Our aim with this section of the review is to describe the financial resources available and how they have been used in the care sector. On 01 October 2015 our Integrated Care Organisation (ICO) was formed to provide adult social care for people in Torbay. From a financial perspective, the council’s role as a commissioning body is to provide a funding contribution to the overall running costs of the ICO.
In 2022/23 the core contract value was £50.6 million plus £2.5 million held as a specific contract contingency with an additional £0.5m grant funding for adult social care market sustainability and improvement. In 2022/23 this contingency was fully used meaning a total contribution of £53.6 million was made to cover cost of client care and operational costs.
The ICO provides a diverse range of services, of which adult social care is a part. This aspect specifically comprises of care management and social care support across Torbay as well as the cost of social workers, community care workers, occupational therapists, physiotherapists, finance and benefit assessors and support service staff. Therefore, the council’s contribution towards ICO running costs aims to cover the cost of these staff, in addition to the actual cost of client care (outlined in more detail below).
The vast majority of adult social care is spent is on the purchase of client care (including residential, nursing, supported living and domiciliary care) from independent providers. The majority of these providers are based within Torbay; however, the ICO also funds some specialist residential care provided out of area. At any point in time there is on average 2,400 people receiving a service of some type.
Net expenditure on the cost of care totalled £61.8million in 2022/23. This is the net figure after taking in to account all client contributions towards the cost of care.
Under national legislation people assessed as having a social care need are also given an individual financial assessment. This assessment can result in a client being asked to contribute towards the cost of any care that the council then puts in place. The income collected from these client contributions in 2022/23 amounted to £14.8million. The total (gross) expenditure on services was therefore £76.6million and the allocation of this gross expenditure across different types of services is illustrated in the following chart.
View the Gross expenditure Breakdown in an accessible format
These services are provided to clients aged 18 and older, with a range of needs such as learning disabilities, mental health issues, dementia, as well as those with sensory or physical disabilities, vulnerable people, and the frail and elderly.
Throughout 2022/23 the trust has faced a number of challenges, driven by sustained pressure from the acute system and commercial market volatility.
There has been an increase in complexity and market fragility which has seen the average cost of packages of care rising throughout the year (over and above any inflationary uplift). Underpinning this is the dynamic between care work and hospitality work and the latter have increased renumeration to attract workers into their sector. To acknowledge this, the council, through national funding – adult social care market sustainability and improvement grant - has been able to increase some rates to residential / nursing providers for people older than 65.
Financial outlook for 2023/24 and beyond
The 2023/24 fee setting process (which incorporated additional increases linked to ASC Market Sustainability and Improvement grant) is now complete and a new structure communicated to providers. The fee uplift is on average 8.4% and takes into account employee cost increases through the National Living Wage and general inflationary uplifts. It is hoped this level of uplift will help stabilise the rates which are broadly in line with the rest of Devon.
The ICO and its partners are committed to ensuring resources are managed so that the ICO can provide the best level of care, for the highest number of clients. Both the council and NHS Devon acknowledge the pressures facing social care and continue to believe that the ICO is still best placed to manage these services (current agreement runs until 31 March 2025).
The ICO will aim to achieve this through the managing of resources across health and social care to deliver a more efficient and effective profile of expenditure. This is needed not only to maintain a financially stable and sustainable model of care, but one that can improve people’s experiences of the service. Such development will be done in consultation with the council and, where it is necessary to make changes to the way services are delivered. Consultation will take place with the people and carers who use those services.
