Respite Care Scotland, 2015

5. Background information

5.1. Data Sources

Audit Scotland (2007/08 to 2008/09)

This data was provided to Audit Scotland by all Local Authorities in Scotland as one of the Statutory Performance Indicators (SPIs). The information was collected and published locally by each council in Scotland. Audit Scotland publishes information about the comparative performance of councils across Scotland in a compendium of all the data. These are available from http://www.audit-scotland.gov.uk/performance/service/, but please note that all respite figures have been superseded with those presented in this publication.

Scottish Government (2009/10 to 2014/15)

The Scottish Government is now responsible for the collection of respite data. This follows Audit Scotland's decision to discontinue the collection of the SPI data for respite care.

For 2014/15, Local Authorities submitted aggregated respite data, returned through a spreadsheet template.

Other data used in this publication has been taken from:

• Scottish Health Survey - Scottish Government
• Scotland's Carers - Scottish Government
• Valuing Carers 2015 - Carers UK

5.2. Understanding the Statistics in this Report

All information in this Statistics Release is based on a year from 1st April to 31st March.

In order to provide an estimate of total respite provision across Scotland, respite nights and respite hours have been converted into respite weeks. Seven respite nights equal one respite week and 52.5 hours equal one respite week. This standard method was agreed by CoSLA and the Scottish Government. In order to convert Direct Payments into respite weeks we have assumed that the cost of one week is £630 and the cost of one hour is £12. This rate is derived from an estimate of residential care weekly costs made by the Respite Task Group.

5.3. Changes to figures for previous years

As part of the collection of the 2014/15 data Local Authorities were given the opportunity to check their previously published respite figures. The changes made to previously published data are given below:

Argyll & Bute 2013/14	12,407 daytime respite hours for 18-64 previously allocated to Day Care Centre have been moved to Day Activities not in a Day Care Centre. There is no change to the overall number of respite hours/weeks provided.
East Ayrshire 2013/14	Daytime respite hours at home for 18-64 reduced from 67,140 to 46,107 following comparison of data with local performance indicators.

In addition, Aberdeen City and Stirling both confirmed that the Direct Payments figures provided in their 2013/14 data submission were for all Direct Payments made, not just those used to provide respite care. Direct Payments made by Stirling to provide respite care in 2013/14 were £122,000, not £1.38m as given in last year's publication. Aberdeen City were not able to provide a revised figure for Direct Payments in 2013/14.

5.4. Data Completeness

While every effort has been made to ensure that data is recorded as completely as possible, the following issues should be noted for the figures published in this report:

• East Renfrewshire was unable to submit any data. The most recently available figures, from 2013/14, have been used as an estimate.
• The data submitted by Orkney is known to be incomplete, as systems to provide respite care data are not yet in place following the introduction of Self-Directed Support. This means that the number of respite weeks provided by Orkney are likely to be understated, and should not be compared to data from previous years.

5.5. Comparability between 2013/14 and 2014/15 data

Local Authorities were asked to submit one set of data for 2014/15, as there has been no change to the national guidance since 2012/13. However, it is clear from the explanatory material submitted by many of the Authorities alongside their data submissions that a range of factors other than genuine changes in service provision may also have affected their recorded figures.

5.5.1. The roll-out of Self-Directed Support

The Self-Directed Support (SDS) Act came into force across Scotland on 1^st April 2014. The level of implementation of SDS varies by Local Authority, with some starting to implement SDS before the Act came into force, and others still working on implementation.

This has had some impact on the respite care provision recorded for 2014/15, with the Local Authorities below mentioning that the changes to provision are likely to be related to the roll-out of SDS:

Aberdeenshire	Unable to identify respite provision where SDS has been used
East Ayrshire	People choosing alternatives to respite through SDS Option 1, leading to a reduction in respite provided
Glasgow City	Increased use of SDS leading to a reduced level of respite care recorded
Highland	SDS thought to have had an impact on overnight respite provision for young people
Moray	Increased use of SDS for respite
North Ayrshire	Respite provided through SDS not currently captured for some groups
Orkney Islands	Comparable data is not available due to SDS/Direct Payments - systems are not yet in place to provide that data, so the 2014/15 data is known to be unrepresentative of actual respite provision
Perth and Kinross	Significant changes to case management system and business processes due to SDS/personalisation, so 2014/15 data not consistent with previous years
Renfrewshire	Figures affected by the introduction of SDS resulting in a change to patterns of care packages including respite
Scottish Borders	SDS has contributed to the change in respite provision between 2013/14 and 2014/15
Stirling	SDS contributing to the shift from direct provision to commissioning services from other providers

