Durham County Council

Durham County council

In early 2022, Durham County Council contacted Valuing Care to discuss project support capacity in completing their Fair Cost of Care requirements for the DHSC. All of the data collected used the LGA toolkit so that a common approach could be taken regionally on reporting and data recording. The project will leave Durham County Council with a verified statistical sample that has been benchmarked against Valuing Care’s own internal models.

It was agreed that domiciliary care support provided the best approach and Valuing Care were tasked with the following: 

• Understanding the current cost structure through surveying the market  
• Managing the data collection process 

Read more on what Valuing Care were tasked with and what is planned here.

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Managing Your Complex Care Packages During Rising Cost Pressures

Managing Your Complex Care Packages During Rising Cost Pressures

Budgetary spend on complex packages of care continue to grow with service demand and overall price increases across Continuing Health Care, Learning Disabilities, Physical Disabilities and Mental Health services.

The expectation is that this will grow again in 2022/23, beyond available resources as inflationary cost pressures from staffing, utilities and extra regulation push up provider costs.

With budget pressures so high it is very hard for commissioning managers to determine what the annual percentage increase in complex care packages should be. It can become extremely tricky to balance the need to ensure sustainability whilst also achieving value for money within such a tight inflation envelope.

Over the coming months providers will be writing to request a 5% or 10% increase, each demand will be supported with calculations to justify the uplift. Given the compelling reasons presented by providers it is hard to work out where the line should be drawn.

 

Historically the organisational approach has been to set a standard inflationary uplift which can favour some providers with excessive profits and penalise others that are operating at effective prices. Most authorities have been through a cost reviewing process at some point over the last few years, however the collected data quickly goes out of date if inflationary uplifts are not assigned on a line-by-line cost basis.

Valuing Care’s approach is to assess the value of the current price and assign an appropriate percentage on a cost line basis: the method is supported by the company’s Purchaser software which stores each case’s cost breakdowns and gives commissioners the ability to update cost lines for the relevant inflation, using Valuing Care’s model costs as a guide. 

 

Each case is stored within Purchaser so that details can be saved and uprated easily. Inflation increases can be accurate and reviewed, year on year. By assigning the correct inflation to the cases that need it most, packages remain sustainable and profit levels are capped elsewhere. So, the next time you receive a provider letter demanding an inflation increase on a care package where you do not truly understand the delivery costs contact us to see how Valuing Care’s Purchaser software can put you back in control of the increasingly challenging market.

 
21st January 2022 | Ray Hart
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Independent Age: Choosing the Right Care Home

Independent Age: Choosing the Right Care Home

People often find themselves doing this in a hurry when there’s a health crisis, but it’s a good idea to think about what you’d like sooner rather than later and discuss this with your family or friends.

Where to start
You should start by having a care needs assessment. This will give you more information about the care you need, and help you think about what support would be best for you. 

Choosing a care home to suit your care needs
There are various types of care home available, depending on the level and type of care you need. The outcome of your care needs assessment should give you an idea of which one would be right for you. If you’re moving as a couple, it can be more difficult to find a home to cater for both your needs

Residentail care homes
These offer personal care, including help with washing, eating and drinking, going to the toilet and taking medication. 

Care homes with nursing care
These offer personal care, but also have qualified nurses on duty at all times. They may specialise in particular illnesses or disabilities, such as dementia.

Care homes offering some residential and some nursing care places
These might be a good option if, for example, your condition is likely to deteriorate and you don’t want to move twice. 

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The Telegraph – Care crisis: this is why Britain’s care homes are charging the dead

The Telegraph – Care crisis: this is why Britain’s care homes are charging the dead

Part of the CMA’s investigation focuses on the terms of contracts entered into when family members enter a care home.  

The watchdog is concerned that homes may be breaking the law by charging large upfront fees when it’s not clear what services they relate to. The inquiry is also looking at cases where care homes continue to collect fees after the person in care has died. In some instances homes are filling beds still being paid for by other families, it is alleged.

Ray Hart of Valuing Care said the bigger issue was homes’ ability to raise charges by as much as they like. “There are cost pressure on them of course but basically these are open-ended contracts and each year they can raise the cost by as much as they like and they don’t give breakdowns explaining the increases.”

