Community Care Statistics 2006-07: Referrals, Assessments and Packages of Care for Adults, England 1
Report of the 2006-07 RAP Collection England, 1 April 2006 to 31 March 2007 Editor: Associate Editors: Paul Niblett Ariane Alamdari Ed Corbet Charlotte Thompson February 2008 Adult Social Services Statistics Price: Free Published by The Information Centre Part of the Government Statistical Service ISBN: 978-1-84636-191-3 This publication may be requested in large print or other formats. For further information contact: online: www.ic.nhs.uk telephone:0845 300 6016 email: enquiries@ic.nhs.uk Copyright 2008, The Information Centre, Social Care Statistics. All rights reserved. This work remains the sole and exclusive property of The Information Centre and may only be reproduced where there is explicit reference to the ownership of The Information Centre. This work may only be reproduced in a modified format with the express written permission of The Information Centre. 2
Summary Referrals 2.04 million contacts from new clients were made to Councils with Adult Social Services Responsibilities in England in 2006-07, relatively unchanged from 2005-06. 1.04 million of these contacts (51%) resulted in further assessment of need or the commissioning of ongoing service and 998,000 (49%) contacts were attended to solely at or near the point of contact. Of the 2.04 million referrals, 586,000 (29%) were self-referrals, 487,000 (24%) were referred from Secondary Health sources (e.g. hospital wards), 277,000 (14%) were referred by family, friends or neighbours, with a further 274,000 (13%) referrals from Primary/Community Health. The remaining 20% were split between internal, Local Authority (LA) housing department, other LA, legal agency, other referrals and where the source was unknown. Assessments Approximately 650,000 new clients had their first assessment completed during 2006-07, relatively unchanged from 2005-06. In respect of waiting times for new clients aged 65 and over, 31 per cent of all new older clients had their assessment completed within 2 days of first contact and 62 per cent were assessed within 2 weeks. This is an increase on the 2005-06 figure of 59 per cent complete within 2 weeks. More than three quarters (79%) of all assessments for new older clients were completed within 4 weeks. Around 1.26 million reviews for existing clients were carried out in 2006-07, a rise of 8 per cent from a year ago and 16 per cent since 2004-05. Packages of care During 2006-07, approximately 1.77 million clients received services provided, purchased, or supported by Councils with Adult Social Services Responsibilities following a community care assessment. This is a rise of 1 per cent since 2005-06. Community-based services were provided to about 1.52 million clients during the year, accounting for 86 per cent of all clients receiving services. In 2006-07 an estimated 586,000 clients received home care, 491,000 clients received equipment and adaptations, 503,000 received professional support (e.g. occupational therapy) and 237,000 received day care as a service following assessment. Clients receiving more than one type of community-based service are included for each service received. 48,000 adults aged 18 and over received direct payments during the year. This is an increase of 29 per cent from 2005-06. Independent sector residential care services were provided to an estimated 203,000 clients, a fall of 2 per cent since 2005-06. An estimated 28,000 clients received council staffed residential care, a fall of 12 per cent since 2005-06, and 105,000 clients received nursing care, down 3 per cent on 2005-06. i
An estimated 1.23 million (69%), of those receiving services as part of a package of care following an assessment, were aged 65 and over. Around 79 per cent of new older clients had received all services specified in their care plan within 2 weeks of their completed assessment. A further 10 per cent waited up to 4 weeks for all services to be provided. Carers Around 353,000 carers received a carers assessment or review during 2006-07, either separately or jointly with the client. Approximately 108,000 (31%) of these carers were assessed or reviewed separately from the person they cared for. Of the 353,000 carers assessed or reviewed, an estimated 315,000 carers (89%) received a service following a carers assessment or review. Of these, 56 per cent received carer specific services, and 44 per cent received information only. ii
Summary Table: Main figures from the RAP returns for 2006-07, showing flow of information. Number of screened contacts Number of clients with completed Number of clients receiving from new clients assessment or review 1 services during the period R1 (contacts for new clients that resulted in further assessment of need or commissioning of service) R2 (contacts for new clients dealt with at or near the point of contact) 1,042,000 New clients for whom the 650,000 Clients 1,522,000 first assessment was receiving completed during the period community based services Existing clients for whom a 1,257,000 review was completed 998,000 during the period Clients 335,000 receiving residential care services 2 Clients with assessment or 217,000 review terminated 1. 2. 3. 4. 5. Total 2,040,000 Total 2,123,000 Total 3,4 1,774,000 Source: RAP proformas The assessment and review figures relate to clients whereas the referral figures are a count of contact events. It is therefore not expected that the referral and assessment figures will match. There should be no double counting of clients within assessments for new clients and within reviews for existing clients on A1. If a client has more than one assessment or review event during the period then details are recorded in relation to the most recently completed event. However, it is possible for a client to be recorded twice on A1 if they were both assessed as a new client and received a review during the reporting period. Some clients will be recorded more than once on the R returns as they may make more than one contact during the period. In addition, the R proformas include all contacts made during the year, regardless of whether or not the client actually received an assessment or any service during the