For Local Authorities that are able to identify respite care that has been provided through Direct Payments (which now forms one option under SDS), the SDS roll-out process would be expected to result in a reduction in the recorded number of overnight / daytime respite weeks and a corresponding increase in the total recorded values of Direct Payments. Of the Authorities listed above, such a situation applies in Aberdeenshire, East Ayrshire, Highland, Moray, Renfrewshire and Stirling.

Some Local Authorities are not currently able to identify support that has been provided for the purpose of providing respite care through Direct Payments (or other SDS options). As SDS rolls out in these Authorities, apparent decreases in the total amounts of respite recorded must also be expected, without necessarily reflecting any change in the level of service provision. Of the Authorities listed above, such a situation applies to Glasgow City, North Ayrshire and Scottish Borders.

Looking forward, the continued roll-out of SDS over the coming years will likely mean that the current focus on recorded overnight / daytime provision will cease to be appropriate. However, when also combined with a situation in which the systems used by some Authorities are not able to record respite-related expenditure information for SDS clients, these changes pose a fundamental challenge to any publication of national level respite data.

5.5.2. Improvements to local recording systems

Several Local Authorities have described what we have interpreted to be substantial changes to aspects of their specific local recording systems over the course of the past year.

Aberdeen City	Data quality issues in 2013/14 data after transferring service management to a Local Authority Trading Company - most of these have been addressed
Aberdeenshire	2014/15 data includes the correction of an error that led to undercounting of daytime respite hours for the 18-64 age group in 2013/14 data
Falkirk	Possible undercount in respite nights for adults in 2013/14, corrected for 2014/15
Highland	Improved recording of daytime respite data for young people
Inverclyde	Adjustment to types of care that are classified as respite
North Ayrshire	Improved data quality by using finance data rather than service data
Scottish Borders	Improved data collection/recording for adult daytime respite
West Dunbartonshire	Improved recording of day care services for users aged 65 and over

5.5.3. The implications of recording changes for national estimates of real terms change in service provision

Both sets of recording changes described above mean that the 2014/15 data from the cited Local Authorities should not be considered directly comparable, in terms of service provision alone, to that from 2013/14. Including all Local Authorities within the national total produces an estimated real terms decrease of 6,630 respite weeks. This, however, includes the effect on respite provision of the issues described in sections 5.5.1 and 5.5.2. Excluding the Local Authorities affected by these changes gives the estimated real terms changes in Table 9 below.

Table 9: Real terms change in respite weeks provided including/excluding impact of recording changes/SDS

	Real terms change	% of respite weeks included
All Local Authorities	-6,630	100%
Excluding LAs affected by SDS	-2,040	72%
Excluding LAs affected by improved data recording	-6,880	63%
Including only unaffected LAs	-2,170	50%

The SDS-related changes tend to result in the underestimation of overnight/daytime respite weeks. Improvements to local data recording often lead to increases in respite weeks reported, but can also result in decreases where respite provision had previously been overestimated.

The figures above suggest that around 4,600 weeks out of the total real terms reduction of 6,630 respite weeks in 2014/15 is due to the continued roll-out of Self-Directed Support. The impact of improvements to local data recording has been broadly neutral overall, with the real terms change to the number of respite weeks being a slightly larger decrease when the affected Local Authorities are excluded.

Where SDS is being used, it is likely that respite care is being provided. At least some of this care will not be included in the data submitted by Local Authorities - for example, where data collection systems have not yet been updated to deal with all aspects of SDS, or where SDS has led to more Direct Payments being made but the Local Authority is unable to provide data on Direct Payments used to provide respite care.

This creates uncertainty over the actual level of respite care provision in 2014/15. To give an indication of the likely amount of respite care being provided, Chart 1 shows a range for the real terms increase in respite weeks since 2007/08. The highest value in this range, an decrease of 2,040 weeks from 2013/14, excludes SDS-related changes in respite care provision. This effectively assumes that provision of respite care is unchanged from 2013/14 for the Local Authorities affected by SDS.

