You said, we did

Date: 14 November 2018 - 9 January 2019 (Consultation 1: Approach)

Date: 26 March - 7 May 2019 (Consultation 2: Proposed rates)

The consultation was in two parts during 2019 in relation to a fundamental review of the residential and nursing care fee structures.

We asked

The first seeking comments on the overall approach and the second seeking comments on the proposed fees. The areas explored via both consultations were a switch to a 2 band structure for OAs, use of CFC for WAAs, updating the cost of care template, how to make annual uplifts, OOC placements and a contract terms and conditions refresh

Consultation Stage 2 Proposals

11. Building on the first stage of the consultation that considered the methodology and approach to be taken in the fee review, the second consultation contained the following proposals:  

• Proposal 1:  Based on the recommended options from C.co, the independent financial consultants appointed to support the development of a fair cost of care,  the Council proposed that for Older Adult Placements, the Residential band should be set at £561 per week (£576 for 2019/20); that the Residential Plus band should be set at £619 per week (£635 for 2019/20); and that the Supplementary Needs Allowance (SNA) rate should be set at £11.36 (£11.66 for 2019/20) per hour;
• Proposal 2: Following the options developed by C.co, the Council proposed that for Working Age Adult (WAA) Placements, the proposed WAA Residential band should be £705 per week (£724 for 2019/20).  The Care Funding Calculator will be used, as it currently is, to calculate the individual cost of care for WAAs with needs greater than those that can be met at the WAA Residential band.
• Proposal 3: In line with the C.co options developed, the Council proposed that band rates should be increased annually for the next 3 years to March 2022 using a blended rate based on Average Week Earning (AWE) services rate and the Consumer Price Index (CPI).  The Council proposed applying AWE to staffing costs only, with CPI being applied to the remaining elements, a 57/43 split. Using the latest rates published in December 2018, this would produce an increase of 2.68% for 2019/20.
• Proposal 4: Contractual changes will ensure the contract is reflective of the current legislation, best practice and guidance. The Council is also seeking to align its quality requirements with those of the Care Quality Commission (CQC). Wording has been updated to be more respectful to people who use the services and to consider changes in terminology. New clauses have been added to reflect changes in legislation such as Human Rights, Health and Safety, General Data Protection Regulations and Equalities. As part of the contractual changes, the Council proposed to remove the voluntary QAF payments but work with providers, via Inspired to Care, to recognise and reward best practice and excellence in care.
• Proposal 5: The Council wishes to make the implementation of the new fee rates as seamless as possible for all involved. To this end the intention is to automatically transfer as many cases as possible to the new appropriate band. To enable this the Council will begin assessing the eligibility of individuals against the proposed new banding definitions from April 2019 onwards. Although new placements will be made on the existing banding definition the information will be used by the authority to support an automatic transfer to new rates. The same approach will also be carried out for reviews undertaken between April and the start of formal implementation. It is the intention of the Council to automatically transfer current Service Users with a Band only placement, and where possible those with SNAs and Third Party Top Ups onto the proposed Residential band.

12. More complex placements will be reviewed to determine the eligibility of the individual within the new Band Definitions. To expedite the implementation, the Council intends to establish a proportionate review process to support this implementation.

Stage 2 Approach and Responses

13. The second stage of consultation began on 26 March and closed on 7 May 2019, six weeks later. The Council publicised the proposed Fee Review consultation by Press Release on the first day of the consultation. In this way the Council gave members of the public the opportunity take part in the consultation from the beginning. The Council also publicised and held a public meeting on the evening of 29 April 2019 that was attended by six people. 

14 . The Council sought the views of residential and nursing care providers, including the representative organisation EMCARE, advocacy organisations and service users with a Deferred Payment Agreement. These key groups were contacted directly, to encourage participation, they were given the option to respond by completing an online questionnaire, by email or by telephone.

