Our final item of business is to take evidence on the financial memorandum to the Carers (Scotland) Bill from the following Scottish Government officials: Fee Hodgkiss, Lynn Lavery, Moira Oliphant and Julie McKinney. Members have received copies of all the written submissions and the briefing paper. We will move straight to questions from the committee. I will start with some opening questions and colleagues will explore in depth some of the issues that are raised.
The policy memorandum states that the intention is that carers
“should be better supported on a more consistent basis so that they can continue to care, if they so wish, in good health and to have a life alongside caring. ... young carers should have a childhood similar to their non-carer peers.”
Part 2 of the financial memorandum contains two estimates for areas of expenditure that do not appear to have been included in the calculation of the total figures that is set out. Those are the costs to NHS Education for Scotland and the Scottish Social Services Council of training that is directly associated with the bill and awareness raising that is indirectly associated with the bill, and the costs to the third sector that are indirectly associated with the implementation of the bill. Can you comment on that?
The training and development costs to be borne by NHS Education for Scotland and the Scottish Social Services Council are included in one of the tables near the beginning of the financial memorandum, as are the costs for development in the third sector. The confusion may have arisen because the costs for NES, SSSC and the third sector do not carry on to 2020-21 and the costs that are presented in the paper to which you refer are the costs in 2020-21. That is why the costs that you ask about are not in the totals.
Thanks for that clarification.
The submission from North Ayrshire Council—my own constituency is in that area—comments on the adult carer support plan. According to North Ayrshire Council, although
“The financial memorandum states that demand will peak at 34% of the population”—
as is made clear on page 5 of the memorandum—in North Ayrshire
“at present 53% of local carers would be eligible for an ACSP”,
which would mean that
“6 FTE additional staff would be required”.
The submission also suggests that the three years of additional support funding for children and younger adults appears to be too low. It states:
“Once a carer has an expectation that they will receive a sum of money to purchase support, it cannot be time limited, this may increase pressures in forthcoming years on carers support within limited budget constraints.”
All in all, North Ayrshire Council is saying that the estimates for the additional work and associated costs are too low and unrealistic. A number of organisations, including the Convention of Scottish Local Authorities and others, appear to have said that. What are your comments?
Before you answer, there is a caveat, as I cannot remember an occasion when a bill came before the committee and people said that the funding was exactly right and that everything was hunky-dory. Having said that, there seem to be substantial concerns about some issues. How did you come up with the figures for adult carers and young carers?
It would have been good if there had been a meeting of minds on the financial estimates—I am sure that the committee would have welcomed that—but the financial memorandum is based on the best estimates possible. We must also acknowledge the difficulties in calculating and estimating demand. That is by no means an exact science—in fact, it is a very grey area—and to a great extent demand will depend on carer behaviour and what predicts that. Moreover, issues such as the bill’s publication, local campaigning and peer-to-peer references from carer to carer will have a bearing on demand. The Scottish Government certainly wants to be ambitious with the bill, but that ambition should not be equated with unrealistic expectations about a demand profile.
The figures that you have quoted are important. Although they are from only one council, we must nevertheless recognise what that council is saying. However, submissions in response to the Scottish Government’s consultation show that other local authorities take a different view of the demand profile and feel that, instead of a peak from year 1, there will be a slower build-up in demand. We do not expect large numbers of carers to come forward from year 1 of the bill’s implementation.
The figures might relate to the number of carers that might be known to that particular council through their association with the cared-for person, but that does not necessarily mean that those carers will want an adult carer support plan. The bill also contains a duty on local authorities to offer an adult carer support plan, but we know from research that, at the moment, not all carers want what is now called a carers’ assessment and that a proportion of carers are content and happy with inputting into the community care assessment or the disabled child’s assessment of the cared-for person.
There are therefore a good number of reasons why the figures could be quite different from those given by the local authority in question, although, as I have said, its comments are important in their own right. However, we know that carers decline the offer of a carers’ assessment. We very much hope that carers who want an adult carer support plan will come forward, but we do not see the situation in quite the same way that those figures might present it.
I am always interested in what this particular local authority says, because, apart from anything else, it is my own authority. It has said that the view in the financial memorandum
“is not based on evidence”.
You also talked about being realistic, but I note that in point vii of paragraph 5 of its submission, COSLA says:
“The unit costs for support to carers are also unrealistic.”
It then points out:
“In England, the government assumes that £967 was the average cost per year for carers requiring short breaks/respite”,
whereas the figure in this bill is only £300. Is that not quite a significant difference?
With regard to the unit costs for support rather than the unit costs for the adult carer support plan or the young carer statement, the Government has based the £333 figure for that unit cost on fairly recent published research from the Carers Trust. I also note that the figure exceeds many of the time to live grants. Time to live is one of the programmes under the voluntary sector short breaks fund. Carers get a direct grant that enables them to purchase what they wish, especially short breaks. That is where the figure of £333 comes from.
It is right that a figure of more than £900 is cited for respite in the English impact assessment. If we were to include a similar figure for respite care in Scotland, it would be a figure of more than £600 rather than a figure of f£900 because that is the national care contract figure for residential care, so that would be the figure. We have not included such figures for respite care or replacement care because the Scottish Government, along with COSLA and others, is considering waiving charges, which I can speak about later, and that will have an impact.
