Response to Audit Scotland Work Programme

Consultation body

Audit Scotland

Response date

August 2011

Focus of consultation

Audit Scotland's proposed work programme

11. Charging for services in local government

This proposed performance audit would be particularly valuable. We have a number of concerns relating to local government charging for community care services:

• The increased level and scope of charges for community care services has placed additional financial pressures on some of the most vulnerable individuals in the community. This is at a time when these households are experiencing additional pressure from the increased cost of living. There is a danger of individuals terminating essential community care services in order to meet other costs, such as the increasing cost of fuel.
• Charging policies do not effectively take account of individual circumstances relating to the cost of living with the illness or level of disability.
• The discretionary nature of local authority power to develop their own charging policy creates a broad variation of charging structures across Scotland and results in a postcode lottery.
• Legislation only provides for local authorities to charge the individual in receipt of a service. However, local authorities frequently charge based on a couples joint resources; despite the liable relatives rule being repealed by the Scottish Parliament in 2007.
• Local authority information on non residential care services and charging policies rarely provide adequate information about the rights of the individual using a service.
• Charging policies are complex and few local authorities are good at explaining how charges were calculated. As a result many people do not understand the rationale behind the cost they are required to meet.
• Many of those receiving community care services are from the lowest income households. They often have little or no opportunity to increase their income. Increased charging for services places significant financial pressures on those individuals and is inconsistent with local authority responsibility to develop anti-poverty strategies.
• COSLA’s guidance recommends nationally consistent income thresholds before charges apply. This is based on weekly minimum incomes related to social security benefits, plus an additional 16.5% buffer. Whilst many local authorities use this recommended threshold, some set thresholds at lower levels.
• The distinction between a health service and social service is not always clear; people often do not understand why they are required to pay for a service that is connected to their medical condition. Charging policies should be consistent, logical and explained to those receiving a service.

How are charges for services set and to what extent are they based on the unit cost of delivering the service?

This audit question would provide useful information. It is our experience that local authority non residential charges for community care services are means tested and relate to the assessed income of an individual, rather than the unit cost of delivering the service.
To what extent are councils relying on income from charges to bridge any funding gaps? This would provide useful information; it would be of particular interest to audit how this has changed over the past decade. We believe that the increasing financial pressure on local authorities has resulted in a growing reliance on income from charging policies. Recent increases in the level of charges and the scope of services charged for are strong indicators of this. Examples include the increase in the percentage tapers used to calculate a charge and increases in flat rates or maximum charges.

21. Mental health follow-up –dementia services

Progress has been made in this area since the publication of Overview of mental health services in 2009. The National Dementia Strategy in 2010 and an increase in the proportion of people with dementia who have received a diagnosis mark significant steps forward.

However, diagnosis reaches only 50% of the estimated number of people with dementia in Scotland and the actions contained within the Strategy must be put into practice in order to have an impact. The proposed audit of dementia services in 2012/13 would be timely to help identify progress under the National Dementia Strategy.

The questions outlined in the consultation paper would provide valuable information on dementia services. A particular focus on the key areas identified by the National Dementia Strategy would be useful:

• Work to improve the support and information that people with dementia and their carers receive following diagnosis.
• Work to improve the response to dementia in general hospital settings, including alternatives to admission and better planning for discharge.

Audit Scotland’s remit extending across health and social care provides the opportunity to identify the level of integration that has been achieved in dementia services. In addition to this, identifying the proportion of the Reshaping Care for Older People Change Fund that can be attributed to the development of support for people with dementia and their carers in the community would be beneficial.
There has been a lack of dementia specific information; it is hoped that the audit should benefit from the ongoing work on improved management and outcome information stemming from the National Dementia Strategy.

26. Telecare: equipment and services to help people remain in their own home

Telecare has the potential to support people with dementia in the community; it can also offer benefits for carers. The value of the range of telecare devices available to support people with dementia is dependent on individual circumstances and the stage of the illness.

In addition to the potential audit questions outlined in the consultation paper, we would welcome a focus on types of telecare and telecare by client group. This would provide useful information on the focus of telecare so far, and areas for development.

Have your say on current consultations and campaigns

You can help Alzheimer Scotland to influence public policy by giving us your opinions and experiences on current issues. We particularly welcome the views of people with dementia and their carers in informing our policy briefings and responses to consultations. The more people who feed in, the stronger our voice.