You said

Consultation with Residential and Nursing Care providers

15. Prior to the consultation, providers were invited to join a Provider Reference Group, to help the Council to shape its approach to the fee review. That group met five times prior to the consultation between April and October 2018. Discussions at that group relating to, amongst other things, the proposed banding definitions and cost template, were considered when developing the consultation proposals. A full report of the work of the Provider Reference Group was included in the consultation materials.

16. The consultation was launched on 26 March by email to all Leicestershire, and out of county providers. In total 285 emails were sent to providers asking them to visit the website and give their views using the online questionnaire.  A follow up email was sent on 17 April to encourage providers to participate and a final reminder was sent on 2 May, five days ahead of the consultation closure date.

17. On 4 March 2019, ahead of the second stage of consultation formally commencing, an email was sent to providers advising them of the forthcoming consultation with advance notification of a series of eight consultation meetings that would be held at localities around the county during the consultation period to facilitate diary planning. Nine providers, representing 30 care homes attended consultation meetings and commented on the proposals using that mechanism. At those meetings, providers were encouraged to visit the website to complete the questionnaire.

18. In total 118 different providers opened one or more of the emails sent during the consultation and the consultation website was visited 617 times, in 478 unique visits. Seven providers completed the questionnaire online, representing 11 care homes.  However, two of the providers that attended the consultation meetings also completed the online questionnaire, so overall, 14 providers (5% of the providers with which the Council commissions placements) representing 35 care homes contributed to the consultation.

19. Although the response rate has been low, with relatively few providers responding, the quality of the responses has been high. The information supplied, from providers with knowledge and expertise in the field, will shape the remaining work on the Fee Review and the final proposals submitted to Cabinet.  

Principle points from provider feedback received

20. Four providers indicated in their responses that the proposed rates for Older Adult placements are still lower than that required by the market, but unfortunately did not submit sufficient financial information to enable the model proposed by C.co to be reconsidered.  The proposed rates are significantly above the current fees and are consistent with benchmarked fees paid against neighbouring authorities.     No concerns have been raised in relation to the proposed Working Age Adult fee. The Council will, in line with its Market Shaping responsibilities, ensure that the market is sustainable when setting its fees.

21. A recurrent theme in the provider engagement events and contained within four of the questionnaires submitted was concern about the proposed annual uplift mechanism, and the use of AWE rather than National Living Wage.  The Council is therefore carefully examining the arguments put forward before making a final proposal to Cabinet.

22. Comments received in relation to the contract, including those made by EMCARE, are currently being considered by Legal Services before the Core Contract, Specification and other Schedules are finalised.  The comments received have not been material in nature but instead relate to clarity of definitions, duties and timescales.  Concerns were raised about the language used such as the repeated need to ‘ensure’, ‘demonstrate’ or ‘indemnify’. Some of these clauses were considered to overreach the Council’s authority and were potentially burdensome, with limited benefit. 

23. Providers that are currently receiving Quality Assessment Framework (QAF) payments, along with EMCARE have raised concerns about the proposal to cease the voluntary QAF payments as part of the implementation of the new fee rates.  However, the proposed new fee rates are above the current band rate and QAF combined so the Council believes the financial impact of the change will be mitigated.  This proposal was also considered during the first stage of the consultation when providers had broad support for a consistent approach to quality that aligned with Care Quality Commission requirements, rather than the current voluntary approach to additional payments. 

24. Feedback from providers with regards to the proposed implementation referred mainly to the need for it to be completed in a timely manner.  Detailed work on this area began during the stage 2 consultation and is continuing to ensure a swift implementation subject to Cabinet approval. 

Consultation with Advocacy Organisations

25. The Council again, as in the first stage of the consultation, contacted advocacy organisations to request comment on the proposals from the perspective of service users, carers and families. Drawn from the Voluntary Action database and those agencies with which the Council contracts, 14 organisations were contacted.  None of the organisations responded to the consultation proposal either by completing the questionnaire, by email or by telephone contact.