Even though the Scottish Government has not included in the financial memorandum a figure for respite care, which would have been more than £600 in the latter years of the demand profile, if they are taken on a pro rata basis, the resources for Scotland are greater than those for England. I should add a caveat, because the Care Act 2014 deals with adult carers of adults, whereas the Carers (Scotland) Bill deals with adult carers of adults, adult carers of children and young carers.
Thank you for that.
In paragraph 9 of its most recent submission, COSLA says:
“Although Scottish Government indicated that it would be prepared to consider any new information which comes to light about the cost estimates ... this willingness did not extend to being prepared to jointly agree revised estimates, or to addressing unfunded pressures on councils that result from this new legislation.”
In paragraph 1.3 of their submission, the national carers organisations say:
“We believe the government should undertake further scoping on the financial impact of the Carers Bill”.
COSLA also says:
“we are calling on the Scottish Government to work with us to reach joint agreement on the model to be used to estimate cost and demand”.
In its conclusion, in paragraph 12, COSLA says:
“many of these concerns are shared by relevant professional associations such as Social Work Scotland, and to an extent by third sector colleagues.”
There seems to be significant concern about some of the financial assessments and, given that the national carers’ organisations include Carers Scotland, the Coalition of Carers in Scotland, the Minority Ethnic Carers of People Project, the Carers Trust Scotland, the Scottish young carers services alliance, Crossroads Caring Scotland and Shared Care Scotland, concern about how the costings have been arrived at seems to be widespread.
You are absolutely correct to say that COSLA, Social Work Scotland and the national carers’ organisations have made those statements. Under fiscal constraints and in an extremely challenging economic climate, it is understandable that those organisations want fair, proper and transparent costings for the bill. They all agree that it is important to support adult carers and young carers—as, of course, does the Scottish Government.
Those organisations have not, however, provided alternative costings to those that are set out in the financial memorandum—at least, they have not provided full alternative costings, especially on unit costs for adult carer support plans and young carer statements or on the demand. Across the spectrum, there is no alternative position on the financial estimates.
You asked how the Scottish Government arrived at the financial estimates. COSLA sent a survey to local authorities on our behalf. We got 22 returns, which is a very healthy rate of return. We also sent questionnaires to health boards and again we got a healthy level of response. The Carers Trust and Coalition of Carers also surveyed care centres on our behalf. A bottom-up approach was therefore taken to estimating the figures in the financial memorandum.
12:15As I have said, and as those other organisations acknowledge, estimating the figures is very challenging and is not an exact science—it depends on carer behaviour. I am happy to set out how we arrived at the unit costs for the adult care support plan, which COSLA, Social Work Scotland and some local authorities have commented on.
I am also happy to talk about the removal of the substantial and regular test, which has been mentioned. There was a transparent process to build up the costings for the financial memorandum, based on the information that was presented to us in the local authority returns. I am happy to set that out in detail in relation to the unit cost of adult care support.
I agree with Moira Oliphant. We recognise the concerns of COSLA and the other local authorities about the accuracy of the estimates but they are our best estimates at this time. We have given a commitment to take on board any new evidence as it comes to light and we will review the estimates.
We propose to do something similar to what we did for the Public Bodies (Joint Working) (Scotland) Bill on the integration of health and social care and create an expert finance group, with representatives of all key stakeholders, including COSLA, to review the costs as we move towards implementation, taking on board any nenw evidence.
As things stand, the estimates are the best position that we have at this time.
Of course, that raises the question of what a best estimate is, but I will leave that just now.
We have been told in written evidence that although the costing for the adult carer support plan appears to have been based on the model of a one-off intervention,
“an outcome based support plan is a process rather than a single event.”
How does that impact on the bill’s financial aspects?
That is a fair point by the national carers organisations, which know how the current carer’s assessments are carried out. Although a carer’s assessment such as the adult carer support plan can involve building up information and can be an iterative process, which can be reviewed, it can also be quite a low-profile form of assessment. It depends on the carer’s situation and on finding out from the carer or young carer the impact of the caring on them and the personal outcomes that they would like to achieve—which brings us back to your earlier remarks—to be able to continue caring in good health, to have a life alongside their caring responsibilities and, in the case of young carers, to have a childhood.
Carer’s assessments can take many forms. We are aware that, as the national carers organisations have pointed out, a carer’s assessment and an adult carer support plan can take longer, especially when there are complex needs and issues to explore. However, we also know from the returns that we have received and from research that the process can be much shorter if the needs are not as demanding.
As for the question of how the unit costs have been derived, it would be a difficult, challenging and detailed exercise to try to build up a unit cost based on the different types of assessment, the number of days it takes to carry them out and so on. We know from the returns that some assessments are carried out by social workers, some by health professionals, some by social care assistants and some by the voluntary sector, and as the financial memorandum itself points out, the efficiencies involved need to be looked at.
The financial memorandum sets out three possible unit costs, with £176 at the top end. I recently spoke to colleagues in London about the estimates in their impact assessment for the provisions for carers in the Care Act 2014, and they also sought returns from local authorities in England on unit costs. The English unit cost is presented in the financial memorandum as £100 but, based on returns from 120 of England’s 152 local authorities—or a 79 per cent return rate, which is very good indeed—the median cost for different types of assessment is now £116, which is much lower than the high-end cost of £176 for Scotland set out in the financial memorandum.
