Cabinet Portfolio Adult Social Care and Health
Strategic Directorate Adult Care, Housing and Public Health
Consideration was given to a report that was submitted for pre-decision scrutiny ahead of the Cabinet meeting scheduled for 11 May 2020 in respect of Financial Support for Older People's Residential Care Homes during the COVID-19 Pandemic.
The Cabinet Member for Adult Social Care and Health, the Strategic Director of Adult Care, Housing and Public Health and the Assistant Director - Strategic Commissioning attended the meeting to present the report and to answer members’ questions.
The report stated that the Secretary of State for Health and Social Care had written to all local authorities on 19 March 2020 outlining the financial support that would be made available to support the response to Covid-19 with regards to the provision of adult care services. In the time since the letter had been received the Council had been allocated two un-ringfenced grants totalling £16.2million that were to be used to support Adult Social Care and other Council services impacted by Covid-19. The report stated that the Secretary of State had specifically reminded local authorities for the need, and of their obligation to support the Adult care provider market in their local area.
The Secretary of State’s letter highlighted that the funding should be utilised to support specific activities surrounding supporting home care providers and the care home sector. It was noted that the requirement to protect the cash flow of home care providers had been addressed by a delegated officer decision taken in April 2020.
The report detailed the specific areas that then Secretary of State had highlighted as key areas that should be targeted for support. These included:
· Helping providers deal with the costs of increased workforce pressures due to higher sickness absence caused by the outbreak
· Facilitating arrangements for adjusting packages as required in a timely and non-bureaucratic way, especially where providers are having to operate beyond normal services in order to respond to need.
· Helping providers to meet costs associated with enhanced infection control and the protection of staff.
· Finding supportive and creative ways to support providers in handling wider pressures caused by Covid-19.
The report stated that care homes were, like all other areas of Adult Care, feeling the impact of Covid-19, in that they were incurring additional costs within a low profit margin business model. It was noted that particular pressures included:
· Increased PPE costs, hand gels and increased costs for routine supplies.
· Accepting admissions at short notice to people discharged from hospital, or where regular informal support ceases to be available for example due to carer illness.
· Higher sickness absence rates among their workforce, especially with staff self-isolating.
· Statutory Sick Pay being paid from the first day of illness, rather than from the fourth day, and the requirements for workers to self-isolate.
· Increased cost pressures from higher use of agency staff.
It was noted that the impact of any one of these pressures could threaten the stability of the Council’s supply of care home beds and consequently have a negative impact on the wider health and social care system in Rotherham. In order to mitigate against the impact of these pressures it was proposed that the money allocated to by the Secretary of State should be used by the Council to provide direct financial support to the 33 Independent Sector Care Homes for Older People that were currently operating in the Borough.
The report provided details of various options that had been considered on how to best support care homes financially during the pandemic. It was recommended that a programme of cash grants be implemented where each care home in the Borough would be awarded a fixed upfront payment of £15,000 to support their additional expenditure as a result of Covid-19 over a 12-week period and that payments be backdated to 1 April 2020. The Cabinet Member for Adult Social Care and Health advised that a budget of £450,000, along with £100,000 of contingency funding was being proposed and noted that the scheme of support would be reviewed after 12 weeks of operation It was noted that this solution would provide the best support all Older People’s Care Homes in Rotherham and consequently the wider Health and Social Care system. The alternative options that had been considered and their reasons for rejection were detailed in the officer’s report.
Members asked how the proposed scheme to support care homes during the pandemic would impact on the Council’s cashflow. The Strategic Director of Adult Care, Housing and Public Health advised that the grants that had been received were to support the wider provision of adult care in the Borough and not just care homes, and that as the money that had been given to the Council by the Government for this specific purpose the proposed scheme would not impact on the Council’s cashflow. The Strategic Director noted that the proposed scheme would however have a positive impact on the cashflow of care homes in the Borough, and as such would enable them meet the financial challenges that the pandemic had presented therefore ensuring the sustainability of the care home sector in the Borough into the future.
Members asked how care homes were managing with regard to caring for residents who were convalescing after being discharged from hospital after recovering from Covid-19 and asked whether these residents were isolated from other residents in the homes. The Strategic Director advised that substantial guidance on infection control in residential homes was available and that this guidance was being closely adhered to in care homes. The Strategic Director assured members that care home providers across the Borough were being supported effectively in order to ensure effective infection control was being implemented and maintained in all care homes. Members also sought assurance on the auditing procedures around the extra costs being incurred by care homes in managing their response to the pandemic. The Assistant Director - Strategic Commissioning noted that all returns submitted by care homes on extra costs incurred would be subject to a rigorous audit process, but noted that the amount and detail of information submitted did vary between the larger and smaller homes due to the level of resource that each home had to provide the required information.
Members asked how the Council was working with care homes in order to manage the discharge processes into care homes and whether the target times for managing Covid-19 discharges were being met. The Strategic Director advised that procedures around the discharge process were working well and that the target of a turnaround times of three hours was being met. The Strategic Director assured members that discharge processes and timescales would be closely monitored as hospitals returned to more normal operating procedures.
Members asked for further information on the current situation regarding care homes that had had an embargo placed on them from taking new residents due to Covid-19 outbreaks. The Strategic Director advised that the number of care homes with embargos on taking new residents changed on a daily basis due to the complex nature of how such embargos were applied, but assured members that the situation was constantly monitored. The Assistant Director noted that the criteria under a which a care home would be prevented from taking new residents had changed since the start of the pandemic.
Members asked about how the grants received from the Government to support adult social care were being used to support home care providers. The Strategic Director provided information on the delegated officer decision taken on 1 April 2020 regarding changing the way that home care providers were paid during the pandemic that would mitigate negative financial impacts of home care providers during this period. The Strategic Director noted that the decision had been able to be taken under delegated authority as the changes required could be financed within existing approved budgets.
That Cabinet be advised that the recommendations be supported.