Issue - meetings

(To receive a report by Pam Clipson, Head of Finance – Adult Care and Community Wellbeing and Alina Hackney, Head of Commercial Services, which invites the Committee to consider a report on Community Supported Living, Residential Care and Residential with Nursing Care Usual Costs prior to its consideration by the Executive on 7 March 2023. The views of the Committee will be reported to the Executive as part of its consideration of this item)

Councillor T A Carter declared a non-pecuniary interest as a trustee of Holbeach and East Elloe Hospital Nursing Home.

Consideration was given to a presentation by the Head of Finance – Adult Care and Community Wellbeing and the Head of Commercial Services, which outlined the key points from the report to the Executive on Community Supported Living, Residential Care and Residential with Nursing Care Usual Costs, including rate construct, risk, the market sustainability and improvement fund, the hardship fund and referred Members to the proposed recommendations.

The Board supported the recommendations to the Executive and during the discussion the following points were highlighted:

·       Assurance was provided that the Council had consulted with the whole market place on the rate construct. Responses received had been mixed but had identified potential challenges for larger organisations, which the Committee expressed concerns about. The Committee was reassured that targeted support would be provided to those considered homes high risk.  An example of support could be the hardship fund, where providers could receive funds for assistance with increased energy and insurance costs. 

·       Lincolnshire County Council had been the only local authority operating a hardship fund during 2022-23 and had also been advising other local authorities on how to operate one. There was potential for the hardship fund to be extended into 2023/24.  The Committee requested details of the application of the hardship fund as part of its regular budget monitoring updates.

·       Non-staffing costs related to a variety of costs, for example costs of taking part in activities and for personal protective equipment.

·       The Committee accepted the rationale used to calculate the proposed levels of fees to be paid to providers for these services.

·       Inspections of homes were undertaken by the Care Quality Commission (CQC) however the Council engaged with relatives and residents as part of an annual review of commissioning arrangements.

·       Historically, star rated/incentive schemes to improve standards had not been successful and the Committee acknowledged a preference to target support where it was most needed whilst aspiring for everybody to be operating at a high standard.

·       The Council had advised CQC of the risks of allowing further care homes to open in Lincolnshire, given the difficulties many homes were already facing.

·       The Committee welcomed the use of block contracts, as a means of supporting and providing stability to the residential care and community supported living market. 

·       The Committee expressed a preference to see the programme of developing intermediate care accelerated, in partnership with the NHS.  An example of this had been the establishment of sixty ‘active recovery beds’, which were already seeing high numbers of people returning to their home to live independently, as opposed to long term residential care.  Funding for active recovery beds was being sought from the NHS, so that this initiative could continue beyond 31 March 2023. 

·       A need to consider to how settings such as community supported living might be promoted to the public as alternatives to residential care was highlighted.  This and other parts of the transformation programme  ...  view the full minutes text for item 63

(To receive a report from the Executive Director – Adult Care and Community Wellbeing which invites the Executive to approve the rates for residential and nursing care fee levels within Adult Social Care)

1.    That the rates set out in the table at paragraph 5.6.1 of the report be approved as the Council’s Usual Costs for both new and existing Learning Disability service users in respect of residential and nursing care with effect from 1 April 2022 for the financial year 2022/23

2.    That the rates set out in the table at paragraph 5.6.2 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 2022 for the year 2022/23

3.    That the rates set out in the table at paragraph 5.6.3 of the report be approved as the Council’s Usual Costs for both new and existing Physical Disability service users in respect of residential and nursing care with effect from 1 April 2022 for the year 2022/23

4.    That the rates set out the table at paragraph 5.6.4 of the report be approved as the Council’s Usual Costs for both new and existing Mental Health service users (aged 18 – 65) in respect of residential and nursing care with effect from 1 April 2022 for the year 2022/23

5.    That the proposed contractual updates set out in section 6 of the report be noted

6.    That the use of £1m from the Adult Care Grant Reserve to establish a fund for the making of payments to providers of residential care and residential with nursing care in Lincolnshire suffering hardship as a result of cost volatility relating to utilities costs and insurances 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 fund including the criteria for the making of payments.

The Executive Director – Adult Care and Community Wellbeing introduced a report which outlined the requirement for the Council to set a framework for Usual Costs for three levels of service: residential, nursing and high dependency across all types of need (older people, physical disability, learning disability and mental health).

The Executive was advised that Residential and Nursing services represented one of the Council’s highest spend and highest risk areas with an annual total of approximately £125m gross spend.   The Head of Commercial Services – People Services detailed a number of elements of the report to the Executive including an outline of the key activities which had been undertaken by officers, the Council’s Usual Cost model process, Fee Setting Methodology, the collection and analysis of Lincolnshire data by Care Analytics, the Actual Cost Modelling Process, the Council’s Proposed Rates, Market Consultation, the Council’s Response to the Feedback and Recent Developments and Contractual Updates.

The Chairman of the Adults and Community Wellbeing Scrutiny Committee presented the comments of the Scrutiny Committee following its consideration of this item at its meeting on 23 February 2022.  The Executive was advised that the Committee had supported the recommendations and the rates proposed, and were satisfied that extensive research had taken place, and the Council had engaged with the Care sector.  Issues raised included the rate of inflation at 4% used in the calculation of the rates, and whether this was a fair reflection.  The Committee also questioned whether the level of funding in the hardship fund would be sufficient.  However, LinCA was supportive of the fund, and felt that the funding level was appropriate.  It was also highlighted that there was a belief that new build care homes seemed to be larger and more focused on self-funders, and there was a need to be aware that some of these homes may need help to diversify.

During discussion by the Executive, the following points were noted:

·       There was a hope that as much of the sector as possible would adopt this, however the majority of the market would be sufficient to satisfy the legal requirements.

·       In relation to the Hardship Fund, assurance was sought that risks to the Council would be minimised in terms of putting money into businesses which may be failing, and it was queried what protections were being put in place to counteract this.  The Executive was advised that one of the key elements in this proposal was the length of relationship that Lincolnshire had with the care sector.  Meetings were held weekly, which was very important in making the right decisions and supporting those homes to improve quality.  This ensured the Council was investing in sustainable businesses and giving people a choice of home within a reasonable distance of their home.

·       It was confirmed that there were criteria in place for the allocation of funds from the Hardship Fund, and there would be an oversight programme for those homes which wished to apply.  Evidence would also need to be provided on  ...  view the full minutes text for item 69