Anna Coles (Strategic Director for People), Moriah Priestley (Interim Head of Commissioning), and James Stannard (Care Home Business Improvement Partner) delivered the ‘Fair Cost of Care and Market Sustainability Plans’ update to the Committee, and highlighted the following points-

a)     As part of the Adult Social Care Reform agenda, all local authorities had been required to engage with their local care providers to complete a ‘Fair Cost of Care exercise’. This engagement work had begun during summer 2022, to better understand the cost of delivering care throughout older-persons care homes and the home care market. Local authorities had been required to publish their final findings by 01 February 2023, and develop market sustainability plans to identify gaps in current care provision, and future options to strengthen resilience;

b)    Plymouth had previously identified gaps in home care provision across the city, particularly for complex dementia care, resulting in delays to domiciliary services and hospital discharges. This sometimes required outsourcing care to other local authorities, which was recognised as having potentially detrimental impacts for patients and their families. From April 2023, Plymouth City Council was looking to uplift home care contracts by 10%, and care home contracts by 8%;

c)     Responses from providers had been low (around 30%) and it had therefore been difficult to draw conclusive trends and outcomes from the engagement work however, it was recognised that:

                                               i.     The care home market had gone through a challenging period recently, and key gaps in provision had been identified;

                                              ii.     Home care providers were stretched a little too thin across the city;

                                             iii.     A ‘zoned’ approach to care was being explored for the city, which would bring care providers and clients closer, thus seeking to address these gaps;

                                             iv.     Other local authorities had experienced similar market trends and care provision challenges.

d)    Significant additional efforts had been undertaken to boost engagement with the care providers, including extending deadlines, personalised sessions, and 1:1 calls. It was recognised that many care providers struggled with a lack of capacity to engage in this exercise, thus leading to a lower rate of return than anticipated. These trends had also been experienced by other local authorities;

e)     Having now concluded, there was not sufficient information to use the ‘Fair Cost of Care’ exercise as it was initially intended, resulting in the need to engage in fee negotiations with individual care providers. Plymouth was therefore now engaging with the market to set its fee rates for 2023/34;

In response to questions from the Committee, it was reported that-

f)      The documentation and assessment process for the ‘Fair Cost of Care’ exercise followed a standardised methodology, set nationally, thus PCC had little ability to amend or simplify the process;

g)     Fee rate negotiations took place annually, examining cost pressures across the market and available resources. The ‘Fair Cost of Care’ exercise was the first national exercise to understand the cost of care across the adult social care market;

h)    PCC regularly engaged with care homes regarding vacancy levels, staffing levels and other performance metrics through contractual arrangements however, this national exercise had been voluntary;

i)      Due to market failures and care provision gaps, the Council had previously explored options to provide care ‘in-house’. This had led to the creation of a care company (@Plymouth Care).

The Committee expressed their disappointment at the low rate of engagement from care providers which had aimed to produce a national picture of care costs, challenges, and opportunities, and agreed to-

1.     Note the outcome of the ‘Fair Cost of Care’ engagement report;

2.     Support the proposed approach to fee setting with providers for 2023/24;

3.     Note the strategic direction as set through the emerging market sustainability plans.