Agenda item

Adult Social Care Fees 2023/24

Report of the Executive Director of Adult Social Care and Health and the Executive Director of Corporate Resources and Customer Services

Minutes:

Mr Jonathan Cunningham, Chair of the North and South Sefton Care Home Group spoke in support of a petition containing 132 signatures which stated:

We the undersigned: “Consider the proposed Sefton increase of social care fees of 16% remains insufficient to cover the cost of care. Sefton recognise that this remains below the true cost of care. Sefton is asked to reconsider and review this proposed fee rate.

Desired Outcome:

1. That Sefton reconsider the rate and increase to at least 20%

2. Sefton provide assurance that it is the True Cost of Care that should be paid.”

The Cabinet then considered the report of the Executive Director of Adult Social Care and Health and the Executive Director of Corporate Resources and Customer Services which set out the fees payable for Sefton Adult Social Care Services and Care sectors for the financial year 2023/24. The fees proposed include a range of care and support services to adults, including Direct Payment Recipients. The report also set out the future strategic direction for services, as part of the national work, which is underpinned by the Department of Health and Social Care national reforms.

The following appendices were attached to the report which reflect the detail of the robust consultation approach and the potential risks for mitigation linked to the Equality Impact Assessments which were monitored and updated throughout the life of the consultation period:

· Appendix A – 2023/24 Fee Increase consultation letters.

· Appendix B – Provider Responses to the consultations.

· Appendix C – Notes from the consultation events held with Providers.

· Appendix D – Care Home Equality Impact Assessment.

· Appendix E – Domiciliary Care & Direct Payment Rates Equality Impact Assessment.

· Appendix F – Supported Living Equality Impact Assessment.

· Appendix G – Extra Care Housing Equality Impact Assessment.

· Appendix H – Community Support Equality Impact Assessment.

· Appendix I – Day Care Equality Impact Assessment

The Executive Director of Adult Social Care and Health outlined the content of the report and referred to a letter submitted by the Chief Executive of the Alternative Futures Group relating to the Sefton Council Supported Living Rates 2023/24 which had been published and circulated to the Cabinet prior to the meeting.

The Cabinet then discussed the content of the report and the appendices published in the agenda and supplementary agenda.

Decision Made: That

(1) the petition be noted;

(2) the contents of the report be noted and having given full consideration to the options outlined in the body of the report and the associated Appendices, including the responses to the consultation from a wide range of Care and Support Providers, and the Equality Impact Assessments undertaken as part of the work, the implementation of the following fee increases set out below from 1April 2023 be authorised having taken into account a range of factors including the response from Providers, national context, risks raised in relation to additional costs, regional averages, any other information available at the time of the consultation and the availability of financial resources:

(3) the proposed fees for Supported Living and Day Care Services be deferred for further consideration at a special meeting of the Cabinet to be held on 8 June 2023 at 10.00am in Bootle Town Hall, to enable officers to undertake a further market analysis to augment employee wages for Supported Living and Day Care Services for consideration by the Cabinet;

(4) Residential and Nursing Care – the following rates be implemented that are higher than the originally proposed rates outlined in the initial consultation exercise:

	Residential Care	Residential Dementia	Nursing	Nursing Dementia
2023/24 Fee	£649.70	£735.09	£668.09	£742.51

2022/23 Fee	£561.10	£634.85	£576.98	£641.26
Weekly Increase	£88.60	£100.24	£91.11	£101.25
% Increase	15.79%	15.79%	15.79%	15.79%

Originally Proposed 2023/24 Fee	£616.87	£697.95	£634.33	£705.00
Originally Proposed Weekly Increase	£55.77	£63.10	£57.35	£63.74
Originally Proposed % Increase	9.94%	9.94%	9.94%	9.94%

(5) It be noted that for Residential and Nursing care services, any existing placements which are costed based on an individual Service User assessment are increased based on the same percentage uplifts detailed in the table above, unless where it is identified that the fee rate is sufficient for the placement. It also be noted that the above fee rates are not the sole funding route to agree a fee rate with care homes as there can be negotiated additional payments to reflect the complexity of care to support individuals when they are placed in a care home setting, which is directly negotiated as part of placement and Care Act assessment activities;

(6) Domiciliary Care – the following rates be implemented that are higher than the originally proposed rates outlined in the initial consultation exercise (apart from the Sleep-in rate) for contracted / Pseudo Dynamic Purchasing System (PDPS) Providers:

