Agenda item

[Alicia Wood, Lead Commissioner - Specialist and Targeted, to present report- the main report to follow]

Emma Bennett, Executive Director of Families, introduced the report and advised the panel that it was being presented for pre-decision scrutiny before it is presented to Cabinet Resources for consideration and approval of the proposed fee increase.  

The Executive Director of Families advised the panel that the Council has a duty to ensure that the care needs of residents in Wolverhampton are met. This work includes reviewing the sufficiency of externally commissioned care fees and if the current fees enable provision of care and for the Council to purchase them and inform an annual review of fees. The annual fee review covers adults externally commissioned care and support service areas and direct payment cost rates. 

The Executive Director of Families outlined the scope of the fee review proposals.

The Executive Director of Families advised the panel that the overall increase of £4.1 million in fees will be met from the growth in Adult Services which will include the funds for the proposed fee review. 

The Executive Director of Families commented on the implications of major reform of social care and the proposed introduction of a fair cost of care policy. The plans will require the Council to draft several policies by the end of September 2022 as part of the reforms, for example, a market sustainability plan for external care provision and a fair cost of care tool to demonstrate how self-funders costs are aligned to the fees funded by the Council.

The Executive Director of Families briefed the panel about the national picture of the demand for social of care provision in Wolverhampton and commented on the increase in demand for social care, particularly during the pandemic.  The Executive Director of Families commented that the service has engaged with providers to get their feedback about the proposed fees and highlighted other factors which have also been considered, for example, the national shortage of care staff as well as retention issues and the continued impact of Covid 19.

The Executive Director of Families advised the panel that in response to the national challenges in the home care and domiciliary care sectors and the concerns of providers, care fee rates were increased mid-year in 2021 to maintain sufficiency. The Executive Director advised the panel that a new rate for Direct Payment Self Employed will be introduced in recognition that there are direct payments Personal Assistants who are self-employed and with different costs to those employed and to the encourage the growth of the sector. A fee proposal includes a recommendation for the rate for people who are self-employed. 

The Executive Director of Families commented on the benefits of the change and gave a summary of the recommendations that Cabinet Resources Panel will be asked to approve.

The panel were invited to scrutinise the proposals.

The Chair thanked the presenter for the report.

The panel welcomed the proposal to introduce direct payments for the self-employed and supported the principal of the initiative.

The panel expressed concern about the situation where people would have to consider selling their home to meet their care costs.

The panel commented on the need for consistency in the level of training and care provided and highlighted the importance of self-employed people being properly trained and working to agreed standards. The panel expressed concern about increases in cost of living and inflation which add to the pressure of vulnerable people being able to meet the cost of homecare.

The Executive Director of Families, commented that the issue of quality relates both to the quality of the agencies and the quality of the workforce in terms of their skills, training and qualifications. 

The Executive Director of Families reassured the panel that all care homes are inspected by CQC and in addition there is the Quality Assurance Team, part of the commissioning team, who work closely with providers to ensure they are prepared for inspections and offering support when there are concerns about the quality of provision. The team work to maintain a positive working relationship with residential and homecare providers.  In addition, intelligence about the quality of care provided by the sector is also informed by complaints or safeguarding concerns reported to the service.

The Executive Director of Families added that future reforms to the health and social care sector will provide further assurance about the quality of provision and the extra responsibilities on local authorities. There is work being done to develop locally agreed quality care standards. The Executive Director of Families offered to present details to a future meeting of the panel about this work. The Executive Director of Families highlighted other examples of other initiatives aimed at improving the quality of care provided and responding to the workforce challenges facing the social care and health sector.

John Linighan, Commissioning Officer, commented on the valuable information picked up by members of the Quality Assurance Team, which was particularly useful during the pandemic, and helped the service to get a better understanding of their issues. The service has worked with providers to resolve issues which has helped to improve the quality of practice and the care given. The Commissioning Officer added that the fee review recognises the impact of increased inflation costs, and the other cost of living increases on the finances of care providers. The service accepts that these providers are a business and the need for them to have enough profit to reinvest into improving the quality of care.

Sue Eagle, Commissioning Officer, endorsed the concerns highlighted in the previous comments and added that the adult care service has experienced a huge increase in the demand as more people wanted to receive care in their own home. This provision of homecare was already a strategic priority for the service to promote independence for people for as long as possible before the pandemic. The Commissioning Officer commented on the impact of challenges during the pandemic of ensuring people who were medically fit could be discharged home from hospital safely.

Sue Eagle, Commissioning Officer, reassured the panel that the service continues to meet with care providers and quality assurance officers check that they are compliant with their own processes and agreed policies. The CQC also continue to monitor the quality of care provided.

Sue Eagle, Commissioning Officer commented that social workers remain involved when a person is receiving homecare to assess the level of care needed, and that the package of care is appropriate for that person to remain in their own home.       

John Linighan, Commissioning Officer, added that the demand for homecare support has been unprecedented and people have been presenting with more complex health and care needs. As a result, care providers have had to be more responsive, particularly during the pandemic.

John Linighan, Commissioning Officer, commented on the importance of having a sustainable care market and the responsibility of the Council to keep to a minimum the number of people waiting for care in their own homes and to support providers to remain responsive to changes in demand.

The panel queried the increase in the demand for homecare during the pandemic and implications of this trend for the future sustainability of the care sector and the costs for residents in care establishments if fewer people than expected consider this option.

The Executive Director of Families commented that there will always be a need for residential care, which may have reduced during the pandemic and changed the way hospital patient discharges are managed.  The Executive Director of Families commented that as a result people have wanted to be supported in their own home rather than move to a residential care home, but it is difficult to say how this trend may impact on projections of future demand. 

The Executive Director of Families added that the situation will hopefully be clearer after the work being done to prepare a market sustainability statement by the end of September 2022. The document will provide more information about expected future care needs and what will be required from the care sector to respond to this.

Sue Eagle, Commissioning Officer, commented that in terms of demand for care, the situation is being closely monitored and agreed that the pandemic has changed demand for people wanting more homecare.

The service is working closely with colleagues in public health to understand the changes in population which will included in the market position statement and reviewing the numbers of people going into the different care settings.

John Linighan, Commissioning Officer, supported the view about the reduction in numbers going into residential care compared to pre-pandemic levels and the possible implications of this change on the future sustainability of residential care home sector. The Commissioning Officer added that people are likely to be moving into care much later in life with greater care needs which will have an impact on the costs of care providers as people with higher needs will require staff with better training and investment in services to provide the care and support needed. The Commissioning Officer commented on the mapping work being done to collect the information.

The panel thanked the presenters for the report. The panel requested a draft of the provisional market sustainability plan for external care provision to be shared with the panel in September 2022.  The Executive Director of Families agreed to provide the information.

Resolved:

1.    The panel agreed to note the report and support the recommendations detailed in the report.

2.    The Executive Director of Families to present a draft of the provisional market sustainability plan for external care provision to a panel meeting in September 2022 for comment.