18 June 2017 | Subscription Required
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Healthcare Leader: CHC demand significant amounts from healthcare budgets

Healthcare Leader: CHC demand significant amounts from healthcare budgets

How to avoid being overcharged

Continuing Healthcare (CHC) packages demand significant amounts from healthcare budgets. Care for patients with complex needs could cost thousands of pounds per week, for many years, so working out a better deal on the prices quoted could create much-needed, sustainable savings. Yet NHS re-organisation has left some areas of CHC to drift, creating an opportunity for providers to inflate their prices, particularly for specialist placements. Price squeezes from other purchasers, such as councils, means that providers are looking more and more towards the health sector as a major source of profit. 

Further pressure comes from the struggle to define needs categories. This has created inconsistency, which providers have used to lift prices, often through additional services. Providers typically charge 10 to 15% more for long term placements made by CCGs than those made by local authorities, even where the inputs are similar. 

Negotiating CHC fees can be one of the most effective ways to get the purchasing process into better shape. Yet in some CCGs teams can be apprehensive about how to apply them in practice, perhaps not knowing how to approach the process or to manage responses from providers.  

The message for CCGs to communicate to their staff is that negotiating is not as difficult as it may seem. Encouraging commissioning teams to adopt money-saving techniques helps them to develop new skills and enables better management and control of future spending. Keep in mind that good negotiators can expect to save typically 10 to 15% against a quoted care package. 

Top tips for negotiators

Get the timing right 

Commissioners often find that the best discount is available in the early stages of the procurement process, when buying a new placement. However, it is possible to negotiate existing contracts. Providers are often more accepting of price negotiations within case reviews.     

Know what you want 

Trying to get a better deal is impossible unless commissioners actually know what they want. Encourage teams to determine the exact needs, and to communicate these to the provider. This way both the care provider and the commissioner know where to start from. 

 

Commissioners should also be clear about the level and type of care, the location and the facilities required, as well as any additional services needed.  

Focus on the patient
Do ensure that the services commissioned meet the patient’s needs rather than those offered by the provider. Like any other market, people may try to sell packages that fit their needs better than those of the patient; there isn’t a one price fits all. 

Know the price range 
Care packages can be complex; there are a range of different costs underlying the care needs of each individual, from the basic financing of the care home building and facilities, to any additional services that the patient requires. You need to understand what is a reasonable price range for the level of care required. 

Organisations should develop an insight into the cost components that make up the price. For instance how many staff, and at what grade, are on shift, and what is the likely hourly rate for each staff type. CCGs that have robust models and banding levels for determining rates for services, which reflect the needs of the patients, will have an advantage here. 

Some CCGs find it useful to create framework agreements to inform providers of the value for money price they would expect to pay for a service. There are also many tools and models you can use to create an activity-based cost for individual packages, enabling commissioners to compare quotes against national averages. If the rate is as too high, it is time to negotiate. 

Pin down the right person

Talking to the wrong person is a waste of everyone’s time, so ensure that the relevant person in the buying team talks to the person at the care providers who is responsible for cost decisions. This might be the care home manager, or the owner of the care group, regional managers or commercial specialists at head office.   

Be calm and friendly 
Encourage teams to be calm, confident and focused on the level of care needed, and the budget they have to work with.  

Understanding the provider/purchaser relationship is also important. Direct those responsible for buying to build rapport with the person they negotiate with, and remember it’s not a battle; both parties need to feel the outcome is acceptable. 

Double check the small print  

Remind your teams that it is not necessary to commit too early to a placement; make sure they have also considered the alternatives. It is much easier to negotiate with leverage, and the knowledge that another provider can be approached.  

Keep options open 
Some care homes may offer clear information on charges, others reserve details for the small print. The Competition and Markets Authority (CMA) is to launch an investigation into whether residents are being treated fairly. There are reports of unfair practices and contract terms, including hidden charges and unexpected fee increases. The investigation will focus on whether there are any breaches of consumer law, but the results will be important for health commissioners to consider.  

