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Published Delegated Executive Decisions

Welcome. This system contains information about published delegated executive decisions, including exemptions.

Decision Number: 0147 2019/20

Executive Portfolio:
Adult Social Care & Health
Decision Number:
0147 2019/20
Exempt / Confidential Item:
No
Ward(s) Affected:
All Wards
Declarations of Interest Received:
None
Title:
Adult Social Care - Care Sector Interim Strategy August 2020-January 2021
Summary of Decision:
Reflect the impact of COVID-19 to maintain a viable and sustainable care sector whilst achieving financial effectiveness for the Council.
Proposed Decision:
Provide time limited financial support to the Care Sector by supporting occupancy levels in Care Homes below ‘expected’ levels, funded from within existing financial resources.
Summary of Reason for Decision:
The proposal addresses the objectives of financially supporting the care sector and demonstrating financial effectiveness.
Reason for Decision:
The financial approach to the COVID-19 pandemic was formulated to respond to the immediate challenge for the Council. Whilst the financial implications of responding to the COVID-19 pandemic are currently funded, this is non-recurrent and any lasting financial effects need careful consideration going forward. To meet the changes in capacity and demand, the Council agreed that from March - July 2020 available beds (at differing occupancies across the period to reflect the variable conditions) should be paid for on a per week basis at the usual rate. Service user preferences may, in the medium and long term, change in response to COVID-19 and could result in a balancing of the service profile across the care sector. For example, there may be a greater use of care at home such as domiciliary care, direct payments or other care models rather than care in residential settings. There also may be residual costs in care settings associated with the additional requirements of providing care after the COVID-19 period, for example, to meet enhanced infection control measures. However, if capacity through the ordinary uptake of services does not return to pre COVID-19 levels, the viability of care providers needs careful consideration, at least until capacity is restored or understood. It's now proposed to fund occupancy levels (at least 70%) in Care Homes, which reflects a tapering of the current support but still reflects a commitment to support Care Homes. Any cost to the Council would be offset by savings on under occupancy which is expected to result in a net budget saving of £1.2m over the proposed period. The period of support will run from 1st August 2020 to 31st January 2021. It’s important to have a flexible approach to supporting the care sector and to that end any significant changes to market conditions (including bed occupancy) that significantly affect providers and by consequence the Council will be considered on a case by case basis via periodic review. The Council will seek to attain assurance from the providers that occupancy levels are accurate, up to date and that bed data reflects available beds for usage. It's difficult to predict what shape the care sector will take after emerging from the COVID-19 period, therefore commissioning models will be developed with the sector to best inform the Council's response to changing circumstances and demand. However, as the immediacy of the possible end of COVID-19 funding approaches, an interim solution ahead of a fundamental commissioning review is sought. The council will need to consider whether there is a blanket approach to support the care sector or whether it’s targeted to specific providers. In doing so equity across care providers would be a priority and because of this it is proposed to treat providers, where applicable, in a consistent way. Care Homes There has been a significant increase in capacity across Care Homes in St Helens with some of the capacity arising as beds could not be immediately accessed due to issues of infection related to COVID-19 or unfortunately as a result of resident deaths. The Council has seen a rapid change in circumstances and the focus has moved from generating capacity in Care Homes to addressing voids and the need to maintain market sustainability and provider viability. The cost envelope to do this is no greater now than pre COVID-19 and can be contained within existing budgets, however the Council currently faces unprecedented financial challenges. Whilst there would seem to be budget savings arising from under-utilisation of services, consideration is required as to whether the expected underspend requires a mitigation of financial support to sustain the market and thereby limit the expected budget saving. The Council is also considering the lessons learned from the recent period. Feedback from providers is vital to understand the challenges arising from this pandemic and the Council has engaged in a consultation exercise with Care Home providers which will inform a shared strategy going forward. A review of the Care Home market has highlighted changes in occupancy analysis as detailed in Appendix One. In summary the period pre COVID-19 had overall percentage occupancy levels in the mid to high 90% with generally over 15 of the 28 Care Homes at 100% occupancy and between 1 or 2 being less than 90% occupancy. The current position is that overall occupancy levels are around 80% with a few Care Homes achieving 100% occupancy levels and around 15 Care Homes being at less than 90% occupancy. St Helens is not alone in facing the challenge of increased capacity in the care sector. Ignoring the fluctuations and potential differences in recording of bed numbers this does highlight an underlying issue around the significant number of beds that are available across the region. Care at Home During the COVID-19 pandemic, care at home has been funded at planned levels pre COVID-19. A decision is now required as to whether services are now funded at commissioned (actual) levels. A review of activity has been undertaken. This is detailed in Appendix Two. Analysis has focused on comparing the following: · Pre-COVID-19 Demand · Current Demand In summary, activity across Domiciliary Care specifically has either increased or has reduced at levels which at this stage are not considered to be detrimental to individual care providers’ ability to continue in business. Therefore it’s not proposed to continue with a blanket approach to support Domiciliary Care and to proceed with payments based on actual activity. However, the Council will consider provider issues on a case by case basis reflecting the turbulence to the market that COVID-19 may pose moving forward. The Council is not unique in facing the challenges arising from the COVID-19 pandemic and it’s clear that councils have not taken a uniform approach to supporting the care sector. The Council has contacted neighbouring authorities to ascertain what their approaches will be towards supporting the care sector in the coming months and await responses. Indications are that, by having already considering potential approaches for the coming months, St Helens is in a strong position to now formulate a clear strategy.
Risks Associated with this Decision:
Risk is based on the variable cost of this proposal and the likelihood of variations (both favourable and adverse) occurring.
Measures to Redress Risk:
Consultation with providers on the range of measures as set out in this report has mitigated risks of challenge from providers relating to the Council’s duty under the Care Act 2014 to ensure providers in the market can operate viably.
Anti Poverty / Human Rights / Agenda 21 Implications:
N/A
Attachments:
Please Contact Andrew Chisnall - Ext 6824 for more details.