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Market sustainability and cost of care exercise

On this page:

  1. Residential cost of care exercise
    1. Introduction
    2. Market engagement
    3. Returns
    4. Data collection
    5. Outputs from residential exercise
  2. Domiciliary cost of care exercise
    1. Introduction
    2. Market engagement
    3. Returns
    4. Data collection
    5. Outputs from domiciliary exercise

Residential cost of care exercise

This document has been produced in response to DHSC requirements for local authorities to ascertain the cost of care in their local area.  It draws on information supplied by providers of residential/nursing providers in the local area.  

Introduction 

Minor adjustments have been made to the data from that supplied by providers deemed permissible within the DHSC guidance e.g. to adjust for assumed occupancy levels, return on capital and operations

Blackpool Council makes no assurances as to the accuracy of the data since not all care home providers responded to the cost of care exercise.  It should also be borne in mind that the exercise was completed following a worldwide pandemic and may not be reflective of how the market is currently operating.

Whilst the council acknowledges that the cost of care has been impacted by inflationary pressures since the information gathering period in 2022, this is mitigated by the fact that the council has not made adjustments to the data which would have the effect of reducing the cost of care.

 In accordance with national guidance requirements from DHSC, the cost of care exercise did not take into account all care settings and, therefore, does not give a complete portrayal of costs across all sectors.

The council also acknowledges its duties under the Care Act 2014.  However, these cannot be viewed in isolation from other pressures on local authority resources, the duty on all councils to deliver a balanced budget and the duty to obtain value for money as referenced in sections 4.27, 4.60 and 4.61 of the care and support statutory guidance.

 The information obtained by the cost of care exercise will be used to inform but not replace future fee setting exercises and commissioning activity.  Any decisions around fees will need to take into account the wide range of services, complexity of service provision, geographical locations of service, availability of resources and the statutory responsibility of the council to deliver a balanced budget.

Market engagement

An introductory meeting was held in March with our providers to brief them on the upcoming reforms and specifically their involvement in a cost of care exercise. A survey was then circulated in April which would provide the authority with information on both client mix and income within residential settings. This information, although not a specific requirement of the cost of care exercise, is important as part of the wider reforms work and would also support the fee setting element of this exercise given that it would allow comparison between total income within a residential setting versus the expenditure being collected. A second meeting was held with all relevant providers ahead of the launch of the cost of care work, due to time factors of the authority being a trailblazer and having to submit information in July 2022 rather than October the decision was made to go with an in-house approach to data collection via an excel template. A walk through demonstration was provided of each template and questions were taken and answered. A week into the collection period the decision was made to accept responses through the online IESE portal that was launched along with the LGA/ARCC Care at Home tool. The collection period was for an initial 3 week timeframe, however, due to a poor response rate we extended this by a further 2 weeks. This message was relayed to providers by e-mail along with an accompanying message by the provider forum chair, highlighting that we were seeking to reach rates that were representative for the area and not a small sample. The lead on this exercise also attended the residential provider forum that was held in person to discuss concerns around the exercise, providers were strongly urged to participate with either full or partial information and the offer was made for accountants to visit on site if required to extract the information ourselves. This led to a further 2 week extension of the deadline meaning that the period had been extended to 7 weeks from the initial 3 weeks at the outset.

In terms of response rate, despite reaching out to providers through numerous methods and the offer of assistance where needed, the overall engagement level was extremely low. For residential settings, we received data from 12 out of 60 providers (20%). One of the providers from the residential cohort wished for their engagement to be officially noted although they only provided a fee rate based on what they believed a ‘fair’ cost of care should look like and did not wish to share any actual expenditure from their current operating costs, the starting point of which was staff pay to be in line with their equivalents working in the NHS. There were huge issues with the reliability of the data and extensive time was dedicated to understanding the numbers that had been submitted and going back to providers to discuss their information. In particular the IESE tool provided numerous issues as there was a lack of understanding on the part of providers as to what was happening with the numbers that they input, in particular around expected levels of return. There were also concerns raised about costs being uplifted to reflect year-on-year uplifts, however, the base data was skewed by Covid related activity that had previously been funded through specific grants such as the Infection Control Grant and Workforce Recruitment and retention fund. This included, but was not limited to, bringing forward the April 2022 uplift to October 2021. The national model then (incorrectly) uplifted this further from April 2022.

