From Grant Funding to Individual Budgets: The Impact On Day Services

1. From Grant Funding to Individual Budgets: The Impact On Day Services Denyse Whillier CEO Age Concern Ealing

2. The Context • Day services are funded through a grant from Ealing Council/ PCT towards the costs of running services; • The balance is made up from income generated from charging for services and fundraising; • 84% of the charity’s income comes from grants; • The service is being re-commissioned from October 2011 with the grant substantially cut; • Because of recent funding cuts, the cost base will be spread across fewer “business units.”

3. Underpinning Principles & Drivers For Change At National Level • Prevention • Personalisation • Partnership • Plurality • Protection • Productivity • People

4. About Our Day Services • One service is run from 2 sheltered housing units - capacity is restricted by room size; • A second service is run in partnership with Ealing Council through a community resource centre that is intended to provide a diverse range of services; costs are currently contained through an SLA on rent, utilities etc; • Both services operate to registration standards following earlier reviews and the expectation that they were to be regulated; • Both services operate high quality case management systems.

5. Current Challenges • Actual attendances are some 30-40% less than the number of allocated places; • Income from charging can fluctuate significantly which makes forecasting difficult; • Marketing; • Staff understanding that these services have to operate in a business like manner if they are to be financially sustainable; • Ealing Council wants the voluntary sector to develop services for those with ‘substantial’ and ‘critical’ needs.

6. The FACS Eligibility Criteria • Day services meet the needs of people from ‘low’ to ‘critical’ needs; • Those we estimate have ‘substantial’ and ‘critical’ needs will require assessments by Ealing Council; • There is an overlap with Ealing Council provision at one centre which could mean we become competitors.

7. An Added Dimension • Staff undertake comprehensive assessment of needs and put together case plans, similar to support plans – will this be necessary going forward? • If not, what will happen to the expertise and reputation we’ve built up? • ACE takes 3-6 social work students on placement each year.

8. Personal Health Budgets • A pilot involving around half the primary care trusts in England is currently underway, testing out personal health budgets in the NHS. • What impact will this have going forward?

9. Issues To Consider • The financial risk is shunted to the provider because each service is purchased individually, rather than on behalf of a group. • Services will have to manage take up through overbooking and clear protocols around payment for example. • Costs have to be accurate and take into account non attendances. • Barriers to non attendance e.g. expensive and inflexible transport have to be addressed. • Local authorities set the benchmark for what they are prepared to pay for services. However the price (and quality) of a service has to be at a level that the person thinks is acceptable too or s/he will make alternative arrangements.

10. More Issues….. • The volume of administrative work will increase and require resourcing. • The infrastructure and systems have to be fit for purpose. • Given the level of financial risk, the charity cannot be financially dependent on income from day services. • The local authority has to work with the voluntary sector to manage this change. • The charity has to become the provider of choice. • Marketing will increasingly become a key activity.

11. And Finally • Is this a move back to lunch clubs?

12. Any Questions?