Fair Cost of Care

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 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.