Returns

Our approach for Return on Operations was to build in a percentage rate across all types of care that was reflective of actual returns and was broadly in line with our current assumptions used for fee setting purposes. The decision was made that a return of 5% for residential settings would be used in this exercise, this is in line with both our current fee model and national benchmarks. For Return on Capital we currently calculate this based on freehold values of the homes and average bed value, similar to one of the suggested approaches within the DHSC guidance set out in Annex E. We continued with this approach and used the freehold values provided, however, it was determined that the average value was more appropriate than the median value and provided a more reflective figure for this exercise. This average value per bed was then divided by the average occupancy rate across these homes to give a weekly value which maintained our current 6% return rather than the 5.5% as suggested in the guidance, which had later reduced to 3.25% at the point of our submission.

Data collection

In accordance with the national guidance from DHSC, the collection basis for the results were to use actuals where possible for Financial Year 2021/22 although this was difficult as the filing period closes in January 2023 therefore most providers did not have finalised accounts but we were happy to accept monthly management account figures if available, the worst case scenario being finalised 2020/21 accounts. The additional request was for updated figures for 2022/23 which included uplifts for key expenditure lines such as staff pay, insurance and utilities, ideally based on actual figures that had gone through the April and May 2022 management accounts. As the expenditure has been broken down on a line by line basis for each sub category this means that we can identify where and what future uplifts are required within the fee model.

 The information provided has been used to calculate the figures on the tables below. Where zero figures were provided and it was determined that no cost existed then these were included in the count of the median figure calculation. Where there were instances of costs being present but providers were unable to quantify with any degree of accuracy then these zero values were omitted and median values calculated based on the information that had been provided, a perfect example being PPE which has been free for social care providers for the last 2 years and at some point these costs will return and will be required as part of the fee rate in the future. The ethos of this exercise has been to include as much information as possible rather than to exclude provider returns that on first viewing appeared to be outliers as a whole.  

All provider returns were examined in detail on a line by line basis and compared to both other returns submitted and also our current fee model. Where further clarification or detail was required we sought to speak to providers to ascertain what figures should be included. The major areas of discussion were staffing and returns. In terms of staffing the difficulty, especially for smaller homes, was that staff could perform a variety of roles rather than one specific. Other areas of concern with staffing related to the number of care hours being reported. Also included in the number of care hours being delivered within a setting some of these will relate to more specialist placements that are outside the scope of this exercise such as CHC funded or complex cases. Furthermore where additional support is required we currently commission 1:1 hours and therefore these costs sit outside of our current fee rate but these hours will have been incorporated into this exercise.

