The Committee considered a report of the Director of Adults and Communities, the purpose of which was to provide an update regarding the final Market Sustainability Plan (MSP) to be submitted to the Department of Health and Social Care (DHSC) at the end of March 2023. The report also provided update on the Fair Cost of Care (FCoC) exercise carried out by the Council and subsequent publication of associated information, and the Council’s position in respect of uplifts to commissioned care package fees for 2023/24. A copy of the report marked ‘Agenda Item 9’ is filed with these minutes.
Arising from discussion and questions, Members noted the following points:
i. Provider uplifts detailed within the report were the result of working both with the external sector and colleagues within the wider corporate teams to respond to inflation for the 2023/24 financial year, whilst appreciating it was a hard time for everyone in the country, including for care providers with them experiencing the national living wage (NLW) uplifts in April 2023 and circa 10% inflation levels. Providers had now been informed of the uplifted fees.
ii. The MSP had been informed by the FCoC analysis on the care homes market, and home care market. Both reports set out the basics of the approach to ascertain FCoC in each market, main results, and assumptions made about profitability in the market.
The results of the FCoC were reasonably close to fees being paid, with the caveat that the FCoC exercise was somewhat flawed, for example, to say that the median costs of care value submitted by providers is the ‘fair cost of care’ is a gross oversimplification, and the home care response rate was very low and therefore the data and analysis of limited value
iii. Research would appear to show that the NHS in Leicester, Leicestershire and Rutland (LLR) had a considerably lower number of people who were identified as requiring Funded Nursing Care and Continuing Health Care. compared with other Integrated Care systems nationally.
If those determinations were not being made, this calls into question the sustainability of the nursing care sector and could be one reason why there are significantly fewer nursing beds in Leicestershire than similar other areas. This also potentially affected the quality of care because providers require funding through the NHS to properly staff nursing care homes., This had been raised as a clinical risk with NHS colleagues and further analysis to better understand and address this issue is ongoing.
iv. People who were previously self-funded in a home with fees higher than the Council rate and whose funding resources had depleted would become former self-funders. The Council would look at each individual case in a person-centred way for the wellbeing of the individual, with the Council exploring whether a third-party fee top up was available, whether it was appropriate to consider moving the person to another care home, or whether the Council funded the additional costs for the individual, with the outcome very often being the latter subject to negotiation with the care home.
v. The average home care package was for 13 to 14 hours per week. At 20 to 30 hours per week this was still well below the median home care fee of £719.00 per week. The service worked in a people centred way, promoting ‘Home First’ to keep people in their own homes with care and support, and was better for the person’s wellbeing and more cost effective.
vi. In terms of the urban-rural continuum when comparing the County and the City Council approach, the City Council operated in a tight geographical care area which had a smaller effect on travelling costs unlike the County Council with more rural, widespread areas. Fee rates were structured at four levels, with rural and isolated areas having higher levels of fees. It was noted there were challenges for a provider to be able to provide two or three packages of care through a care run which could be spread out quite significantly.
vii. Members were reassured that the Council was supporting rural and isolated areas, with a key piece of evidence being how long it took for people to get into care, which had been a significant problem in the past, and with people being more supported at home. Growth levels in the market had not been reflected in higher levels of growth in rural and urban areas, where there continued to be growth in home care.
viii. In terms of the residential care market, it was noted there was stability with sufficient beds in residential care, but with nursing care beds there was an issue about the size of the market, though the quality was very good. Members further noted that in order to bring more providers into the County to expand the market, as in any business providers would look to see whether or not there was a viable return and demand for the service they were offering. Whilst demand continued to be low, Leicestershire would not see any new market entrance, unless specifically aimed at people who could fund their own care. The home care market, with a fee structure, that pays higher fees in rural areas, is operating effectively.
a) That the report on the final Market Sustainability Plan (MSP) to be submitted to the Department of Health and Social Care (DHSC) at the end of March 2023 be noted.
b) That the update on the Fair Cost of Care (FCoC) exercise carried out by the Council, the subsequent publication of associated information, and the Council’s position in respect of uplifts to commissioned care package fees for 2023/24 be noted.
c) That the Director be requested to provide updates on the position of the residential and nursing care market, and information on the distortion of nursing care bed numbers in comparison to other areas around the country.