Research and analysis

Improved Better Care Fund (iBCF): provider fee reporting, 2020 to 2021

Published 16 December 2021

Applies to England

Main points

Local authority feedback indicates that the additional Improved Better Care Fund has enabled average fee uplifts in 2020 to 2021.

Over 90% of local authorities stated that they increased the average fees that they pay to external providers of home care: age 65 and over care homes without nursing, and age 65 and over care homes with nursing.

On a weighted average basis, first considering a counterfactual scenario where COVID-19 did not occur, local authorities reported that fee rates for home care – age 65 and over care homes without nursing, and age 65 and over care homes with nursing – would all have increased by 4.3% when compared to 2019 to 2020.

Also on a weighted average basis, considering reported fee rates actually paid excluding whole-market support such as the Infection Control Fund, local authorities reported that fee rates for home care increased by 6.2%, fee rates for age 65 and over care homes without nursing increased by 8.6% and fee rates for age 65 and over care homes with nursing increased by 9.2% when compared to 2019 to 2020.

Introduction

Adult social care provides support for older people and working age adults with personal and practical care needs, as well as support for their carers. In England, adults may be cared for informally by family, friends and neighbours, or formally through services that they or their local authority pay for. Publicly funded adult social care is means-tested and primarily funded through local government; those with eligible needs, assets of less than £23,250 and low incomes, can receive help towards their care and support costs.

Adult social care currently constitutes the largest area of discretionary expenditure for local authorities. To help address the pressures of an ageing population with increasingly complex care needs, increasing demand from younger adults who need support, and rising care costs, additional dedicated funding for adult social care has been made available to local authorities in recent years. This funding has included:

• adult social care support grants
• investment to ease NHS winter pressures
• the adult social care precept (flexibility to raise council tax)
• the Infection Control Fund and the Rapid Testing Fund
• the Improved Better Care Fund (iBCF)

This management information release provides data on fee levels and fee uplifts paid by local authorities to adult social care providers in the financial year 2020 to 2021. This information is reported annually by 150 local health and wellbeing boards, via a questionnaire collecting information as part of the fund reporting process.

This information was previously published by Ministry of Housing, Communities and Local Government (MHCLG), now the Department for Levelling Up, Housing and Communities (DLUHC). See the previous MHCLG 2019 to 2020 release alongside its data spreadsheet and questionnaire template.

Fees paid to external care providers

Due to delays relating to the coronavirus (COVID-19) pandemic, questions on provider fees were included at the end of quarter 4 of the financial year 2020 to 2021 (rather than at the end of quarter 2 as in previous years) to ascertain whether the additional iBCF funding was having an impact in helping local care markets through fee uplifts. While official unit cost data is already collated by NHS Digital through the Adult Social Care Finance Return (ASC-FR), it is published in the annual Adult Social Care Activity and Finance Report 6 months after the end of the financial year to which it relates. (The ASC-FR report for 2019 to 2020 was published in December 2020 and the ASC-FR report for 2020 to 2021 was published at its usual time of October 2021.) The iBCF collection is of added value because it specifically relates to external care providers and is more timely when running to its usual timetable. As described below, we have also added questions to understand the impact of COVID-19 on the data.

Respondents were asked to provide fee rates for 2020 to 2021 versus comparable data from 2019 to 2020. A similar set of questions were asked in September 2019, comparing the first 6 months of 2019 to 2020 with 2018 to 2019. For some local authorities, the fee rates in this release for 2019 to 2020 are significantly different from those collected in September 2019. Much of the difference will be due to final 2019 to 2020 data now being available that covers the whole of the financial year, but some may reflect inconsistencies in reporting.

There are also some inconsistencies when comparing 2019 to 2020 and 2020 to 2021 data to the ASC-FR report. Inconsistencies between ASC-FR and iBCF data will in part be explained by differences in definition and purpose. The iBCF return asks respondents to exclude full cost clients (people who must fully fund their care as they do not meet the needs and means eligibility thresholds for local authority care, but have asked the local authority to arrange their care on their behalf) as their fee rates may not be representative of those for local authority eligible clients, but for different reasons, the ASC-FR guidance asks respondents to include full cost clients. (Full cost clients are included in ASC-FR data because councils will be interested in the social care outcomes achieved for such clients.) The iBCF return also asked respondents not to include any of their own overheads, as the focus is on the payments made to care providers.

The collection of local authority fee rates has been complicated by the impact of the pandemic. In discussion with local authorities, we chose to collect:

1. fee rates for a counterfactual scenario where COVID-19 did not occur (with fee rates as reported by local authorities, for example based on expected fee uplifts)

2. actual fee rates (but excluding the impact of COVID-19 support provided to the whole market, such as through the Infection Control Fund)

The difference between them therefore partly reflects the impact of COVID-19.