period. Since movement between service types is possible, a client may receive more than one type of residential care service during the period. Therefore, this figure may contain some double counting. This figure is the number of clients receiving one or more services at some point during the year and excludes double counting. This figure includes clients receiving services provided, or commissioned by the CSSR during the year following a community care assessment. The client's assessment may have taken place in the current reporting period or in an earlier year. It includes new services that have started during the period and those carried forward from a previous period. A client may appear on different parts of the RAP proformas during different periods. For example, a client may have appeared as a contact on the R returns during the period 1 April 2005 to 31 March 2006, but then appear as a client with a completed assessment on the A returns in the 2006-07 survey. The same applies to services. iii
Contents 1: Introduction 1 2: Referrals and First Contacts 2 3: Assessments 4 4: Packages of care 13 5: Waiting times 21 6: Carers 27 7: Background Notes 29 8: Content of the returns for the 2006-07 30 9: Completions and Response 32 10: Data Quality 37 11: Related Publications 41 12: Further Information 42 Annex 1: Reference Tables 43 Annex 2: Flow Chart of RAP Proformas 85 Annex 3: Performance Indicators 86 Annex 4: Basis of return of RAP Proformas 108 Annex 5: Completion of RAP Proformas 114 iv
List of Tables and Figures Figure 2.1: Table 3.1: Figure 3.1: Figure 3.2: Figure 3.3: Figure 3.4: Estimated number of contacts from new clients during the period by source of referral, England 2004-05 to 2006-07. Estimated number and percentage of clients with completed assessments and reviews by age group, 2004-05 to 2006-07. Percentage of new clients with completed assessments by primary client type and age group, England 2006-07. Estimated number of new clients with completed assessments by primary client type and age group, England 2006-07. Estimated number of existing clients for whom a review was completed during the year, England 2004-05 to 2006-07. Percentage of new clients with completed assessments and existing clients with completed reviews by primary client type, England 2006-07. 3 5 6 7 8 9 Figure 3.5a: The percentage distribution of the outcome, for age group 18-64, 2006-07. 10 Figure 3.5b: The percentage distribution of the outcome, for age group 65 and over, 2006-07. 10 Figure 3.6: The percentage of outcomes recorded on A5 by client group, 2006-07. 11 Figure 3.7: Table 4.1: Figure 4.1: Figure 4.2: Figure 4.3: Figure 4.4: Table 4.2: The distribution of new clients with completed assessments by ethnic group and anticipated sequel to assessment. Estimated number of clients receiving services during the year by service type and age group, 2004-05 to 2006-07. Estimated number of clients receiving services during the period by type of service and age group, England 2006-07. Percentage of clients receiving services by primary client type and age group, England 2006-07. Estimated number of clients receiving community based services during the year, England 2005-06 and 2006-07. Estimated number of clients receiving community based services by age, England 2006-07. Estimated number of clients receiving community based services by service type and age, at 31 March 2006 and 31 March 2007. 12 14 15 16 17 18 19 Figure 4.5a: Ethnicity of clients receiving services aged 18-64, England 2006-07. 20 Figure 4.5b: Ethnicity of clients receiving services aged 65 and over, England 2006-07. 20 v
Figure 5.1: Table 5.1: Figure 5.2: Table 5.2: Figure 5.3: Table 5.3: Figure 5.4: Table 5.4: Figure 5.5: Figure 5.6: Table 6.1: Figure 6.1: Figure 6.2: Estimated length of time from first contact to first contact with client following referral by age group, 2006-07. Estimated length of time from first contact to first contact with client following referral for clients aged 65 or over, 2006-07. Estimated length of time from first contact to first contact with client following referral for clients aged 65 or over, 2006-07. Estimated length of time from first contact to completed assessment for new clients for whom the assessment process was completed during the period by age group, 2006-07. Percentage distribution of all new clients for the length of time from first contact to completed assessment in England, 2004-05 to 2006-07. Cumulative distribution of all new clients for the length of waiting time from first contact to completed assessment by age group, 2004-05 to 2006-07. Estimated length of time from first contact to completion of assessment for new clients by primary client type and time band, England 2006-07. Estimated length of time from completed assessment to receipt of all services for new clients aged 65 and over for whom all services were put in place during the period, 2004-05 to 2006-07. Distribution of the estimated length of time from completed assessment to receipt of all services for new clients aged 65 and over, England 2006-07. Percentage distribution of all new clients aged 65 and over for the length of time from completed assessment to receipt of all services in England, 2004-05 to 2006-07. Estimated number of carers offered an assessment/review or receiving a service by age group of carer, 2006-07. Percentage of carers assessments/review, and outcomes of assessment/review, by assessment type and service delivered, 2005-06 to 2006-07. Estimated number of Carers receiving different types of services provided as an outcome of an assessment or review by age group, 2006-07. 21 22 22 23 23 24 24 25 26 26 27 28 28 Figure 9.1: Number of full returns by RAP proforma, England in 2005-06 and 2006-07. 34 Figure 9.2: Number of full, partial or empty returns by RAP proforma, England 2006-07. 35 Figure 9.3: Number of CASSRs using a whole count as the basis of return, by RAP proforma, England 2005-06 and 2006-07. 36 vi
