The Scottish Government

Emergency - unacceptable risk

High - serious risk in relation to daily living

Medium - moderate risk

Low - minimal or non threatening risk to quality of life

Low category (minimal or non-threatening) clients are sent a letter saying they are on a waiting list due to budgetary restraints

Emergency

High

Medium

Low

Guarantee to meet Emergency and High level needs. Will meet Medium needs within available resources.

Low level needs - no services provided directly - offer advice only; but personal care in this category would be provided

Four categories:

Very High - the user is housebound, has no access to alternative supports and requires help on a daily basis with personal care and daily living tasks

High

Medium

Low - As a result of a disability or frailty, support with personal care and daily living tasks would enhance the quality of life of the individual (and so their ability to maintain independent living in the community.)

Funding moratorium in place and only new Very High category cases receive a service.

Critical - the risk of major harm/danger to person or major risk to independence

Substantial - risk of significant impairment to the health and well being to person or significant risk to independence

Moderate - some impairment some risk to independence

Low - promoting a persona quality of life or low risk to independence

The seriousness of the risk to the individual and its impact on the person or others inform the council's decisions about what needs are to be met by services. People assessed as being in the moderate or low categories are below the threshold for access to care services.

The Council's eligibility and Priority Framework states that "A person in only eligible for social care where needs are identified above the threshold line determined by policy and where there is no-one else willing/ able/ appropriate to assist. Alternatives to the need for social care must always be explored during the assessment to include the contributions from family/ wider community/ voluntary sector/ council resources."

Band 1 - The service is essential to the client remaining in the community and the Home Help, or Social Care Worker is the only person available to complete the required tasks on the days and at the times allocated. These tasks are essential to the user's well being and / or to the support of the carer and that if the service was not provided the user or family would have to be admitted into residential care or hospital. The service is essential to keep the person at home, as a direct alternative to admission to care or hospital.

Band 2 - The service is essential to the client, family and / or carer but the service could be reduced or suspended temporarily and the client and / or carer could cope without harm in a time of acute shortage. The situation could not be sustained without frequent, regular help.

Only people in Band 1 are guaranteed a service; those in Band 2 will be provided with a service if resources are available. People assessed as requiring only non-personal care services are not eligible for council services.

Very high

High

Medium

Low

Not appropriate - people not meeting criteria and things unlikely to change so no benefit from regular review

Head of Services will put in place a line of eligibility in line with demand and resources.

Critical - the risk of major harm/danger to person or major risk to independence

Substantial - risk of significant impairment to the health and well being to person or significant risk to independence

Moderate - some impairment some risk to independence

Low - promoting a persona quality of life or low risk to independence

Needs must be assessed as above moderate to be eligible for services.

Moderate and low - told have to wait

High priority

Medium

Low

Current service delivery is restricted to the highest priority

Medium - go in waiting list until budget allows

Low - no service

High

Medium

Low

Finite resources means may have to operate a waiting list for low priority needs

High

Medium

Low

Low priority - most likely response will be to be given information and advice

Critical/ urgent priority

Substantial / high priority

Moderate / medium priority

Low priority

Low priority will not normally receive a full assessment and will not be eligible for assessed services. People in this category may still benefit from meals at home, open access lunch clubs or signposting for advice, guidance and information.

P1 - immediate risk to life and limb

P2 - people with limited other support

P3 - require input to maintain daily living functions

P4 - where deterioration would occur or social isolation

P5 - enhance / maintain quality of life, but deterioration not expected

P6 - no risk factor apparent

P6 - no provision will be made

Critical

Substantial

Moderate

Low

People in Moderate and Low categories may be advised of a delay and put on a waiting list

Critical

Substantial

Moderate

Low

Priority 3 - Moderate - will be met where resources allow

Priority 4 - Low - needs will not be met

Priority bands 1 - 4

Domestic care services not normally provided to people in bands 3 and 4

Domestic care services provided only if they form part of an intensive package for people in bands 1 and 2

Priority levels 1 - 3

Priority level 3 delivered - subject to availability after 1 and 2 satisfied.