Outputs from residential exercise

Cost of care exercise results for age 65+ care homes

65 + care home details
Cost of care exercise results - all cells should be £ per resident per week65+ care home places without nursing65+ care home places without nursing, enhanced needs65+ care home places with nursing65+ care home places with nursing, enhanced needs
Total Care Home Staffing £419.70 £456.23 £627.18 £663.72
Nursing Staff £0.00 £0.00 £207.49 £207.49
Care Staff £292.56 £329.09 £292.56 £329.09
Therapy Staff (Occupational & Physio) £1.78 £1.78 £1.78 £1.78
Activity Coordinators £5.98 £5.98 £5.98 £5.98
Service Management (Registered Manager/Deputy) £44.40 £44.40 £44.40 £44.40
Reception & Admin staff at the home £0.00 £0.00 £0.00 £0.00
Chefs / Cooks £28.34 £28.34 £28.34 £28.34
Domestic staff (cleaning, laundry & kitchen) £37.51 £37.51 £37.51 £37.51
Maintenance & Gardening £9.13 £9.13 £9.13 £9.13
Other care home staffing (please specify) £0.00 £0.00 £0.00 £0.00
Total Care Home Premises £25.66 £25.66 £25.66 £25.66
Fixtures & fittings £3.78 £3.78 £3.78 £3.78
Repairs and maintenance £19.18 £19.18 £19.18 £19.18
Furniture, furnishings and equipment £2.70 £2.70 £2.70 £2.70
Other care home premises costs (please specify) £0.00 £0.00 £0.00 £0.00
Total Care Home Supplies and Services £103.78 £103.78 £103.78 £103.78
Food supplies £32.65 £32.65 £32.65 £32.65
Domestic and cleaning supplies £8.22 £8.22 £8.22 £8.22
Medical supplies (excluding PPE) £1.74 £1.74 £1.74 £1.74
PPE £2.49 £2.49 £2.49 £2.49
Office supplies (home specific) £2.66 £2.66 £2.66 £2.66
Insurance (all risks) £6.26 £6.26 £6.26 £6.26
Registration fees £2.85 £2.85 £2.85 £2.85
Telephone & internet £2.89 £2.89 £2.89 £2.89
Council tax / rates £1.22 £1.22 £1.22 £1.22
Electricity, Gas & Water £32.00 £32.00 £32.00 £32.00
Trade and clinical waste £6.13 £6.13 £6.13 £6.13
Transport & Activities £3.55 £3.55 £3.55 £3.55
Other care home supplies and services costs (please specify) £1.10 £1.10 £1.10 £1.10
Total Head Office £13.61 £13.61 £13.61 £13.61
Central / Regional Management £0.00 £0.00 £0.00 £0.00
Support Services (finance / HR / legal / marketing etc.) £7.58 £7.58 £7.58 £7.58
Recruitment, Training & Vetting (incl. DBS checks) £6.03 £6.03 £6.03 £6.03
Other head office costs (please specify) £0.00 £0.00 £0.00 £0.00
Total Return on Operations £28.14 £29.96 £28.14 £29.96
Total Return on Capital £35.03 £35.03 £35.03 £35.03
TOTAL £625.92 £664.28 £833.40 £871.76

 

deatails
Supporting information on important cost drivers used in the calculations:65+ care home places without nursing65+ care home places without nursing, enhanced needs65+ care home places with nursing65+ care home places with nursing, enhanced needs
Number of location level survey responses received 11 11 11 11