Table 1 shows that, on average for a counterfactual scenario where COVID-19 did not occur, local authorities planned to increase the average hourly fees paid to external providers of home care to £18.34 per contact hour in 2020 to 2021 (a 4.3% increase on 2019 to 2020). With respect to age 65 and over care homes without nursing, the average fee was £623 per client per week (a 4.3% increase), and for age 65 and over care homes with nursing, the average fee was £705 per client per week excluding NHS Funded Nursing Care (a 4.3% increase). This compares with a 6.2% increase in the National Living Wage from £8.21 to £8.72 per hour in April 2020, and 1.0% CPIH inflation in the 12 months to March 2021 (the time of data collection). While wages are the largest cost for care providers, general inflation will affect their non-wage costs.

Table 2 shows that, for actual fee rates that reflect the impact of the pandemic (aside from support provided to the whole market such as the Infection Control Fund which is excluded) average hourly fees paid to external providers of home care were £18.68 per contact hour in 2020 to 2021 (a 6.2% increase on 2019 to 2020). With respect to age 65 and over care homes without nursing, the average fee was £649 per client per week (an 8.6% increase), and for age 65 and over care homes with nursing, the average fee was £737 per client per week, excluding NHS Funded Nursing Care (a 9.2% increase).

See the accompanying spreadsheet for full local authority data tables, including cartograms of fee rates and uplifts.

This release uses weighted averages that are consistent with the methods used by NHS Digital. Home care fees and uplifts are weighted by each local authority's mid-2019 population aged 18 and over, and care home fees and uplifts are weighted by the 2019 to 2020 NHS Digital unit cost denominators (the number of weeks of care) for externally run age 65 and over care homes without nursing and all age 65 and over care homes with nursing. A zero weight is assigned where fee or uplift data is missing. We chose not to use the 2020 to 2021 NHS Digital denominators, which will have been impacted by short run effects of COVID-19 and represent a departure from the timing used in previous reports.

For each of the 3 fee types for which data was collected and for both scenarios, most local authorities (over 90% in each case) reported that their average fees were increasing in comparison to 2019 to 2020. For the small number of cases where unit costs were reported to be falling and additional commentary provided, explanations included that:

• a new Complex Cases Team had identified joint packages of nursing care with health
• the full year's data is now available
• the local authority's fee rates had fallen due to variation in demand, intensity and location of placements

The small number of very high uplifts are in some cases described as being driven by the following factors, though inconsistencies in respondents' calculations may also play a role:

• paying staff on a shift basis in an area of high employment
• commissioning of additional capacity from providers with a higher rate than the prime provider
• increases in enhanced payments for dementia support

The range of local authority responses in respect to the annual percentage uplifts submitted for each category is illustrated in the accompanying full local authority level dataset.

Table 1: change in average fees paid to external care providers as at 2020 to 2021 (counterfactual if COVID-19 had not occurred)

Home care (£ per contact hour), care homes (£ per client per week)	External providers for home care	External providers of care homes without nursing for clients aged 65 and over	External providers of care homes with nursing for clients aged 65 and over
Local authority average fee 2019 to 2020	£17.59	£597	£676
Local authority average fee 2020 to 2021	£18.34	£623	£705
% increase	4.3%	4.3%	4.3%
Number of local authorities with increase (uplift)	140	138	135
Number of local authorities with no change	7	4	4
Number of local authorities with decrease	3	7	10
Number of local authorities with missing/invalid data	0	1	1

Table 2: change in average fees paid to external care providers as at 2020 to 2021 (reported fees excluding whole-market support such as the Infection Control Fund)

Home care: £ per contact hour, care homes: £ per client per week	External providers for home care	External providers of care homes without nursing for clients aged 65 and over	External providers of care homes with nursing for clients aged 65 and over
Local authority average fee 2019 to 2020	£17.59	£597	£676
Local authority average fee 2020 to 2021	£18.68	£649	£737
% increase	6.2%	8.6%	9.2%
Number of local authorities with increase (uplift)	141	142	140
Number of local authorities with no change	4	2	2
Number of local authorities with decrease	5	5	7
Number of local authorities with missing/invalid data	0	1	1

Acknowledgments

The Department of Health and Social Care (DHSC) would like to thank all 150 health and wellbeing boards for reporting the data which has been drawn on for this report. The iBCF quarterly data collection is managed by DHSC working in collaboration with DLUHC and supported by the Better Care Support Team (BCST).

About this data

Collection

Quarterly reporting for the additional iBCF was administered alongside the Better Care Fund (BCF) quarterly reporting by the Better Care Support Team (BCST) which is a team that is jointly funded by DHSC, DLUHC and NHS England to support the delivery of the BCF. All local areas submitted reporting returns on spreadsheet-based templates made available on the 'Better Care Exchange' which is the online collaboration platform for the BCF. 150 returns were received, with Cornwall and the Isles of Scilly submitting joint returns, giving a 100% response rate in total.