With regard to the returns from local authorities and the unit costs for the current carer assessment, only two authorities out of all those that made returns presented a unit cost of more than £300. Four or five presented unit costs of less than £100, with the rest congregating in the middle between £100 and £250 or so, and we derived from that an estimate of £176. That said, we acknowledge that the unit cost will be variable, depending not only on whether the assessment is an iterative one or one involving a much simpler process but on whether it relates to complex or more straightforward needs and whether it involves rurality, travelling time and so on.
Some local authorities—I do not know how many—are beginning to look at telephone or online assessments, but they would be valid only in certain circumstances. After all, carers value face-to-face interventions. One local authority terms its assessment a conversation, another calls it a journey and a number call it a carer support plan, but the point is that that kind of face-to-face intervention is valued.
It is difficult to look across the piece, and we have done our best with the information that has been presented. Concern was expressed that we had not taken account of the figures over £300, but the fact is that only two of the returns were at that level. Although the median unit cost in England is £116, we agree that there is merit in considering whether the unit cost should be increased towards £176 to take account of rurality and other issues, but that issue would be explored by the finance group that Julie McKinney has referred to.
Thank you for that comprehensive answer. I will now move to questions from the committee.
In response to the convener, you said that other organisations had not provided alternative costings.
That is the case across the piece for the financial memorandum.
Would their doing so cause you to revisit the figures?
As I have said, organisations did not provide alternatives across the piece. I think that Social Work Scotland and COSLA said that they did not want to present an alternative at this stage, because it was not right or appropriate to present one set of estimates against another. That is not the way that we want to work. We want to work together on this; indeed, we presented our estimates to COSLA in mid-February.
I am certainly aware of the fact that any adjustment for the number of carers coming into the system or any change in demand will impact on costs. However, given the very uncertain position in estimating demand, the Scottish Government has done the best that it can in the circumstances.
For the purposes of the bill, we accept the estimate that we have. However, as I have said, if, over time and through the working group, we can get more robust estimates or more submissions from local authorities with sufficient evidence to back up the position, we will take them into account and look at them as they have been presented.
You have both said that there are a huge number of uncertainties with a demand-driven service, which I am sure is right. Let us assume that COSLA turns out to be right and that the more expensive estimates that some local authorities are coming up with are correct and your figures are significant underestimates. Were that to happen, would the Scottish Government commit to underwriting any shortfall or would that be just tough luck on local authorities?
We will look again at the evidence once the bill has been implemented. If there is a significant difference between the estimates and the costs, we will obviously need to look at the issue again in light of the overall Scottish Government financial settlement and at the options available to us at that time alongside other policy and legislative commitments.
Perhaps it would be fairer to put my question to ministers, who would have to confirm that.
Absolutely.
After all, this is an important matter. As the convener has suggested, there is always a difference between what local authorities, for example, say that the costs will be and the Scottish Government’s estimates, with the answer often lying somewhere in between. The important question is: who bears the risk if the figures are wrong? Is it the local authority or the Scottish Government? However, I will put that question to ministers—you have already answered it.
Moving on to some of the detail in the memorandum, I direct you to table 3 on page 34, which sets out the costs to the national health service. I will skip the first row of costs, which are for “YCS”—or young carer statement—“recurring”, as they are pretty small. The next row of costs, which relate to “Information and advice service”, appear to be £2 million a year; that figure does not change, which I can sort of understand. However, the third row, on “Duty to support carers”, sets out costs of £3 million in year 1, and that amount does not change at all over the five-year period. Are you confident that over six years there will be no increase in the costs of a duty to support carers? That strikes me as odd.
I can explain that. The £2 million for the information and advice service and the £3 million for the duty to support carers across all the years add up to the £5 million that is available now and which has been available for the past number of years to health boards for carer information strategies. Arguably, the figures should not have been presented in the financial memorandum—and I say “arguably”, because the vast majority of duties are on local authorities. Health boards themselves have only two duties.
Because there has been so much favourable comment and very credible information about the impact of the relatively modest sum of £5 million for carer information strategies by health boards, which have built up expertise working with the third sector and local authorities over a number of years, the decision has been taken to include that funding in the financial memorandum and to recognise the value of what has been achieved so far. As a result, the £2 million for the information and advice service as well as the £3 million for the duty to support carers that you focused on will be added to the funding that has been attributed to local authorities for the duty to support carers as set out in the table on page 33.
12:30
You sound fairly confident about that.
The costs of the support plan are set out on page 32 of the financial memorandum. In the top row, which goes from 2017-18 to 2022-23, the costs start at a maximum of £1.82 million and increase year on year to a maximum of £18.86 million per year. According to you, the figure will not increase after that but will recur from 2021-22. Is that right? Once the maximum of £18.86 million has been reached, can it not increase?
We see that figure as the maximum based on the 34 per cent of carers who would receive an adult carer support plan by that time. If we were to maintain that 34 per cent, the numbers could, if anything, start to decline in the latter years, and we want the expert group to look at the bill’s longer-term implications over perhaps a five to 10-year period. The figure is a maximum that could reduce, and that could free up resources to invest in the duty to support carers.