Number of locations eligible to fill in the survey (excluding those found to be ineligible) 60 60 60 60
Number of residents covered by the responses 116 60 91 37
Number of carer hours per resident per week 22 25 22 25
Number of nursing hours per resident per week 0 0 9 9
Average carer basic pay per hour 13.01 £13.17 £13.01 £13.17
Average nurse basic pay per hour £0.00 £0.00 £23.07 £23.07
Average occupancy as a percentage of active beds 93% 96% 93% 92%
Freehold valuation per bed £30,442.11 £30,442.11 £30,442.11 £30,442.11


65+ care home places without nursing

65+ details
Details MedianLower QuartileUpper Quartile
Total Care Home Staffing £419.70 £419.70 £343.08 £461.18  
Nursing Staff £0.00 £0.00 £0.00 £0.00  
Care Staff £292.56 £292.56 £232.09 £310.83  
Therapy Staff (Occupational & Physio) £1.78 £1.78 £1.77 £1.80  
Activity Coordinators £5.98 £5.98 £4.20 £9.90  
Service Management (Registered Manager/Deputy) £44.40 £44.40 £42.35 £51.46  
Reception & Admin staff at the home £0.00 £0.00 £0.00 £0.00  
Chefs / Cooks £28.34 £28.34 £21.08 £34.12  
Domestic staff (cleaning, laundry & kitchen) £37.51 £37.51 £33.26 £43.30  
Maintenance & Gardening £9.13 £9.13 £8.33 £9.78  
Other care home staffing (please specify) £0.00 £0.00 £0.00 £0.00  
Total Care Home Premises £25.66 £25.66 £13.18 £42.94  
Fixtures & fittings £3.78 £3.78 £1.04 £10.04  
Repairs and maintenance £19.18 £19.18 £12.14 £25.01  
Furniture, furnishings and equipment £2.70 £2.70 £0.00 £7.10  
Other care home premises costs (please specify) £0.00 £0.00 £0.00 £0.79  
Total Care Home Supplies and Services £103.78 £103.78 £70.39 £159.95  
Food supplies £32.65 £32.65 £22.87 £37.87  
Domestic and cleaning supplies £8.22 £8.22 £4.74 £21.37  
Medical supplies (excluding PPE) £1.74 £1.74 £0.57 £6.90  
PPE £2.49 £2.49 £1.89 £3.22  
Office supplies (home specific) £2.66 £2.66 £1.59 £3.40  
Insurance (all risks) £6.26 £6.26 £5.71 £10.30  
Registration fees £2.85 £2.85 £1.60 £3.25  
Telephone & internet £2.89 £2.89 £1.73 £3.45  
Council tax / rates £1.22 £1.22 £1.00 £2.13  
Electricity, Gas & Water £32.00 £32.00 £25.10 £37.55  
Trade and clinical waste £6.13 £6.13 £3.49 £6.92  
Transport & Activities £3.55 £3.55 £0.10 £7.32  
Other care home supplies and services costs (please specify) £1.10 £1.10 £0.00 £16.27  
Total Head Office £13.61 £13.61 £1.72 £54.42  
Central / Regional Management £0.00 £0.00 £0.00 £16.03  
Support Services (finance / HR / legal / marketing etc.) £7.58 £7.58 £1.58 £16.45  
Recruitment, Training & Vetting (incl. DBS checks) £6.03 £6.03 £0.15 £8.26  
Other head office costs (please specify) £0.00 £0.00 £0.00 £13.69  
Total Return on Operations £28.14 £28.14 £21.42 £35.92  
Total Return on Capital £35.03 £35.03 £35.03 £35.03  
TOTAL £625.92 £625.92 £484.83 £789.44

