Care Act 2014

Social Care & Funding Reform

Understanding the Costs

The Lincolnshire Model

By Glen Garrod

Director of Adult Social Services

Lincolnshire County Council

Lincolnshire Context• Population of 718,800• Predominantly Low Skilled, Low Paid Economy, Pockets of Deprivation• Lowest quartile in terms of council tax rates• 29% of total service budget spent on social care in 2013/14• Cost of in-house services reduced from £27m to £3m between 2011/12 & 2013/14• Revenue Budgets in 2013/14

• Gross £206.431 • Net £140.709

• Additional ongoing Cost Pressures identified including:• Demographic Growth (Highest Growth of over 75s in East Midlands)• On-going pressures within Learning Disabilities Services• Residential and Nursing rate agreements• Impact of Care Act and Dilnot recommendations• Integration with Health

The Lincolnshire Model

Attempts to estimate the additional cost to Lincolnshire County Council as a direct result of the implementation of the Care Act 2014.

• Increase in Asset Thresholds

• Implementation of the Care Cap

• Statutory Responsibilities to Carers

• Additional Assessment Activity

• Loss of Existing Service User Income

The Lincolnshire Model

Concept of the model is simplicity, with the emphasis on local variation so that it can easily adjusted to suit local conditions and is built on the following basis:

• Use of Formulae where possible

• Use information that is generally available to all (e.g. Service User and Brokerage data)

• Use recognised assumptions around areas such as inflation and asset values

• Incorporate other pieces of intelligence

The Lincolnshire ModelSources of Data Include:• Existing Service User Data

• Average levels of Income for Self Funders• Model the impact of threshold increases on existing SU• Establish Attrition Rates

• Laing & Buisson Evaluation of Lincolnshire Residential Sector• Used to calculate estimate of self funders • Detail of self funder rates

• Brokerage Data• Establish average hourly rates of Dom Care• Establish average hours of care delivered

• Land Registry Data to establish average property values around• Terraced• Semi Detached• Detached• Maisonettes

• Staff and Assessment Data to establish cost of additional assessment activity

The Lincolnshire Model

Findings:

• Cost to Lincolnshire over ten years estimated to be £157m

• Impact of threshold will be felt immediately• £6.4m cost of new services users• Reduction in existing contributions £1.7m• Total financial impact including on-going assessment costs in 2016/17 is

£11.7m

• Impact of Care Cap not felt until Year 7 (2022/23)• Due to lower than average cost of residential care

• Impact does not reduce over time, at year 10 (2025/26) additional financial impact totals £20.6m

The Lincolnshire Model

Analysis Year 1 – from 2016/17

Analysis Against Actual Costs 2013/14 Actuals (£m) Dilnot Outcomes Yr 1 (£m) %

OP Net Residential Spend/Additional Cost 64.945 6.482 10%

OP Gross Expenditure/Additonal Cost 88.803 6.482 9%

       

OP Residential Income/Loss of Income 21.675 0.390 2%

OP Non Residential Income/Loss of Income 5.246 0.234 4%

       

WAA Residential Income/Loss of Income 2.759 1.028 37%

WAA Non Residential Income/Loss of Income 0.667 0.077 12%

       

Adult Care Total Gross Cost 206.431 11.754 5%

Adult Care Total Net Cost 140.709 11.754 8%

The Lincolnshire ModelAnalysis Year 10 – 2025/26

Analysis Against Actual Costs2013/14 Actuals

(£m)Dilnot Outcomes Yr 10

(£m) %

OP Net Residential Spend/Additional Cost 64.945 17.382 27%

OP Gross Expenditure/Additonal Cost 88.803 17.382 20%

       

OP Residential Income/Loss of Income 21.675 0.146 1%

OP Non Residential Income/Loss of Income 5.246 0.074 1%

       

WAA Residential Income/Loss of Income 2.759 0.539 20%

WAA Non Residential Income/Loss of Income 0.667 0.027 4%

       

Adult Care Total Gross Cost 206.431 20.617 10%

Adult Care Total Net Cost 140.709 20.617 15%

The Lincolnshire Model

Next Steps:

• Continued work to establish the cost of reforms with regional and national finance groups

• Further validation and correction of the model

• Look to establish other examples of best practice and apply to the model

• Establish the impact of any significant revisions pre/post general election

• Apply further budgetary changes e.g. changes to residential rates

The Lincolnshire Model

Headline findings - support

23/10/2014 Care Act Stocktake and support 10

99% of councils said they were aware of the tools and support that have been developed nationally (Q45). Councils were asked which tools have advanced their confidence in delivering the Care Act (Q45a), and also to outline any additional support, guidance or information that would increase their confidence for implementation in 2015 (Q46). Their responses are below:

Existing tools that have “most advanced confidence in ability

to deliver Care Act reforms” (Q45a)

Revised Lincolnshire model 90%

Care Act Factsheets 86%

Care Act Clause Analysis 82%

Draft regulations and guidance 80%

Care Act Stocktake 78%

Draft capacity planning model 66%

ADASS updates 66%

Additional tools, guidance or information requests (Q46)

More timely release of regs/guidance/allocations

Financial modelling tools and information

Greater clarity on eligibility

Workforce development tools

Peer support and best practice sharing

National communications tools

Legal support

Continued focus on technology suppliers

National guidance on IFAs