In December 2021 the government set up the Market Sustainability and Fair Cost of Care fund 2022 to 2023.
The purpose of this piece of work was to support councils and local authorities to understand the cost of providing care locally on the islands and to ensure this support remains sustainable.
Fair Cost of Care (Appendix C)
Council of the Isles of Scilly Market Sustainability Plan
Introduction
In December 2021 the government set up the Market Sustainability and Fair Cost of Care fund 2022 to 2023. In line with other local authorities. The Council of the Isles of Scilly has undertaken a Fair Cost of Care Exercise, its aim is to evidence and to ensure that residential and domiciliary care has long-term sustainability on the islands and that care is presented in a unit of cost per hour. This exercise is not undertaken to set rates, but to provide an understanding of the level of need, the cost, support and the sustainability of services in the short to long-term. This was again reviewed in November 2024.
This exercise has highlighted the uniqueness of the geographical area that the Isles of Scilly presents. It's small but ageing population has unique pressures and demands that are currently generally met by adult social care on the islands.
The Isles of Scilly has one residential care home that has 12 beds, this service provides formal respite, Intermediate care, Reablement, day services and domiciliary care. During 2023 to 2024 it has been agreed to build a new residential care home on the hospital site, this will remain a 12 bedded unit and domiciliary care will be from this location. As part of this relocation a review of the Model of Care is taking place to support more integrated working across services, this will support developing new and innovative ways of supporting people to stay at home for longer by developing training, understanding and technology.
Revised assessment of current sustainability of local markets.
The council of the Isles of Scilly provides services to its community with a population of 2271 people, of those people 26.2% are over the age of 65. This statistic indicates a very high level of people over the age of 65 with large numbers over the age of 70, 80 and 90 compared to the rest of the UK and most of the world. This statistic indicates due to the long life expectancy the demand for services is amplified by a high life expectancy on the islands.
The Council of the Isles of Scilly has responded to these pressures, by focusing on preventative measures to support people for longer term in the community without paid services and extending the time when more complex care would be needed. It is also noted that the vast majority of people who require services have significant ties to the islands, its culture and people. Therefore moving away from this area would/could have a significant impact on individuals well-being.
The Council of the Isles of Scilly and its cost of care exercise focuses generally on market sustainability and on the need of its community to ensure in the long term the service can remain flexible, intuitive and person centred.
It is recognised that inflationary pressures will increase the burden on services over the next five years. To alleviate this all staff are employed on the national green book wages to ensure comparatively with other care providers, in addition a market forces supplement is paid to its staff to ensure care services compare favourably to similar organisations across the islands. Government grants, while modest relating to fair cost of care, are used to support this approach. This approach will continue through to 23/24 and will be reviewed each year after that. A larger increase will be required above inflation for 24/25. Each year all charges including care home charges, domiciliary care charges, Meals on Wheels charges et cetera are taken to the council members for agreement. Adult Social Care published the cost of the service on the council website.
The Isles of Scilly is dependent on Council led services to provide the residential and domiciliary care on the island. The main threat to sustainability of these services is the staff team. While generally recruitment is steady the pool of people on the islands is very limited. There is a significant need for housing to enable off island recruitment to ensure new people have the right skills and knowledge to provide effective safe care. Currently there is a housing crisis on the islands, as there is across most of the south-west of England. However, this is more pronounced on Scilly due to the geographical location of the islands. This has resulted in the Council declaring a housing crisis in 2022, highlighting the uniqueness of the housing market and that most of the islands are owned by the Duchy of Cornwall. In addition, the council have worked closely with the Duchy of Cornwall to bring forward new homes through the conversion of redundant buildings and there are plans for approximately 10 homes arising from their current phase of work on two sites (one at Old Town, one in Hugh Town). Between 2023 and 2025 the council has allocated seven properties specifically for adult social care and this has reduced the pressure on housing for new recruits. During this period of time however there has been a national shortage of people to cover caring roles in residential services.