Supporting information
Supporting information on important cost drivers used in the calculations:65+ care home places without nursing
Number of location level survey responses received 11
Number of locations eligible to fill in the survey 60
Number of residents covered by the responses 116
Number of carer hours per resident per week 22
Number of nursing hours per resident per week 0
Average carer basic pay per hour £13.01
Average nurse basic pay per hour £0.00
Average occupancy as a percentage of active beds 93%
Freehold valuation per bed £30,442.11
Enhanced needs details
65+ care home places without nursing, enhanced needsCostMedianLower QuartileUpper Quartile
Total Care Home Staffing £456.23 £456.23 £372.40 £586.49
Nursing Staff £0.00 £0.00 £0.00 £0.00
Care Staff £329.09 £329.09 £261.41 £396.78
Therapy Staff (Occupational & Physio) £1.78 £1.78 £1.77 £1.80
Activity Coordinators £5.98 £5.98 £4.20 £9.90
Service Management (Registered Manager/Deputy) £44.40 £44.40 £42.35 £51.46
Reception & Admin staff at the home £0.00 £0.00 £0.00 £0.00
Chefs / Cooks £28.34 £28.34 £21.08 £34.12
Domestic staff (cleaning, laundry & kitchen) £37.51 £37.51 £33.26 £43.30
Maintenance & Gardening £9.13 £9.13 £8.33 £9.78
Other care home staffing (please specify) £0.00 £0.00 £0.00 £39.37
Total Care Home Premises £25.66 £25.66 £25.66 £25.66
Fixtures & fittings £3.78 £3.78 £1.04 £10.04
Repairs and maintenance £19.18 £19.18 £12.14 £25.01
Furniture, furnishings and equipment £2.70 £2.70 £0.00 £7.10
Other care home premises costs (please specify) £0.00 £0.00 £0.00 £0.79
Total Care Home Supplies and Services £103.78 £103.78 £103.78 £103.78
Food supplies £32.65 £32.65 £22.87 £37.87
Domestic and cleaning supplies £8.22 £8.22 £4.74 £21.37
Medical supplies (excluding PPE) £1.74 £1.74 £0.57 £6.90
PPE £2.49 £2.49 £1.89 £3.22
Office supplies (home specific) £2.66 £2.66 £1.59 £3.40
Insurance (all risks) £6.26 £6.26 £5.71 £10.30
Registration fees £2.85 £2.85 £1.60 £3.25
Telephone & internet £2.89 £2.89 £1.73 £3.45
Council tax / rates £1.22 £1.22 £1.00 £2.13
Electricity, Gas & Water £32.00 £32.00 £25.10 £37.55
Trade and clinical waste £6.13 £6.13 £3.49 £6.92
Transport & Activities £3.55 £3.55 £0.10 £7.32
Other care home supplies and services costs (please specify) £1.10 £1.10 £0.00 £16.27
Total Head Office £13.61 £13.61 £13.61 £13.61
Central / Regional Management £0.00 £0.00 £0.00 £16.03
Support Services (finance / HR / legal / marketing etc.) £7.58 £7.58 £1.58 £16.45
Recruitment, Training & Vetting (incl. DBS checks) £6.03 £6.03 £0.15 £8.26
Other head office costs (please specify) £0.00 £0.00 £0.00 £13.69
Total Return on Operations £29.96 £29.96 £22.88 £42.19
Total Return on Capital £35.03 £35.03 £35.03 £35.03
TOTAL £664.28 £664.28 £573.37 £806.76
Supporting information
Supporting information on important cost drivers used in the calculations:65+ care home places without nursing, enhanced needs
Number of location level survey responses received 11
Number of locations eligible to fill in the survey 60
Number of residents covered by the responses 60
Number of carer hours per resident per week 25
Number of nursing hours per resident per week 0
Average carer basic pay per hour £13.17
Average nurse basic pay per hour £0.00
Average occupancy as a percentage of active beds 96%
Freehold valuation per bed £30,442.11
Places with nursing
65+ care home places with nursingMedianLower QuartileUpper Quartile
Total Care Home Staffing £627.18 £627.18 £532.05 £796.46
Nursing Staff £207.49 £207.49 £158.73 £267.61
Care Staff £292.56 £292.56 £262.32 £378.51
Therapy Staff (Occupational & Physio) £1.78 £1.78 £1.77 £1.80
Activity Coordinators £5.98 £5.98 £4.20 £9.90
Service Management (Registered Manager/Deputy) £44.40 £44.40 £42.35 £51.46
Reception & Admin staff at the home £0.00 £0.00 £0.00 £0.00
Chefs / Cooks £28.34 £28.34 £21.08 £34.12
Domestic staff (cleaning, laundry & kitchen) £37.51 £37.51 £33.26 £43.30
Maintenance & Gardening £9.13 £9.13 £8.33 £9.78
Other care home staffing (please specify) £0.00 £0.00 £0.00 £0.00
Total Care Home Premises £25.66 £25.66 £25.66 £25.66
Fixtures & fittings £3.78 £3.78 £1.04 £10.04
Repairs and maintenance £19.18 £19.18 £12.14 £25.01
Furniture, furnishings and equipment £2.70 £2.70 £0.00 £7.10
Other care home premises costs (please specify) £0.00 £0.00 £0.00 £0.79
Total Care Home Supplies and Services £103.78 £103.78 £103.78 £103.78
Food supplies £32.65 £32.65 £22.87 £37.87
Domestic and cleaning supplies £8.22 £8.22 £4.74 £21.37
Medical supplies (excluding PPE) £1.74 £1.74 £0.57 £6.90
PPE £2.49 £2.49 £1.89 £3.22
Office supplies (home specific) £2.66 £2.66 £1.59 £3.40
Insurance (all risks) £6.26 £6.26 £5.71 £10.30
Registration fees £2.85 £2.85 £1.60 £3.25
Telephone & internet £2.89 £2.89 £1.73 £3.45
Council tax / rates £1.22 £1.22 £1.00 £2.13
Electricity, Gas & Water £32.00 £32.00 £25.10 £37.55
Trade and clinical waste £6.13 £6.13 £3.49 £6.92
Transport & Activities £3.55 £3.55 £0.10 £7.32
Other care home supplies and services costs (please specify) £1.10 £1.10 £0.00 £16.27
Total Head Office £13.61 £13.61 £13.61 £13.61
Central / Regional Management £0.00 £0.00 £0.00 £16.03
Support Services (finance / HR / legal / marketing etc.) £7.58 £7.58 £1.58 £16.45
Recruitment, Training & Vetting (incl. DBS checks) £6.03 £6.03 £0.15 £8.26
Other head office costs (please specify) £0.00 £0.00 £0.00 £13.69
Total Return on Operations £28.14 £28.14 £22.93 £39.31
Total Return on Capital £35.03 £35.03 £35.03 £35.03
TOTAL £833.40 £833.40 £733.06 £1,013.85