1 : Introduction The Referrals, Assessments and Packages of Care Project (RAP) was developed to provide a coherent set of National Statistics on adult community care. Community care is the process by which requests for social care help made to Councils with Adult Social Services Responsibilities (CASSRs) are translated, via assessment and care planning into appropriate services. Most of the information presented has been collected since 2000-01; the exception of some waiting times data and information around carers that were collected for the first time in 2004-05 and 2005-06 respectively and the age split of clients receiving services by ethnicity in 2006-07. Most of the national figures presented in this report are estimates as they have been grossed up to allow for non-response. When comparing data from the last three collection periods it should be borne in mind that the level of completion and quality varied over these years. This, together with changes in the recording procedures used by CASSRs, may explain in part some of the observed trends. Information presented here relates to England for the period 1 April 2006 to 31 March 2007. National and regional level information is given in this report; analysis at CASSR level is available on the Information Centre for health and social care Internet site at: http://www.ic.nhs.uk/pubs/commcarestats0607rapc Chapter 2 provides information on the findings around client referrals and the number dealt with at first contact and also the rate of contacts per 100,000. Chapter 3 has detailed information on the number of assessments and reviews carried out by councils broken down by age group and primary client type. This chapter also provides information on the outcome of assessment by ethnicity. Chapter 4 shows the type of packages of care that clients receive by primary client type and age group. This chapter provides information on the type of service provided and the ethnicity of clients receiving services. Chapter 5 provides information regarding waiting times between first contact and first contact with client, from first contact to completed assessment and from completed assessment to provision of all services. Chapter 6 details information on carers, the number of carers offered an assessment and those that received a service by the age of the carer and the primary client group of the person cared for. The next five chapters are for reference and should be read in detail in order to fully understand the information provided in this report. They provide background information on the RAP project and draw to your attention data quality issues and the completeness of the returns received by councils. 1
2 : Referrals and First Contacts Introduction In 2003-04 the referral forms were redefined to only include contacts from new clients, those clients not on the books of the Councils with Adult Social Services Responsibilities (CASSR) at the time the contact was made. When contacts are initially made to CASSRs, they are screened to determine whether information, advice or a basic service is appropriate, or whether further investigation and assessment are required. Basic details, e.g. the person s name and address are collected at this stage. A decision is then made as to whether the contact should be passed on for further assessment of need or commissioning of ongoing service (an R1 contact), or whether their needs can be met at or near the point of contact (an R2 contact). During the year there were 2.04 million contacts from new clients made to CASSRs in England, this figure is relatively unchanged from 2005-06. 1.04 million of these contacts (51%) resulted in further assessment of need or the commissioning of ongoing service and 998,000 (49%) contacts were attended to solely at or near the point of contact. This is similar to the distribution from 2005-06. Contacts from new clients that led to further assessment of need or commissioning of ongoing service (R1) Around a half of all contacts resulted in a further assessment or commissioning of ongoing service, with the number of contacts remaining the same as last year at 1.04 million. Table R1.1 (Annex 1) shows the number of contacts from new clients (either requiring further assessment or attended to at or near to the point of contact) by type of council. Around 2,600 contacts per 100,000 from new clients aged 18 and over required a further assessment or commissioning of ongoing service in England; this rate varied by council type. The Metropolitan Districts had the highest rate with 2,900 contacts per 100,000 aged 18 and over whilst the London Boroughs were the lowest with 2,200 contacts per 100,000. Contacts from new clients that were dealt with at or near the point of contact (R2) The rate of contacts from new clients dealt with at or near the point of contact was 2,500 per 100,000 for England, with some variation by type of council. The lowest rate was in the Shire Counties with 2,000 contacts per 100,000 and the highest was 3,400 contacts per 100,000 for Metropolitan Districts. Source of referral for contacts (R3) From 2003-04, Councils with Adult Social Services Responsibilities (CASSRs) were asked to indicate the main source of referral for all contacts. Figure 2.1 and Table R3.1 show the number and percentage distribution of all contacts from new clients during 2006-07 by source of referral. In 2006-07, of the 2.04 million contacts, around 586,000 (29%) were self-referrals, 487,000 (24%) were referred from Secondary Health sources (for example, by hospices or hospital wards), 277,000 (14%) were referred by family, friends or neighbours, 274,000 (13%) referrals from Primary/Community Health. 52,000 clients (3%) were from an unknown referral source which is an increase of 12 per cent from 2005-06. The increase in the unknown referral source is due to four councils which reported large increases from 2005-06. Excluding these four councils from the analysis would result in a 10 per cent decrease in unknown referrals. 2
Figure 2.1: Number of contacts from new clients by source of referral, England 2004-05 to 2006-07. 600,000 2004-05 500,000 2005-06 2006-07 Number of contacts 400,000 300,000 200,000 100,000 0 Primary health/community Health Secondary Health Self Referral Family/Friend/Neighbour Internal (i.e. own SSD) LA Housing Department or Housing Association Other departments of own LA or other LA Legal Agency Other Not Known Source of referral Source: RAP proforma R3 3