To protect your organisation against unforeseen price hikes, ensure that purchasers specify all the requirements, including price, within the contract, and that there are set mechanisms for calculating inflation and future increases in need. Nobody wants any surprises, so ask teams to double check the small print. 

Get help 
There are training courses to help staff gain the practical skills required for assessing CHC placements and achieving value for money.  

For teams that prefer to assign the task to a professional, care fees specialists are another option. The best offer a range of tools, both computer based and with human support, to guide commissioners through the costings, taking he worst aspects of the negotiation process away.  

17 May 2017
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Health Tech Newspaper: The Cultural Change of using technology to purchase CHC placements

Health Tech Newspaper: The Cultural Change of using technology to purchase CHC placements

Are we ready?

Ray Hart, director at Valuing Care, discusses the cultural change of using technology to improve the purchasing process for CHC placements. He discusses the benefits, and explains why training is essential to its success. In most industries, for people in the workforce whose roles have purchasing responsibilities, there are processes in place, and access to data, to help decision making. This information is largely technology-based and helps the purchaser get the best price whilst still ensuring sustainable supply. 

In Continuing Healthcare (CHC), this isn’t always the case. Nurses and assessors for instance, commonly purchase CHC packages over the telephone or via face-to-face meetings without any pricing information to back those transactions. They are responsible for purchasing thousands of pounds worth of care, and yet often this task is completed without challenge to the prices providers quote, and without question on the breakdown of those costs.

Given the need for greater scrutiny of costs in healthcare, together with the urgency to reduce expenditure and achieve value for money, new technology is bringing much needed improvement. It is enabling assessors to delve deeper into the costs of care packages on a real-time basis, and challenge the rates quoted; bringing the purchasing process in line with other industries. There are some CCGs and CSUs leading the way here, adopting innovative technology to improve practices, yet overall progress across the board has been slow.

In reality, this is not a complex issue to tackle, it achievable for any department. So what is holding back progress? Whilst technology that enables a much smoother CHC purchasing process brings clear benefits for healthcare in terms of improving financial and operational efficiencies, it also creates challenges for these teams. Changing old working practices and habits, for many is a difficult hurdle to overcome, and the key here is training and engagement.

It is a huge cultural change for frontline workers; having to use technology for an element of their role which in the past has always been manual. Therefore it’s essential to engage the workforce in the developments and encourage commitment. Part of this is to communicate and train people on how using technology to complete this process will improve day-to-day working practices, and their own skill set, as well as highlighting the benefits it brings to healthcare as a whole.

In reality, this is not a complex issue to tackle, it achievable for any department. So what is holding back progress? Whilst technology that enables a much smoother CHC purchasing process brings clear benefits for healthcare in terms of improving financial and operational efficiencies, it also creates challenges for these teams. Changing old working practices and habits, for many is a difficult hurdle to overcome, and the key here is training and engagement.

It is a huge cultural change for frontline workers; having to use technology for an element of their role which in the past has always been manual. Therefore it’s essential to engage the workforce in the developments and encourage commitment. Part of this is to communicate and train people on how using technology to complete this process will improve day-to-day working practices, and their own skill set, as well as highlighting the benefits it brings to healthcare as a whole.

Adding a new area around the detailed components of cost is not easy but, rest assured, the providers selling packages of care know the underlying cost of their care and work this way. Without being similarly armed with that knowledge the advantage will always be on the supplier’s side.

However, implementation of this type of technology makes teams more price aware, and provides real-time information on costs. For people with purchasing duties, having a better understanding of costs and the price they should be paying for care, is fundamental. It facilitates better decision making and enables commissioners to secure value for money with providers. It also encourages people to think about other techniques, such as negotiating, to reduce costs; which in an ever financially challenged healthcare, is invaluable.

A further advantage of having a more effective purchasing processes in place is that it allows staff to reallocate their time to frontline duties, rather than being tangled up in admin-related work. This is a welcome step forward for most healthcare professionals.

As the number of CHC placements in the NHS continues to rise, with 62,000 people eligible for CHC funding in 2015/16, the potential for innovative technology in this area is enormous, it’s a significant breakthrough and is imperative to future sustainability. Technology helps overcome the limitations of the current approach to purchasing CHC placements, and with greater visibility and control over costs, commissioners will manage and purchase better, more cost-effective CHC placements.

