Agenda item

33.1     The Head of Supply Management and the Learning Disability Commissioning and Supply Development Manager (Market Resilience and Engagement) delivered a presentation to the Committee on the latest position of the local care market for older people’s homecare, older people’s bedded care and specialist working-age adult care. The presentation also highlighted the current risks and challenges facing providers and the local care market. A copy of the presentation that was delivered was included in the meeting agenda.

33.2     The Committee welcomed the update, discussed the presentation, and asked questions on the following issues:

·                     Funding reforms – the Committee considered the potential impact of upcoming national funding reforms highlighted in the presentation, including whether there would be challenges presented by self-funding clients having unviable expectations of what the local authority could arrange in terms of care packages. The Director of Adult Social Care and Health responded that the biggest challenge for the Department was expected to arise from the element of the planned reforms that would enable self-funders to ask the local authority to arrange residential care placements on their behalf, as the fees the Council paid to providers were expected to need to be uplifted significantly to cover the loss in income providers would see from self-funding clients moving to local authority rates. This uplift would be required for those providers’ business models to remain viable; and an exercise to determine the sustainable fee rate required to be paid by the Council to providers was currently underway.

·                     Categories of residential care provision – the Committee asked if the categories of residential care provision outlined in the presentation (for example ‘nursing dementia’) could be further split by different models of living arrangements and whether the Department had assessed to what extent different living arrangements resulted in better outcomes for residents. The Head of Supply Management and Learning Disability Commissioning responded that the categorisations used in the presentation mirrored the registration categorisations used by the Care Quality Commission. The Head of Supply Management recognised that the definitions were broad and covered a range of models; for example, a ‘registered residential home’ covered provision that catered to 4 or 5 clients as well as provision that catered to 40 or 50 clients, both with potentially very different living arrangements. However, it would be very challenging for the Department to develop a more detailed, consistent categorisation of those models of care and that prevented assessments of the impact of those arrangements on outcomes from being made.

·                     Specialist working-age services – the Committee asked if the Department expected that the increase in referrals to specialist working-age services post-COVID, highlighted in the presentation, would be maintained longer-term. The Head of Supply Management and Learning Disability Commissioning responded that it was unclear if referrals to these services would be maintained at the higher post-COVID level long-term but knew we could expect to provide support over a long period of time for those who were being referred as they were younger clients who often required support over their lifetime. In the longer-term, it was possible that demand for services would continue to increase as families with children receiving learning disability support had different expectations of the support that could be provided to meet their child’s needs as an adult than had perhaps historically been the case. The experience of the coronavirus pandemic had also led to people seeking diagnoses and support for mental health conditions which may result in an increased need for services. The Assistant Director, Strategy, Commissioning and Supply Management added that the Department was seeing increasing complexity in the needs of people with mental health conditions seeking help and that there was not always appropriate provision in the care market to meet those people’s needs. The Department would therefore need to work with partners across the Integrated Care System to ensure those needs could be met in future.  

·                     Care Home closures – the Committee noted the figures regarding care home closures referenced in the presentation and asked how closure of care homes impacted the Department’s work to support and maintain the local care market. The Director of Adult Social Care and Health responded that while every care home closure had both an impact on the individuals receiving care within them, and on the Department as it reduced choice and made it more challenging to broker placements; the extent of the impact on the wider care market depended on the nature and size of the care home. By way of an example, the loss of a specialist care home in a rural area would hypothetically have a particular impact due to the loss of local, specialist provision. The Director assured the Committee that the Department did whatever it could to reduce the number of care home closures but that the impact of this was limited as care homes were ultimately independent businesses. The focus on developing homecare provision was part of the Department’s approach to building resilience in the market to reduce pressure on, and need for, residential care beds.

·                     Homecare fees – the Committee noted that homecare rates paid to providers had had a 6% uplift backdated to January 2022 and asked if the Department had assurances that this uplift was making its way to homecare staff. The Assistant Director, Strategy, Commissioning and Supply Management confirmed that the Department did have intelligence that both the rates the Council paid homecare providers were broadly comparable with rates paid in other areas and that uplifts in fees were, in part, passed on to staff.

33.3     The Committee RESOLVED to note the report.