3 : Assessments Introduction There were an estimated 650,000 new clients for whom the first assessment was completed during 2006-07. There were around 1.26 million existing clients with completed reviews reported in 2006-07, an increase of 8 per cent from 2005-06. For those new clients with completed assessments, the assessment process may have started prior to, or during the current reporting period. The client would have been recorded as a contact in form R1 either in this period or a previous collection period. It should also be noted that the assessment and review figures relate to clients. There should be no double counting of clients within assessments for new clients and within reviews for existing clients on A1. If a client has more than one assessment or review event during the reporting period then details are recorded in relation to the most recently completed event. Therefore, each individual is counted as a new client only once. However, it is possible for a client to be recorded twice on A1 if they were both assessed as a new client and received a review as an existing client during the reporting period. If an individual came to the CASSRs as a new client more than once during the period this would be picked up on R1, as the R returns are concerned with contact events, not clients. New clients with completed assessments (A1, page 1) In 2006-07, of the 650,000 new clients with completed first assessments, about 78 per cent were classified as having a 'physical disability, frailty and sensory impairment', a further 17 per cent of clients were classified as having the primary client type mental health, 3 per cent as vulnerable people and 1 per cent had a learning disability. These proportions have remained fairly stable since 2004-05. More detail can be found in Table A1.1 (Annex 1). Table 3.1 shows the estimated number and percentage distribution of clients with completed assessments or reviews by age group between 2004-05 and 2006-07. Over a quarter of all new clients with a completed assessment were aged 18-64 (190,000), about 13,000 (7%) more than in 2005-06. Nearly three fifths (56%) of assessments were for people aged 75 and over (362,000), about 10,000 (3%) less than in 2005-06. The increase for 18-64 year olds of 7 per cent is mainly due to three councils which reported large increases from 2005-06. Excluding these three councils gives an increase of only 2 per cent. 4
Table 3.1: England Estimated number and percentage of clients with completed assessments and reviews by age group, England 2004-05 to 2006-07. Number of new clients for whom the first Number All ages 18-64 65-74 75 and over Thousands and percentages % of All ages total 75 and 18-64 65-74 over assessment was completed during the year 2006-07 650 190 98 362 29 15 56 Percentage change from 2005-06 0 7-4 -3 2005-06 651 177 103 372 27 16 57 2004-05 649 175 104 371 27 16 57 Number of existing clients for whom a review was completed during the year 2006-07 1,257 373 156 727 30 12 58 Percentage change from 2005-06 8 15 5 6 2005-06 1,162 325 149 687 28 13 59 2004-05 1,086 292 141 652 27 13 60 These figures for 2004-05 are estimations based upon the actual figures from 150 A1 forms Source: RAP proforma A1 These figures for 2005-06 are estimations based upon the actual figures from 150 A1 forms These figures for 2006-07 are actual figures from 150 A1 forms Figure 3.1 shows the percentage of new clients with completed assessments within each primary client type and by age group in 2006-07. It can be seen that the 75 and over age group is dominant in the physical disability, frailty and sensory impairment and vulnerable people client groups, accounting for 64 per cent and 53 per cent respectively. The subset 'physical disability, frailty and/or temporary illness' accounted for 79 per cent of the assessments for the physical disability, frailty and sensory impairment client group, which is similar to 2005-06. Clients aged 18 to 64 classified as having substance misuse or learning disabilities account for 96 per cent and 91 per cent of their respective primary client groups. 5
Figure 3.1: Percentage of new clients with completed assessments by primary client type and age group, England 2006-07. 100% 80% 60% 40% 20% 0% Physical disability, frailty and sensory impairment Learning Disability Mental Health Primary client type 18-64 65-74 75 and over Substance Misuse Vulnerable people Source: RAP proforma A1 In 2006-07 93,000 new clients aged 18-64 with completed assessments were in the physical disability, frailty and sensory impairment primary client group (49%). A further 40 per cent of these clients were classed as having mental health needs. The 75 and over age group had the highest number of clients as physical disability, frailty and sensory impairment with 327,000 (90%) and 9,200 (3%) in the vulnerable people category. Figure 3.2 illustrates this. Clients in the age groups 65 to 74 and 75 and over have similar client characteristics. Both had around 90 per cent of newly assessed clients with physical disabilities, frailty or sensory impairments, whilst clients classed as having learning disabilities and substance misuse accounted for less than 1 per cent of these age groups. 6
Figure 3.2: Estimated number of new clients with completed assessments by primary client type and age group, England 2006-07. 400,000 350,000 Vulnerable people 300,000 Substance Misuse Number of clients 250,000 200,000 150,000 100,000 Mental Health Learning Disability 50,000 0 18-64 65-74 75 and over Age group Physical disability, frailty and sensory impairment Existing clients with completed reviews (A1, page 2) Source: RAP proforma A1 The number of reviews has been increasing over the last three years for all age groups as illustrated in Figure 3.3. The age distribution of existing clients with completed reviews was similar to that for new clients with completed assessments (Table 3.1). The largest increase in the number of reviews for existing clients in 2006-07 was for those aged 18 to 64 (15%), with clients aged 65 to 74 and 75 and over also experiencing rises of 5 and 6 per cent respectively. 7