Supporting information
Supporting information on important cost drivers used in the calculations:65+ care home places with nursing
Number of location level survey responses received 11
Number of locations eligible to fill in the survey 60
Number of residents covered by the responses 91
Number of carer hours per resident per week 22
Number of nursing hours per resident per week 9
Average carer basic pay per hour £13.01
Average nurse basic pay per hour £23.07
Average occupancy as a percentage of active beds 93%
Freehold valuation per bed £30,442.11
Places with nursing enhanced needs
65+ care home places with nursing, enhanced needsCostMedianLower QuartileUpper Quartile
Total Care Home Staffing £663.72 £663.72 £531.13 £891.44
Nursing Staff £207.49 £207.49 £158.73 £267.61
Care Staff £329.09 £329.09 £261.41 £396.78
Therapy Staff (Occupational & Physio) £1.78 £1.78 £1.77 £1.80
Activity Coordinators £5.98 £5.98 £4.20 £9.90
Service Management (Registered Manager/Deputy) £44.40 £44.40 £42.35 £51.46
Reception & Admin staff at the home £0.00 £0.00 £0.00 £0.00
Chefs / Cooks £28.34 £28.34 £21.08 £34.12
Domestic staff (cleaning, laundry & kitchen) £37.51 £37.51 £33.26 £43.30
Maintenance & Gardening £9.13 £9.13 £8.33 £9.78
Other care home staffing (please specify) £0.00 £0.00 £0.00 £76.71
Total Care Home Premises £25.66 £25.66 £13.18 £42.94
Fixtures & fittings £3.78 £3.78 £1.04 £10.04
Repairs and maintenance £19.18 £19.18 £12.14 £25.01
Furniture, furnishings and equipment £2.70 £2.70 £0.00 £7.10
Other care home premises costs (please specify) £0.00 £0.00 £0.00 £0.79
Total Care Home Supplies and Services £103.78 £103.78 £70.39 £159.95
Food supplies £32.65 £32.65 £22.87 £37.87
Domestic and cleaning supplies £8.22 £8.22 £4.74 £21.37
Medical supplies (excluding PPE) £1.74 £1.74 £0.57 £6.90
PPE £2.49 £2.49 £1.89 £3.22
Office supplies (home specific) £2.66 £2.66 £1.59 £3.40
Insurance (all risks) £6.26 £6.26 £5.71 £10.30
Registration fees £2.85 £2.85 £1.60 £3.25
Telephone & internet £2.89 £2.89 £1.73 £3.45
Council tax / rates £1.22 £1.22 £1.00 £2.13
Electricity, Gas & Water £32.00 £32.00 £25.10 £37.55
Trade and clinical waste £6.13 £6.13 £3.49 £6.92
Transport & Activities £3.55 £3.55 £0.10 £7.32
Other care home supplies and services costs (please specify) £1.10 £1.10 £0.00 £16.27
Total Head Office £13.61 £13.61 £1.72 £54.42
Central / Regional Management £0.00 £0.00 £0.00 £16.03
Support Services (finance / HR / legal / marketing etc.) £7.58 £7.58 £1.58 £16.45
Recruitment, Training & Vetting (incl. DBS checks) £6.03 £6.03 £0.15 £8.26
Other head office costs (please specify) £0.00 £0.00 £0.00 £13.69
Total Return on Operations £29.96 £29.96 £22.88 £44.06
Total Return on Capital £35.03 £35.03 £35.03 £35.03
TOTAL £871.76 £871.76 £674.34 £1,227.84

