Agenda item

[Report of the Assistant Director for Commissioning. To be introduced by the Cabinet Member for Adult Social Care and Culture.]This report sets out a suggested approach to implement care act guidance on choice and third party top-ups for placements in Adults accommodation-based services (i.e. care homes, shared lives, supported accommodation) for cabinet sign-off. A third party top-up is where a relative or a family member of a person pays the difference between the person’s personal budget, and the actual cost of a service.

The report outlines a policy tantamount to the formalisation of existing practice. The policy sets out how residents will be given a choice of service if they are accessing accommodation-based services, and when a third party top-up may apply.

The Cabinet Member for Adult Social Care and Culture introduced the report which set out the obligations of the Council to ensuring that residents were given an appropriate choice of good quality care homes. The policy also put in place a framework to manage circumstances where residents choose to live in a costlier environment, and how they can use ‘third party top-ups’ to access their preferred choice.

The Cabinet Member outlined that this policy builds on existing practice and seeks to ensure that residents have a consistent experience in choosing a care home or other service. The policy also ensures that the Council was compliant with its obligations under the Care Act (2014)

RESOLVED

1. To agree the approach for calculating service users’ personal budgets as set out in paragraph 5.3 of the attached report.

2. To agree the third party top-up policy for accommodation based services attached as Appendix 1.

Reasons for decision

The Care Act 2014 and The Care and Support and After-care (Choice of Accommodation) Regulations 2014 allows local authorities to apply third party top-up arrangements where service users/families choose accommodation-based services to meet identified needs which are more expensive than the local authority usually pays and exceeds the service user’s personal budget. A third party top-up is an arrangement whereby a person known to a service user pays the difference between the cost of a service and their personal budget.

Currently, personal budgets are calculated based on the market rates of placements identified to meet individual needs. Haringey does not currently have a formal choice or third party top-up policy for accommodation-based services. This in practice means that fees paid for given placements varies widely. This fee variation is not always a reflection of differences in need or limits in supply, but in some cases may reflect service users and family members choosing particular placements that are of higher cost. This in effect leads to a higher personal budget than the assessed needs would require.

The Council does occasionally reach agreement with service users and their families for a ‘third party top-up’ where there is a difference between the care home a service user/family chooses to live in and their personal budget, based on the costs of a placement which meets their needs. However, this is not implemented consistently.

All of our North Central London neighbouring local authorities have a top-up policy. These are summarised in Annex 1 but the approach taken is largely consistent within each borough. In essence, where service users are presented with a choice of services which can meet their needs, but reject these in favour a more expensive option than their personal budget allows, then the service user must fund the difference between their preferred placement fee and their personal budget via a third party top-up.

In most instances within Haringey’s neighbouring local authorities the difference between a service user’s personal budget and the total cost of a service is funded via a third party top-up because a service user’s income and savings is factored into the amount they pay on a weekly basis towards the cost of their care following a financial assessment. The service user cannot withhold a proportion of their income for the purpose of paying a top-up.

It is recommended in this report that a similar policy is introduced in Haringey. There are a number of variants to this broad approach dependent on how personal budgets are calculated which are summarised in an options appraisal below.

Alternative options considered

Haringey had two principal options in relation to calculating service user’s personal budgets and implementing a third-party top up policy. These were:

1. To base the personal budget above which third party top-ups should apply on ‘usual rates’ based on a benchmarking of average costs to meet needs, to be up-rated on an annual basis. These usual rates could form the basis of a resource allocation system for personal budgets, which service user’s top-up via a third party should they wish to purchase care and support in excess of the personal budget rate

2. Personal budgets are calculated on a client-by-client basis, based on the average costs of provision that is identified by the commissioning team which can meet the assessed needs of service users. Should a service user or their family reject the choices presented to them by the commissioning team and express a preference for another, more expensive service, they will be required to make a third party top-up over the agreed personal budget.

5.1         It is recommended that the Council implements a variant of option b. This is for the following reasons:

-      Option b is a more adaptable approach to the specific needs and requirements of service users. Given the wide spectrum of needs of the client groups that access accommodation-based services, basing personal budget allocations on a resource allocation system may be problematic and more open to challenge.

-      Option b will be more responsive to the capacity of the marketplace to meet people’s needs and to the rates that they are able to provide a care package at based on individual need. This is more in line with the terms of the Care Act around ‘sufficiency’ of personal budgets, specifically:

Clause 11.25 “consideration should… be given to local market intelligence and costs of local quality provision to ensure that the personal budget reflects local market conditions and that appropriate care that meets needs can be obtained for the amount specified in the budget”

-      Option a would be complex to administer and to determine the resource allocation system. Rates would have to be set for each client group, and would be challenging to develop in a way sensitive to fluctuations in individual need.

It was recommended that a variant of option b be implemented based on the following principles:

-      The Council should set personal budgets based on quoted costs of meeting individual need and outcomes.

-      The average fees used to determine service user’s personal budgets should be calculated based on the average of the two least expensive offers from suppliers which meet outcomes on a case-by-case basis. More expensive offers should be discounted to ensure that the Council makes placements based on achieving user outcomes and best value.

-      Where only one offer is received below the Council’s ‘price banding’ for older people’s residential and nursing placements (agreed across North Central London), then the Council will base the personal budget on the price which falls within the banding, should the service user/family reject this arrangement.