To consider the above report

Members considered approval of a policy to apply the provisions of the Care Act around costs where the Royal Borough became responsible for funding people in care homes who had previously funded their own care costs or had them paid by the NHS.

Councillor Carroll explained that adult social care operated on the basis of ability to pay therefore there was a significant element of means testing. The increasing demographic burden on adult social care was a national challenge. This was a positive challenge as it meant people were living longer, it should be celebrated but there was a need to ensure the system was equitable.

The borough had a statutory responsibility to meet the eligible care needs of adults including those who moved into care homes in the borough and subsequently ran out of money. The cost was usually then more than the council would pay for people with similar needs. The council would always look to negotiate down the costs but usually the council would exercise its discretion to allow a person to remain in their current care home.

The proposal, consistent with other local authorities, was to set a personal budget for accommodation in a suitable place with a view to only fund to that level or lower. The wellbeing principle would always apply in all cases. If medical evidence confirmed that moving an individual would have detrimental and significant impacts then the individual would be allowed to remain even if costs were higher.  This would ensure all were treated equitably and ensure sufficient resources for all eligible residents.

Councillor Coppinger highlighted that the borough had more care homes beds per head of population than any other authority. New care homes were told that they needed to ensure an individual could afford the accommodation for the rest of their life however some did not in the knowledge that there would always be someone who picked up the cost in the end. The proposals ensured equity for all.

Councillor Davey commented that if the cost was £1,000 a week to provide care, 1,329 beds equated to £64m a year. The council needed to learn from its neighbours in Slough using 30% of the beds for the same population however the culture in some families there was also to keep elderly people in the family home.  Councillor Davey suggested that an alternative would be to pay families to host an older person at £1,000 month. In a perfect world this would save £50m and the mother could be at home for the children, who would feel more loved and there would be less chance they would get into bother. The old person would feel loved and would add value to the family, for example helping with homework.

Councillor Carroll explained that the council was required to source care for those unable to pay under the means tested threshold. The council commissioned care from providers at some of the most competitive unit costs in the country. The report dealt with when people ran out of money and the council had the legal responsibility to look after the individual but the costs could be higher than the negotiated unit rate. All would be offered the same level of care unless there were specific circumstances.

Councillor Reynolds questioned whether there was a definition of ‘detrimental and significant impacts’. Moving people would always have some form of detrimental impact. He also questioned why the report stated at paragraph 4.1 that there were no direct financial implications when the report was designed to save the council money. The proposals were at the expense of the most vulnerable.

Councillor Knowles accepted that the council needed to be able to negotiate with care homes. However towards the end of a person’s life they became vulnerable to change of any sort. He understood medical conditions would be taken into account but to show compassion he felt there needed to be a form of appeal process.

Councillor Carroll accepted the proposed amendment to include an appeal process. There was already provision under the legislation but a localised process was a good idea. He highlighted that the wellbeing principle was a legal requirement in the Care Act. He was strongly in favour of equity; the system should not be skewed to those at one end of the financial spectrum.

Councillor C. Da Costa commented that she worked in the medical field and had an elderly grandmother who had died a few years previously therefore she understood the scenario of someone being moved from one care home to another. Any move was always detrimental and often caused confusion. Most people did not do as well in a new home even if of a higher quality. She highlighted the need to ensure safeguards were in place to ensure moves were as minimal as possible. She asked how many people the council was currently required to pay for at a higher level.

Councillor Johnson commented that he endorsed the need for a robust, transparent appeals process but there was a need to introduce a system to ensure equitable outcomes for both those in care homes and those who had to pay for the care, the council taxpayer. Every judgement would be based on hard medical evidence but in a compassionate manner taking into account the views of the individual and their family. The policy would give the council the ability to negotiate an equitable level. Along with Councillor Carroll he would meet with ministers in the new government to push for fairer funding and reform of the system.

Councillor Jones welcomed the introduction of an appeals process. Her position was to ensure people could stay in their own homes as long as possible. She felt it would be better to offer a personal budget that people could top up themselves if they wished for in-home care. She requested that the professionals making decisions on the wellbeing principle be outside the budget constraint process.

Councillor Carroll referred Members to paragraph 2.5 which showed the number of additional individuals the council was responsible for that had previously been self-funded. 15 individuals had been funded between Apr-Nov 2019 at a cost of £0.5m. He confirmed that healthcare professionals would make the wellbeing principle decisions and they were not budget constrained. He would discuss with officers the legality of Councillor Jones’ suggestion relating to in-home carers. He was aware that safety assessments had to be undertaken and a safety-first principle was always applied.

There was a need to reform adult social care and he would push ministers in the new government to ensure the large Conservative majority did not just get Brexit done but also addressed adult social care as well.

It was proposed by Councillor Carroll, seconded by Councillor Coppinger, and:

RESOLVED: That Council notes the report and:

i)          Approves the policy to apply the provisions of the Care Act around costs where the Royal Borough becomes responsible for funding people in care homes who have previously funded their own care costs or had them paid by the NHS.

ii)         Supports an appeals process to take into account the needs and wishes of individuals, family members and the wider social group, in line with the Care Act.