To really resolve the issue in the long term the council highlighted the need for more new built homes, the local plan suggests approximately 105 by 2030. To achieve this the Council have lead on the facilitation of the delivery of new homes on 2 sites, the former secondary school site at Carn Thomas and land adjacent to Ennor Fam at Old Town. The Carn Thomas site is council owned and working with Live West a scheme for 27 new homes went out for public consultation in the Autumn with full plans expected shortly. This site aims to be on site in 2024, with new homes available 2025/26. The smaller Ennor Farm site brings forward 12 serviced plots for self-builders with infrastructure site works scheduled for early summer 2023, new homes will started once the site works are complete. In addition the local plan works proactively to consent windfall housing sites for individuals to self-build. The current housing monitor shows a number of new properties under construction. It is recognised that there is a need for key worker properties to ensure essential services including care can continue on the islands.
The next most important piece of work that will ensure sustainability in the longer term is the integration project that supports joined up working between adult social care and the health service. The long-term aim is to have one service for adults across the islands integrating both health and social care to ensure seamless person centred care is available when needed. Part of this process was a plan put to central government for an integrated hospital/care home that will ensure both domiciliary care, health, and community care is undertaken from one place with one staff team in the long-term. In September 2023 the council of the Isles of Scilly and Cornwall foundation trust were approached to provide a business plan for the refurbishment of the hospital and the builder of a new care home on the hospital site. As stated earlier a key part of this proposal is to develop an integrated health and social care model that will support this island community for years to come. The business plan or successful and building started in early 2024 and is due to be completed late in 2025.
The ongoing sustainability and resilience of market provision is largely modelled on the demand by the community on its services. The Council of the Isles of Scilly adult social care team has, and continues, to work with small private providers supporting them with information and advice, as well as training if requested, to try and develop a competitive care market on the islands.
The Council of the Isles of Scilly works continuously to try and ensure both the quality and the value of its placements on the islands and on the mainland. The council’s ability to shape this marketplace is limited due to being the main single service provided by the council. It is a challenge when budget setting but also provides the ability to work flexibly with its partners to meet the needs of the community.
In essence the council has seen a small increase year-on-year for domiciliary care cost and residential care has remained busy but consistent. The main changes over the last five years with its domiciliary care/residential services is the increase in complexity and as a result of this, training has been increased to ensure the needs of the community can be met. It is expected, in line with regional and national expectations, that inflationary pressures will require increases in funding in the next 2 to 3 years and on into 2025/2026 to ensure sustainability of service.
Ongoing impact up until 2025/26
The lack of choice for island residents is an ongoing problem. The island social work team continue to look for and promote the care market on the islands however to date this has had some success but has not developed a successful marketplace. The experience of the social work team and its understanding of the unique environments of the Isles of Scilly has helped develop creative solutions to ongoing problems such as providing care over multiple islands.
It is the council’s opinion that the domiciliary care market will remain stable, flexible and resilient over the coming years. The increase that has taken place in recent years and the projected increase will be incorporated and will ensure stability.
65+ care home market
The council is committed to deliver timely, quality, appropriately funded care to its community. It has developed short/medium term and long-term plans to ensure that sustainability
Short/Medium Term
To review the “care” market within the islands and continue to seek positive ways of developing this market.
To review and use the fair cost of care grant to identify gaps and risks in the market.
To work with partners in developing and ensuring effective cost-effective quality of care.
To work with councillors and partners to support the council’s services to ensure services remain sustainable.
To work with partners to improve the quality and understanding of the services provided.
To continue to develop an integrated adult social care team that will provide flexible, effective cost-effective and responsive services to the islands.
To invest in housing solutions that will provide an effective workforce in the care setting.
To develop a new integrated model of care that will support multiagency interventions in the community and engage a preventative agenda that will reduce the need for formal paid services and therefore the need for residential services.
Long-Term
To provide a fully integrated adult care service that will support the local community in the most effective way.