26 . Contact has continued with the Carers Group of the Learning Disability Partnership and a presentation was also made to the Learning Disability Partnership Board at its April 2019 meeting. A Task and Finish Group was convened by the Leicestershire Equality Challenge Group at which the Stage 2 consultation and the EHRIA were reviewed. 

Public Engagement

27. Following the issue of a press release, and a letter sent to all the service users, or their representatives, with a Deferred Payment Agreement (DPA), the Council held a public meeting on 29 April 2019. Six people attended representing four older adults in care homes, three of whom were using a DPA; the other person was a self-funder. At this meeting the fee review was explained, as was the consultation undertaken to support the review, and the desire to obtain the views of members of the public. It was also explained that the proposed increase in the fees for 2019/20 will result in some people who pay top ups having their top up payment reduced or removed completely and that these changes would be backdated to 8 April 2019.

28. There was discussion about the cost of care incurred by people living in care homes and their families both through the ‘means tested’ charges that apply and the top up payments that are made. Questions were also asked in relation to Government Policy in this area, including the proposed cap on care costs that was not implemented. 

29. When asked about whether a care home must justify an increase in fees, it was explained that regarding Council placements, which only account for approximately 35% of places in Leicestershire, increases are agreed via the annual fee review. Most self-funding people in care homes have negotiated their fee individually with the care home and the Council is not involved in those fees unless asked to support by the person or their family.

30. There was a discussion about how a DPA would be affected and it was explained that the Council had written to people with a DPA because the proposed increase in fees would affect them directly. 

31. People present supported an increase in fees on the basis that costs were increasing and that homes needed the money to provide a good quality service. Good examples of workers, on low pay, providing good care were mentioned and those present asked if the Council could do anything to ensure that fee increases could be translated into better pay for care staff.  It was explained that while there are laws and regulations regarding pay, the main driver of pay is market forces. Providers need staff and must pay the rate that will attract them

Consultation with EMCARE

32. EMCARE supported the development of the proposals via the Provider Reference Group ahead of the consultation. It has also encouraged its members to take part in the consultation; but did not complete an online questionnaire or submit a written response.  However, two meetings were held with EMCARE at which their views were sought and have been incorporated into the general feedback on the proposals.   

We did

A two band structure was implemented, use of the CFC was embedded, an updated cost of care template was published, a methodology foe annual uplifts was agreed but there was some  disagreement about the particular metric (average weekly earnings or national living wage) that should be used, proposal relating to dealing with OOC placements were not changed and an updated contract was issued. 
 

Date: November 2018 – January 2019

To gain comments on the revisions proposed to the new Developer Contributions policy to ensure that its fit for purpose.

We asked

We asked stake holders in the development process for their views on a draft revised approach to securing developer contributions. Revised guidance has been produced to ensure that the impact of new development is correctly captured and mitigated against through the provision of necessary infrastructure, services and community facilities. This new approach was considered to be necessary to capture the uplift in development that was being experienced in Leicestershire and was projected to continue into the future.

You said

The Council received 33 responses to its consultation which spanned, Town and Parish Councils, developers, planning agents, the consultees in the planning process and local residents. They were all generally positive about the changes proposed but raised concerns about the status of the document in the planning process, whether:

• the suggested contributions would be affordable
• the thresholds for some of the payments were realistic
• the council should continue to include a monitoring fee

Questions were also raised in relation to whether the council should continue to request Travel Packs in legal agreements and whether monies collected for libraries would also be shared with the Community Managed Libraries.

We did

Leicestershire County Council was pleased at the positive response that was received to the new document and sought to clarify its status when determining planning applications. We also sought to clarify that the Government had changed the CIL regulations to allow monitoring fees to be charged. Evidence was also produced to justify the trigger points proposed and the question of viability and how the requirements in the policy impacted on it were also clarified. It was clarified that Travel packs were necessary to meet a national requirement for more sustainable forms of travel and it was also made clear that library monies would also be shared with those run by the local communities and not just invested into facilities run solely by the county council.