 

Supporting information
Supporting information on important cost drivers used in the calculations:65+ care home places with nursing, enhanced needs
Number of location level survey responses received 11
Number of locations eligible to fill in the survey 60
Number of residents covered by the responses 37
Number of carer hours per resident per week 25
Number of nursing hours per resident per week 9
Average carer basic pay per hour £13.17
Average nurse basic pay per hour £23.07
Average occupancy as a percentage of active beds 92%
Freehold valuation per bed £30,442.11

Domiciliary cost of care exercise

This document has been produced in response to DHSC requirements for local authorities to ascertain the cost of care in their local area.  It draws on information supplied by providers of domiciliary providers in the local area.

Introduction

Minor adjustments have been made to the data from that supplied by providers deemed permissible within the DHSC guidance e.g. to adjust for return on operations

 Blackpool Council makes no assurances as to the accuracy of the data since not all providers responded to the cost of care exercise.  It should also be borne in mind that the exercise was completed following a worldwide pandemic and may not be reflective of how the market is currently operating.

 Whilst the council acknowledges that the cost of care has been impacted by inflationary pressures since the information gathering period in 2022, this is mitigated by the fact that the council has not made adjustments to the data which would have the effect of reducing the cost of care.

In accordance with national guidance from DHSC, the cost of care exercise did not take into account all care settings and, therefore, does not give a complete portrayal of costs across all sectors.

The council also acknowledges its duties under the Care Act 2014.  However, these cannot be viewed in isolation from other pressures on local authority resources, the duty on all councils to deliver a balanced budget and the duty to obtain value for money as referenced in sections 4.27, 4.60 and 4.61 of the Care and support statutory guidance.

The information obtained by the cost of care exercise will be used to inform but not replace future fee setting exercises and commissioning activity.  Any decisions around fees will need to take into account the wide range of services, complexity of service provision, geographical locations of service, availability of resources and the statutory responsibility of the council to deliver a balanced budget.

Market engagement

An introductory meeting was held in March 2022 with our providers to brief them on the upcoming reforms and specifically their involvement in a cost of care exercise. A second meeting was held with all relevant providers ahead of the launch of the cost of care work, due to time factors of the authority being a trailblazer and having to submit information in July 2022 rather than October the decision was made to go with an in-house approach to data collection via an excel template. A walk through demonstration was provided of the template and questions were taken and answered. A week into the collection period the decision was made to accept responses through the iESE portal for residential settings and therefore we made the decision to also accept responses via the LGA/ARCC Care at Home tool. The collection period was for an initial 3 week period, however, due to a poor response rate we extended this by a further 2 weeks. This message was relayed to providers by e-mail along with an accompanying message by the provider forum chairs, highlighting that we were seeking to reach fee rates that were representative for the area and not based upon a small sample. A decision was made to extend the deadline again which led to a further 2 week extension meaning that the data collection period had been extended in total to 7 weeks from the initial 3 weeks at the outset.

In terms of response rate, despite reaching out to providers through numerous methods and offering assistance where needed, the overall engagement level was extremely low. In domiciliary care we received data from 3 out of 11 providers (27%), however, it was felt that these providers did provide a representative sample given the hours that we commission a significant amount of our hours from them and their returns were broadly in line with each other. However, it has not been possible to compare the costs of small and large providers as part of this exercise.

Returns

For returns on operations the decision was made to equalise this with the residential figure. At present there is a differential between the returns in our models and it was felt that this was an opportune moment to equalise at 5% which would mean an increase for domiciliary care providers.

Data collection

The collection basis for the results were to use actuals where possible for Financial Year 2021/22 although this was difficult as the filing period closes in January 2023 therefore most providers did not have finalised accounts but we were happy to accept monthly management account figures if available, the worst case scenario being finalised 2020/21 accounts. The additional request was for updated figures for 2022/23 which included uplifts for key expenditure lines such as staff pay ideally based on actual figures that had gone through the April 2022 accounts. As the expenditure has been broken down on a line by line basis for each sub category this means that we can identify where and what future uplifts are required within the fee model.

 The basis for this exercise was to include as much information wherever possible rather than exclude returns that upon first viewing appeared to be outliers. If any figures required further investigation or clarification then the authority sought to hold conversations with providers, a request as to who had supplied the information along with contact details had been added within our template. In Blackpool we commission domiciliary care inclusive of travel time therefore this is the reason for a zero figure on this expenditure line. This also means that we do not have different costs for visits that vary in length. Instead, we commission an amount of time that allows for the visit to be completed appropriately and allows for onward travel to the next visit (or inward travel to the particular visit) so that carers are paid for all time at work. Blackpool is geographically compact, with care ‘rounds’ typically organised in local area ‘patches’.

On expenditure lines where a zero figure has been reported this is due to providers not reporting expenditure within those areas. We have worked on the basis that providers may have been unable to quantify costs against particular descriptions but that additional costs have been collated under different headings and therefore all expenditure has been reported in full.