In its submission, COSLA suggests that when this was happening south of the border, it was assumed that the jump from year 1 to the maximum would take two years. You have assumed that it will take five years. Can you explain why that is more likely? Has anything happened down south that has led you to think that the two-year period was a mistake? Are you able to expand on that?
I am. COSLA, Social Work Scotland and others are right to point out that the timeframe for the build-up for the adult carer support plan in Scotland is different to that for the carer’s assessment in England.
The reason is that, according to the estimates that we have built up from the local authority returns that we received, more carer’s assessments are carried out in England as a proportion of the population than in Scotland. As the impact assessment for the Care Act 2014 shows, 370,000 carer’s assessments were carried out in 2013-14; 10 per cent of that figure is 37,000, but the estimates suggest that nowhere near 37,000 carer’s assessments were carried out in Scotland. In fact, it is estimated that only about 12,000 carer’s assessments of adult carers were carried out. As a result, we are starting from an extremely low base compared with the situation down south.
It is true that carers can be assessed with the person whom they care for—there are different types of assessments—but, if we are talking about carer’s assessments, the base that we have is very low. When we take into account other types of assessments, including assessment with the cared-for person, the figure doubles from 12,000 to 24,000, but that is still low compared with England. Because the profile starts from such a low base, the build-up period will have to be longer. I note, however, that it builds up in the later years.
You have taken the average unit cost for the assessments as being £176. You have put that at the top end of your table. You give low, medium and high figures, and you have put that figure as the high one. You have spoken to people in local authorities and you have drawn an average. Is the figure of £176 just splitting the average for local authority A and local authority B, for instance, or did you consider the number of assessments in each authority and then average the figures out? I do not know which local authorities had figures of £260 and £300 but, if those are the authorities with more assessments—the larger local authorities—and if the very small local authorities have lower unit costs, the average might be slightly skewed. Have you taken into account the number of assessments in each local authority, or have you just taken an average figure for each local authority and divided it that way?
For each questionnaire return that we received, the unit cost itself was not presented. What was presented was the number of assessments carried out in a year and the cost of carrying out those assessments. We then calculated the average unit cost for each authority, based on that. It was an arithmetical calculation. To that extent, the number of assessments carried out in each local authority area was taken into account.
Referring to your comparison with English local authorities, where the figure was £100 to begin with—you now say that it is £116—are you definitely comparing apples with apples, or is there something different about those assessments that could make the costs in England lower?
On the information in the impact assessment, we do not have the full information on the English costs, but colleagues said that, like us, they got returns and they got a unit cost for each local authority area. They said that, similarly to the situation here, the unit costs in England varied widely, with the lowest being less than £100. They said that it was exactly the same as it is for us, and that there were a few places where the cost was over £300. They did some sort of weighting according to area so, to that extent, the figures could be different, but that was the basis of their figures.
It is instructive to look at the English costs. The number of complex cases will be similar north and south of the border, although there may be more issues around rurality and remoteness in Scotland.
I refer you to the financial memorandum at page 46. The table features the “Cost of support”, with the £333 unit cost that you spoke about. In one of your earlier answers, you mentioned that the English figure is £967 and that, if you were calculating the Scottish one on a like-for-like basis, it would be closer to £600. What is the difference between that £600 figure and the £333 unit cost figure that you have used in the financial memo?
The £333 unit cost is based on research from the Carers Trust. It has to be said that there is not a huge amount of research in the area. It is based on direct support to carers.
A point was made in the response from the national carers organisations that the £333 figure does not include short breaks, although it includes advocacy, information and advice and emotional support. However, we have costed information and advice separately. Therefore, the £333 figure appears to be reasonable, certainly in comparison with time to live grants, which are given directly to individual carers under the voluntary sector short breaks fund. As we would expect, those grants vary depending on individual circumstances, but the £333 figure is certainly above a good level of grants under the time to live fund. To reiterate, the £333 represents direct support to carers.
The £609 figure that has been quoted is the per-person cost of respite care in a care home. That would be for a cared-for older person going into a care home so that the carer gets a short respite. As a result, we have not included that figure at the moment, because there are challenges around existing regulations on waiving of charges that we want to take stock of. Therefore, there is a need for further work. However, the figure down south of £900 is not directly comparable to the figure here. The £333 figure, as an average unit cost, could certainly provide a good level of support to carers.
At this point, since you have referred to the table on page 46 and I have it in front of me, I apologise to the committee for an error in the figures. Social Work Scotland is indeed right, and we value its very careful eye and scrutiny of the figures. Under the £333 unit cost column, we have the figure for 2020-21 as £24.808 million, but it should be £36.288 million. We will take that new figure into account.
Regarding the earlier part of your answer, you are saying that further work is needed to look at getting rid of charges and so on. Is there any possibility that the £333 unit cost could become a unit cost of £609?
Again, it is for the group that Julia McKinney mentioned to look at the matter in more detail. We have done the best that we can with what we have. I referred to the waiving of charges. Would you like me to talk about that and why it has an implication for what we are saying?
Possibly, yes. The point that I am driving at is that, if the £333 becomes £609, that in effect will double the cost of the bill. I am just trying to work out whether there is any risk of that happening and, if so, how big a risk it is. As a Finance Committee, we are trying to establish what the parameters might be.