Figure 3.3: Estimated number of existing clients for whom a review was completed, England 2004-05 to 2006-07. 1,400 Number of clients (thousands) 1,200 1,000 800 600 400 200 2004-05 2005-06 2006-07 0 All ages 18-64 65-74 75 and over Age group Source: RAP proforma A1 Figure 3.4 compares the percentage of new clients with completed assessments with the percentage of existing clients with completed reviews within each primary client type. The distribution by primary client group of clients with completed reviews compared to that for new clients with completed assessments has some variation. Almost three quarters (72%) of the 1.26 million clients with completed reviews were classified as the primary client type physical disability, frailty and sensory impairment compared to 78 per cent for new clients with assessments. Clients classified as having the primary client type learning disability accounted for 8 per cent of all completed reviews for existing clients but only 1 per cent of completed assessments for new clients. 8
Figure 3.4: Percentage of new clients with completed assessments and existing clients with completed reviews by primary client type, England 2006-07. 80% Assessments Review s 60% 40% 20% 0% Physical disability, frailty and sensory impairment Mental Health Vulnerable people Primary client type Learning Disability Substance Misuse Clients with terminated assessments or reviews (A1, page 3) Source: RAP proforma A1 There were an estimated 217,000 clients for whom the assessment or review process was terminated during the period 2006-07, 32,000 (18%) more than the previous year. Over four-fifths of the 32,000 increase is attributed to four councils who reported large increases from 2005-06. Without these four councils the national trend has increased by 4 per cent Almost two-thirds (65%) of terminated assessments or reviews were for clients aged 75 and over. A further 21 per cent were for clients aged 18-64 and the remaining 14 per cent were in the 65-74 age group. Anticipated sequel to assessment (A5) CASSRs were asked to record the sequel to assessment that was anticipated, or intended, at the time that the assessment was completed (most recent event only). The anticipated sequel considers the whole package of care (rather than specific services). Of those new clients with a completed assessment: More than two-thirds (69%) of clients had some or all new services intended or already started (including those started and finished) at the time the assessment was completed. A fifth (21%) of clients were not offered or intended to be provided with new services upon completion of assessment. There were around 51,000 (8%) clients for whom the anticipated sequel to assessment was other. These clients may have, for example, gone into hospital, left the area or passed away before service got underway. The remaining 3 per cent of clients declined the services offered by their council. 9
Figures 3.5a and 3.5b illustrate the distribution of outcomes by age group. The younger age group 18 64 had a higher percentage of outcomes as No (new) services offered or intended (26%) compared to the 65 and over age group (18%). Figure 3.5a: The percentage distribution of new clients with a known or anticipated sequel to assessment for the age group 18-64, England 2006-07. 2% 9% Figure 3.5b: The percentage distribution of new clients with a known or anticipated sequel to assessment for the age group 65 and over, England 2006-07. 3% 8% 18% 26% 63% 71% Some or all (new ) services intended or already started No (new ) services offered or intended Some or all (new ) services intended or alread started No (new ) services offered or intended (New ) service(s) offered but declined (New ) service(s) offered but declined Other sequel Other sequel Source: RAP proforma A5 The distribution of the outcomes recorded on A5 between client groups is shown in Figure 3.6. The chart shows that all client groups have at least 60 per cent of some or all (new) services intended or already started. Clients with mental health needs had the highest proportion of no (new) services offered or intended at 31 per cent. 10
Figure 3.6: 100% The percentage of new clients with completed assessments by primary client type and anticipated sequel to assessment, England 2006-07. Other sequel 80% 60% (New ) service(s) offered but declined 40% No (new ) services offered or intended 20% Some or all (new ) services intended or already started 0% Physical disability, frailty and sensory impairment Learning Disability Mental Health Primary client type Substance Misuse Vulnerable people Ethnicity of clients with completed assessment (A6) Source: RAP proforma A5 Of the 650,000 new clients with a completed assessment reported on A6, 627,000 had a known ethnic group. The remaining 3 per cent of clients were allocated to the category Not stated. This is an improvement on 2005-06 where 5 per cent of clients were allocated to the not stated category. Although there has been some improvement, there is variation in the level of completion by CASSR, and some councils were unable to reconcile differences between the data reported on proforma A5 and the data reported on proforma A6. All 150 councils provided information on the ethnicity of their clients with only 1 council providing a partial return. Of those with a known ethnic group, 91 per cent of new clients with completed assessments or reviews reported on A6 had the ethnic group White, 3 per cent of clients were of the ethnic group Asian or Asian British and a further 2 per cent were Black or Black British'. This profile is similar to 2005-06. There was some variation in the anticipated sequel to assessment by ethnicity. The groups Other ethnic group' had the highest percentage (30%) of clients who were not offered or intended to be provided with new services upon completion of assessment compared to 20 per cent of clients whose ethnic category was White. This is illustrated in Figure 3.7 and more detail can be found in Table A6.1 (Annex1). 11
Figure 3.7: The distribution of new clients with completed assessments by ethnic group and anticipated sequel to assessment, England 2006-07. 100% Other sequel 80% 60% (New ) service(s) offered but declined 40% No (new ) services offered or intended 20% Some or all (new ) services intended or already started 0% White Mixed Asian or Asian British Black or Black British Any other ethnic group Ethinicity Source: RAP proforma A6 12
