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First Report for the Range and Capacity Review of Community Care Services for Older People: Projections of Community Care Service Users, Workforce and Costs

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Projections of Community Care Service Users, Workforce and Costs

Chapter 5 - Baseline data

The baseline was collected from Scottish Executive censuses, the Information and Statistics Division (ISD) of NHS Scotland and the Scottish Household Survey (SHS). The population projections are the Government Actuary's Department's 2002-based projections.

Service recipients

Unless otherwise stated, the data are available by age (65-74, 75-84, 85+) and gender.

  • NHS bed

    • Source: ISD Scotland's SMR50 patient-based return.

    • Date: 1 April 2003.

    • Description: Patients aged 65+ in geriatric medicine and GP other than obstetrics in a long-stay unit for care of the elderly.

  • Private nursing home

    • Source: ISD(S)34 return.

    • Date: 31 March 2002.

    • Description: Long-stay residents aged 65+ living in a private nursing home.

    • The ISD(S)34 return does not contain information on the number of long-stay residents by age and gender. Approximately 96% of all residents are long-stay, and this figure has been applied to the information on all residents, to estimate the number of long-stay residents by age and gender.

  • Residential care home

    • Source: Scottish Executive Health Department's (SEHD) R1 return.

    • Date: 31 March 2002.

    • Description: Long-stay residents aged 65+ living in a residential care home.

  • Sheltered housing

    • Source: SE Development Department's S1B return.

    • Date: 31 March 2002.

    • Description: People aged 65+ living in sheltered housing accommodation.

    • The S1B return covers dwellings and not occupants. There is no known information on sheltered housing tenants and so it has been assumed that there is a 95% occupancy rate of people aged 65+, of which 90% are singles and 10% are couples.

    • The S1B return covers dwellings provided by Public Agencies and Housing Associations only.

  • LA home care

    • Source: SEHD H1 return.

    • Date: Week ended 31 March 2003.

    • Description: People aged 65+ receiving LA home care.

    • LA home care is defined here as being home care provided to people at home (excluding those in residential care) purchased by a local authority, even if it is provided by another LA or by the private or voluntary sectors.

    • Intensive home care clients are defined here as receiving 10 or more hours of care a week.

    • The model uses individual-based information on the numbers of hours of care received, which has been derived from a dataset covering 69% of all LA home care clients. The figures have been grossed to estimate total numbers, controlling for known age/gender sub-totals.

  • Informal care

    • Source: The Scottish Household Survey.

    • Date: Financial year 2002/3.

    • Description: People aged 65+ receiving informal care.

    • Respondents were assumed to receive informal care if they receive regular help or care from a household member, relative, friend or neighbour.

  • Private care

    • Source: The Scottish Household Survey.

    • Date: Financial year 2002/3.

    • Description: People aged 65+ receiving private care.

    • Respondents were assumed to receive private care if they have a home help who has been hired privately.

  • Day care

    • Source: SEHD D1-B return.

    • Date: Week ended 31 March 2003.

    • Description: People aged 65+ attending a day care service.

    • Day care is defined here as being all day services that are provided or commissioned by an LA, as well as all other registered day services.

  • Community nursing

    • Source: ISD(S)29/30 return.

    • Date: Year ended 31 March 2003.

    • Description: People aged 65+ seen by a district nurse or health visitor.

    • The data are not available by gender, and the age bands are 65-74 and 75+.

    • The baseline data are not of National Statistics' standards and have not been published. Projections will therefore need to be treated with caution. It is, however, thought that the data will produce more reliable projections than if less recently published data were used.

  • NHS Chiropody

    • Source: ISD(S)8 return.

    • Date: Year ended 31 December 2002.

    • Description: People aged 65+ receiving NHS chiropody services.

    • The data are not available by age or gender, and are really for 'pensioners', i.e. males aged 65+ and females aged 60+.

    • The figures exclude the hospital service.

Workforce

The baseline workforce figures (excluding informal carers) are for the number of whole-time equivalent staff in post plus vacancies.

Where vacancy data were not available, workforce vacancy rates have been calculated to be 3% of total posts (i.e. filled posts + vacant posts) required.

  • NHS bed

    • NHS workforce projections have not been included in the model, as national workforce planning is led by the National Workforce Committee, with a new group, the Workforce Numbers Group, leading on the workforce numbers and modelling across all staff groups. Further information can be obtained in the Scottish Health Workforce Plan 2004 baseline at

  • www.scotland.gov.uk/publications.

  • Private nursing home

    • Source: ISD(S)34 return.

    • Date: 31 March 2002.

    • Description: Nursing staff in post, including nursing auxiliaries, assistants and bank staff, and vacancies.

