Agenda item



Report ACH23-011


The Committee considered a report setting out the proposed Bromley Adult Social Care Market Sustainability Plan for agreement. The report also sought agreement on the spending of the Council’s allocation of the government’s Market Sustainability and Improvement Fund that supported the changes outlined in the plan.


In support of government social care reforms, the Council was required to submit an Adult Social Care Market Sustainability Plan to the Department of Health and Social Care (DHSC). The purpose of this plan was to assess the impact the Council’s current fee rates were having on the local adult social care market; and how the Council was preparing for the introduction of legislative change that would give self-funding social care service users a right to ask councils to find their care, and access the same rates that councils paid for the care and support, from October 2025.


The Assistant Director for Integrated Commissioning advised that in December 2021 the government had published a white paper, People at the Heart of Care, which outlined a 10-year vision for adult social care. Included in the white paper were proposals for a Fair Cost of Care and Market Sustainability policy that intended to address the practice of councils paying provider fees for care homes and domiciliary care services that did not adequately cover the cost of these services. The impact of this policy change for the Local Authority was significant due to Bromley having a large and elderly self-funder population, as well as there being a large number of care homes located in the borough. For these reasons the gap between what the Council paid for care and support services, and what local care homes and domiciliary care services charged self-funders, would  be greater than that for other areas. The Council would need to put in place additional care assessment and brokerage and placement resources to meet a new demand for support from self-funders. Without government support the cost to the Local Authority of levelling up its fees with that of self-funders could be in the region of £10m per annum.


Members were advised that officers engaged with the local market and had undertaken a cost of care survey of the older people’s care homes and domiciliary care agencies based in the borough. The providers were asked to complete a government designed questionnaire on their activities and the actual costs of providing services – there had been a very positive response rate from local providers, with useful data received. The survey results were used to arrive at a median cost of care for the borough for these types of provisions, and to make an analysis of the local market of providers, which would allow the Council to ‘move towards’ paying a ‘fair rate’.


The Assistant Director for Integrated Commissioning advised Members that the Market Sustainability Plan was a requirement of the reform preparations, and had been completed using a template of criteria provided by the DHSC. It provided an analysis of the care market and plans for future years – a key part of this related to supporting people to live in their own homes for as long as possible. It was noted that all domiciliary care had been recommissioned two years previous, and the Local Authority had moved to a model of eight Patch Providers. They wanted these Patch Providers to provide around 60%-70% of the provision across the borough, and the additional funding received from the government would be used to support this coverage. The priorities relating to care homes were around creating a sustainable and affordable care homes market within the borough. They would target those care homes that supported the largest number of elderly people – there were 13 care homes that supported around two thirds of this cohort. Members were informed that funding would also be spent on supporting sustainability for Extra Care Housing (ECH), and looking to increase supply, as this was a good accommodation offer for the elderly frail and those with disabilities.


The Assistant Director for Integrated Commissioning highlighted that this process would be managed over a number of years, with the Council ‘moving towards’ the target. It was not known if the government grant would be received in future years and therefore care would be needed to ensure that any increase in fees could continue to be met if the grant was withdrawn. Providers would be advised that where the government grant was ended it would affect future fees. Consultations on the plan were taking place with providers in advice of the report going to the Council’s Executive.

In response to questions, the Assistant Director advised that the Market Sustainability Plan presented would take the Council towards the requirements from October 2025 – in terms of moving towards increasing fees and targeting specific parts of the market. From 2025, it was anticipated that further government funding would be required to accommodate the changes that needed to be put in place – for example, if self-funders were to approach the Council to access care, additional staff would be needed to undertake both care and financial assessments and identify the care and support required. If further funding was not received it would create a burden for the Council. The Director of Adult Social Care advised that the Programme Manager – Adult Social Care Reforms was leading on a piece of work looking at how they could complete assessments – using IT and providing the opportunity for people to self-assess, which would minimise the additional staff required. Alongside this, they were looking at providing advice to people to check that they had explored all options – different patterns of people going into care homes were being seen, with many funding their own care going in much earlier as they were not aware of other opportunities. They were looking to improve the information offered, reminding residents that alternative support was available and ensuring that a clear steer of what was an appropriate cost of care was provided. It was hoped that this would keep people away from services that used their resources up much quicker, and support more people at home – they could also signpost residents to invest their money more wisely, so their personal wealth was protected, and used when required.


A Member asked for further information regarding how the £150k allocated to support the preparations for the new arrangements would be used. The Assistant Director for Integrated Commissioning advised that this money would be used to support transition, including purchasing new technology to help people undertake self-assessments and access services online. The Director of Adult Social Care said that the Local Authority would also be working in partnership with the Social Care Institute for Excellence – they had been invited to be part of the work they were developing at a national level, and it was hoped some additional benefits would be received. It was noted that only a small element of the grant could be retained for administration.


A Member noted the reference made in the report regarding quality, with 31 out of the 35 providers in the borough having an overall CQC rating of ‘good’ or better. It was enquired how many of the 31 were rated as ‘outstanding’. The Director of Adult Social Care advised that 4 providers were rated as ‘outstanding’, with 27 providers were rated as ‘good’. In response to further questions regarding the steps being taken to help the remaining four providers to improve, the Director of Adult Social Care informed Members that the Local Authority had a Contract and Compliance Team who worked closely with the provider market. As highlighted, there would be some providers whose rating dropped down to ‘requires improvement’. If this occurred, everyone who received services from the provider would be reviewed and given the opportunity to move to a different provider, if they so wished. However it was noted that, as personal relationship had often been formed, most individuals/families chose to stay with the provider – this was monitored very closely and if there were any significant concerns the Operational Services Team would strongly advocate that people changed providers A block was also put on any new packages of care until the provider performance had improved. The Director of Adult Social Care said she was not aware of any situations where there had not been places available to move individuals that had requested to change providers.


A Co-opted Member enquired if the removal of cross-subsidy would have an effect on those who were currently struggling to fund their care packages. The Assistant Director for Integrated Commissioning said that, as a result of introducing the fair cost of care policy, it was anticipated that there would be a levelling out of costs and those individuals would be paying less of their own money.


RESOLVED that Executive be recommended to


i.)  Comment on and agree the Bromley Adult Social Care Market Sustainability Plan:


ii.)  Agree the spending proposals for the Council’s allocation of the Market Sustainability and Improvement Fund; and,


iii.)  Delegate to the Director for Adult Services, in consultation with the Portfolio Holder and Director of Finance, the allocation of Market Sustainability and Improvement Funding with reference to the government guidelines and in accordance with principles outlined in the Market Sustainability Plan.

Supporting documents: