Agenda item

Integrated Commissioning and Section Agreement for Care Homes for Older People in Gwent Region


Key Issues:


Partnership Agreement for Pooled Budget Arrangements for Care Homes for Older People in the context of the Social Services and Wellbeing (Wales) Act (2014) which sets out:


·         Duties and expectations around partnership working.

·         A Regional Partnership Board (RPB) comprising ABUHB, Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen Local Authorities, 2 county voluntary service organisations and representatives of the regional citizen’s panel and provider forum.

·         The RPB will undertake an assessment of population health and social care need, and developing an area plan to meet those needs.


A major priority for the RPB is the development of arrangements to pool funds for care home arrangements and the establishment of a partnership agreement (Section 33 Agreement) to enable integrated commissioning and pooled funds for care home

Accommodation to be in place by April 2018, subject to approval by all partners.


The Gwent region has been the pilot area for Wales to develop a Model Partnership Agreement (MPA) for pooled budget arrangements for older people.


The scope of the agreement, and its design principles, were aligned to the draft priorities for older people contained in the Population Needs Assessment (PNA) and the draft Area Plan which is currently the subject of consultation.


A 2016 national analysis of the current size and scope of the care home sector showed that in 2015/16 there were


·         nearly 18,000 placements by local authorities and health boards, which included 4,877 placements of people funding their own care.

·         There were 21,823 registered beds in care homes for older people on the census date and the combined local authority and health board spend was approximately £369 million excluding client contributions, third party payments and the fees paid by those individuals who fund their own care.


RPBs will be expected to develop written agreements concerning any formal partnership arrangements which involve a delegation of function.  Partners can make arrangements for the establishment and maintenance of a ‘pooled fund’ which is made up of contributions from the partners to allow payments to be made towards expenditure incurred in the exercise of National Health Service functions or health-related (Local Authority) functions in arranging care for Older People (over 65) in Registered Homes.  Any changes to this approach will require further approval by all partners to the agreement.


Initial market analysis, as at September 2017, shows there were a total of 95 care homes for older people in the Gwent region offering 3,363 beds. There is a mixture of sole providers that own and operate one home, medium sized providers that own and operate more than one home and a number of national companies that operate care homes across the region.  Few homes are registered solely for residential, residential care for people with dementia, nursing or nursing care for people with dementia. Many homes offer a combination of beds, across all types of care e.g. dual registration for residential and nursing or dual residential and nursing care for people with dementia. Appendix 1.

Current risks and challenges in the care home sector


·         An anticipated benefit is an integrated regional commissioning approach to care homes in a coherent, strategic approach which will support the sector in its medium and longer term business planning and mitigate the current risks the sector is experiencing.

·         Recruitment and retention of registered general nurses and registered mental health nurses is becoming particularly challenging as is the recruitment and retention of registered managers and care staff.

·         There is an increasing demand for care provision for older people with mental health conditions such as dementia, in both residential and nursing care homes, whilst there has been a decrease in demand for residential and nursing only provision.

·         Across the region, older people are being supported to remain as independent as possible in their own homes for as long as they are able to. As a consequence people entering a care home for older people are now older and often require more complex care.

·         Bed vacancies do not necessarily align with need as vacancies are often not in the required category of care or in the locality of need. Despite efforts to realign the market to better reflect need, the market can be slow to respond.

·         There is evidence that the size, structure, age, layout and location of care homes across Gwent is having an impact on sustainability.

·         Rising cost pressures is another a feature that threatens sustainability. It is anticipated that the incremental increases each year until 2020 in the National Living Wage, the growing costs of recruitment and retention, employee pension costs and other costs such as the purchase of equipment will continue to exert an upwards pressure on operating costs.

·         Care home workers are also subject to registration from April 2018, although this will be phased in over several years. There is a need to plan for registration so it does not adversely impact on retention and recruitment.

·         Risks and challenges that have been identified in relation to joint commissioning and pooled budgets for care home commissioning:


i.        effective management of a Section 33 Agreement so that there is timely and sufficient local management information.

ii.        ensuring partner budget management and reporting requirements are fully met. The size of the spend on this care provision means that this is vital.

iii.        engaging providers in revised commissioning arrangements in due time and without compromising current provision.

iv.        ensuring joint commissioning arrangements do not cut across individual commissioners care home fees setting arrangements (which are determined at organisational level and approved by each organisation.


·         In order to mitigate the risks, the development of a Section 33 Agreement for care home placements draws on the experience and learning from the regional pooled budget arrangements put in place for the Gwent Frailty Programme (refreshed in 2016) and the Gwent Wide Integrated Community Equipment Service (GWICES). It is also recognised that this Section 33 Agreement will be on a much larger scale that anything that has been undertaken previously. This is one of the key reasons that the pooled fund recommended does not include a financial risk sharing arrangement at this stage.




Member Scrutiny:


The Head of Social Care, Safeguarding and Health introduced the report and invited questions:


A Member questioned if the proposals would result in a reduction in care for dementia patients.  The Head of Social Care, Safeguarding and Health stated that working together as a group of five authorities with the Health Board will provide opportunities through joint commissioning to redesign dementia care home facilities for the future. 


Supporting documents: