8. DISTRIBUTION OF RESOURCES
The Review Group recommends that the Scottish Government with COSLA should in the short-term:
- Address the need for improvement in the current information systems, developing better, more accurate systems to collect comprehensive and accurate information which will enable costs to be tracked effectively at a national and local authority level in future; and
- Improve local accountability by ensuring that a performance framework for long-term care services for older people is built into the Single Outcome Agreement model.
89. The second strand of our remit was to consider the distribution of the total FPNC resources amongst local authorities through the Grant Aided Expenditure ( GAE) system. A detailed analysis of distribution methodology is set out in Part 4 of our report. In reaching our conclusions on distribution we considered evidence from Scottish Government officials about the operation of the distribution methodology and the views of individual local authorities about whether this provided an appropriate reflection of their relative spending need. We also considered advice on current discussions between the Scottish Government and COSLA on the future operation of the GAE methodology, in light of the move to Single Outcome Agreements in 2008-09.
Current Distribution of Funding
90. The CDG originally recommended that the new resources for FPNC policy should be "ring-fenced" to ensure they were used specifically for the care of older people - at least until new robust outcome agreements could be developed. In the event Ministers decided against "ring-fencing" and resources were directed through the core Local Government Finance Settlement and GAE distribution methodology, so there was no specific allocation of the resources for FPNC; rather it has been for each local authority to set budgets according to local priorities.
91. A specific distribution methodology was adopted for the allocation of resources to local authorities for the costs of meeting the FPNC flat rate payments for people in care homes, based on the actual numbers of potential self-funding residents. However, for funding for personal care services for people in their own homes, the existing Home Based Elderly GAE distribution was used. Individual local authorities complained from the outset of the policy that this distribution - based on the age profile of older people, but also adjusted for other factors including deprivation, older people living alone and the incidence of limiting long-term illness - did not reflect the factors giving rise to additional costs, specifically the loss of charging income from self-funding clients.
92. Some 6 years later there is no obvious correlation between the distribution of resources for FPNC and those councils which have experienced most difficulty implementing the policy. Spending levels per head vary widely and the best performers are not necessarily the highest spenders. The Auditor General also identified significant concerns about the quality of the financial returns collected from and provided by local authorities on their expenditure on FPNC. We would strongly endorse the recommendation in his report that the Scottish Government and local authorities improve central monitoring and local information systems to collect more accurate and comprehensive cost information about FPNC and other aspects of care and support services.
93. Regardless of the quality of the financial returns, it is evident that there are significant differences in the level of difficulty that individual local authorities have experienced in implementing the policy. Our analysis did not provide clear evidence of whether this related to differences in funding, efficiency, or other factors that might impact on a council's relative ability to deliver care services, such as the effectiveness of local partnership working with the NHS. Although it may be a factor, it is clear that these issues extend wider than the distribution methodology. We consider, therefore, that there would be advantage in looking more widely at improving the quality of local authority performance information for long-term care services for older people and we see a role for the Social Work Inspection Agency in assisting this.
Future Distribution of Funding
94. In light of the shift announced by the Scottish Government in December 2007, as part of the Local Government Finance Settlement 2008-11, to move local government funding away from a focus on processes and inputs to a focus on outcomes it was made clear that individual GAE lines would no longer be referred to or published.
95. The 2007-08 GAE figures were retained and up-rated to take account of the most up-to-date distribution indicators (such as population, deprivation etc) as a base for the distribution methodology for the 3 years 2008-11. That included a change in the GAE line for FPNC in Care Homes, which was moved from a historic caseload basis to a formula basis, but no change was made to the line for FPNC at home.
96. In line with those recent developments, we recognise that dialogue with COSLA around the development of Single Outcome Agreements ( SOAs) with each local authority will be crucial in ensuring that additional resources are directed towards sustaining the FPNC policy and in securing improved outcomes for older people.
97. Under the new arrangements, the onus will be on local authorities to decide where resources are directed to achieve the agreed outcomes set out in the 32 individual SOAs to be agreed with the Scottish Government. We recognise that developing and setting in place SOAs in the current financial year, 2008-09, represents a huge adaptive challenge and that the process is an iterative one which can only be perfected with time and experience. We commend the moves to establish a generic indicator for Community Care which would be part of each council's SOA.
98. The Auditor General's report recommended that the Scottish Government and local authorities should review the method for distributing FPNC resources to councils, to ensure that these accurately reflect the factors which influence local demand for services.
99. We understand that the Scottish Government has already agreed with COSLA that the future operation of the distribution system (not just for FPNC) needs to be considered over the next few years within the context of the wider changes to the relationship between central and local government, including the establishment of SOAs.
100. We consider that the proposed wider review is the appropriate forum through which any specific consideration of the future distribution arrangements for FPNC should be progressed. Whatever model is agreed, it should have regard to the demographic pressures and their impact at individual local authority level.
Expected waiting times are not specified at present. But expectation is of targets for referral to completion of assessment and/for completion of assessment to service delivery to be agreed by LAs.