5.6. Reasons for large increases/decreases in respite provision

Any large increases or decreases (+/- 20%) in recorded respite provision for overnight and daytime respite weeks were queried with the Local Authorities concerned. Some of the reasons identified within Local Authorities for such changes are given below:

Increases in recorded provision:

• Improved reporting systems / under-estimation of figures in previous years (see Section 5.5)
• Day care centres focusing on providing support to older people with higher levels of need
• The introduction of administrative services such as a 'Respite Bed Bureau'
• Promotion of activities that provide respite

Decreases in recorded provision:

• The roll out of Self-Directed Support / increased use of Direct Payments (see Section 5.5)
• The temporary / permanent closures of care homes / centres
• Reductions in residential placements available and / or maximum length of placement stay
• Introduction of charging for Day Care services, leading to reduced demand
• Improved processes for putting long-term packages of care into place, leading to lower demand for respite care
• High use service users moving to supported living arrangements

Unknown changes in recorded provision

• Transition of individuals with significant needs between age categories
• Changes to the way that care services are delivered, or to priorities in service delivery

5.7. Methodology used by Local Authorities

The guidance for the 2014/15 data collection is the same as that used for the 2013/14 data collection, which is available on the Scottish Government website: http://www.gov.scot/Topics/Statistics/Browse/Health/RespiteCarenew

Background information on this guidance has been provided in a Q & A document: http://www.gov.scot/Topics/Statistics/Browse/Health/RespiteCarenew/ShortBreakQA

Respite data is something that has proved to be very complex for Local Authorities to capture. This means that each Local Authority may use a variety of data collection methods and sources of information to collect the required information as specified in the guidance.

The data is collected from management/financial information systems, from manual records or direct from private/voluntary respite suppliers and is most commonly a combination of these data sources.

The data will also incorporate a number of different services depending on the services available within a Local Authority, examples of the services included are; Day Care, Home Care, Short Breaks/Holiday breaks, Direct Payments and short stays in Care Homes.

5.8. Cost of respondent burden

To calculate the cost of respondent burden to this survey each Local Authority was asked to provide an estimate of the time taken in hours to extract the requested information and complete the survey form. The average time for the 19 Local Authorities that provided this information has been used within the calculation below to estimate that the total cost of responding to this survey is £14,100 (rounded to nearest £100). It is also noted that the time taken to respond also varies widely across Local Authorities, from less than 5 hours to more than 250 hours.

5.9. Other data sources

To calculate percentage changes in population between 2007/08 and 2014/15, the National Records of Scotland mid-year population estimates for mid-2007 to mid-2014 have been used. Scotland-level data is reproduced in Table 10 below.

Table 10: Mid-year population estimates for Scotland, by age group, 2007/08 to 2014/15

Year	MYE used	0-17	18-64	65 and over	All persons
2007-08	mid-2007	1,053,044	3,270,951	846,005	5,170,000
2008-09	mid-2008	1,052,278	3,292,876	857,746	5,202,900
2009-10	mid-2009	1,052,762	3,308,581	870,557	5,231,900
2010-11	mid-2010	1,045,490	3,334,488	882,222	5,262,200
2011-12	mid-2011	1,042,058	3,361,478	896,364	5,299,900
2012-13	mid-2012	1,038,464	3,349,385	925,751	5,313,600
2013-14	mid-2013	1,035,394	3,345,444	946,862	5,327,700
2014-15	mid-2014	1,033,183	3,346,028	968,389	5,347,600

This data is available from the National Records of Scotland website: http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/population/population-estimates/

5.10. Further information

This Statistics Release is available on the Internet: http://www.gov.scot/Topics/Statistics/Browse/Health/Publications

Information at the Local Authority level is shown in the Annexes to this Statistics Release. Additional care should be taken when interpreting year-to-year changes within this data, especially in the cases of the Authorities who have experienced known recording changes over the past year (as listed in Section 5.5).

Further details and analysis of the data presented in this Statistics Release are available on request from the address under Correspondence and Enquiries given below.

This statistics release was published on 15^th December 2015. The previous publication in this series was published on 28^th October 2014.