Critical

Substantial

Moderate

Low

No direct services are provided to people in Low band

Essential

Needed, but will not be harmful

No demonstrable risk

Last category - would get a minimal service for preventative reasons

Emergency - unacceptable or immediate risk; to

High

Medium

Low - the service user and / or carer(s) appear to be at low risk in relation to daily living.

Access to services is prioritised to people in the top three categories.

High

Medium

Low

For Low priority - community care services alternatives may be offered

0

0

0

6

0

12

7 - waiting for care home vacancy

3 - waiting outcome of guardianship issue

1 - family wishes client to remain in hospital

1 - waiting for financial information from family

0

0

0

0

13

Moratorium on funding non urgent new cases

No vacancies in care homes of choice

0

0

0

0

0

0

0

7

Payments delayed due to funding constraints

0

2

1 - family making arrangements for move

1 - waiting for vacancy in home of choice

0

0

0

0

0

1

Delay due to disagreement with family that NHS continuing care was required

0

0

1

Waiting for vacancy in nursing home(s) of choice

0

0

4

Waiting for vacancies in homes of choice

0

9

Lack of capacity in care homes

34

(an additional 23 are awaiting funding status to be confirmed)

Lack of capacity in care homes

0

0

0

0

0

0

16

Waiting for client agreement on contractual issues

1

Awaiting vacancy in home of choice

5

4 - waiting for vacancy in home of choice

1 - guardianship issues

0

INA

25

The main reason is client/family choice/ exercising right to choice of home.

4

Note all payments are automatically backdated to date of admission or date of application whichever is later.

2

(reason for wait is not recorded)

3

Waiting for vacancy in homes of choice

4

Payments delayed due to funding constraints

4

Waiting for vacancies in care homes/ home of choice

5

Waiting for vacancies in care homes/ home of choice

0

0

1

Waiting for vacancy in home of choice

1

5

2 - do not want to move as yet.

3 - no suitable beds have become available.

5

1 - waiting for vacancy in EMI unit.

4 - waiting for vacancies

0

0

14

Waiting for vacancy in homes of choice.

0

0

0

0

6

Already in receipt of FPC for care services provided to them at home.

Reason for wait is no suitable care home vacancies.

1

Waiting for vacancy in suitable care home

(an additional 3 are waiting a financial assessment to determine funding status.)

0

0

6

None of the delays are due to funding issues but due to issues such as guardianship issues and waiting for vacancies in homes of choice

0

0

5

3 - waiting for vacancy in home of choice.

1 - waiting for vacancy in dementia unit.

1 - problems in confirming financial assets and lack of co-operation from relatives to get the client placed.

0

0

0

0

0

0

0

5

Lack of vacancies in care home sector and some exercising choice

12

Lack of vacancies in care home sector and some exercising choice

0

2

Waiting for vacancy in home of choice

2

Adults with incapacity issues

0

6

Waiting for vacancy in home of choice

INA

(13 people waiting but not all of these will be self funders)

All those that are waiting are waiting vacancies in care homes

0

0

1

Waiting for vacancy in home of choice

0

0

0

38

53

139

0

0

0

0

0

0

0

15

14

8

Funding moratorium

25

Funding moratorium

0

0

0

0

0

0

0

6

Staff shortage/ care provider not available

179

Lack of capacity (funding and providers) to cope with demand for personal care services

161

0

0

0

0

0

0

0

0

0

0

101*

Lack of finance

INA/ all are receiving care from unpaid carers

6

12

Staff shortage/ care provider not available

10

0

0

0

0

0

0

INA

INA

INA

0

0

0

0

0

0

1

5

Lack of funding to meet commitments

5

0

0

0

1

Delay not caused by funding issues.

0

0

1

0

0

0

0

0

0

0

0

4

12

Delays are primarily due to problems in purchasing or providing home care in rural areas.