4 : Packages of care Introduction The RAP P proformas request information on the number of clients receiving services following a community care assessment. These proformas collect information on clients who were either receiving services during the period 1 April 2006 to 31 March 2007 or who were on the books to receive services as at 31 March 2007. Information is sought on the type of service, as well as the age group, primary client type and ethnicity of the client. Note that the client s assessment that led to services may have taken place during 2006-07 or in an earlier year. Care should be taken when interpreting tables on services, as for example, some clients may have received more than one type of service if they have moved between residential and communitybased service sectors within the year. However if a client is receiving concurrent community-based and residential services they should only be recorded under the appropriate residential sector. It is also possible that clients who had been receiving services during the current period were assessed during a previous collection period so there is not a direct comparison between assessment and packages of care figures. From 2004-05 onwards carers services were included in the RAP return. In some cases services that are put in place may benefit both the carer and the client. In this case councils were asked to decide who benefited most from the service, the client or the carer, not both. As a result this may lead to fewer clients receiving services compared to earlier years where carers are decided to be the principal beneficiaries of the services, in particular for respite care. The RAP guidance relating to clients receiving services was restated for 2004-05 to only include clients who are assessed by social services and have a care plan. Prior to 2004-05 some CASSRs included clients receiving services from grant-funded organisations without a community care assessment and therefore data from 2004-05 is not comparable to previous years. Additional clarification was also given on the recording of some types of services. These amendments mainly affect clients receiving community based services. Type of Services provided to clients (P1) Table 4.1 shows an estimated 1.77 million clients receiving services (following a community care assessment) during the year, an increase of 1 per cent since 2005-06. Independent sector residential care services were provided to 203,000 clients, a 2 per cent drop from 2005-06. 105,000 clients received nursing care, a fall of 3 per cent since 2005-06, while 28,000 clients received council staffed residential care, a fall of 12 per cent from last year. The number of clients receiving community based services has increased by 2 per cent since 2005-06 to 1.52 million. 13
Table 4.1: England Service Estimated number of clients receiving services by service type and age group, England 2004-05 to 2006-07. All Ages 18-64 2004-2005 2005-06 2006-07 65 and over All Ages 18-64 65 and over All Ages 18-64 Thousands 65 and over Total number of clients receiving services 1 1,720 492 1,228 1,748 518 1,231 1,774 543 1,231 Community-based services 2,3 1,455 444 1,011 1,494 472 1,022 1,522 497 1,025 Day Care 242 107 135 244 108 136 237 107 131 Meals 176 11 165 165 10 155 150 10 139 Home Care 4 584 100 484 596 105 491 586 106 480 Overnight respite - not clients home 70 21 50 68 19 49 57 16 41 Short term residential - not respite 63 13 50 64 12 51 62 13 49 Direct payments 24 17 7 37 25 13 48 31 17 Professional Support 420 204 217 444 216 228 503 248 254 Transport 5 63 24 39............ Equipment and adaptations 479 102 377 499 112 387 491 109 382 Other 5 95 36 59 120 46 74 126 51 75 Residential Care 3 Independent sector residential care 206 49 157 207 50 157 203 49 154 LA staffed residential care 38 6 32 32 4 27 28 3 24 Nursing care 112 11 101 108 11 97 105 10 94 The figures for 2004-05 are estimates based on the figures from 150 P1 forms and 148 P2f forms The figures for 2005-06 are estimates based on the figures from 150 P1 forms and 150 P2f forms The figures for 2006-07 are estimates based on the figures from 150 P1 forms and 150 P2f forms Source: RAP proformas P1 & P2f.. = Data is no longer available 1. The 'Total of clients receiving services' is the number of clients receiving one or more services at some point during the year excluding double counting. 2. Since movement between services is possible, a client may have received more than one type of service during the year and thus there may be some double counting across service categories. 3. The figures for the number of clients receiving each different component of service do not necessarily sum to the total of clients receiving community-based services as a client may receive more than one component of service during the year. 4. Covers both "home help/ home care" and "overnight respite - clients home". 5. From 2005-06 'Transport' is now collected separately and will now be counted as 'Other' if Transport is the only service received by the client. If the client receives another service (e.g. day care) as well as transport, they will be recorded under that service (i.e. day care) and not under 'other'. 14
Services provided by age group and primary client type Figure 4.1 shows a comparison of the number of clients receiving services in 2006-07 by service type. Around 1.23 million or 69 per cent of clients receiving any type of service during the year (following an assessment) were aged 65 and over. There was variation by type of service with 67 per cent of community-based services and 90 per cent of nursing care services being provided to older people aged 65 and over. Figure 4.1: Estimated number of clients receiving services by service type and age group, England 2006-07. 1,200,000 1,000,000 18-64 65 and over Number of clients 800,000 600,000 400,000 200,000 0 Community based services LA residential care Service type Independent sector residential care Nursing care Source: RAP proforma P1 Just under three quarters (72%) of the total number of clients receiving services in 2006-07 were of the primary client type physical disability, frailty and sensory impairment (1.28 million), 83 per cent of which were aged 65 and over. Figure 4.2 shows the percentage of clients within each primary client type by age group. The majority of clients with learning disabilities (91%), mental health needs (61%) and substance misuse (92%) were aged 18 to 64. 15
