calculation for the increasing numbers of people who receive individual
budgets and direct payments.
7.4.2
More work is required before a recommendation can be made to
Cabinet. It is suggested that officers consult with stakeholders and take
a report to Scrutiny Panel and bring a report back to Cabinet in the New
Year with practical examples of the impact on people using services
and the Council’s budget.
CONCLUSION
8.1 The implementation of individual budgets is undoubtedly one of the most
fundamental changes that have taken place in recent years in the delivery of
social care for adults. It requires many changes to the policy and procedural
framework and also to systems such as ICT and finance. For the workforce
there are changes planned to job roles and team structures, as well as the
need to retrain staff to work in new ways. In addition, the services we currently
provide will have to adapt or may no longer be fit for purpose if people decide to
take their services in different ways.
8.2 Individual budgets are proving to be popular and are giving people greater
choice and control. However, there are uncertainties over how well some
people will cope and it has been necessary to build safeguarding into the
process. In addition, it is difficult at this stage to quantify the financial
implications. While these are intended to be cost neutral, there are some
potential cost pressures in the short to medium term, against which contingency
budget has been set aside in 2010/11.
Ref: Cab008pas/CABINET
Date: 26th November 2009
Jonathan Phillips
Director, Adults, Health and Social Care
FOR FURTHER INFORMATION ON THIS REPORT CONTACT:
Phil Shire, Head of Wellbeing and Social Care, Adults, Health and Social Care
Directorate, 1 Park Road, Halifax. HX1 2TU Tel: 01422 393809
DOCUMENTS USED IN THE PREPARATION OF THE REPORT:


Our Health, Our Care, Our Say. White paper (2006)
Putting People First. A shared vision and commitment to the transformation of
Adult Social Care (2007)