4

0

0

0

1

0

0

2

INA

INA

0

0

0

0

0

0

0

6

Lack of care providers in rural areas

2

0

0

0

1

36

Lack of care provider to provide service at time of users' choice or location

23

31

391

220

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

Waiting client choice over service provider

1

0

0

0

0

INA

INA

0

0

0

0

INA

INA

8

Our current policy and statutory responsibility is to offer alternative services to those who have been approved for a Direct Payment but are awaiting funding.

0

0

INA

INA

0

0

0

0

0

0

1

Due to difficulties being experienced in concluding the community care assessment.

1

0

0

INA *

INA

0

0

0

0

0

0

0

0

0

0

0

0

2

'These are in the process of being put in place'

1

0

0

13

3

1,045

51.7

90.9

Angus has a buoyant private sector market attracting people who retire to the area. It has a higher than average number of places per 1,000 population aged 65+. The occupancy rate is about the Scottish average but there is under capacity in some parts of the area.

742

41.9

91.8

Argyll and Bute has an under capacity problem, especially in the more rural and islands communities. This has contributed to waiting lists for care home places in these areas. However there is a historical legacy of over capacity in the Helensburgh and Dunoon areas. The council is testing the market to gauge whether it should externalise its care homes.

1,184

39.7

84.8

Dumfries and Galloway Council externalised its care homes in 1998. As well as drawing in investment into the old local authority homes this also attracted some new private sector homes into the area. The number of care home places per 1,000 population aged 65+ and the occupancy rate are below the Scottish averages.

2,955

42.9

94.9

Edinburgh has lost around 500 care home places since 2000 (mainly due to market forces such as very high property values in the Capital making it more profitable for care home owners to sell their property than continue to run it as a care home). The City's remaining homes have a relatively high occupancy rate contributing to waiting lists for places. The City has had to place people in homes outside the area. Edinburgh is one of the few local authorities planning to increase the number of care homes/ places.

690

49.4

87.1

Although overall the number of places has fallen and occupancy rates are below Scottish average, Stirling has a buoyant and expanding private sector market in some rural parts. This is creating increased demand for FPC/ FNC from people moving to the area. There is under capacity in some rural areas and over capacity in the more urban parts of Stirling.

620

42.2

88.2

Around 30% of care home places in West Dunbartonshire are local authority homes. There are no particular over/ under capacity issues and no waiting lists for care home places. The main issue for the council is the need to invest heavily to bring its care homes up to standard.

38.191

46.2

90.3

Unmet need is identified and logged as part of the assessment process using the CareFirst assessment tool, " however it is not collated or analysed in a systematic way at present."

Information about unmet need recorded via the CarenapE assessments are collated both via local Resource groups and centrally. The council is progressing towards collating this information through IRON (Indicator of Relative Need), but needs to complete training of staff and introduction of auditing procedures before internal reporting and analysis of data can be undertaken.

Unmet need is identified through the assessment process but it is not reported or analysed. This is still to be developed as part of the in-house development of the council's information database system.

Until the implementation of the SWIFT information system (summer 2006) the council lacked an electronic database to allow it to systematically collate and analyse information on unmet need. The new system will allow the reporting of information about unmet need

The council collates information about the broad areas of unmet need such as the levels of home care, day care, respite, day care places, at a more strategic level.'

This information has been used at a strategic level to inform the configuration of services to try to meet unmet need. For example, deploying care workers differently and to provide a higher level of service with the same resource; developing and extending older people's day care. The council is also piloting a different way to deploy Occupational Therapists to meet demand for their services. Information about local strategic level needs and unmet need has also been analysed in specific service reviews such as Learning Disabilities Day Care and Residential Care Homes.

At a wider strategic level, data has been collated for specific work, undertaken in 2006 with neighbouring local authorities and the NHS and has assisted in developing JPIAF Improvement Targets and development of a joint commissioning strategy.

Unmet need is logged, and subsequently reviewed and prioritised by the home care organiser with responsibility for the area. The information is collated centrally and used to provide information about the overall level of unmet need and to inform strategic planning such as the Joint Capacity Plan.