Report by George McCaig, Head of Care Support and Brian Robertson, Head of Adult Social Care on behalf of Elaine Mead, Chief Executive

Transcription

1 Highland NHS Board 9 April 2013 Item 5.7 ADULT SOCIAL CARE FEE RATES AND CHARGING 2013/2014 Report by George McCaig, Head of Care Support and Brian Robertson, Head of Adult Social Care on behalf of Elaine Mead, Chief Executive The Board is asked to: Note the background to and range of, adult social care contracts which have transferred to NHS Highland from The Highland Council; Note the fee and charge setting and contract arrangement processes which have applied previously; Agree to the proposed governance arrangements to apply to future fee setting and contract arrangements; Agree to the proposed fee and contract arrangements to apply from ; Agree the change from RPI to CPI as the basis for increasing charges. 1.0 Background 1.1 In the delivery of adult social care services, The Highland Council, like all other local authorities across Scotland, previously met the needs of service users through a variety of services, with some services provided in-house and some provided from independent and third sector providers. 1.2 Consequently, the partnership agreement signed by both The Highland Council and NHS Highland in March 2012, included the transfer of all adult social care contract and grant arrangements with independent and third sector organisations, from The Highland Council to NHS Highland on 1 April As a result, these arrangements have now been assigned to NHS Highland and therefore the contract or funding arrangement is now between NHS Highland and the relevant independent and third sector organisation. 1.4 The scope of these contract and grant arrangements cover all adult social care client groups (e.g. older people; learning disability; mental health; physical disability; sensory impairment; drug and alcohol addictions etc) and all service types (e.g. care homes; care at home; day care; housing support; support etc). 1.5 There are over 200 separate contracts in place for the delivery of adult social care services from the independent and third sector and the value of this activity is around 58m per annum. 1.6 In the administration of these contractual arrangements, there is an annual cycle of activity, the key action of which is to identify, agree and internally approve the fee rate and contract arrangements to apply to each service purchased, in advance of the new financial year. Once this process concluded, there is a further action to then notify providers and put the necessary contractual documentation in place, ideally before the start of the financial year, so the correct payments can be initiated. 1.7 A process therefore needs to be put in place within the NHS, to facilitate the fee and contract administration tasks referred to above; and also for the relevant governance arrangements to be complied with.

2 1.8 Similarly, prior to integration on 1 April 2012, Highland Council Social Work charged for a number of the services that it provided in line with established policy. Those policies and associated guidance documents are the National Assistance Act 1948 (Assessment of Resources Regulations 1992) for Residential Care and the COSLA Charging Guidance for Non Residential Social Care. The COSLA charging guidance is reviewed annually. 1.9 The policies and guidance provide a framework to ensure that charges implemented are transparent, fair and equitable so that users of services only pay what they can reasonably afford towards the costs of providing those services. These include services that are provided directly by the organisation as well as services that are delivered on its behalf by independent or third sector partners. The process of assessing charges at an individual level is common to all local authorities in Scotland, although the actual level of charges differs from authority to authority The partnership agreement in place with the Highland Council allows NHSH to charge for services delivered or commissioned by it in the exercise of Adult Services Delegated Functions. It also states that the level of charges, and the policies relating to write-off/waiving of charges shall be a matter for NHSH, subject only to such parameters as the Commissioning Group may notify to the NHSH from time to time The sections below therefore set out the previous approaches to fee and charge setting and contract arrangements, the proposed future approach and governance arrangements and seeks approval for the fees, charges and contract approach for Previous Approach to Fee Setting and Contract Arrangements 2.11 Each service previously purchased by The Highland Council and now purchased by NHS Highland, is categorised by a fee rate category. The list of fee rate categories is as undernoted: 1. Care home (NCHC) 2. Care home (non standard) 3. Care home (standard) 4. Care at home (block) 5. Care at home (spot) 6. Housing support (long term) 7. Support (standard) 8. Support (non standard) 9. Day care (block) 10. Day care (spot) 11. Voluntary organisations (service contracts) 12. Voluntary organisations (grants) 13. Respite (residential) 14. Respite (home based) 15. Non care home (non standard) 16. Telecare 17. Out of area contracts 2.12 This categorisation adds to the ease of communicating with providers, particularly around the time of confirming any new fee arrangements, as generally, the same fee principle is applied within each fee category The commencement of the purchase of services from an independent or third sector provider has in the past been through one of three routes; 2