Figure 4.2: 100% Percentage of clients receiving services by primary client type and age group, England 2006-07. 80% 60% 40% 20% 0% Physical disability, frailty and sensory impairment Mental Health Vulnerable people Learning Disability Substance Misuse Primary client type 18-64 65 and over Source: RAP proforma P1 Community Based Services provided by type of service and client characteristics (P2f) Community-based services (for example, home care, day care and meals) were provided to 1.52 million 1 clients during 2006-07 (86% of all those receiving services). It is possible that many of these clients received more than one of the components of community-based services. A small number of Councils with Adult Social Services Responsibilities were unable to provide information on the types of community-based services received on RAP form P2f, in this case estimates were made based on the community-based service figures reported on RAP form P1. During the period, 1 April 2006 to 31 March 2007, an estimated 586,000 clients received home care a decrease of 2 per cent since 2005-06. Around 491,000 clients received equipment and adaptations, a drop of 2 per cent from 499,000 in 2005-06. In 2006-07, there were 503,000 clients who received professional support, (this includes any professional activity undertaken by the care manager, social worker or other professional staff, such as Occupational Therapists, that is beyond the process of care management), around 13 per cent more than last year. This increase may reflect the tendency of councils to move clients towards supported living and out of residential homes. An estimated 237,000 clients received day care services and 150,000 clients received meals during 2006-07. Figure 4.3 shows the number of clients receiving community based services during the years 2005-06 and 2006-07. Components within community based services that experienced a decline between 2005-06 and 2006-07 were home care, day care, meals, overnight respite, short term residential and equipment and adaptations. Overnight respite not in the client s home fell by 15 per cent, 48,000 clients received direct payments, increasing from 37,000 in 2005-06, a rise of 29 per cent. 1 For 2006-07, the total for all clients receiving community based services on form P2f is not the same as the figure on form P1 due to council entering the total for all clients instead of the total of those receiving community based services. Therefore, this figure is taken from P1 rather than P2f. 16
Figure 4.3: 600,000 Estimated number of clients receiving community based services, England 2005-06 and 2006-07. 2005-06 2006-07 500,000 Number of clients 400,000 300,000 200,000 100,000 0 Home care Day care Meals Overnight respite - not clients home Short term residential - not respite Direct payments Professional support Equipment & adaptions Other Components of service Source: RAP proforma P2f Figure 4.4 shows there is some variability in the services received by the different age groups of clients. 93 per cent of meals, 82 per cent of home care and 78 per cent of equipment and adaptations were received by clients aged 65 and over. The only component where the greater proportions of clients were aged 18 to 64 is direct payments at 64 per cent. reflecting the fact that this is the age group for whom direct payments were first made available 2. Although, direct payments are increasing at a faster rate for clients aged 65 and over (37% increase from 2005-06) compared to younger adults (25% increase). The 18-64 year olds make up just under half of those clients receiving professional support. 2 Direct payments for community care services were extended to older people in 2000 and to Children Act services and carer services in 2001. 17
Figure 4.4: 600,000 Estimated number of clients receiving community based services by age, England 2006-07. 18-64 65+ 500,000 400,000 Number of clients 300,000 200,000 100,000 0 Home care Day care Meals Overnight respite - not clients home Short term residential - not respite Direct payments Professional support Equipment & adaptions Other Components of service Source: RAP proforma P2f Clients on the books to receive community based services as at 31 March 2006 (P2s) Councils with Adult Social Services Responsibilities were asked to record the number of clients on the books to receive community-based services on the last day of the period (i.e. on 31 March 2007 as opposed to any time during the whole year). This information forms the basis of 5 PSS Performance Assessment Framework (PAF) Indicators (A0/C29, A0/C30, A0/C31, A0/C32 (BVPI 54) and AO/C51). Provisional data was used as evidence by the Commission for Social Care Inspection (CSCI) and was published in November 2007 3. Table 4.2 shows a total of 1.02 million clients were recorded as receiving community-based services on 31 March 2007 a rise of 1 per cent from 2006. This is around two thirds of the number of clients recorded as receiving community-based services at any time in the twelve month period. Similar to services received during the year, the majority of clients on the books to receive community based services at 31 March 2007 were aged 65 and over (63%), with 50 per cent of all clients being aged 75 and over and 13 per cent in the 65 to 74 age group. Most services (69%) were received by clients classified in the primary client type physical disability, frailty and sensory impairment whilst 19 per cent of clients were in primary client type mental health. There was a fall in the number of clients receiving Day Care, Meals, Home Care and Planned Short breaks since 2006, with the largest fall for meals (13%). The largest increase was Direct Payments with a rise of 27 per cent. The category professional support also increased by 17 per cent from 2006. The distribution of services received by clients by age group remained broadly similar to that for 2006 although the proportion of clients receiving professional support had increased by 5 percentage points to 31 per cent. 3 Performance Assessment Framework Performance Indicators were published in full at http://www.csci.org.uk/professional/for_councils/performance_assessment.aspx 18