The type of support to carers will vary. It has to be said that, because the £333 figure excludes information and advice, it is a fair amount per carer whose needs are eligible and who is being supported in this way. It could be less than £333 and it could be more.
I do not want to put words into the mouths of the carers organisations, but one of their views is that they want more person-centred types of support. I refer in particular to short breaks. There can be a variety of short breaks, including some that are not traditional. Although some traditional forms of respite are very much relevant, we can try to get in an element of innovation regarding the type of holiday break. Even purchasing a greenhouse is quoted as providing a break for some people, and although that is not seen as traditional respite, we know from feedback that there are carers who would say that with that sort of facility they can do what they want and get time out from caring. That is what they want. Respite does not have to mean that the cared-for person is in a care home.
Your point is valid, as there is a range of costs. However, it would not be appropriate to say that, in all cases, the unit cost will be over £600. That will not be the case. It is often said that carers do not want very much, but of course they want support, in the right way and at the right time to meet their needs and the needs of the person whom they are caring for.
12:45
We have been going over the same ground a bit and I will do so as well—we seem to be focused on some of the issues.
I am from Glasgow and therefore I am looking at Glasgow City Council’s submission. I do not quite understand. You suggested that, although you received estimated costs from different organisations and you took an average, you did not have a specific figure from every local authority. Glasgow City Council said that it
“estimated that a carer assessment in Glasgow costs around £280”
and that, for young carers, it
“submitted an estimated unit cost of £394.”
The financial memorandum assumes costs ranging from £72 to £176. Are those two things different, or are they like for like? How do the figures compare?
With regard to adult carers, it is as we have discussed. The response from Glasgow City Council set out the unit cost of £280, and two of the other responses that we received from local authorities gave costs for adults of over £300. Glasgow was one of the 10 authorities that presented costs of between £101 and £299. The cost that was presented by Glasgow was taken into account in working out the figure of £176.
In your answer to Mr Brown, you agreed that, because Glasgow is bigger, that would have pulled the average up a bit.
I think so, yes.
Therefore, Glasgow City Council cannot currently do the assessment for £176. Are you saying that it is overdoing matters, perhaps by sending two people along when it should send only one and that there is too much management cost and that kind of thing?
I would not say that. All the authorities were given a brief outline of what would be included in a unit cost, such as the staffing costs and so on. I would not want to comment in that negative way on Glasgow’s costs. As I have said, Glasgow did not present the highest cost.
It was challenging to look at the issue, because we were presented with such a wide range of unit costs. I know that Glasgow’s assessments tend to concentrate on carers with very intensive caring situations and in very difficult situations. As far as I am aware, those assessments are carried out by the social work department. Other carers in Glasgow go through a self-assessment process, which is carried out either wholly or partly by the voluntary sector, and the cost of that will not be as high. If the voluntary sector picks up cases that should be referred to the social work department, the cases will be referred.
That is my very broad-brush understanding of how Glasgow operates. I would not want to say that Glasgow is providing too many social workers, but we know that a lot of the costs are taken up by staffing. There should be a critical look at the efficiencies of the process.
As part of the further work that is to be undertaken, it would be helpful to look at the average costs that were submitted by the authorities and to share good practice to enable authorities to drive down their costs. We want to make the assessments as efficient as possible and to learn from good practice.
My perspective is that Glasgow City Council can be top heavy at times and that it does not use the third sector very well. On the other hand, talk of efficiency makes me think of Atos. That may be efficient—churning people through and telling them that they are all fit for work—but I do not know whether that kind of efficiency gives the best assessment. I have concerns in that area.
My other concern is about the £333 figure, which we have also talked about quite a lot. In case I have not understood it, could you please explain this to me? If there is a young person caring for a parent or another adult, the £333 will pay for the young person to go to scout camp or guide camp or something like that for a week. What happens to the older person?
There is a wider issue regarding who cares for the cared-for person when, in this instance, the young carer is away.
The young carer statement will consider the personal outcomes for the young carer. If it is deemed that the young carer would benefit from the type of scout camp intervention that you mention, that would happen. That is seen as bespoke support. Providing that the needs have been determined to be eligible before that process, that would be funded.
With the person who the carer is caring for, there could be a number of situations. Another family member could stand in or a carer centre could work with the local authority to agree on an intervention, as we understand happens.
The young carers festival takes place each year in East Linton. I do not know if any committee members have been to it, but it is great fun. Six hundred young carers go there every year. In some cases, they are away from the parent or sibling for whom they care for the two days’ duration. The parent can be without the young carer, and they manage their support in other ways. We know that, in some cases, the carers centre will provide support or will negotiate with the local authority.
Replacement care is certainly an issue with the broad policy. For carers to get away from the caring situation or to get a life of their own, replacement care needs to be provided in some instances. That does not apply in all cases, however.
Is there any financial provision for that replacement care?
It comes back to the issue around the waiving of charges, to which I have alluded on a few occasions. I ask you to bear with me while I outline a bit of the history, because it leads up to where I am getting to. The previous Minister for Public Health gave a commitment when the Social Care (Self-directed Support) (Scotland) Bill was going through Parliament. That bill—now the Social Care (Self-directed Support) (Scotland) Act 2013—contains a power to support carers, and the minister gave a commitment that, if the power is used, charges will be waived for the support that the carer receives, because carers are providers of services and should not be charged for the services that they provide.