To carry out regular reviews to ensure that the market continues to develop and the Isles of Scilly maintains sustainable services.
Domiciliary care market
Short/Medium Term
Continue to support the island community to be independent as possible for as long as possible reducing reliance on paid services.
To review and use the fair cost of care grant to identify gaps and risks in the market.
To work with partners in developing and ensuring effective cost-effective quality of care.
To work with councillors and partners to support the council’s services to ensure services remain sustainable.
To work with partners to improve the quality and understanding of the services provided.
To continue to develop an integrated adult social care team that will provide flexible, effective cost-effective and responsive services to the islands.
To invest in housing solutions that will provide an effective workforce.
To continue to develop creative ways of providing paid support in a difficult environment in the care setting.
To develop a new integrated model of care that will support multiagency interventions in the community and engage a preventative agenda that will reduce the need for formal paid services and therefore the need for residential services.
Long-Term
To provide a fully integrated adult care service that will support the local community in the most effective way.
To carry out regular reviews to ensure that the market continues to grow and the Isles of Scilly develop sustainable services.
Fair Cost of Care Appendix B
The Isles of Scilly is an archipelago off the coast Cornwall and has approximately 2100 people living across five islands. Due to its size the islands have a single care home that provides domiciliary care, day care, respite and long-term residential care for islanders. This service is funded, staffed and managed by the Isles of Scilly Council Adult Social Care department.
We have a bespoke service centred on the needs of a very small island community and how Adult Social Care responds to its demands from the community.
As a result there has been a 100% response rate due to there being one residential service that also provides domiciliary care. Due to its size and lack of market forces competition, it has been difficult to assess how best to use this information.
As a result of the above it is not possible to provide a mean.
Staff within this establishment are paid above the national minimum wage, with a market forces supplement to make the salary more competitive within the island environment. They are paid as part of the Council of the Isles of Scilly pay scheme, who are green book employers. Wages are negotiated on a national level, ensuring pay keeps in line with national pay scales.
The data for both services was taken from 2022. Increases in costs to the service are part of the council’s yearly financial structure increases and are based around the current/projected inflationary pressures. The proposed costs go through councillors, to ensure that the community are in agreement with how services are funded.
Pressures within the care home are mainly retention of staff, providing a responsive service that supports effective day care provision, respite, reablement and long-term care. The staffing structure currently enables flexibility to increase or decrease staffing when required. It is not possible to employ agency staff, due to the small island environment. Therefore both the domiciliary care and the residential care have bank staff. In addition to this it can be difficult to provide domiciliary care support to off island residents, due to weather, tides and other extraordinary circumstances. Each island has a first responder who can support in an emergency.
Due to its geographical size domiciliary care has very limited travel time, i.e. 2 to 5 minutes and is therefore factored into the care time. Domiciliary care in the community is carried out in a time efficient way that minimises the cost for each person. However the vast majority of the support that takes place is for older people and will therefore generally go up, not down, as health deteriorates. Due to its ability to respond, the islands can generally make changes to visit length by reassessing/reviewing within a 24 - 48-hour process. This again reduces the strain on the service and enables the domiciliary care service to be more efficient.
The pay for staff within the domiciliary care services are above the national minimum wage with a market forces supplement to make the job more competitive within the island environment. They are paid as part of the Council of the Isles of Scilly pay scheme, who are green book employees. Wages are negotiated on a national level, ensuring pay keeps line with national pay
Work has begun to look at individuals who are currently self-funding and then due to changes in legislation may not continue to pay for their own care. This work has highlighted that it will affect a small number of people. However, it would also indicate that individuals coming into the service in the short term, may not be self-funders and may be required to pay contributions, or be funded by the local authority. This will not have a significant immediate effect on adult social care funding.
The council of the Isles of Scilly has a housing strategy to provide affordable and key worker accommodation on the islands that will support the sustainability of key services, including care services.
