To report on progress and recommendations concerning the residential and nursing fees for 2013/14.

A report by the Director of Adult Social Services informed the Cabinet that the Council commissioned a range of community based social care services and the primary aim of commissioning was to support vulnerable people to be as independent as possible.  The Council’s Commissioning Strategy had, therefore, been focused on supporting people more effectively in their own homes.  Members noted in relation to care homes in Wirral, that the Council’s intention for 2013/14 was to set fees that maintained capacity in the nursing sector, whilst recognising that there was a need to reduce reliance on general residential provision.  The Strategy promoted a shift towards more specialist dementia care provision, and the development of extra care housing and alternatives such as intermediate and domiciliary care.  This approach was reflected in the Council’s market position statement and in its Commissioning Strategy.  Care home fees were, however, set with due regard to providers actual costs as well as commissioning intentions.  The Council’s duty to achieve best value was a factor.

The Director’s report set out the outcome of consultation with care home providers on 2013-14 care home fees and proposed the fees for 2013-14.  The rates offered in the proposal were summarised in the report and the detailed calculations were provided in Appendix 1 to the report.  The Director informed that the proposal was calculated using the Efficient Wirral Care Home model.  The model aimed to make due allowance for actual costs and market returns.  The model was intended to calculate a fair and reasonable weekly rate for the four different categories of care home placement.

The Director reported that all comments received during the consultation period had been carefully considered by officers and a response had been provided to consultees as quickly as possible.  A general log of comments and responses had been maintained and circulated to all providers as and when updated.  The log did not set out the source of comments.  In some cases the comment had been a request for further information or clarification of the Council’s fee proposal.  This information or clarification had been provided.

The Cabinet noted that other comments had suggested amendments to the proposal.  The suggested amendments had been considered and providers had been informed whether or not the suggested amendment had been accepted and the reason for the officers’ decision.

The Cabinet noted that a number of homes had made comments through a firm of solicitors which was representing them.

Appendix 2 to the report set out all the comments received, and officers’ responses that had informed the final 2013-14 proposal.  Where detailed working papers were relevant, these had been referenced in Appendix 2 and detailed in Appendix 3.

A summary of the main issues raised in the consultation was also set out in the report.

Mr Lawson Stebbings was invited to address the Cabinet on the consultation process and the proposed care home fees for 2013-14.  He informed Members that he was of the view that if the fee proposal was implemented the Council would not be complying with its legal duties.  He referred to a perceived error in relation to vat which he believed had not been corrected.  He also considered that the Council had failed to establish the true costs, that its proposal was based on errors and assumptions and that it had under estimated the cost of care.  Mr Stebbings told the Cabinet that officers had wrongly and inappropriately had put the care of adults and businesses at risk.  He considered that their actions constituted misconduct in public office.  Mr Stebbings believed that these actions had gone way beyond maladministration and were affecting the care of the most vulnerable in the Borough. 

The Leader of the Council thanked Mr Stebbings for his address.  He then referred to the serious criticisms Mr Stebbings had made and called on the Director of Adult Social Services to respond to the criticism that had been levied.

The Director of Adult Social Services reported that there had been a detailed consultation process.  He considered that Mr Stebbings should have raised his concerns during the consultation period and should not have raised such issues at this Cabinet meeting.  The Director also informed that a reasonable calculation had been made, elements of the model had been challenged and he was happy to share the calculations with the care home sector.  The Director indicated that he would be replying to Mr Stebbings, in writing, on the issues he had raised. 

The Director informed that he was confident that the information he had provided in his report would allow the Cabinet to make an informed decision.

The Cabinet Member for Adult Social Care told the Cabinet that comparisons had been made with neighbouring areas and that the model used had been carefully thought out.  She was sorry that the owners of care homes did not think that the proposal was fair.

The Leader of the Council also informed that he was confident that the proposals were reasonable and lawful.  He then moved the following motion which he asked the Cabinet to approve along with the recommendations set out in the Director’s report:

‘Cabinet believes that residential and nursing care homes are an important part of provision in Health and Social care, however it is vital that they are seen as one part of a whole system.  We are still seeing far too many people in Wirral having to leave their own homes, especially after a Hospital admission to be cared for in residential establishments.

Cabinet would like to see greater innovation in the way that Health and Social Care works together locally to support people in their own homes.  We want to see a health and social care system that is fully integrated.  And we want to ensure that energy is focussed on those areas that will have maximum impact with regard to developing and promoting integrated care across the whole health and social care system.

I am therefore recommending to Cabinet that Wirral Council should become a “Whole Person Care” innovation Council.  This important initiative, led by Andy Burnham MP, Shadow Secretary of State for Health, will enable Wirral to work with other Councils, and to share learning with regard to what works. 

This initiative will provide a platform for shaping integrated Health and Social Care for the 21^st century through innovative Councils such as Wirral.’

RESOLVED: That

(1)   the implementation of the final proposal be as set out below:

(2)  Cabinet believes that residential and nursing care homes are an important part of provision in Health and Social care, however it is vital that they are seen as one part of a whole system.  We are still seeing far too many people in Wirral having to leave their own homes, especially after a Hospital admission to be cared for in residential establishments;

(3)  Cabinet would like to see greater innovation in the way that Health and Social Care works together locally to support people in their own homes.  We want to see a health and social care system that is fully integrated.  And we want to ensure that energy is focussed on those areas that will have maximum impact with regard to developing and promoting integrated care across the whole health and social care system;

(4)  this Council will become a “Whole Person Care” innovation Council.  This important initiative, led by Andy Burnham MP, Shadow Secretary of State for Health, will enable Wirral to work with other Councils, and to share learning with regard to what works; and

(5)  this initiative will provide a platform for shaping integrated Health and Social Care for the 21^st century through innovative Councils such as Wirral.