See the accompanying questionnaire template for full details of the questions used for collection.

Data quality

The status of the data was assessed prior to publication. Although cleaning took place to exclude invalid returns, the datasets were not subject to additional quality assurance. Local authorities were not, for example, contacted for clarifications and corrections except where data was obviously invalid. Some local authorities do show high or negative fee rate changes that are at least questionable. In these cases, we have still published the data to ensure transparency, as it is difficult to determine which are incorrect and which reflect substantial adjustments. The ‘Voluntary compliance with the Code of Practice for Statistics’ section below contains further information on data quality and quality assurance as part of voluntary compliance with the Code of Practice for Statistics.

For some local authorities, the fee rates in this release for 2019 to 2020 are significantly different from those collected in September 2019. Much of the difference will be due to final 2019 to 2020 data now being available that covers the whole of the financial year, but some may reflect inconsistencies in reporting. To avoid inconsistency between reported fee rates and percentage uplifts, the template only allowed respondents to enter fee rates. Percentage uplifts were then calculated and displayed to the user.

One local authority reported that they had provided care home fee rates net of user charges rather than gross of user charges as intended. We have suppressed the net figures and will clarify the collection spreadsheet when it is next used.

Data analysis

The analysis was undertaken and quality assured by DHSC with input from DLUHC. The data underwent a series of basic validation checks to exclude any invalid returns. However, as noted above, further clarifications from local authorities were not sought. See the accompanying spreadsheet for the full local authority level dataset.

Voluntary compliance with the Code of Practice for Statistics

The Code of Practice for Statistics was published in February 2018 to set standards for organisations in producing and publishing official statistics and ensure that statistics serve the public good.

This Improved Better Care Fund (iBCF) release is a management information release rather than an official statistics publication. This is due to the volume of qualitative information collected and limitations in the quality assurance process. Nonetheless, where possible, attempts to adhere to the code of practice have been made, which are outlined below.

Trustworthiness: trusted people, processes and analysis

Honesty and integrity (T1)

The iBCF quarterly and year-end reporting data releases are managed by analysts and policy officials in DHSC, working together with officials from DLUHC and the Better Care Support Team (BCST). This involves the design of data collection tools and analysis.

Independent decision making and leadership (T2)

The work is governed by the DHSC Social Care Evidence team, with input from DLUHC. It is accountable to DHSC’s Head of Profession for Statistics.

Orderly release (T3)

Access to the data before public release is limited to DHSC, DLUHC, BCST and NHS Digital staff involved in the production and the preparation of the release. We will follow the DHSC revision policy.

Transparent processes and management (T4)

DHSC have robust, transparent, data-management processes. All data are provided by local authorities who received notification that the data would be published. Data quality issues are clearly set out in this publication.

Professional capability (T5)

Analytical work is managed by professionally qualified and experienced analysts - professional members of the Government Economic Service, Government Statistical Service and the Government Social Research profession.

Data governance (T6)

DHSC uses robust data collection and release processes to ensure data confidentiality.

High quality: robust data, methods and processes

Suitable data sources (Q1)

Data originates from all health and wellbeing areas in England with data provided by all local authorities responsible for providing adult social care services, with this collection achieving a 100% response rate. The local authorities are ultimately responsible for the quality of their data, though the template clearly explains data requirements immediately above the data entry boxes. However, where the quality of data is unclear, the issues are clearly highlighted. Alternative National and Official Statistics are signposted where relevant.

Sound methods (Q2)

Data collection tools and processes are robustly designed and tested prior to use. The guidance, validations and questionnaire for the data collection have been refined over time. The approach to weighting is consistent with the Adult Social Care Finance Return from NHS Digital and the questions have been revised to capture COVID-19 impact.

Assured quality (Q3)

While the data has been checked for errors and quality assured by analysts in DHSC, further validation and triangulation with additional data sources has not taken place. As such, the release clearly states that the data are self-reported and highlights any limitations.

Public value: supporting society’s need for information and accessible to all

Relevance to users (V1)

Understanding how the additional iBCF funding is being used is of significance to central government, local authorities and their partners, as well as in the public interest.

Accessibility (V2)

Officials have had access to the data prior to publication to monitor progress and the impact of the iBCF. The data may therefore be used for operational purposes before publication in this data release. We have used accessible formatting to ensure the content is accessible to a wide range of users.

Clarity and insight (V3)

Data are clearly presented and explained, with suitable visualisations and underlying local authority level datasets made available.

Innovation and improvement (V4)

This data collection series started in Spring 2017 and has been progressively refined. We will continue to do so.

Efficiency and proportionality (V5)

Burdens on data providers have been considered. DHSC and DLUHC have worked to streamline the collection process by combining with the Better Care Fund performance reporting process from 2018 to 2019.

Accompanying tables

An accompanying spreadsheet is available to download alongside this release, containing local authority level data tables and cartograms.

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