Table 4.2: England, at 31 March Service Estimated number of clients receiving community based services by service type and age, England at 31 March 2006 and 31 March 2007. 2006 2007 All Ages 18-64 65-74 75 and over All Ages 18-64 65-74 Thousands All community based services 1 1,009 357 132 520 1,023 376 132 515 75 and over Day Care 192 94 21 78 183 91 20 73 Meals 108 7 12 89 93 7 10 77 Home Care 2 386 76 51 258 370 77 48 245 Planned Short breaks 49 17 4 27 44 17 4 24 Direct payments 32 22 3 7 41 27 4 9 Professional Support 267 155 28 85 312 179 32 101 Equipment and adaptations 235 61 42 132 240 61 43 136 Other 86 36 11 40 85 37 10 38 The figures for 2006 are estimates based on the figures from 150 P2s forms Source: RAP proforma P2s The figures for 2007 are estimates based on the figures from 150 P2s forms.. = Data not available 1. The figures for the number of clients receiving each different component of service do not necessarily sum to the total of clients receiving community-based services as a client may receive more than one component of service during the year. 2. Covers both "home help/ home care" and "overnight respite - clients home". Individual Budgets (P2s) In 2006-07 13 councils piloted individual budgets. Individual budgets are designed to help people take control of their own social care budgets, manage their support and choose the services that suit them best. At 31 March 2007 around 400 clients aged 18-64 planned to receive services or a direct payment via an individual budget. A further 180 clients who planned to receive services or a direct payment via an individual budget were aged 65 and over. More details can be found in Table P2s Individual Budgets (Annex 1). Ethnicity of clients receiving services (P4) Of the 1.77 million clients receiving services, 1.72 million (97%) had their ethnic group specified. In the 18-64 age category of those with a known ethnic origin 90 per cent were of 'White' ethnic origin, 4 per cent were 'Asian or Asian British', and 4 per cent were recorded as being of 'Black or Black British' origin. The 65 and over distribution has a slightly higher proportion of clients of White ethnic origin at 96 per cent. 19
Figure 4.5a: Ethnicity of clients receiving services aged 18-64, England 2006-07., Asian or Asian British, 4.1% White, 90% Other, 10% Black or Black British, 3.8% Other, 1.1% Mixed, 0.9% Chinese, 0.2% Source: RAP proforma P4 Figure 4.5b: Ethnicity of clients receiving services aged 65 and over, England 2006-07., Asian or Asian British, 1.7% White, 96% Other, 4% Black or Black British, 1.3% Other, 0.4% Mixed, 0.1% Chinese, 0.1% Source: RAP proforma P4 20
5 : Waiting times Introduction From 2000-01, information was collected on the waiting times 4 for new clients from first contact to completed assessment. Time from first contact to first contact with client (previously start of assessment), and from completed assessment to receipt of all services were collected from 2003-04 onwards. Waiting time between first contact and first contact with client (A9) Figure 5.1, Table 5.1 and Figure 5.2 provide information on the waiting times between first contact and first contact with client for 2006-07. Table A9.1 (Annex 1) details the waiting time between first contact and first contact with client by age group. 86 per cent of all clients were contacted within two days of their first contact, but this varied between age groups as illustrated in Figure 5.1. 76 per cent of clients aged 18-64 were contacted within two days of their first contact compared to 89 per cent for those aged 65 and over. Figure 5.1: Estimated length of time from first contact to first contact with client following referral by age group, England 2006-07. Less than or equal to 2 days More than 2 days and less than or equal to a w eek More than a w eek and less than or equal to 2 w eeks All ages 18-64 65 and over More than 2 w eeks 0% 20% 40% 60% 80% 100% Source: RAP proforma A9 Table 5.1 shows the waiting time between first contact and first contact with client for the older client group (65 and over). 4 Waiting times in RAP are based on calendar day, not working days. 21
Table 5.1: England Estimated length of time from first contact to first contact with client following referral for clients aged 65 and over, England 2006-07. Numbers and percentages Time bands Number (thousands) % Distribution Cumulative Distribution All contacts 516 100 Less than or equal to 2 days 461 89 89 More than 2 days and less than or equal to a week 24 5 94 More than a week and less than or equal to 2 weeks 10 2 96 More than 2 weeks 21 4 100 The figures for 2006-07 are estimates based on the figures from 150 A9 forms Source: RAP form A9 The waiting times for clients aged 65 and over are similar across client groups as shown in Figure 5.2. 81 per cent of clients with a learning disability waited less than or equal to 2 days from first contact to first contact which was the lowest across all client groups. Figure 5.2: 100% Estimated length of time from first contact to first contact with client following referral for clients aged 65 and over, England 2006-07. More than 2 w eeks 80% 60% More than a w eek and less than or equal to 2 w eeks 40% More than 2 days and less than or equal to a w eek 20% Less than or equal to 2 days 0% Physical and sensory disability/frailty Learning Disability Mental health Substance misuse Vulnerable people Primary client type Waiting time between first contact and completed assessment (A7) Source: RAP proforma A9 Table 5.2 shows of the 636,000 new clients reported as receiving a completed assessment during 2006-07, 31 per cent were assessed within two days of the first contact (compared with 29% in 2005-06), 60 per cent of clients were assessed within two weeks of first contact. This is an increase on the 2005-06 figure of 58 per cent complete within 2 weeks. 79 per cent of all assessments for new older clients (aged 65 and over) were completed within 4 weeks. 6 per cent of older clients waited for more than 3 months. 22