The Scottish Government developed regulations and guidance around that waiving of charges, and it was stated that, if local authorities use that power under section 3 of the 2013 act, after going through the carer’s assessment and so on, the charges will be waived.
Waived by whom? In my scenario, the person who is being cared for goes into the Four Seasons care home in Baillieston, and the charge is £600. Bupa or the Four Seasons is not going to waive such charges.
That would be done by the local authority. It could be that the charge for a direct short break such as a holiday would be waived, but—
Sorry, but waived by whom? By the Four Seasons?
By the local authority.
But the person is not in a local authority home; they are in a private home.
Okay. I do not know about that.
We have virtually no local authority homes.
I do not know about that.
Referring to support under section 3 of the 2013 act, the issue and the challenge that have arisen are around replacement care. COSLA and some local authorities have told us that it is unfortunately not possible to say whether replacement care benefits the carer or the cared-for person. If it benefits the carer, the charges would be waived. If it benefits the cared-for person, normal charging would apply. Charging would be waived where it supports the carer.
People understand the issue and concede that it is sometimes difficult to judge whether replacement care benefits the carer or the cared-for person or both. In some instances, it might be straightforward. If the replacement care is provided by a day care centre and the cared-for person is going there to promote their independence and to have something good to do there, we can say that that is supporting the cared-for person, in which case normal charging would apply. It is challenging and difficult to know whether replacement care is for the—
Yes, I take that distinction about replacement care, but my fundamental point is that somebody is going to incur a cost. If the person stays at home and just gets a few hours of extra visits, it will be Cordia, in Glasgow’s case, that will pay for somebody to provide that. Somebody has got to pay the wage. If the replacement care is at a proper care home, that means £600 going to the private company or whatever it is. I am struggling to understand who will pay that bill.
If it is provided within the local authority, it would be the local authority that would waive the charges. We will come back to you on the question that you raise about private care homes.
Leading up to the challenge that we have, we had a number of discussions with COSLA, a few local authorities and the national carers organisations to try to deal with the issues that have arisen around the waiving of charges. We do not yet know what we will do—ministers need to take a final decision on that.
On the matter of how to resolve the impasse, I point out that not many authorities are using the power to support carers under the 2013 act. That might be because of the uncertainty around the charging issue or it might be because the act is relatively new legislation—there could be a whole host of reasons. The issue certainly needs to be examined, and we are doing so.
I appreciate your answer, but I remain convinced that there are costs that I am not seeing in the financial memorandum.
I was going to ask about something else, but I would like to pick up on this issue first. You are going to come back to us on the £600 care home charge. Are you assuming that there is an issue there, in that that would be seen as support for a carer, as opposed to support for a cared-for person? If it relates to support for a cared-for person, there is no issue—the £600 just has to be paid.
That is right. That is the challenge. Some local authorities say that they cannot implement the waiving of charges regulations because they simply cannot say whether the support is primarily for the carer or for the cared-for person. If that is the case, as some local authorities say it is, that is a challenge. Arguably, if the support is directed through the carer’s assessment, it is support for the carer, but some local authorities have said that there might be pressure on practitioners to say that the support is for the cared-for person, so that charges can be applied. There might also be pressure from carers to say that the support is definitely for the carer, so that they can get the support without paying a charge for it.
We understand the complexities and difficulties around the matter. As I said, we have had a number of meetings with COSLA, local authorities and the national carers organisations to try and find a way forward. Because the situation is unresolved at the moment, the financial memorandum does not capture any costs around replacement care.
Will there be new regulations under the bill, or will there simply be new regulations to replace those under the Social Care (Self-directed Support) (Scotland) Act 2013?
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A decision has not been made about that. COSLA has said that it would like the current regulations to be changed, but we are unable to do that because we have not agreed a way forward. It may be that the current regulations will stay in place until the provisions in the bill are commenced, when different regulations will come in, depending on what is agreed. A decision has not been reached yet.
Local authorities are working with the existing regulations, and a handful of them are saying that they want to support carers in that way and will work with the power in the Social Care (Self-directed Support) (Scotland) Act 2013 and with the regulations—that they will waive the charge for carers and will support them. Some local authorities are saying that it is just too difficult, and other local authorities are saying that they do not need to use the regulations at all because they are supporting carers through carer centres in their locality and that that system is working well. It is a complex picture.
Do you envisage issuing a supplementary financial memorandum to the bill, or will the matter not be resolved within that timeframe?
It will need to be resolved. We envisage issuing a supplementary memorandum to take account of the issues.
You will have to resolve it with COSLA within the next few weeks or months.
Yes.
The matter is connected to my main question. The overwhelming bulk of the costs arise from the adult carer support plans and—even more—from direct support to carers. COSLA highlights the tension between them, saying:
“Within the context of a finite resource being made available under the Carers Bill, there is the concern therefore that resources which could have been available for direct support are instead required to be diverted to assessment.”
