Black boxes begone! Notes from the Charging Policy Working Group (22nd August 2005) Appendix 9 from the AKA report

 

At the last Council meeting last month, Cllr Pat Williams gave a speech (reported in full on this blog) in which she stated “There is also a lack of personal accountability for the numerous errors of judgement made by officers and councillors during the period which led to the involvement of the Improvement Board.”

How true that is, Cllr Pat Williams! Appendix 9 to the Anna Klonowski Associates report was the notes of the Charging Policy Working Group held on the 22nd August 2005. It was heavily redacted with a black marker pen. This was the document I asked Graham Burgess to release without redactions at the public session of the Improvement Board back in November. He hasn’t got back to me on that point so here it is below. I agree with Cllr Pat Williams there has been a lack of accountability, hopefully this will go some way to address it!

Charging Policy Consultation
Notes of a meeting held on 22nd August 2005
Westminster House, Birkenhead

Present

Older people’s representative
Service user/carer representative x 2
A representative of Wirral MIND gave apologies
Advocacy Services Representative
Councillor Pat Williams (Lib Dem)
Councillor Denise Roberts (Labour)
Councillor Les Thomas (Con)
Mike Fowler (Assistant Director Finance & Support Services)
Breda Dutton (Business & performance Manager)
Hilary Grant (Client Financial Services Manager)

Purpose
The purpose of this meeting was to consult with party spokespersons and a number of representatives of users and carers on Wirral’s charging policy for social care services delivered to people in their own homes. It is intended that the outcome of this and other consultations will be presented to the Health and Social Care Select Committee prior to recommending to Cabinet any revisions to the Charging Policy as directed by Cabinet in March 2005.

Process
Mike Fowler (MF) gave a presentation (attached) which outlined the type of services the Council charges for and how they are calculated. The presentation went on to explain why the Council believed changes to the policy were necessary and what options might be considered.

The Group asked questions during the presentation and these are recorded in the attached table. The Group did not intend to make any specific recommendations to Council but agreed to review these notes and make subsequent representations as were considered appropriate.

It was recognised that not all client groups were adequately represented and MF gave assurance that there would be other processes to ensure as many people as possible were consulted prior to Cabinet making a decision on future charges.

