Agenda item

(To receive a report by the Executive Director – Adult Care and Community Wellbeing which invites the Executive to consider and approve the setting of rates for residential care and residential care with nursing cost)

1.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Older People service users in respect of residential, nursing and high dependency care with effect from 1 April 2024 for the year 2024/25.

2.    That the rates set out in Table 2 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Learning Disability service users in respect of Band 1, Band 2 and Band 3 with effect from 1 April 2024 for the year 2024/25.

3.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Mental Health service users in respect of standard and nursing care with effect from 1 April 2024 for the year 2024/25.

4.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Physical Disability service users with effect from 1 April 2024 for the year 2024/25.

5.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for service users needing 1:1 care with effect from 1 April 2024 for the year 2024/25.

6.    That the replacement of the Hardship Fund that operated in 2023/24 with a Hardship Process with effect from 1 April 2024 for the year 2024/25 be approved.

7.    That authority be delegated to the Executive Director Adult Care and Community Wellbeing, in consultation with the Executive Councillor for Adult Care and Public Health, to determine the detailed conditions governing the Hardship Process contained in Section 3 including the criteria for making payments.

The Executive Councillor for Adult Care and Public Health introduced a report which detailed the process for the setting of Usual Costs for both Residential Care and Residential with Nursing Care.  It was highlighted that the setting of the Council’s Usual Cost was central to its compliance with statutory obligations.  In particular, the rate that the Council establishes as its Usual Cost would contribute significantly to the sustainability of the market and its ability to provide sufficient places capable of meeting need.  The rates were established following a comprehensive market assessment carried out in 2021.  The rates underpinned the Council’s Framework contract for the three year period to 31 March 2025 and incorporated an annual review to minimise the risk of the rates losing pace with the economy, especially with the increase in national living wage.

The Executive Director – Adult Care and Community Wellbeing presented the report and advised that this was a major area of spend for the Council, and there was also a legal duty to ensure that the rates the Council paid took into account the costs of delivery.  It was also noted that the rates the Council offered were not necessarily the ones that providers would accept.  It was important to providers that they had as much as notice as possible regarding what the rates would be in the future, so that they could plan their businesses.

The Head of Financial Services outlined the financial impacts of the proposal which included an uplift of 7.3% to reflect general inflation and especially the increase in the National Living Wage.  It was noted that the financial impact of this was included within the Council’s Budget.  Attention was also drawn to changes to the arrangements for responding to providers facing financial challenges, where the intention was to move away from a fixed Hardship Fund and replace this with a flexible Hardship Process. This would be open to commissioned providers to enable them to approach the Council where they were at risk of closure due to financial loss, and which would include an open book assessment to be completed between the Council and the provider.  Any financial support provided would be time limited with a recovery plan agreed between both parties.

Clarification was sought in relation to the top up mechanism, and officers advised that people had a choice in where they wanted to live, and if someone chose a home that charged a price higher than the Council’s rates, then they or a relative would need to cover the difference between that cost and the Council’s rate.  However, if the person was eligible for full funding, then the Council would have to offer a placement in a home at nil cost to the individual, even if this was above the Council’s usual rate if no other suitable placement was available.  Following a national campaign by the Local Government Ombudsman, the Council, like almost all local authorities, was shifting to a position where it paid the gross fee to the provider and recovered the top up from the third party.  The Council had always been legally responsible for the total amount, but the switch to gross payment simplified matters for both the Council and the provider and gave protection to individuals against unreasonable increases in top up rates.

The Chairman of the Overview and Scrutiny Management Board presented the comments of the Adults and Community Wellbeing Scrutiny Committee following its consideration of this report at its meeting on 28 February 2024 where the Committee strongly supported the recommendations to the Executive.  It was reported that the Committee had congratulated the Team involved in the detailed work on the calculations of the proposed rates; and believed that the proposals overall represented a fair price for the services.  The Hardship Process was also welcomed by the Committee, as a mechanism to support residential care homes in financial difficulty.

During discussion by the Executive, the following was noted:

·       The difference between the Hardship Fund and Hardship Process was queried, and officers advised that the Hardship Fund had been a fixed amount of funding set aside to assist homes with paying the additional costs of fuel, insurance and energy.  The Hardship Process would be for homes to approach the Council if they were going to struggle meeting their costs, the council would go through the income and expenditure of an individual home and provide assistance where necessary.  Any financial support provided would be time limited with a recovery plan agreed which would encourage financial sustainability of the home.

·       In relation to the Equality Impact Analysis, it was queried why 65+ was still used as an age band as life expectancy had increased significantly.  Officers advised that there was a gender imbalance as life expectancy for women was longer than that for men.  It was possible to further divide the date by age beyond 65 years, and indeed the large majority of older people living in care homes were over the age of 75, however, considering the shift to older people as being 65+ was a national figure.

RESOLVED

1.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Older People service users in respect of residential, nursing and high dependency care with effect from 1 April 2024 for the year 2024/25.

2.    That the rates set out in Table 2 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Learning Disability service users in respect of Band 1, Band 2 and Band 3 with effect from 1 April 2024 for the year 2024/25.

3.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Mental Health service users in respect of standard and nursing care with effect from 1 April 2024 for the year 2024/25.

4.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for both new and existing Physical Disability service users with effect from 1 April 2024 for the year 2024/25.

5.    That the rates set out in Table 1 in paragraph 2.6 of the report be approved as the Council’s Usual Costs for service users needing 1:1 care with effect from 1 April 2024 for the year 2024/25.

6.    That the replacement of the Hardship Fund that operated in 2023/24 with a Hardship Process with effect from 1 April 2024 for the year 2024/25 be approved.

7.    That authority be delegated to the Executive Director Adult Care and Community Wellbeing, in consultation with the Executive Councillor for Adult Care and Public Health, to determine the detailed conditions governing the Hardship Process contained in Section 3 including the criteria for making payments.