Charging reform: Taking forward the learning from the trailblazer work

Six councils agreed with the Department of Health and Social Care (DHSC) that they would be trailblazers to test out the Government’s proposals for Charging Reform which were published in 2021. The purpose of this briefing is to set out some key learning from those trailblazers which all councils may want to consider in the immediate future irrespective of whether charging reform is implemented in October 2025. We believe that this learning is important to help address some of the challenges facing adult social care. There are lessons for the Government (now and in the future) as well as for local authorities. We have identified in bold text which organisations need to act in response to this advice.

This briefing does not address the issues arising from the cost of care which continues to be a live issue for all councils. We will continue to provide support on cost of care, working closely with DHSC and providers.

Local authorities face challenges recruiting social workers and others who carry out care assessments. Trailblazers had to consider how to manage a significant increase in the number of assessments in a short period of time. Revised ways of working through the use of technology, a proportionate approach to assessments and other streamlined approaches to working with individuals needs considering in more detail to alleviate existing staffing shortfalls and deal with forecast demand pressures that would arise from the rollout of revised charging policy. We acknowledge progress on these elements of work already. One important output is the development of a good practice guide by the Chief Social Worker, developed with the Principal Social Workers Network, on how to manage assessments proportionately. This advice was circulated to DASSs on 24th July 2023. An online needs self-assessment good practice guide has also been published. Local authorities will need to consider what they will do in response.

DHSC has developed the new LA intranet to ensure all the materials they are sharing on digitising and streamlining assessments can be found in one place – local authorities can request access to the intranet by emailing: [email protected]

Improving current charging arrangements

Local authorities may want to review their current charging arrangements. It is important that individuals are aware that they may have to pay towards their care and how much this might cost. This should include developing payment arrangements which help with debt collection and make individuals aware that debts will need to be recovered. Charging reform as proposed in 2021 will still mean that individuals will need to be assessed financially.

Trailblazers discussed with the Department of Health and Social Care the need to review government policies on Deferred Payment Agreements, Deprivation of Assets, and on the use of “Top Up” payments. All of these will affect the way that local authorities approach the financial assessment of individuals. If reforms go ahead, the Government will need to publish revised guidance on these issues.

Implications for the use of IT within adult social care

Trailblazers encountered some major issues in working with IT providers – particularly providers of Case Management Systems (CMS). In part, this reflected the fact that there were only six authorities working as representatives for all single tier and county councils with the national CMS providers and the specification for the work focused on meeting minimum care account requirements within tight timescales for reform.

Six local authorities do not have the collective voice or influence of many local authorities working together. Any IT development that requires mandatory change for all local authorities must reflect the views of all customers which need to be set out in a clear and realistic specification. It is important to recognise that codesign, testing and iterative implementation are essential for successful digital delivery. Open data standards must be part of any approach because opportunities to use other technologies could lead to more rapid development of alternative solutions. As ADASS and LGA, we support councils coming together to present a unified voice to IT suppliers that makes clear our collective expectation for open standards and APIs.

With specific focus on charging reform, the key IT issues are not the development of care accounts but helping manage the increased demand. Alongside continuing to learn from Trailblazers, case studies are available from Surrey, Norfolk, Kirklees and Dorset council approaches to assessment.

Any new national developments should recognise that there will be significant development costs for IT providers which will have to be funded if a quality product is to be developed. The Government should address this as part of any new proposals. It is important to challenge IT system providers to innovate and seek new ways to support service delivery, access to systems and join up with health systems to mitigate staffing and skills shortages and, therefore, it should not be surprising if they innovate beyond a so-called ‘minimum viable product’.

With 153 separate contacts in place with seven CMS system suppliers, further consideration should be given to how to contractually mandate change across all suppliers to meet national policy requirements on this scale, within a specified timescale, and most importantly, consideration as to how to handle the commercial and contractual implications nationally, as there was no mechanism to do this.

All trailblazers realised that they had limited information about self-funders in their area.

Some information is available through information submitted by care providers to the Care Quality Commission through the Provider Information Return. Registered providers submit this information annually on a 12 month rolling basis (i.e. 1/12th of providers submit information each month). Partners in Care and Health have been working with CQC to share aggregated information from the Provider Information Return with councils, and through comparing with information on current registered providers drawing out an estimate of self-funders in an area. This is updated with the latest data every month. Our reflection is that the information on care home self-funders is more reliable, but not wholly accurate. The information on self-funders receiving community care is less reliable given the variation in both the changing scale of provision over time, and the variability in size and complexity of packages.

Further information has been published by the Office for National Statistics (ONS) - Estimates of the self-funding population, England: 2022 to 2023. The ONS estimates were published in July 2023 and cover the period March 2022 to February 2023. The data is broken down by geographic variables and care provider characteristics.

Self-funding in care homes data

Self-funding in the community data

To view the ONS datasets:

Care homes and estimating the self-funding population, England - Tables 4 and 5 detail the proportion of self- and state-funded care home residents by council area.

Estimating the size of the self-funding population in the community, England - Tables 3 and 4 detail the proportion of self- and state-funded community care service users by council area.

Charging reform highlights the importance of understanding the self-funder market to model demand and estimate potential costs. However, in the absence of charging reform, it is still essential that local authorities understand better the self-funder market because this is an important part of the local care market which will impact on the level of provision and the cost of care for both self-funders and the local authority (and the NHS). It is also important to recognise that local authorities may want to work more closely with self-funders to ensure that they have better information to decide on the options they face. The quality of information – and ease of access of that information - that is available on Council (and community and potentially Integrated Care Systems) websites is important and, in the best examples, is a core part of the information, advice and guidance offer.