3 a) Where a service was specifically commissioned through a procurement exercise; b) Where a specialist service was identified by a provider to meet a specific unmet need, and where the Council agreed that the proposed service fit with its strategic goals and negotiated a specialist fee with the provider to secure these services; or c) Where a new service provider entered the market to deliver a standard service, and after meeting baseline requirements regarding registration, insurance, viability and business plan, the Council commenced purchasing from the provider on a spot purchase basis Each contract currently contains provision for an annual review of the fee rate. The approach previously taken was that the same principle approach would apply to each fee rate category, and that the objective would be to ensure equity, transparency and affordability Previously, there were mechanisms in place to negotiate/discuss proposed fee rates. For example, for care homes for older people, these were (and are) subject to negotiation nationally between CoSLA and Scottish Care; and for care at home services, there is regular dialogue with the sector locally to enable fee rate issues to be discussed. For many fee rate categories, fee and contract arrangements have been confirmed by letter, following approval, with a open offer of dialogue on fee and contract issues Financial Year 2013/14 will also be the first year in which NHSH will set the charges for Adult Social Care Services. Under the Highland Council regime, the next step in the process would have been to inform service users of the increase in charges (normally the November Retail Price Index (RPI) rate as published in December), giving them one month s notice. Members should also be aware that there is a comprehensive financial assessment process in place. This follows the national guidelines set down by COSLA and ensures that all clients are assessed fairly and are only charged for a service if they have the means to pay The approach and timing adopted previously within the Council, was that around December/January in each financial year, fee and charge projections would be prepared based on scenarios associated with available funding, national and local agreements, the objectives of the Service and the Council and with any saving or pressure proposals fed into the Council s budget setting process. Where any fee proposals/increases fell within the RPI, these would be approved by the Director of Social Work and any saving or pressure proposals were contained within recommendations to the February budget meeting of The Highland Council for approval. In advance of the recommendations going to Council, an advance letter would be issued to providers to advise them of the process and timescales and following approval, confirmation would be issued to providers, advising of the fees to apply for the forthcoming financial year, and corresponding contract variation documentation would be issued, for return in advance of 1 April. 3 Proposed Future Fee Setting and Contract Arrangements 3.1 The availability of a commissioning strategy will enable a longer term approach to the services commissioned by NHS Highland. 3.2 Notwithstanding, it is necessary to have a clear process set out for how future (April 2014 and beyond) fee and contract specific issues are addressed within NHS Highland, and the required governance arrangements and timing for these issues. 3.3 It is proposed that a Fee and Charges Contract Working Group is set up from October each year, consisting of Finance, Operational Unit, Strategic Commissioning, Adult Social Care and Contracts Team representation, who would, by the end of December 3

4 each year, prepare fee and contract recommendations for internal consideration and sign off by the Chief Executive. This process would involve a review of the proposed approach by the Chief Executive and Director of Finance, to ensure the approach represents the NHS s agreed direction of travel meets the Board s objectives and is affordable. An assurance report would be then provided to the Highland Health and Social Care Committee early in the new financial year. 3.4 A summary of the proposed key stages and timings are as undernoted: When October December January February March April to What Fee and contract proposals prepared by Working Group First review and feedback by Chief Executive and Director of Finance Chief Executive and Director of Finance approval Providers notified New fee and contract arrangements implemented by Contracts Team Assurance report to Highland Health and Social Care Committee 4 Proposed Fee and Charge Arrangements for There is a need to approve and implement fee and contract arrangements for It is acknowledged that this approval is being sought later than ideally desirable, which will be addressed in future years with the clear arrangements as set out above. 4.2 The full range of proposed fee rates and contract arrangements, for which approval is being sought, is as set out at Appendix Within the proposals, there are some specific pressures to highlight, which relate to: a) National Care Home Contract (NCHC): The NCHC (both the fees to apply and the contract terms) is negotiated annually by CoSLA with Scottish Care, on behalf of local authorities/health boards. Negotiations for are later than normal this year and it is not yet clear what the outcome will be. It is important to highlight that the NCHC relates to older adults only but that in previous years The Highland Council has chosen to apply this same increase to care home places for other client groups and has met this additional cost. b) Care at Home (spot purchase): Fee arrangements for the spot purchase of care at home services have been static for a number of years. Following discussions with the sector, an increase on the hourly rate is proposed as a transitional step, to assist the sector to better attract and retain staff and promote continuity. It is proposed that the current individual rates increase by a flat rate of 1 per hour, thereby creating a maximum pressure of 200k. Budget provision has been made for this pressure. c) Contract pressures: Several of the contracts in place have an end date beyond 31 March 2013 and have an indexed uplift mechanism within the contract terms. These arrangements create a pressure of around 30k, which there is a contractual obligation to meet. Budget provision has been made for this pressure. d) Charging: Originally RPI was used the basis of the increase because all increases in pensions and benefits were set by the government using RPI. These are now set using the Consumer Price Index (CPI). For this reason it is recommended that the CPI figure is used in 2013/14 as the basis for increasing charges in 2013/14 which recognises the charges in income levels for clients receiving pensions/benefits. Using CPI will increase charges by 2.7%. RPI for the same period was 3.1%. Details of the charges are given in Table 1. 4

