Agenda item

Report from the Strategic Director of Adult Care, Housing and Public Health.

Recommendations:

That approval is given to consult on a new Adult Care Charging Policy, that includes both non-residential and residential charging and will include consideration of the following areas:

1. The removal of the maximum charge for non-residential care, while maintaining the minimum charge of £1. Recommended.

2. The introduction of an administrative charge for organising care for people who fund their own care. Recommended.

3. The inclusion of all disability benefits when carrying out non-residential financial assessments for services. Not Recommended.

The Cabinet Member for Adult Social Care and Health presented the report explaining that the Council charges for social care based on the ability to pay. The policies for non-residential charges were last reviewed in 2019, and it was recommended that another review be undertaken after five years. The report sought approval to consult on introducing two changes to the non-residential element of the policy and incorporating residential charging into a new combined policy.

Regarding the proposal to abolish the maximum charge it was noted that the current policy capped the amount charged for home care, direct payments, and support for living at the standard rate for in-borough residential care (£690 a week). The proposal was to remove this cap, affecting those assessed as able to pay more but currently subsidised by others.

Concerning the proposal to charge a feel for arranging care for self-funders it was noted that the Council had the right to charge for arranging care for people who funded their care themselves. The proposed fee was around £250 a year, affecting 224 people currently in this category.

As regards to the proposal regarding the inclusion of all disability benefits in financial assessments, it was noted that this proposal was considered but not recommended for inclusion in the consultation.

The consultation would be conducted through an online questionnaire and face-to-face drop-in sessions over a 12-week period during the summer. Letters would be issued to inform people of their opportunity to provide feedback. The outcome of the consultation exercise would inform a future joint residential and non-residential charging policy for adult social care, subject to Cabinet approval before the end of 2025.

The Strategic Director for Adult Care, Housing and Public Health clarified that this was part of the process in terms of seeking approval to consult but explained that the Council had gone through a process of reviewing the non-residential policy and upon legal advice, felt the residential and non-residential charging policies should be combined. This would be a new policy even though there would not be any material changes.

The Chair highlighted that additional benchmarking information had been circulated by email outside of the meeting to members of the Overview and Scrutiny Management Board.

The Chair invited members of the Overview and Scrutiny Management Board (OSMB) to raise questions and queries on the points raised earlier.

Councillor McKiernan asked for clarification on what the lower middle rate and higher rate was? The Strategic Director for Adult Care, Housing and Public Health explained that the numerous benefits discussed came at different rates depending on the assessment that the person had received in terms of their needs by benefit agencies. There could be a lower rate and a higher rate or different rates within that which were dependent on the assessment for the disability benefit. The Cabinet Member for Adult Social Care and Health explained that people were asked a number of questions about things such as feeding, washing, their mobility, and interactions with the social environment etc. That led to a point score for each of the criteria, meaning that if the threshold for lower payment was reached, then that would be what was received, more points would mean you received a higher rate. It was a points-based system based on need.

Councillor A Carter expressed concerns about removing the maximum charge for non-residential care and the administrative charge for self-funders for organising care. He highlighted the risk of inadequate home care leading to higher long-term costs. He emphasized that inadequate home care could lead to increased morbidity and mortality, and potentially higher costs for the council eventually.

The Strategic Director for Adult Care, Housing and Public Health explained this was the reason for the consultation to understand what the challenges were, and the issues residents could have with the proposal. No one wanted to see people without the appropriate care, the appropriate delivery. A number of people chose not to be financially assessed, which was their own choice, and they could choose to ask the Council to organise their care or do it themselves. The Council would offer support as needed but the principle of being able to charge for that service when someone was able to pay the full cost of their care.

Councillor Blackham suggested a tiered charge based on the level of council involvement. He emphasized the need for value for money and that charges should reflect the amount of effort put in by the council.

The Strategic Director for Adult Care, Housing and Public Health explained this was around the principle of charging for a service when someone was deemed able to pay the full cost of care. Other authorities used this approach, and it was something to look into as part of the consultation process.

Councillor Yasseen stressed the importance of effective engagement and mitigating risks. She suggested profiling to identify and address potential gaps. She also highlighted the need for transparency in what the charges covered along with ensuring that no one was left behind due to affordability issues.

The Strategic Director for Adult Care, Housing and Public Health welcomed the point raised around helping people to understand the breakdown of any proposed charges and what that included. He clarified that the advice and information provided was around the procured services, which were under contract. The Council had a flexible purchasing system, where everyone was vetted, and every provider reviewed under the CQC rating. The Council also had its own internal quality assurance process to ensure services were up to scratch and good. The Council wanted to move to co-production and had a co-production board.

Councillor A Carter noted that the Carbon Impact Assessment and the Equality Impact Assessments seemed superficial and further work would be required to truly consider the potential impacts associated with the proposal. The Strategic Director for Adult Care, Housing and Public Health explained there was no proposed implementation at this time, only a consultation. The report submitted following the consultation process would include more information about the impacts of any proposals. He provided assurance that the Council’s commitment to prevention was key in getting help, advice, and information at the earliest stage to residents.

Councillor Marshall raised concerns about the accessibility of the consultation for service users who may not be online. She stressed the need for face-to-face sessions to ensure that everyone affected has the opportunity to provide feedback. She questioned the rationale behind the annual fee and whether it would be fair for those requiring minimal input from the council.

The Strategic Director for Adult Care, Housing and Public Health said it was known that some local authorities charged an initial fee and then a smaller fee in consecutive years, so anything was possible in terms of that charging process.

Councillor Brent sought clarification on whether the assessments for disability benefits were based on national or local definitions, highlighting concerns about the potential impact on service users. He pointed out the need to understand the definitions of need and how they were assessed.

Councillor McKiernan inquired about the potential budget impact of the proposed changes and whether they would significantly improve the budget situation. The Strategic Director for Adult Care, Housing and Public Health said he could not answer that question but felt proposals would increase the income into the Council.

Resolved: That the Overview and Scrutiny Management Board supported the recommendations to Cabinet which proposes:

That approval is given to consult on a new Adult Care Charging Policy, that includes both non-residential and residential charging and will include consideration of the following areas:

1. The removal of the maximum charge for non-residential care, while maintaining the minimum charge of £1. Recommended.
2. The introduction of an administrative charge for organising care for people who fund their own care. Recommended.
3. The inclusion of all disability benefits when carrying out non-residential financial assessments for services. Not Recommended.