Outputs from domiciliary exercise

Exercise results
Cost of care exercise results - all cells should be £ per contact hour18+ domiciliary care
Total Careworker Costs £13.20
Direct care £10.01
Travel time £0.00
Mileage £0.30
PPE £0.29
Training (staff time) £0.24
Holiday £1.12
Additional noncontact pay costs £0.00
Sickness/maternity and paternity pay £0.28
Notice/suspension pay £0.00
NI (direct care hours) £0.62
Pension (direct care hours) £0.34
Total Business Costs £4.27
Back office staff £1.78
Travel costs (parking/vehicle lease et cetera) £0.00
Rent/rates/utilities £0.41
Recruitment/DBS £0.09
Training (third party) £0.00
IT (hardware, software CRM, ECM) £0.24
Telephony £0.12
Stationery/postage £0.06
Insurance £0.09
Legal/finance/professional fees £0.00
Marketing £0.04
Audit and compliance £0.00
Uniforms and other consumables £0.08
Assistive technology £0.00
Central/head office recharges £1.27
Other overheads £0.01
CQC fees £0.08
Total Return on Operations £0.88
TOTAL £18.35

 

supporting information
Supporting information on important cost drivers used in the calculations:18+ domiciliary care
Number of location level survey responses received 3
Number of locations eligible to fill in the survey (excluding those found to be ineligible) 11
Carer basic pay per hour £10.01
Minutes of travel per contact hour 0
Mileage payment per mile £0.20
Total direct care hours per annum 99086

 

careworker costs

DescriptionCostMedianLower QuartileUpper Quartile
Total Careworker Costs £13.20 £13.20 £12.87 £13.60
Direct care £10.01 £10.01 £9.94 £10.10
Travel time £0.00 £0.00 £0.00 £0.00
Mileage £0.30 £0.30 £0.24 £0.36
PPE £0.29 £0.29 £0.27 £0.32
Training (staff time) £0.24 £0.24 £0.23 £0.25
Holiday £1.12 £1.12 £1.11 £1.14
Additional noncontact pay costs £0.00 £0.00 £0.00 £0.00
Sickness/maternity and paternity pay £0.28 £0.28 £0.18 £0.29
Notice/suspension pay £0.00 £0.00 £0.00 £0.03
NI (direct care hours) £0.62 £0.62 £0.58 £0.78
Pension (direct care hours) £0.34 £0.34 £0.33 £0.35
Total Business Costs £4.27 £4.27 £3.24 £5.37
Back office staff £1.78 £1.78 £1.71 £2.52
Travel costs (parking/vehicle lease et cetera) £0.00 £0.00 £0.00 £0.00
Rent/rates/utilities £0.41 £0.41 £0.35 £0.42
Recruitment/DBS £0.09 £0.09 £0.05 £0.11
Training (third party) £0.00 £0.00 £0.00 £0.00
IT (hardware, software CRM, ECM) £0.24 £0.24 £0.12 £0.28
Telephony £0.12 £0.12 £0.11 £0.16
Stationery/postage £0.06 £0.06 £0.05 £0.07
Insurance £0.09 £0.09 £0.08 £0.13
Legal/finance/professional fees £0.00 £0.00 £0.00 £0.04
Marketing £0.04 £0.04 £0.02 £0.04
Audit and compliance £0.00 £0.00 £0.00 £0.00
Uniforms and other consumables £0.08 £0.08 £0.04 £0.09
Assistive technology £0.00 £0.00 £0.00 £0.00
Central/head office recharges £1.27 £1.27 £0.64 £1.40
Other overheads £0.01 £0.01 £0.01 £0.04
CQC fees £0.08 £0.08 £0.07 £0.09
Total Return on Operations £0.88 £0.88 £0.88 £0.89
TOTAL £18.35 £18.35 £16.99 £19.86
Basic pay
o Carer basic pay per hour£10.01£10.01£9.94£10.10
o Minutes of travel per contact hour £0.00 £0.00 £0.00 £0.00
o Mileage payment per mile £0.20 £0.20 £0.18 £0.23
o Total direct care hours per annum 99086 99086 91334 103519
Basic pay
o Carer basic pay per hour£10.01£10.01£9.94£10.10
o Minutes of travel per contact hour £0.00 £0.00 £0.00 £0.00
o Mileage payment per mile £0.20 £0.20 £0.18 £0.23
o Total direct care hours per annum 99086 99086 91334 103519