HIVEMIND

This is a discussion document add ideas comments as you see fit

Whenever funding comes into discussion there are a number of ever present themes

• Too much profit
• Not enough funding from COSLA to meet cost of care
• Self funding fees are a rip off
• Not sustainable for the future
• Big corporations care more about shareholders
• The NCHC dos not reflect the Health and Social Care Standards
• More demands on services without extra funding
• Smaller care homes not sustainable

What next?

One size does not fit all – the Care Home Sector is diverse with different models of ownership, location, workforce models etc.

I am, therefore, setting out a manifesto for Care Home Funding based on the following

Fee setting

Fees to be set by an independent regulator which is able to take evidence from across the sector and beyond. This will then be used to make decisions on fees to be set for the next 12 months. They then make this presentation to those who provide funding and it is then their decision as to what they will fund. Doing this will mean that a fee will be identified based on what is needed rather than what is affordable – the affordability will sit with others to work out what they will pay and what they will not fund

Applies to all

Once a fee has been set by the regulator that is the fee for all residents and if it is not paid in full then it has to be identified why not and what is not going to be paid for. All fees will be through the statutory services. The statutory funding can then have a charging policy based on income, assets and ability to pay.

Considerations

Fee should be based on a number of factors

• Locality – Local circumstances are important homes in small rural communities will have different needs to those in urban settings. Funding needs to respond to locality. For example a 60 bed home may well work in Edinburgh but is not as sustainable in Ullapool
• Health and Social Care Standards – The fee must be based upon the implementation of these standards to a certain performance level- at present a grade 4 is seen as a performance target for all HSCPs. If full fees are not paid then the funders need to identify which standards they are not prepared to meet and at what level they expect to see performance and this has to be agreed with the regulator
• Localism – a funding premium which supports localism could be a factor. Fees can support care homes to use local suppliers – within a 10 mile radius in urban areas and larger in rural settings. This will support local economies to thrive and embeds a care home in its local community
• Workforce – this needs to support terms and conditions equitable with NHS
• Size of home – fees will need to factor in size of home and ensure that wide range of homes are able to be supported
• New guidance/ work streams -Any new guidance etc within the 12 months of the fee rate cannot be enacted without an impact assessment of cost carried out by the regulator and they will then decide if new guidance can be issued along with the resources to do so.
• Sustainability/provider return – There needs to be acknowledgement of the needs for funding to be sustainable to provide contingency funding and for providers to have acceptable level of return for their work and service
• Climate Change/ Circular Economy – a premium could be factored into the fee for care homes which are developing low carbon/waste initiatives. This could be a number of initiatives
  • Lessen haulage miles – buy local
  • Lessen food miles – buy local and seasonal
  • Use of alternative heat/ energy – solar/heat pumps
  • Reduction in single use plastic
  • Moving to electric vehicles
  • Supporting staff to use green commuting options