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2021/22 fee developments

Over the last weeks, Care England has continued its work on behalf of the adult social care sector concerning 21/22 fee rates, including:
• Writing to Ministers regarding the need for sustainable funding.
• Liaising with colleagues in local government.
• Press work to raise the difficulties being faced by the sector in the public arena.
• Writing to all Directors of Adult Social Services in England.
• Liaising with the DHSC, NHSE and CCGs regarding the future of CHC fees.
• Highlighting the impact of decreased occupancy rates on provider sustainability.

COVID-19 costs:
In the current context, fee rates which reflect the real cost of care are more important than ever. The COVID-19 pandemic has imposed a whole new cost and operational reality upon the adult social care sector, and this needs to be reflected in the fees for 21/22. A failure to do so has the potential to imperil an already destabilised care sector further. This follows the fact that for too long, care providers have been offered fees which have barely covered inflation, let alone increases in the National Living Wage. Therefore, we have been particularly worried to see local authorities and CCGs offering 0% fee proposals in recent weeks, representing a decrease when inflation is accounted for.

Going forward, it is therefore incumbent upon commissioners to support providers through the fee rates which are offered to them. Whilst they are also obliged to do so under section 5(2)(d) of the Care Act 2014, which states that the Council is legally obliged in fulfilling its responsibilities under section 5, to consider “the importance of ensuring the sustainability of the market (in circumstances where it is operating effectively as well as in circumstances where it is not”). In turn, councils are legally responsible for considering market stability issues as part of 21/22 fee rates. Similarly, CCGs have legal duties when considering and setting CHC fee rates as set out by Monitor and NHSE within the National Tariff Payment System.

It is prudent to note that the recent twists and turns regarding the vaccine further indicate that the costs associated with COVID-19 are likely to persist into the medium term. We recognise that some costs will have been covered up to the 31st March through the second round of the Infection Control Fund, free PPE and other such funds such as the £149 million for testing. However, after this date and without their extension (so far only PPE has been extended), providers’ costs must be accounted for.

Decreasing occupancy rates:
Alongside these costs, care providers have also been confronted by a plethora of other pressures resulting from the COVID-19 pandemic. For example, COVID-19 has impacted the occupancy rates of adult social care providers. Some providers are experiencing unparalleled drops in occupancy levels which many believe will stretch into the medium and longer-term. This has been a result of both reduced admissions, but also, higher death rates amongst adult social care users. As a consequence, social care providers base costs have increased. Decreased occupancy rates have, in turn, increased care costs per head. Therefore, our view is that local authority and CCGs rates must take account of these developments. Most recently, Care England has followed this issue up by writing to the Secretary of State for Health and Social Care, where we called for the Government to work towards the implementation of a comprehensive occupancy strategy.

Range of tasks being fulfilled by care staff:
COVID-19 has altered the range of tasks staff are required to fulfil. For example, care homes have had to perform some of the following tasks in addition to their usual duties to name but a few:
• Enhanced Infection Control procedures.
• Supervising new forms of communications between families and residents, alongside supervising visits.
• Increased COVID-19 testing for residents, staff and visitors.
All these tasks and others should be seen as a part of the new reality which has and will continued to be imposed upon care homes in the coming weeks and months.

Going forward:
In turn, we would encourage members to engage in a forthright manner with local authorities and CCGs, stressing the need for fees to reflect the new cost of care. Ultimately, 21/22 fee rates represent a crystallising moment regarding whether the COVID-19 pandemic has changed anything. Do we continue to underfund the social care system, or do we forge a new path which enhances provider sustainability alongside supporting society? For, if anything, COVID-19 has demonstrated the importance of the sector in contributing to local communities, economies and health systems throughout the length and breadth of the United Kingdom. Sustainable funding will ultimately allow providers to continue delivering quality and person-centred care in the coming years and decades.

As ever, we look forward to your feedback and working on behalf of all our members.