5 Charge Current Charge 2013/14 Charge Proposed Number of users Current Annual Income 2013/14 Annual Income Day Care 5.00 per week K 196K Day Care Meals Care at Home/Support Work 3.30 per meal K 42k 17.20/ per hour 17.65/ 15.45p K 486K Telecare 5.50 per week K 462K Self Financing Care Home residents Stairlift service charge Variable Variable M 1.94M 60 annually No Increase k 42K Total 3.09M 3.17M Table 1 5 Implementation of Fee, Charge and Contract Arrangements 5.1 Subject to approval to the proposals by the Board: a) all providers will receive confirmation of the ; b) the appropriate contractual documentation to reflect any agreed contract extension arrangement, will be issued; c) agreed payment levels will commence as appropriate. Where these are not known by the implementation date (possibly the NCHC), these will be applied as soon as they are confirmed nationally, and backdated to the relevant date. In the meantime, current fee rates will be paid, pending this confirmation. d) Clients due to pay a charge will be given 1 calendar s month notice, with the new charges being implemented 1 June It is recommended that the implementation approach is progressed, as set out above. 6 Contribution to Board Objectives 6.1 The successful implementation of the proposals in this report will assist to achieve the following specific objectives of NHS Highland Quality Objectives : Objective 7: delivering integrated care; and Objective 10: delivering efficient services. 7 Governance Implications Staff Governance: no impact. Patient and Public Involvement: as it is recommended that NHSH continues to follow Highland Council practice in 2013/14, there is no need to consult on these specific charges. These arrangements have been the subject of consultation in 5

6 the context of the Joint Community Care plan. No separate consultation on these charges would have taken place under the Highland Council regime. Clients would be given 1 month s written notice of these increases as previously. Clinical Governance: no impact. Financial Impact: refer to Table 1 above. 8 Risk Assessment 8.1 No change in the charging process is being proposed. Although any increase in charges in never likely to be fully welcomed, it is clear that the increase is based on the generally accepted rate of inflation and that inflation base has been changed to CPI to mirror the change in the inflation base now used by Central Government to uprate pensions and benefits. There are no new charges. 8.2 Clients/patients are advised that if they do not agree with the charged levied, the matter should be raised with the Care Charge Review group. The purpose of the care charge review group is to deal with individual cases where there is a dispute over the charge raised. It therefore plays a key role in the overall approach to ensure fairness and transparency. It can also provide a learning/quality control mechanism which can be used to improve processes. 8.3 In terms of fees, the negotiations regarding the national care home contract rate have not yet been concluded and may represent a financial pressure dependent on the fee increase finally agreed and the level of additional funding provided by the Scottish Government. 9 Planning for Fairness 9.1 In terms of charging, all service users are being charged the same amount in respect of day care, meals and care at home. There are no differences in terms of client group, gender, race, age, belief etc 9.2 The only service users that will pay the full residential charge are those individuals who have either been financially assessed as having the ability to do so or have chosen to do so due to their own individual circumstances. Other users who have been financially assessed may be determined as eligible for a subsidised service due to, for example, benefit entitlement. This means that all service users have access to council and private sector residential facilities on the basis of their assessed need and not on the basis of their ability to pay for these services 10 Engagement and Communication 10.1 Please note the communication actions as set out at section 5 above for fees. Clients are given one month s notice of any increase in charges and advised of their recourse to the Care Charge Review Group should they disagree with these charges. This is in line with previous practice and their expectations. George McCaig Head of Care Support Health and Social Care Brian Robertson Head of Adult Social Care Health and Social Care 28 March

7 Adult Social Care Fee and Contract Proposals Appendix 1 Fee Rate Category Fee Approach 1. Care home (NCHC) As per Cosla agreement. 2. Care home (non standard) As per Cosla agreement. 3. Care home (standard) As per Cosla agreement. 4. Care at home (block) As per contract. 5. Care at home (spot) 1 flat rate increase. 6. Housing support (long term) Standstill (i.e. same as 2012/13) 7. Support (standard) Standstill. 8. Support (non standard) Standstill. 9. Day care (block) Standstill. 10. Day care (spot) Standstill. 11. Voluntary organisations (service contracts) Standstill. 12. Voluntary organisations (grants) Standstill. 13. Respite (residential) As per contract. 14. Respite (home based) As per contract. 15. Telecare Standstill. 16. Non care home (non standard) Standstill. 17. Out of area contracts As per host authority. 7