Duration / Service Element*	2023/24 Rate	Originally Proposed 2023/24 Rate	2022/23 Rate
1 Hour	£21.56	£19.66	£17.89
45 Minutes	£16.17	£14.75	£13.42
30 Minutes	£10.78	£9.83	£8.95
Sleep-in (8 Hour Night)	£95.86	£95.86	£87.40
Waking Night (8 Hour Night)	£172.48	£157.28	£143.12

*Any call duration outside of this framework will have been commissioned by request with Service Users and uplift will apply on a case-by-case basis. It is noted that future commissioning arrangements are currently being put in place which highlight that the Council does not seek to commission 15 - minute visit durations.

(7) Direct Payment recipients who access an Agency - that the above Domiciliary Care hourly rate be implemented and that rates for night services be increased to the following:

Duration / Service Element	2023/24 Rate	Originally Proposed 2023/24 Rate	2022/23 Rates
1 Hour (Domiciliary Care & Community Support)	£21.56	£19.66	£17.89
Sleep-in (10 Hour Night)	£119.83	£119.83	£109.25
Waking Night (10 Hour Night)	£215.60	£196.60	£178.90

(8) Direct Payment recipients who utilise a Personal Assistant - the following rates be implemented, which include a 11.92% increase to the daytime hourly rate and the associated waking-night rate:

Duration / Service Element	2023/24	2022/23
1 Hour	£14.55	£13.00
Sleep-in (10 Hour Night)	£119.83	£109.25
Waking Night (10 Hour Night)	£145.50	£130.00

(9) Community SupportServices

Duration / Service Element

2023/24 Rate

2022/23

Rates

1 Hour

£21.56

£17.89

(10) Extra Care Housing Services - the following rates be implemented that are higher than the originally proposed rates outlined in the initial consultation exercise and constitute a 11.99% increase:

Duration / Service Element	2023/24 Rate	Originally Proposed 2023/24 Rate	2022/23 Rate
Hourly Rate	£18.77	£18.41	£16.76

(11) Individual Service Funds – the rates be increased based on the proposed 9.84% increase awarded to Supported Living services:

Duration / Service Element	2023/24 Rates	2022/23 Rates
1 Hour	£19.31	£17.58
Sleep-in (9 Hour Night)	£107.85	£98.33
Waking Night (9 Hour Night)	£173.79	£158.22

(12) it be noted that the method applied to the calculation and payment of sleep-in services are maintained under the current Domiciliary Care, Direct Payment, Supported Living and Individual Service Fund contractual and policy guidelines which is based on the expectation that Providers / Direct Payment recipients pay staff the hourly rate calculated within these rates;

(13) It be noted that fee rates will also be reviewed as part of future commissioning / procurement work for certain sectors. Final decisions on any such revised fee rates will be agreed as part of the associated procurement exercise decision-making processes and subject to their assessed affordability, the Executive Director of Adult Social Care and Health be granted delegated authority in consultation with the Cabinet Member – Adult Social Care and the Executive Director of Corporate Resources and Customer Services to implement such decisions; and

(14) the future fee modelling approaches outlined in this report, particularly with respect to the Real Living Wage be noted.

Reasons for the Decision:

To enable the Council to set the fees payable for services, during the financial year period 2023/24 and to give further consideration to proposed fees for Supported Living and Day Care Services at a further Cabinet meeting.

Alternative Options Considered and Rejected:

1. Not awarding increases – this option was rejected in relation to all service areas as there is a requirement to ensure that fee levels are increased to consider the outcome of consultation and in relation to increases to Provider’s costs, such as the increase to the National Minimum Wage.

2. Awarding lower rates to the Residential and Nursing care, as proposed at the beginning of the consultation – this option was considered but rejected following the analysis of the consultation responses and wider impacts, principally current market conditions, cost pressures being experienced by the sector and the national Market Sustainability and Cost of Care programme, and the specific additional funding allocated for the programme.

3. Awarding lower rates to Domiciliary Care (which then has linkages to Direct Payments – Agency, Community Support and Extra Care Services) as proposed at the beginning of the consultation – this option was considered but rejected following the analysis of the consultation responses and wider impacts, principally current market conditions, cost pressures being experienced by the sector and the national Market Sustainability and Cost of Care programme and the specific additional funding allocated for this programme.

Supporting documents: