Agenda item

[Becky Wilkinson, Director ot Adult Services, to present report]

The Chair invited Becky Wilkinson, Director of Adult Services, to present the report. 

The Director of Adult Services advised the panel that the presentation is an update on report presented earlier in the year about Government proposed health and social care reforms. At that time there was a commitment to bring a more detailed update on the plans to a future meeting. 

Wolverhampton along with five other authorities were invited by the Department of Health and Social Care to participate in the Adult Social Care Reform Trailblazer. The aim of the plan was to test out how the introduction of the fair cost of care reforms would work in practice. The local authorities involved would share best practice from the implementation of the changes ahead of a national roll out of the scheme. The Director of Adult Services advised the panel that the trailblazer scheme is expected to start in January 2023 and the national rollout is planned for October 2023

The Director of Adult Services outlined the background to the Government’s proposals and the key objectives of the reforms, for example, from the plan to introduce a new cap of £86,000 on the amount anyone in England will have to spend on their personal care over their lifetime. 

The Director of Adult Services commented that the fair cost level will differ according to the area. There will also be changes to the social care means test for accessing local authority funding. The upper capital limit will increase from £23,250 to £100,000 and the lower capital limit will increase from £14,250 to £20,000.  

The Director of Adult Services advised the panel that there will be additional money from government to support the implementation of the reforms as it is expected that the current rate the Council pays for care will increase and the amount that self-funders pay will decrease. The Director of Adult Services commented on the benefits of being part of the trailblazer programme. 

The Director of Adult Services advised the panel that in addition to implementing the statutory requirements of the reforms those local authorities involved in the trailblazer would also need to implement specific non-statutory requirements.

The Director of Adult Services gave an update on the progress to date and the assessment of different risks linked to being involved in the trailblazer project. The Director of Adult Services commented on the good progress made to date and the success in recruiting additional social workers and other specialists to better understand the impact of the proposals. 

The response from home care providers has been good but there is an issue about engaging some care home providers, especially nursing care home providers. 

The Director of Adult Services reassured the panel that work is being done to improve the returns from care home providers and that overall, the work is on track to be completed by the deadline.

The Director of Adult Services advised the panel that work is being done to identify the number of self-funders in the city as the reforms will enable the Council to act as a broker to negotiate their care home fees on their behalf.

The Director of Adult Services commented that a wider risk highlighted in implementing the reforms is the issue of affordability as an initial analysis of returns from provider care homes suggest that the median hourly cost is significantly above the rate currently paid by the Council. The Council is required to produce a market sustainability plan but without having details of the Government grant settlement figure which will be difficult. 

The Director of Adult Services highlighted the risks of potential legal challenge from care home residents and to the financial viability of those care homes who have a high proportion of self-funders. A further risk which has been raised with the Department of Health and Social Care is managing the expectations of providers and residents following the publication of a median fair cost of care rate about the future level of fees.

The Director of Adult Services commented on the work being done to mitigate the risks listed but added that some of the risks were outside the direct control of the Council to manage. 

The Director of Adult Services outlined the timetable for the project. A proposal on moving forward with the Council’s involvement with the trailblazer programme will be presented in November 2022 to the Leader, Cabinet Resources and Executive Team for approval. The Director of Adult Serviced proposed that a further report on the plans could be presented to the panel in January 2023 before a final decision is made to go live. 

The panel were invited to comment on the presentation.

The panel queried the implications of introducing a cap of £86,000 on what someone would have to pay for personal care if they had property and savings above this amount. The Director of Adult Services advised the panel that there is a means test for accessing local authority funding support. There is work being done to develop different financial scenarios to give a guide about impact of the introduction of the personal care cap. The panel welcomed the idea.

Meena Dulai, Head of Service Adult Improvement, advised the panel that the cap of £86,000 is only for personal care needs and the local authority will decide if the care needs are eligible. The Head of Service Adult Improvement commented that in a situation involving a self-funder they can decide what care they will pay for, but if they approaches the local authority for financial support, they would need a financial assessment to decide the level of funding  from the Council.

The panel discussed the issue of financial support for accommodation costs.

The panel discussed the workforce challenges facing the care sector and highlighted the need for care to be delivered properly and safely by staff who have been appropriately trained. The panel asked for more details to be included in the proposals about plans for recruiting people with the skills and expertise needed to deliver the programme.

The panel queried the number of care home providers who have agreed to take part in the trailblazer programme and if there was a minimum number needed for the work to go ahead.

The Director of Adult Services responded that 58 percent of home care providers have responded, based on return rate of 42 per cent and the responses are broadly representative of the sector. However, there is concern about the number of responses from the nursing sector care homes and a request has been made to Department of Health and Social Care for an extension to the deadline. The Director of Adult Services commented that there are some reservations from care providers about sharing all their financial information with the Council, especially around their costings for essential care. The Director of Adult Services added that the response was not unexpected, and reassured the panel that work is being done to contact care providers to encourage them to be part of the programme. This work is being supported by a communication plan.

The panel queried how the level set for median fair cost of care would apply in a situation where people have different care needs and specifically how people this would be factored into the financial assessment. The Director of Adult Services explained that there is work being done to consider different care packages and to develop weighted medians to reflect this difference in care needs. The Head of Adult Improvement added that a consultant has been appointed to undertake this specific work. The Head of Adult Improvement agreed to share a briefing paper on the findings with the panel when the work is completed.

The panel queried the plans for making the public and care home providers aware and updated about the changes.

The Director of Adult Services Care commented on the challenges in advising residents in care, who may lack capacity to make their own decisions and advised the panel of the work being done with Department of Health and Social Care to advise them of the changes. Further work is planned to develop a communications strategy to explain the changes to the wider public.

The panel queried the reference in the presentation to a possible legal challenge arising from the reforms where some services that someone is currently paying for may not be eligible towards the care cap financial assessment.

The Head of Service Adult Improvement commented that the issue is likely to arise for self-funders who can choose the services they want. The Council when doing the assessment under the reforms may not consider the service to be an eligible need, which could lead to the Council getting more complaints and possible legal challenges about this decision.

The panel expressed concern about the practicalities of the proposed changes and highlighted the likely differences in regional care costs and the complexity and challenges in trying to implement the reform plans. The panel commented on the likely beneficiaries from the reforms and there was concern that the change will not result in achieving greater equality in the way that the policy aims have been presented.

The panel discussed the issue of the low pay and poor working conditions of care home workers and the added financial pressures this group may face. The panel suggested that this issue should also be considered as part of the preparation for the implementation of the care home reforms.

The Director of Adult Services acknowledged the difficulties caused by the introduction of the cap when applied to homes with different valuations, as in some cases the value of the home will be less than the £86,000 personal care cap limit. The reason for being involved in the trailblazer was to share these and other concerns about the possible impact of the reforms onto the Department of Health and Social Care. The Council is waiting for feedback on the issues raised following a visit last week by colleagues from the Department of Health and Social Care.

The panel requested that a copy of the timeline for project plan is shared at the beginning of every month so that progress can be monitored. A meeting of the panel could be arranged if a project task or milestone in the plan is likely to be missed or slipped to understand the reasons for the change.

The panel thanked the presenter for the report.

Resolved:

1.    The panel comments on the presentation to be noted.

2.    The Director of Adult Services to share the financial modelling work about how the reforms might affect people with different care needs.

3.    The Director of Adult Services to share an update on project plan at the beginning of each month.

4.    The panel to consider arranging an extra meeting in January 2023 for pre-decision scrutiny of the final decision about the Council’s involvement in the Adult Social Care Reform Trailblazer project.