In 2021, when the Government published ‘People at the Heart of Care‘ an important element of the white paper required local authorities to promote market sustainability.
As a result, Dorset Council worked with social care providers, including Dimensions, to develop an analysis of the cost of delivering care services and used this as the basis for its decisions about what to pay for care.
This ‘Cost of Care’ exercise was carried out by ARCC, an independent consultancy, to ensure it was fair. As a result, Dorset increased the rate it pays providers to a level that allowed Dimensions to pay competitively in the local jobs market.
Fair pay supports higher quality care
Dimensions in Dorset is now able to choose the best candidate for each job, with less money spent on agency fees and more managers per person supported, even allowing for complexity of individual needs. Because Dimensions has longstanding colleagues who know the people they support well, the quality of that support is high, morale is high and staff retention is high.
Vikki Lee-Dampier, Dimensions Operations Director for the South region, said: “I’m co-chair of the Provider Forum in this area and during the pandemic there was a lot of feedback saying that we were losing staff to retail and hospitality. The commissioning team listened to providers and fair pay became the focus of the local authority.”
Dorset Council also funded a Care Association for the county and agreed to fund registration to the group for providers during the first year, to get it off the ground.
This forum is an important collective voice for providers because it can speak on their behalf without any organisation risking its reputation with a commissioner by voicing criticism.
The Care Association works closely with the commissioning team and has continued to focus on fair pay for all health and social care providers. As a direct result of the uplift in fees, 130 full time posts have been filled compared with a number in the 90s during the pandemic. And over the New Year period of 2023, Dimensions received an outstanding rating from CQC for the Dorset support.
Fair pay for better recruitment
An individual Dimensions supports wanted to move into their own home just after the ‘Cost of Care’ exercise and there were concerns suitable colleagues could not be found, because recruitment adverts had been out for months with no applicants.
Vikki-Lee Dampier said: “As the applications started coming through as a result of the uplift in pay, we were soon able to recruit a fully funded team.”
One man who was supported by agency staff on occasions was having between 7 and 14 behaviours of distress a week, which has reduced to about one a month as a result of support from a consistent staff team.
Fair pay supports independent lives
When Leonard Cheshire closed its homes during COVID, Dimensions was able to support three women to move into a home together.
Vikki said: “They’ve got a consistent team of people. One of the women has significant autism and she can really hurt herself when she’s distressed. So there was a lot of worry around the transition. She lived with Leonard Cheshire for 16 years, so there was concern that this transition could go wrong and it could really upset her. And yet, she hasn’t been distressed once.”
In its inspection, CQC stated the home was: “People-led, inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were absolutely at the centre of collaborative and respectful circles of support. Staff valued the knowledge and experience of people’s relatives and held them in high regard.”
Working with families
Dimensions works with families to ensure better outcomes for the people they support, including he mother of a young woman who has never trusted a provider to support her daughter before.
She’s always supported her daughter herself, and selected her own help via managing a Personal Health Budget. But she’s now handing the reins over to Dimensions. Vikki is leading on the support planning by working closely with her mother to ensure the support is person-centred and individual.
Commissioning a fair cost of care
All local authorities should prioritise carrying out a fair ‘Cost of Care’ exercise.
In Dorset, the council extended the deadline to increase the number of responses from providers and repeated the exercise the following year. It also supported a care association to give providers an opportunity to discuss issues.
The care association joined the provider forum which is a group for learning, partnership working and sharing best practice. In Dorset the providers were able to speak openly about the problems they were facing and compile questions for commissioners and give them time to research and find the answer rather than putting them on them on the spot in a meeting. This has improved partnership working significantly.
Dorset Council knew that the existing provider forum wasn’t working as well as it could and it took steps to support and improve it and provide financial help. The situation was different before the fair ‘Cost of Care’ exercise, with providers having to hand back packages of support.
Dorset has agreed to stick to its care framework and as a result it avoids negotiated rates. It’s a good example of effective collaboration and partnership between commissioners and providers. When the Dimensions support in Dorset is fully staffed there are 130 full time posts and before the cost of care exercise recruitment levels were in the 90s and yet after the first cost of care exercise the numbers started to build and now recruitment stands at 110% in some of the homes.
Partnership working has been so successful between providers and the commissioning team at Dorset Council that it has asked Vikki from Dimensions, The Care Association and a couple of other providers to be part of its peer review ahead of its first inspection by CQC.