23 November 2016
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BBC Radio 4 – You & Yours

BBC Radio 4 – You & Yours: Ray Hart, Director at Valuing Care, is interviewed by Winifred Robinson

Care home fees for people funding themselves could rise by between six and ten percent by the time the new national living wage comes into force in April, according to industry watchers. We hear from…

Listen to it below.

25th January 2016
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Daily Mail: Rising Care Home Fees

Daily Mail – Rising Care Home Fees

Care Crisis!

The cost of a room in a care home, presently about £750 a week, will be £1,000 a week by 2020, experts warn. However, with Britain facing a nationwide care funding crisis, even that figure could soar. 

A report by the Care Quality Commission (CQC) last week found services for the elderly were nearing breaking point. The care watchdog warned of a wave of home closures if staff and funding gaps are not filled, adding that in the past six years 1,500 homes had closed. 

The firms running care homes will try to plug the gap by raising fees, experts say. Valuing Care, a respected care fees analyst, predicts they will rise 8 per cent a year ‘for the next decade’.

That would mean the average fee reaching £1,020 a week by 2020, or £53,040 a year and that accounts only for a place in a residential care home. Fees for elderly people needing specialist medical care may be even higher than that.

Most people will have to pay this themselves as local authorities currently cover your care bills only if you have less than £23,250 in savings, investments, properties and other assets (£26,250 in Scotland and £24,000 in Wales).

That means nearly all homeowners will face large weekly bills and, once their cash has drained away, they may have to sell that home to cover the cost. The exception is where a spouse still lives in the property or if you put a charge on it. The latter simply means the care provider collects its fees after the resident dies and their relatives sell the property.

The Government had wanted to place a £72,000 cap this year on the total cost of care for the over-65s but the measure has been delayed until 2020 at least. Experts now fear that it may never come in and even if it does, the cap is likely to exclude board and lodging.

So even residents who have spent £72,000 on fees could continue to face bills for as much as £12,000 in England (the new rules would not apply to Scotland and Wales).Most people think a care home stay will be relatively short but the typical stay is eight years.

Ray Hart, director of Valuing Care, says: ‘If you’re staying somewhere for that long, the cost becomes incredibly important. ‘In some cases, people are running out of equity in their homes, so they turn to their pension and use it all purely on care home fees.

‘Then you could be left turning to the council, which may have to move you somewhere completely different that doesn’t give the quality of care you need. That can be very traumatic.’

Money Mail, in association with Bupa, has produced an essential guide to care funding and the crucial decisions families have to make about choosing what kind of support their loved ones will need and how to pay for it. It aims to help all families through every step of this ‘traumatic’ process. Last week’s CQC report raised fears of a repeat of the collapse of Southern Cross healthcare group, which went into administration in 2011.

Southern Cross ran 750 homes across the country and its collapse left 30,000 elderly residents urgently seeking somewhere else to go. Earlier this month, a care home in North Wales closed, leaving 21 elderly people with dementia with nowhere to live. Rosewood Healthcare Group, which ran the home, said it was no longer viable and was losing money.

That is why choosing the right type of care and home is so important. Our guide will take you through all the options and provide you and your family with the best tools and information. One option is to have care in your own home, instead of moving into a residence permanently.

A carer might charge between £15 and £20 an hour — so you could get around 40 hours of care for the same price as the average week in a care home. Care homes also allow people short stays of anything from a few hours to a few weeks. If your assets are more than £23,250, however, you will still have to pay for this type of care.

However, anyone in England with nursing needs — regardless of how they pay for them — can apply for the Registered Nursing Care Contribution of £156.25 a week to offset the costs. The rules are different in Scotland, where as much as £249 is available, and in Wales, where it is £140.90.

Those with severe needs can apply to have their entire care bill paid by the NHS, through so-called Continuing Healthcare. This figure is not means-tested but whether you can claim depends on the local health service’s assessment of your nursing needs.The definition of ‘severe’ is vague, but tends to mean that you need round-the-clock attention. If the health of a loved one declines significantly, you can have them reassessed.

18th October 2016
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