To propose changes to the weekly fees paid in relation to nursing and residential care homes for older people for 2013/14. The report also indicates how fees will change for the next three years prior to a further review of costs.  The date for the next full review will be 2016/17.

The Cabinet Member Corporate Strategy and Finance presented a report about the Open Book Review, which proposed changes to the weekly fees paid in relation to nursing and residential care homes for older people.  The report made proposals for 2013/14, and also indicated how fees would change over the following three years, up to the next scheduled full review in 2016/17.  He highlighted the following points in relation to the report:

• The Open Book Review demonstrated that the Council had been paying more on average for residential and nursing care than its comparable authorities.  He advised that the review had looked at the actual costs of providing care in Herefordshire and the Council was now at a point where it could propose a Maximum Usual Price (MUP) as a preferred option for further consultation with providers.
• He emphasised the importance of being clear to clients and providers about how the pricing would be structured, and who would be paying for what elements of care, including what items would be deemed as “additional” or “top-ups”. 
• He reported that there would be a transition period leading up to any new rates taking effect from 1 January 2014, and that discussions with providers would continue about pricing and the format of contracts. 

The Solicitor of the Council tabled amended recommendations to the report, which made clear that what was being recommended was the approval of a preferred option as the basis for further consultation with providers, and that this consultation would inform the final decision on the MUP.  Members accepted the amended recommendations. 

The Assistant Director Peoples’ Services thanked the providers for their co-operation throughout the comprehensive consultation process, and added that the amended recommendations enabled a further period of consultation with the providers.  She confirmed that the proposals ensured that the Council would continue to meet its statutory obligations, and that all who needed care would receive it equitably and reasonably. 

During the ensuing discussion, members made the following points:

• Those who were most vulnerable would be the Council’s priority, and measures would be put in place to protect them and provide the appropriate level of care. 
• The involvement of the Health and Wellbeing Overview and Scrutiny Committee was welcomed, and Cabinet encouraged other members also to engage in the process.
• A wider discussion with the community was also necessary, for example the voluntary sector, to offer greater choice and flexibility to clients. 
• Concern was expressed that certain aspects of the review lacked sufficient detail, and the chairman of the Health and Wellbeing Overview and Scrutiny Committee felt that there was potential merit in calling in any decisions made on the basis of the recommendations before Cabinet.  Members requested that instead of instigating the call-in procedure, which would potentially disengage the service providers, the Overview and Scrutiny Committee be enabled to work on an integrated approach with Cabinet, so that the review and consultation process could continue. 
• Assurance was given that there would be sufficient time to enable the review to be fully inclusive and take account of the needs of local residents. 

RESOLVED:  that

(a)  the Open Book Review approach that has been used, including evaluation of the alternative options and methodology for evolving the Herefordshire model be noted;

(b)  the proposed Maximum Usual Price (MUP) (as set out in paragraph 11.2, Table 1 of the report), for older people’s residential and nursing care purchased by the council be approved as the preferred option for further consultation with providers, and the involvement of the Health and Wellbeing Overview and Scrutiny Committee; and

(c)    delegated authority be given to the Director for People’s Services, in consultation with the Cabinet Member Health & Wellbeing, having due regard to the outcome of the further consultation, to finalise the MUP and undertake a formal procurement exercise. This procurement exercise shall include the introduction of a new outcome based contract and framework approach, and an annual indexing process, with a view to implementation of this MUP, effective from January 1st 2014, and a further review scheduled for 2017.