Care providers often come to us with concerns they face with local authorities failing to meet the cost of providing care at the standard that providers themselves deem necessary to maintain compliance with the regulations. Providers complain of being largely ignored by those in charge of making such decisions within the local authority and many consequently staff their services not in line with that which the local authority pays but instead at the level that providers deem appropriate, which can be in excess of that for which funding is provided.
Prevention is better than cure, and maintaining an understanding of what is required to provide care at the appropriate level, regularly and often, is key. Whilst there is no golden formula in respect of interacting with local authorities, continuing to provide evidence in respect of your costs and, importantly, the needs of service users will stand you in good stead. Looking at the dispute resolution and any fee review clauses within your contracts and complying with these offers a strong foundation against which any challenges to fees may be brought. You should utilise such mechanisms in order to stand the best prospects of success in any fee uplift. It is understandable that providers can fail to prioritise this task and significant funding gaps can develop in time if challenges are not made in a timely manner.
Ultimately, in order to achieve what you deem to be a fair fee for the delivery of care, taking into account all of the pressures upon your business, you should be ready and willing not to compromise on the fee the local authority pays. It is your business and irrespective of the local authority it is you who remains responsible for staffing and indeed running your service at the level that you deem to be appropriate to provide good care to your service users.
Providers must also be willing to serve notice on service users if the local authority is unable to meet your considered requests. This is a strong position which should be supported but is one few providers are willing to adopt. There is of course the business side of working in the sector but that is also necessarily intertwined with the caring side with good reason. It must be remembered no matter how it is communicated providers are essentially extensions of the state and you are acting on the state’s behalf in the provision of care for those that are funded by the state.
No matter the pressures on local authority and NHS budgets you as a provider should challenge and continue to apply pressure upon those fee payers. Some providers may consider it better to simply accept the fees they receive given the difficulty in making challenges which result in positive change in respect of the amount of fees received. This however may be a missed step. The caring business is a business and if the state funders of care state that their coffers only extend to meet costs which fall below that which you reasonably expect in line with your business model for providing good care then this should be unacceptable.
The challenge should be made regularly and often in line with your calculations in respect of staffing and the costs of running your service. Providers should interact with the provisions within contracts held with the local authority and should present cogent arguments in support of increased fees being necessary to meet the needs of service users. Providers should raise challenges on admission and regularly throughout the life of the service user in line with the service user’s presentation and material changes to service users’ needs.
Providers should be comfortable with the fees they are receiving in order to enable the provider to provide good care to service users and pay its staff enough so as to engender continuity of tenure both for staff and for the service users they care for.
Making the decision to challenge fees paid by the public purse is one that should be considered throughout the course of the provision of care at the service. Simply accepting the fees that are offered without proper scrutiny of the same should not be the default position. Providers should feel empowered to make their case for increases in fees and not be dissuaded from setting out their specific case for increases to fees whenever the need arises.