C.Co was commissioned by Bradford City Council, in partnership with Bradford City CCG, Bradford Districts CCG and the Bradford Care Association to undertake an independent and collaborative Cost of Care analysis exercise that produced the actual cost to deliver care and provide a robust evidence base, reflecting the local market to inform its fee setting process.
Working with the Council, CCG and the local providers, C.Co deployed a robust and methodical approach to understanding both the local market and the provider costs incurred in delivering Residential, Residential EMI, Nursing, Nursing EMI and Continuing Healthcare provision in Bradford.
- Established a means to arrive at a local cost of care;
- Developed an agreed process across the Bradford Care Association, CCG and Council.
- For Care home provision, with agreement from the providers categorised and analysed different staff costs associated with the delivery of residential, residential EMI, nursing, nursing EMI provision for both older and working age adults;
- Developed a local cost model that was informed by local data, based on actual costs incurred;
- Was collaborative, engaging providers in the methodology, data design and accurate data collection;
- Benchmarked findings against statistical comparators, as well as neighbouring authorities and national datasets;
- Provided audit and assurance of the existing BCC Cost of care model;
- Provided a banding structure for care fees across different client groups and provision;
- Produced fee levels for the council to formally consult upon;
- Provided recommendations on supplementary needs assessment (uplifts);
- Provided a methodology for calculating annual uplifts, ensuring the exercise provided long term sustainability for the council.
Working with similar stakeholders in Bradford
In accordance with CIPFA’s Cost of Care Guidance, C.Co worked collaboratively with providers to establish an accurate local cost of care. Further to a structured communication exercise with providers, C.Co delivered a series of workshops with providers to understand the cost elements that drive care delivery; including, but not limited to care worker costs, (e.g. salary, NI, Pension), business costs (food, management, overheads, property and capital) and profit margins.
The workshops engaged over 90 providers and involved collaboratively agreeing the cost elements to be included in the exercise, agreeing approaches to calculating corporate overheads, cost of capital and profit levels whilst also capturing feedback on current challenges (e.g. legislative challenges such as Waking Nights, Sleep Ins, National Minimum Wage, Employers Pension contributions and CQC requirements) and commissioning approaches. Providers including local single home organisations, to national organisations that operated across boundaries, engaged in the exercise.
The workshop exercise resulted in the co-design of the costing methodology and a data questionnaire which was issued to providers for them to feedback their local cost data for analysis. Agreeing commercial confidentiality, C.Co supported providers to compile consistent cost information through drop in sessions and telephone support.
On receipt of data, we undertook detailed and bespoke cost and quality modelling that provided the council and providers with a local actual cost of care for the borough (cost per hour, cost per week and cost per bed) across the in scope care categories. Our analysis accounted for the complex nature of residential care and the differing costs to deliver care (particularly staffing costs) across the care categories (residential, residential EMI, residential nursing, nursing EMI, palliative) to provide the council with a fair cost of care for each category. Our analysis was then further substantiated with Benchmarking analysis through statistical comparators.
A key enabler to the accuracy and completeness of responses was for Providers to feel a part of the process and not as though this is being ‘done’ to them. Historically, the council had a challenging relationship with providers. C.Co’s engagement expertise managed and mediated a situation of conflict to drive open communication and mutually beneficial results. In doing this we engaged with providers both before, during and after the costing exercise was undertaken, ensuring they were supported by our team throughout, encouraging ownership and understanding of the process, transparency throughout, as well as clarity on what the output of the exercise will be used for and how this may impact them in the future.
The output of the project was a robust evidence base that informed how the council set its care fees for the forthcoming years in a manner that supported the wellbeing of people who receive care and support, and was fair for the service providers ability to meet statutory requirements and also support a sustainable market of care in the context of local authority budget pressures. Our final product was in the form of a report and presentation to commissioners and providers.