Notes of User/Carer Consultation

Presentation	Discussion and Comment
1. What Services are charged for ?
MF explained the three types of charges. These are (a) for people who live in residential or nursing homes, (b) for people who are helped to live at home, and (c) for meals-on-wheels.	Noted
The remit of this consultation is (b) and (c). Charges for residential and nursing care are set by Government and cannot be influenced locally.	Noted
MF explained charges for people who are helped to live at home are based on Government guidance ‘Fairer Charging’ which assesses people’s ability to pay (based on their income, benefits and savings)	It was noted that Councils do not have to charge, but if they do they must adhere to the principles within this Guidance.
People who receive meals delivered to their homes were charged £1.60 per meal. No account is taken of their ability to pay.	In response to a question raised by Councillors, MF confirmed this price had not been changed since December 2000, and if inflation had been applied each year the charge would now be £1.81.
2. How are charges worked out?
MF went through the steps to calculate charges for people supported with a community care package and identified the three bases of charges. These were:-	Noted
(a) Charges against disposable income.This is currently 27%. Disposable Income is the amount above the minimum the Government believes is necessary to live on (ie Income Support levels).	MF confirmed that (i) people whose only source of income was Income Support were not charged, (ii) carers income was not taken into account, and (iii) Mobility Allowance was not included as income.
(b) Charges against benefits.Currently £5.27 per week for people who receive Disability Allowance (DLA), or £7.27 for higher DLA	The group asked for information on the current levels of this Allowance. HG responded £40.55 per week for Medium DLA, and £60.60 per week for higher DLA. Over 80% of claimants receive the Medium level.
(c) charges against savings.Currently £1 per week for every £250 above £12,500. People with more than £20,500 are assessed to pay the full cost of their care	MF clarified the £1 was the assumed income from savings to be added to Disposable income in 2(a) above. The Group asked who set these levels and MF responded they are in the guidance but Council’s were free to set higher figures (not lower).
3. Why does the Council think the policy should be reviewed?
MF summarised the ‘Fairer Charging policy, the main principles are:-(a) Charges should take account of people’s ability to pay (b) Charges should be equally applied across all client groups	It was acknowledged the current policy does this in accordance with the Fairer Charging Guidance.MF reported there were some groups, and service types, not being charged in the same way. These were (1) Adults with Learning Disability who attend Day Centres, and (2) Adult living in Supported Living services – previously classed as residential care.The Group felt this was unfair, and that everyone should be assessed in the same way, although it was noted the group most affected were not represented at this event.
MF reported the existing policy had not been changed for 5 years	Noted
The Council agreed budget savings in 2005-06 of £150,000 from Fairer Charges and £50,000 from Meals	Noted
4. Options
MF summarised the options that could be considered by the Council. These are:-(a) Charge more for people with over £20,500 savings (ie raising the full price) (b) Charge more against disposable income (c) Charge more against Disability related Benefits (d) Increase the price of Meals on Wheels (e) Include people who only receive Day Care or Supported Living Services in the charging policy	There was concern that people just over the limit would have their savings reduced rapidly. MF confirmed the Council ‘could’ raise the threshold for being assessed to pay the full price.The Council could either change the %-Take figure or increase the minimum level before charges start to apply (eg Income Support + £10) The Council could change the charge against Disability benefits. Few Councils take all the Benefit in charges, many take between £10 and £15 per week. The Council can charge up to the full price for meals (currently £2.42) Most Councils operate the same Fairer Charging policy for these type of services
5. Exploring each option in turn ->
(a) Charge people with over £20,500 more. The current policy is to charge £6.14 per hour. The actual cost to the Council is between £9 and £11. If the Council raised its charge to £7.14 an additional £75,000 would be raised.	The Group asked how many people this would affect, MF reported approximately 500 people (there are actually 540 people paying on average £27 per week, which raises £750,000 pa)The Group felt it would be fair to charge people more who were more able to pay because they had more assets, but were concerned people who were just over the threshold would quickly drop below it. There was also concern people would divest themselves of their savings purposefully to avoid paying charges. MF explained there were few people who were ‘just over’. Most people paying the full price had elected not to reveal the level of their savings and had ‘chosen’ to pay full cost. The group would like to ask the Council to consider raising the £20,500 threshold to protect those who were ‘just over’ the limit. On this basis, people with more substantial savings would be more likely to accept higher charges; bearing in mind the subsidy that would still remain.
(b)Charge more against disposable incomeThe current policy is to charge 27% of disposable income. MF explained that for every ‘percentage point’ above this the Council would raise an additional £10,000 (eg if the charge was 30%, £30,000 would be generated.	MF confirmed there would be 1,200 service users affected by varying the %-Take figure.Many other Authorities charge between 30% and 35%.
(c) Charge more against Disability related BenefitsPeople who get DLA/AA are charged £5.27 per week at the lower level or £7.27 at the higher. Raising the charges by £1 per week would generate an additional £94,000 per year.	The Group felt it fair that people should use these benefits to pay for their care as this was the purpose of the benefit.
(d) Increase the price of Meals on WheelsThe current price per meal is £1.60. The average in the North West is £1.85. The price had not changed in 5 years. Raising it to £1.85 would raise an additional £30,000.	The Group asked what the actual price of each meal was. MF responded £2.42 taking into account the cost of the meal, regeneration, and transport.The Group still felt at £1.85 it was good value for a two course meal
(e) Charge people in Supported LivingMany people are not charged for Supported Living Services. Applying the Fairer Charging Policy would raise £40,000 per year	The Group felt people receiving these services should be assessed to pay charges in the same way as other service users. MF reported up to 80 people would be affected.The other group not currently charged is Adults with Learning Disability who only receive day care. Up to 100 users may be affected and MF reported potential collection difficulties.
MF asked the Group to comment on the current method of payment.Users currently receive a statement against which they can make regular payments using a swipe card	The group felt the statements were a good idea but felt regular monthly invoices would be an improvementThe group also felt more use of standing orders and direct debits would aid collection (this needs to be offered as a choice) The Group asked MF to consider ‘rewards’ for opting for Direct Debits similar to those offered by utility Companies
Summary of messages from the Group to CommitteeMF asked the Group what comments they would wish to make to the next Committee	‘Fairness’ was considered to be the key consideration. Benefits that were paid for people with disability should be used to pay charges. Avoid putting people into poverty by charging against low incomes. People with higher income and savings should be assessed to pay more. £1.85 is good value for a hot two course meal delivered to your own home The savings threshold should be increased to avoid people fluctuating between full cost and assessed charge when they have around £20,500. All client groups and service types should be charged in the same way.

Summary

The meeting ended with the following bullet points to be included in a report to Committees in November 2005

• ‘Fairness’ was considered to be the key consideration.
• Benefits that were paid for people with disability should be used to pay charges.
• Avoid putting people into poverty by charging against low incomes.
• People with higher income and savings should be assessed to pay more.
• £1.85 is good value for a hot two course meal delivered to your own home
• The savings threshold should be increased to avoid people fluctuating between full cost and assessed charge when they have around £20,500.
• All client groups and service types should be charged in the same way.

Next Stage

MF reported an intent to report the outcome of consultation to the Health and Social Care Select Committee in October and Cabinet in November. However the fact that representatives of Learning Disability services could not attend it was decided to delay the report for one month. This
would also give an opportunity to invite further comments from older people themselves by a postal questionnaire.

Recommendations

Members of the Group are asked to confirm this record as a true reflection of the discussion that took place on the 22nd August and make any further representations they feel appropriate.

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