The additional cost figures in table 2 of the Personal Care at Home Bill impact assessment are shown in millions of pounds. This is labelled in the amended version of the impact assessment, which was published on 11 January 2010. A copy has already been placed in Library.
The model referred to in paragraphs 5.12, 5.13 and Annex B of the impact assessment is still under development. For this reason, its output has not been incorporated into any of the figures reported in the impact assessment. The model will continue to be updated and refined as more information becomes available.
The Personal Social Services Research Unit (PSSRU) has constructed a dynamic microsimulation model to produce estimates for the Green and White Papers of the costs and other impacts of reforms to the funding system for care and support for older people. The model consists of data on almost 30,000 older people in waves 3 to 15 of the British Household Panel Survey. The data include information on each person’s age, gender, household composition, disability (activities of daily living), income, savings, receipt of informal care and other characteristics.
Table 13 of PSSRU discussion paper 2644 sets out the unit costs of residential care and community care that are used in the modelling. These are derived from data provided by local authorities via the Personal Social Services (PSS) EX1 return. They are assumed to increase by 2 per cent. per year in real terms, in line with expected rises in real earnings.
The NHS Information Centre provides the information for part (c) Table 35e as a response to a Health Select Committee Question. This table contains the unit costs for the hourly rate for home care provided or commissioned by Councils with Adult Social Services Responsibilities (CASSRs) to adults (aged 18 and over).
The unit cost of services provided or commissioned by CASSRs to adults is collected via the PSS EX1 return. The PSS EX1 return collects both financial and activity information and has been the responsibility of the NHS Information Centre since April 2005. Prior to this date data were collected by the Department.
The unit costs are average costs and are calculated using gross total cost for home care (i.e. including capital charges and before deducting client contributions) divided by the total number of home help/care contact hours for all adults (aged 18 and over) during a sample week, multiplied by 52.
The activity figures for clients receiving home care are taken from a survey in a typical week in September each year. The figures are for services provided or commissioned by a local authority. This will exclude private arrangements by an individual.
In 2007-08 a change has been made to the definition of capital charges to bring the PSS EX1 data in line with the 2006 local authority Accounting Statement of Recommended Practice. This means that total cost cannot be compared historically.
A new column was added to the PSS EX1 return in 2007-08 to record grants to voluntary organisations against the appropriate service line to allow more meaningful unit costs for provision by others to be calculated. Grants are now excluded from the unit cost expenditure as only activity relating to the CASSR care plan can be recorded and used in the unit cost calculation. This change combined with the change to the definition of capital charges which applies to both own provision and provision by others means that the unit costs for 2007-08 cannot be compared with previous years.
The Personal Social Services Research Unit (PSSRU) has constructed a dynamic microsimulation model to produce estimates for the Green and White Papers of the costs and other impacts of reforms to the funding system for care and support for older people. The model consists of data on almost 30,000 older people in waves 3 to 15 of the British Household Panel Survey. The data include information on each person’s age, gender, household composition, disability (affecting activities of daily living (ADLs)), income, savings, receipt of informal care and other characteristics. The modelling assumes that disability rates (by age and gender) remain constant over time.
Each disabled person in the model is assigned:
informal care, which is imputed on the basis of disability and living alone;
Fair Access to Care Services (FACS) guidance category, which is imputed on the basis of disability and other factors; and
a normative care package, assigned on the basis of their needs (disability and household composition).
Table 10 of PSSRU discussion paper 2644 sets out the numbers of older people in the model that fall into each level of need, as defined in FACS, based on their severity of impairment, before any consideration of their informal care situation. Table 12 sets out similar information after consideration of informal care.
The starting point for the estimates of service users who are defined as critical under FACS reporting difficulty with four or more ADLs shown in table 2 of the Impact Assessment is an estimate of the number of FACS critical users at home taken from PSSRU’s microsimulation model for older people. This initial estimate differs from the FACS critical volume figure in table 10 of the PSSRU discussion paper 2644 in two important regards. First, the figures in the discussion paper relate to those in both residential and domiciliary settings, whereas what is important for the purpose of the Impact Assessment is the number of those living at home. In practice, almost all those in a residential care setting are likely to have critical needs. And secondly, the figures in the discussion paper are estimated before informal care considerations. Since receipt or not of informal care is part of the assessment of Fair Access to Care, it is an important consideration in determining the number of people deemed to be FACS critical.
The next step is to estimate the number of FACS critical individuals reporting difficulty with four or more ADLs. This is done using the information in table 1 of the Impact Assessment, and is explained in detail in the responses I gave to him on 14 December 2009, Official Report, columns 762-3W.