    • Agency staff have been excluded.

  • Residential care home

    • Source: SEHD R1 return.

    • Date: 31 March 2002.

    • Description: Care and 'other' staff in post, plus vacancies (estimated).

  • Sheltered housing

    • Sheltered housing workforce projections have not been included in the model as no data are available.

  • LA home care

    • Source: SEHD H1 return.

    • Date: 31 March 2003.

    • Description: Staff in post employed to provide home care services directly to clients, plus vacancies (estimated).

    • Managers, organisers and other purely supervisory staff, and administrative staff have been excluded.

    • The H1 return only includes staff in post directly employed by the LA, and so staff providing home care purchased from outside each LA are excluded. The total number of staff required has been calculated by multiplying the number of directly employed staff per directly delivered hour of care by the total number of home care hours provided or purchased.

  • Informal care inside household

    • Source: The Scottish Household Survey.

    • Date: Financial year 2002/3.

    • Description: People providing informal care to a person aged 65+ living inside the same household.

    • Informal care inside and outside the household has been calculated separately to avoid double-counting carers.

  • Informal care outside household

    • Source: The Scottish Household Survey.

    • Date: Financial year 2002/3.

    • Description: People providing informal care to a person aged 65+ living outside the household.

    • Respondents were assumed to give informal care outside the household if they provide regular help or care for any sick, disabled or elderly person not living with them.

    • Informal care inside and outside the household has been calculated separately to avoid double-counting carers.

  • Day care

    • Source: SEHD H1 return.

    • Date: 31 March 2003.

    • Description: Management, care and other staff in post, plus vacancies (estimated).

  • District nurse

    • Source: ISD Scotland.

    • Date: 31 March 2003.

    • Description: District nurses in post, post under review and vacancies.

    • Posts under review are defined here as 'posts which are vacant as at 31 March 2003 because they are under review or held open to cover for peak workload or staff on courses, maternity leave or sick leave'.

  • Health visitor

    • Source: ISD Scotland.

    • Date: 31 March 2003.

    • Description: Health visitors in post, post under review and vacancies.

    • Posts under review are defined here as 'posts which are vacant as at 31 March 2003 because they are under review or held open to cover for peak workload or staff on courses, maternity leave or sick leave'.

  • NHS podiatrist

    • Source: ISD Scotland.

    • Date: 31 March 2003.

    • Description: Qualified NHS podiatrists and unqualified podiatry/foot care assistants in post, post under review and vacancies.

    • Posts under review are defined here as 'posts which are vacant as at 31 March 2003 because they are under review or held open to cover for peak workload or staff on courses, maternity leave or sick leave'.

    • Projections for chiropody patients exclude the health service, but the baseline data for podiatrists cover all those employed by the NHS. Therefore, projections will need to be treated with caution as they may overestimate the number of podiatrists required.

Unit costs

Where applicable, unit costs have been uprated to 2004/5 prices using the Treasury's GDP deflator series. (The deflator series used in the model is the series published following the Office for National Statistics' Quarterly National Accounts First Release on 26 March 2004.) All unit costs are given as gross figures.

  • NHS bed

    • Source: Scottish Health Service Costs 2002/3 Report 40LS.

    • Date: 2002/3.

    • Baseline unit cost: 997 per inpatient week.

    • Unit cost at 2004/5: 1,048 per inpatient week.

    • Source of funding: 100% NHS funded.

    • The dataset contains two outliers, which have been removed to give the baseline unit cost. The original dataset gives a unit cost of 1,003 (1,055 in 2004).

  • Private nursing home

    • Source: National Review Group (NRG).

    • Date: 2004/5.

    • Baseline unit cost: N/A.

    • Unit cost at 2004/5: 417 per resident week.

    • Source of funding: NHS/LA/Privately funded, using data from the ISD(S)34 return, although no age/gender breakdown is available.

    • The ISD(S)34 return does not include information on fees charged by individual private nursing homes. Therefore, the fee suggested by the NRG has been applied to all private nursing home residents. It is important to note that the fee applies to publicly funded residents only, and residents who are privately funded can be charged any amount.

    • Background to the NRG: The NRG was established in September 2001 to conduct a review of the costs associated with providing nursing and residential care homes for older people in Scotland, and to determine a framework for appropriate fee levels for application from 1 April 2002. These fee levels apply to publicly funded residents only. The suggested fee level at 1 April 2004 for care homes with nursing has been set at 417.37. Although at the time of this report the figure has not yet been agreed, it is considered to be very likely that it will be, and fees will be backdated to 1 April 2004 from the date of agreement.

  • Residential care home

    • Source: SEHD R1 return.

    • Date: 31 March 2002.

