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Integrated Strategic Commissioning

This page provides information about the integrated strategic commissioning function for Adult and Health Services, Children and Young People's Services and NHS North East and North Cumbria Integrated Care Board.

'Commissioning' is the process of specifying, securing and monitoring services to meet the needs of individuals both in the short and long-term. This often involves joint commissioning with both internal and external partners.

We are responsible for commissioning services for children, young people and adults and also public health initiatives. This work includes forecasting demand for services, ensuring quality and market development and operating a robust commissioning and contracting process. This includes providing accountability in our contract processes, ensuring high quality services and delivering value for money. We manage relationships with a large and diverse number of service providers, within the health and social care sector and wider sectors. As an integrated strategic commissioning team, we work with partners to ensure effective commissioning to support the delivery of strategic priorities.

To assist in this, we have developed The local market for children's, adults, public health and housing services which brings together key information about our priorities and upcoming opportunities for the market, including the housing market for children and adults. The MPS does not contain statistical information about all the service user groups that we work with - this information is contained in the County Durham Joint Strategic Needs Assessment (JSNA).

'Fair Cost of Care' process 2022

In early 2022 all Local Authorities were asked by the Government to carry out a survey on the care costs ('Cost of Care') of care homes for older people and domiciliary (home) care services. This was linked to the then planned implementation in October 2023 of national reforms to adult social care funding and the charging regime. Those reforms have since been deferred to at least October 2025, subject of course to any further changes which may occur nationally in the interim period.

In terms of care homes specifically, the national funding reforms would have led to more people being eligible for Council funding than is currently the case. There would be some variation in the impact of this across the different areas of the UK, as the level of assets that individuals have typically varies by region and area. As many care homes for older people charge higher fees to private residents, reforms could have led to financial issues for both care home operators and local authorities.  Our understanding was that the Government's intention was for the 'Cost of Care' survey to provide an indication of the extent to which fees paid by Local Authorities may need to rise as this change took effect, to help minimise the impact on care home operators. 

The Government had also carried out financial modelling which suggested that some Local Authorities were paying both care home and domiciliary (home) care fees which may not be at a level necessary to sustain the long-term viability of the services.  Further information can be found in the Department of Health and Social Care (DHSC) impact assessment on charging reform.

In accordance with DHSC guidance, the Council submitted the documents required by DHSC on the results of the 'Cost of Care' surveys as well as a provisional 'Market Sustainability Plan' (MSP) in mid-October 2022. The Council did not share or publish these documents at the time, based on national guidance outlining that DHSC planned to review Local Authority submissions and to engage with Local Authorities to ensure that submissions were covering the required detail and were based on sound evidence, and that DHSC would ask Local Authorities to publish 'Cost of Care' reports at a point following the deadline for submission.  The Council to date has not received any feedback from DHSC. DHSC has subsequently advised Local Authorities in late December 2022 that they should publish the 'Cost of Care' reports by 1 February 2023.

The documents as submitted to DHSC are available below:

Please note that these documents fail the minimum legal accessibility requirements. Please contact us if you require assistance with them.

    These are the Durham care home and domiciliary care 'Cost of Care' reports and the provisional Durham MSP. Note that the Council is not required to publish the provisional MSP under the DHSC's guidance but have decided to do so to aid transparency.  DHSC have confirmed that the current expectation is for Councils to submit to them a final MSP by the end of the current financial year and the Council is currently working on this. The MSP which we are sharing here should therefore be read as a provisional plan which is subject to change and providers should also be aware that some of the information included may now be of more historical interest, since the Government decision to delay the national charging reforms. Should Government decide to implement charging reforms in 2025 some of this information may again become relevant and the Council will comply with all national requirements should this lead to further local work.  We would also like to clarify that DHSC have indicated that they may still ask some Local Authorities to review the documents which they have submitted, we will keep providers informed should this be the case in Durham.

    As explained in the documents, the Council position is that while the surveys provided some useful information about the costs of services put forward by providers who completed the survey and engaged in the process, there are significant data issues and some fundamental underlying principles which present challenges with using the results as a direct guide to future fee levels.  We understand that a similar conclusion was reached by many other Local Authorities.  DHSC have also made it clear that the outcome of the 'Cost of Care' exercise is not intended to be a replacement for the fee-setting element of Local Authority commissioning processes or individual contract negotiations.

    Providers should also note that the Council assumed, based on DHSC guidance and feedback, that the technical requirements of the exercise were for the Council to report unadjusted figures (including medians) in its feedback to DHSC. This was also influenced by our previous understanding that allocations of 'Cost of Care' funding to Councils may have been at least partly determined by the results submitted by Local Authorities. The National funding which was made available to "fund" these reforms has been reallocated and distributed as a Social Care Grant with explicit conditions that it is being provided to help Local Authorities fund inflationary and demographic pressures in Children's and Adults Social Care. There are a range of such pressures across non-Older People care home and domiciliary care markets. We understand that funding is no longer linked to 'Cost of Care' data.

    Given the concerns over the data set out in 'Cost of Care' reports as attached, the Council intends to carry out some detailed work on the adjustments that will need to be made to the 'Cost of Care' data before this can be used as one of our range of indicators to assist with future fee setting, either now or post funding reform.  Specifically, for care homes the Council will use DHSC guidance to make adjustments in respect of Return on Capital, Return on Operations and Occupancy. For domiciliary (home) care, the Council intends to carry out work to further understand the impact of Direct Contact and Travel Time on indicative fee levels.

    The Council is committed to working with providers on these areas and will do so through the usual meetings and forums held to facilitate joint working, building on the 'Cost of Care' and MSP work we have carried out in partnership over the last year.