I imagine that that last bit relates to COSLA’s scepticism about the 34 per cent peak. Assessment will be demand led, so if the percentage proves to be higher, local authorities will have to respond to that. This is where I do not know the detail of the bill well enough. Is there a lot of flexibility around the support that must be provided? In other words, are there national criteria, or are there just local criteria, which could vary quite a lot between different local authorities? If local authorities had to spend more on assessments, could they, under the bill, just take the money from the resources that they had set aside for direct support?
We would hope that sufficient resources would be provided for assessment, for the adult carer support plan, for the young carer statement, and for supporting carers who meet the local eligibility criteria that will be determined. The point that COSLA and a few others are making is that they feel that there is a disproportionate emphasis on assessment as opposed to support. The scenario that is envisaged is of assessment consuming resources without any good outcome.
The adult carer support plan and the young carer statement will be available to all carers, and that was seen as the way forward. However, that does not mean that resources will be spent in the wrong way, if I can put it that way. There is research evidence. I refer the committee to research carried out by Midlothian Council and the Voice of Carers Across Lothian, which found that assessment is extremely valuable if it is carried out properly and that carers feel supported through an empathetic and outcome-based assessment. The research points to the conclusion that a carer who has not been listened to previously values the assessment in the first instance.
The financial memorandum sets out financial estimates for the adult carer support plan and the young carer statement and then for information and advice. There are provisions in the bill that allow authorities to look at whether, through the adult carer support plan, the carer’s eligible needs could be met by information and advice services—we know that carers value information and advice—or by general services in the community. If their needs cannot be met in those ways, the authority would move on to the duty to support and would look at bespoke, targeted support, in accordance with the eligibility criteria.
On 34 per cent of carers having an adult carer support plan, there has been a steady build-up to reach that figure from quite a low base, and the estimates were made on that basis. Fee Hodgkiss may be able to comment on the health and social care experience survey, the number of carers who feel supported at the moment and so on.
My general point is that, with some legislation, if the figures in the financial memorandum are underestimated, the money will just have to be found from somewhere. However, if this financial memorandum is wrong, will it be just the carers who suffer? There is so much flexibility around the criteria for support that there are no implications for public expenditure; it will just mean that carers might not get the support that you would like them to have.
The financial envelope is important here. In drawing up their local eligibility criteria, local authorities will have regard to the amount of resources that they have. It will be incumbent on them to do that. However, it is normal for them to take account of the resources that they have. It would not be a matter of putting a carer through the process for an adult carer support plan or a young carer statement and then leaving them hanging. Resources are going into information and advice services, and there are also resources for the duty to support. Nevertheless, local authorities will have to take account of the resources that they have available and look at the thresholds for support.
I suppose that, under the legislation, they could give them, crudely, £100 rather than £300—that would not be breaking the law.
The local eligibility criteria must be drawn up in a transparent way and must be published, and carers and young carers must be involved in drawing them up. It has to be a transparent, open process, and there has to be local democratic accountability. However, if what you describe happened, I do not think that the authority would be breaking the law.
The section on savings is interesting, but you have not really factored in any of that. Is the potential for savings just mood music?
There is some research evidence—I think that it is presented in the policy memorandum—to show that supporting carers, especially through early intervention and preventative support, can result in savings to health and social care. The policy memorandum cites three sources for that evidence, which is based on English research.
It is acknowledged across the piece that more early intervention and preventative work needs to be done. Certainly, there is a lot of anecdotal evidence that, if carers are supported in the right way, that will prevent the cared-for person from being admitted to hospital or other institutional care and will prevent carer breakdown. There will be savings, but the area is ripe for further evaluation and research. The financial memorandum also refers to potential savings being made through carers remaining in, rather than giving up, employment. Again, that is based on some research that was done down south and some estimates that the financial memorandum acknowledges as being broad brush.
I will try to be brief. You have mentioned research a couple of times, Ms Oliphant, including in relation to respite and short breaks. It strikes me that local authorities ought to maintain a list of people or organisations that provide respite and short breaks for carers, and should know how much such provision costs. I struggle with the idea that no data is available on how much it costs a local authority to provide respite and short breaks. Did you attempt to get that information directly from local authorities, rather than rely on the Carers Trust research that you mentioned?
The direct answer is no. The £333 covers all types of support. There is no duty in the bill to provide short breaks, so we looked at different types of support in the round. I do not know whether local authorities have the information that you would like to see. They certainly have information about respite weeks, because the Scottish Government collects data annually from local authorities on respite weeks and publishes it in the autumn. However, I do not think that the data covers the cost of providing respite weeks. Again, that issue is certainly worthy of further exploration.
I appreciate that there is no such duty in the bill, but at the same time you have to factor in an assumption that a number of assessments will identify short breaks or respite as being appropriate support for individuals. Although there might not be a duty, it is only fair to assume that that will arise, and therefore it would be good to have an idea of the likely costs and whether the assumptions in the financial memorandum are sufficient. One of the concerns raised by the national carers organisations is that if the financial memorandum’s numbers are insufficient, we will see amendments to local eligibility criteria that will raise the threshold for receipt of support, potentially excluding a large number of carers from that support because the available funding will not cover provision. Do you recognise that concern?
Yes. The national carers organisations and Shared Care Scotland have made the point that the resources for the duty to support are heavier for the later years that are referred to in the financial memorandum than they are for the earlier years, and that there might be an issue around short breaks in the earlier years, although there is not so much of an issue in the later years. That is certainly a valid point, and the finance group that is being set up will look at it.