    • Baseline unit cost: Varies from 297 to 2,141 per resident week, depending on the home's sector and type.

    • Unit cost at 2004/5: Varies from 319 to 2,328 per resident week, depending on the home's sector and type.

    • Source of funding: NHS/LA/Privately funded, using data from the R1 return.

    • Background to the cost calculations: As charges differ between the different sectors and types of residential care home, the homes were grouped according to their sector and type (e.g. private home for people with mental health problems) and average charges calculated for each group. The projections for residential care home residents were then split according to the proportions in each group of homes in the base year, and the group charges were applied to their respective projections. The figures were then summed to give a national cost. This method was used to ensure that a group's fee would only contribute to the national figure in direct proportion to the number of residents in each group. Therefore, a group with relatively few residents would not disproportionately affect the national cost.

  • Sheltered housing

    • Sheltered housing cost projections have not been included in the model as data are not available.

  • LA home care

    • Source: 'With Respect to Old Age - A Report by the Royal Commission on Long Term Care, Research Volume 1'.

    • Date: 1995/6.

    • Baseline unit cost: 8.50 per hour.

    • Unit cost at 2004/5: 10.70 per hour.

    • Source of funding: Assumed to be 100% LA-funded. There is no known information on sources of funding for LA home care services and so 100% LA funding has been assumed, although private sources also contribute.

    • There are no known data on unit costs of LA home care. The Royal Commission Report on Long Term Care used a UK-wide figure of 8.50 per hour, in 1995/6 prices.

  • Private care

    • Source: The average cost per client week is the same as LA home care.

    • Date: N/A.

    • Baseline unit cost: N/A.

    • Unit cost at 2004/5: Approximately 68 per client week.

    • Source of funding: 100% private funding.

    • There are no known data on the average cost of home care which is provided privately, or suitable data on the number of hours of private care received. Therefore, it has been assumed that private home care clients receive the same number of hours per week, charged at the same hourly rate, as LA-provided home care. Averaged across the age/gender groups, this equates to just under six and a half hours of care received each week, at a charge of 10.70 per hour. However, the cost projections are calculated separately by age and gender to take into account the different numbers of hours of care received by each group.

  • Day care

    • Source: 'With Respect to Old Age - A Report by the Royal Commission on Long Term Care, Research Volume 1'.

    • Date: 1995/6.

    • Baseline unit cost: 28 per attendance.

    • Unit cost at 2004/5: 35 per attendance.

    • Source of funding: Assumed to be 100% LA funded.

    • There are no known data on unit costs of day care. The Royal Commission Report on Long Term Care used a UK-wide figure of 28 per attendance, in 1995/6 prices.

    • There is no known information on sources of funding for day care services and so 100% LA funding has been assumed, although it is acknowledged that other sources of funding for day care do exist.

  • District nurse

    • Source: ISD data - SFR 8.3.

    • Date: 2002/3.

    • Baseline unit cost: 27 per visit.

    • Unit cost at 2004/5: 28 per visit.

    • Source of funding: 100% NHS funded.

  • Health visitor

    • Source: ISD data - SFR 8.3.

    • Date: 2002/3.

    • Baseline unit cost: 32 per visit.

    • Unit cost at 2004/5: 34 per visit.

    • Source of funding: 100% NHS funded.

  • NHS chiropody

    • Source: ISD data - SFR 8.3.

    • Date: 2002/3.

    • Baseline unit cost: 19 per treatment.

    • Unit cost at 2004/5: 20 per treatment.

    • Source of funding: 100% NHS funded.

The model and scenarios

The model is sensitive to changes made to the underlying assumptions, and the following sections discuss the population projections used in the model, and describe seven scenarios which illustrate how using different assumptions can affect the projections. Tables give the relevant figures for service recipients, workforce and costs in five-year intervals. The percentage change between each five-year interval is shown in brackets, and the overall percentage change from 2004 to 2019 is shown in the final column.

Scenario 1 describes the base model, where population projections are the main driver.

Scenario 2 looks at what could happen if people in an NHS bed or care home, and classified as being of low or moderate dependency, live at home and are given LA home care and community nursing as an alternative.

Scenario 3 gives projections assuming that those in an NHS bed, and classified as being of low or moderate dependency, can be accommodated in a care home.

Scenario 4 looks at the projections produced by assuming that people receiving 20 or more hours a week of LA-provided home care are moved to a care home.

Scenario 5 considers what could happen if formal care is offered as a substitute to a proportion of people receiving informal care.

Scenario 6 shows how the expenditure projections can vary if the annual increase applied to the unit costs changes.

Scenario 7 incorporates recommendations from the Joint Future Agenda into the base model.