Your comment that local authorities will surely have information about the costs of respite and short breaks is valid, and we want to look at that further. I know that there is a concern that the provision of respite weeks has reduced. The national carers organisations are concerned that at least some local authorities are not providing adequate respite weeks to meet need—that certainly is an issue.
The voluntary sector short breaks fund is a modest sum of £3 million, which is not factored into the financial memorandum. However, I think that ministers would want to look positively at the fund’s future. Replacement care is another relevant issue—it is sitting there at the moment because of the waiving of charges this year.
13:15Perhaps it is also worth making the point—it is not directly relevant to short breaks, but it is relevant to the wider picture—that we do not have a figure for the resources that local authorities spend directly on supporting carers because we did not get 32 responses to the questionnaire and some of the responses did not set out the figures. However, the figures that we have from about 12 local authorities show that more than £5 million is being spent on direct support to carers, and that will include short breaks. The financial memorandum does not take that off, so there is existing funding in local authorities. Arguably, the Scottish Government is being generous in leaving that level of funding in place.
Another thing that is apparent from the questionnaire returns is the amount of funding that is spent on indirect support to carers, which can include respite for the cared-for person, equipment and adaptations, and so on. We asked for that figure, and in the returns that we got the total came to £40 million. That is only for a certain number of local authorities and we would not want to say that all that money is for indirect support to carers, but a proportion of it will be. That money is in the system as well—it carries on, as does the integrated care fund.
As far as we know, the last year of the integrated care fund will coincide roughly with the commencement of the provisions in the Carers (Scotland) Bill. Again, although there is no ring fencing for that fund, we know from partnerships’ submissions to the Scottish Government that almost all local authorities will spend resources on carers because they value the support that carers provide.
That overall resourcing is the wider picture and context. However, your point about eligibility for short breaks and downwards pressure is valid and it is one that we would want to consider more widely within that wider context of all the funding.
Okay. Social Work Scotland has raised concern about the use of the £176 average as the top-level number in the financial memorandum. Obviously, if it is the average, it is not the top, so why did you use it as the top level? The deputy convener highlighted Glasgow City Council’s comments, and other local authorities have given unit costs that are well over £176.
It was a minority of local authorities that gave unit costs of more than £176. The reason why the unit cost for the adult carer support plan was set out in that way was to give the Finance Committee an indication that assessments can be carried out in different ways. I mentioned telephone assessments and so on. The lowest figure, which is £72, was not originally the lowest. We took out of the equation the lowest and the highest figures, because they were at the extremities.
The £176 figure is presented as the average across a good number of local authorities. There are ones at the higher end, so I understand Social Work Scotland saying, “You haven’t presented the higher ones.” That is the case, but there would appear to be a good reason for that, especially given what we know about the costs of assessment down south. However, it is something that will be looked at and considered further.
In its submission, Glasgow City Council raised concerns about the period of three years being used as the length of time that people normally care for, pointing out that someone whose child has complex needs will be a carer for more than three years. Where does the three-year figure come from? What is it based on?
I think that it relates to the work that was done to arrive at the figure of £333, based on a three-year episode of caring. We recognise that carers can care for much longer than that.
Is it merely a case of something being lost in translation by Glasgow City Council?
Yes. It does not mean that carers care for three years and that is it. Some would, but that is clearly not the case for all. The £333 is the unit cost every year.
I will try to be brief. I want to reflect on the concerns that other members have raised about the allocation of costs for replacement care. Is it not the case that if a carer is allocated that £333 for support, but a replacement care package is not in place because of the problem of waiving charges, that renders the effect of the duty to support either meaningless or at least severely impaired?
That is why the issue needs to be resolved in time for stage 2. It is very likely that a stage 2 amendment to the bill will be considered, as the waiving of charges is an outstanding issue.
I want to get a sense of the issue’s extent and importance. Is the reality not that the cost of replacement care could be the major cost of the bill? It could have the major cost impact on Government and councils, and, as it stands, it is not in the financial memorandum.
You are right—it is not in the financial memorandum, for the reasons that I have stated. The cost of replacement care could be in the region of £30 million across Scotland—that is at present prices. Replacement care could be support primarily for the cared-for person or primarily for the carer, or it could be of benefit to both. As I say, categorising replacement care is challenging.
If you have an estimate of £30 million, why was it not included in the financial memorandum, even alongside a statement that it was dependent on negotiations with COSLA?
The figure was worked out fairly recently, after the financial memorandum was submitted. We did not mean not to be straightforward about it. Also, the waiving of charges issue is still outstanding. I think that it is fair to say that a further financial memorandum should be presented, but it probably would not have been appropriate to present a figure of £30 million, had it been known, because some replacement care could certainly be of prime benefit to the cared-for person rather than the carer.
I will leave it at that just now, convener. I think that there are huge questions about some of that.
I thank committee members. I also thank the witnesses for their responses, although I think that we need clarification from the minister on some of the issues that have been raised today. I will write to the minister this afternoon, seeking a response before we consider our report, which is due to go the lead committee on 27 May. I think that there are still a lot of questions that my colleagues want answers to. We might have to revisit the matter at some point in the near future.
Meeting closed at 13:24.Previous
Fiscal Framework