Most councils across England are using the Care Funding Calculator (CFC) to negotiate fees for residential care or supported living placements for people with learning disabilities, with reportedly significant savings made as a result. But how does the CFC work as an assessment tool for care managers? In an interview with Community Care, Buckinghamshire Council care manager Liz Williams, who has been using the tool for the past two years, explains its benefits.
More on the Care Funding Calculator
A free Excel-based tool produced by Improvement and Efficiency Social Enterprise (iESE), which supports councils to become more efficient.
Used by 125 councils across England to negotiate fees for residential care and supported living placements for people with learning disabilities. Not recommended for older people’s services.
Delivered £45m in savings across 51 of these councils from 2008-12, according to data collected by iESE.
It carries some support from providers. The Voluntary Organisations Disability Group (VODG) says that “despite some weaknesses” in costing assumptions, it is a “useful tool for calculating fees”.
Council and provider leaders have drawn up a protocol governing its use, which promotes fair negotiation, a balance of risk between providers and commissioners and an emphasis on outcomes for service users.
More information: Improvement and Efficiency Social Enterprise
For what assessments or reviews is the CFC used?
The CFC is used in standard reviews for people with learning disabilities in residential care or supported living in Buckinghamshire, and cases where people are moving into different accommodation to increase their independence or move closer to home, under the council’s My Life My Home (MLMH) programme. Williams carries out reviews under the MLMH programme.
How is it used?
Williams says the reviews she carries out have two parts: a narrative assessment, which aims to “get to understand the person in general terms”, and the CFC, which goes into much more detail about their care and support needs. She and colleagues take tablet computers with them to the reviews to input the information.
The information for the CFC assessment is drawn from the service user, where they are able to provide it, their family or wider circle of support, or from their existing provider’s support plan. The provider should be able to evidence how much support a person needs to carry out a particular activity from their daily support logs.
Inputting all the information on to the CFC spreadsheet, when you have it, takes about 30 minutes.
What questions does the CFC ask?
It asks about the activities, tasks and other needs that the service user requires support with, covering personal care, social activities, independent living skills and staying safe. For each, it asks about the level of support needed (in terms of staffing numbers and skill levels), the frequency with which it is needed, and the duration.
For instance, it asks whether the service user needs support to do their own laundry, whether this is shared support (with other service users) or 1:1 support, how many times a week, how often each time, and whether this requires a basic grade care worker, senior care worker or nurse.
There is also a section called “improving outcomes”, covering activities where the service user wants to gain greater independence but for which additional input may be required to help them to do so.
The structured nature of the CFC means that it acts as an “aide memoire” to ensure the assessment covers all relevant needs, says Williams.
What are the benefits of the CFC for care managers?
The CFC has made the process for agreeing placements and reviews less time-consuming, says Williams. Senior managers and panels have confidence in the CFC’s objectivity as a measure of need, meaning signing off new placements or changes in care packages is much quicker than before.
“Previously the process for negotiating placement costs was very time-consuming,” she says. “You had to involve senior management to get their authority.”
She also says it is good at tracking a service user’s progress in being able to do things for themselves.
“If you’re looking at someone moving towards independence you can look at how things have changed [between reviews] and the time reduction [in the support required to carry out a task]. It gives you quite a good measure of the time reduction.”
“It’s not cumbersome tool,” she says. “I’d struggle if I didn’t have it.”
What are the other benefits?
“It is equitable; the same parameters are being used by all the care managers,” she adds. “It doesn’t rely on the care manager being exceptionally persuasive to get their case through the panel.”
How personalised is the CFC to individuals’ needs?
Williams says that the detail that the CFC goes into enables it to be highly personalised.
“It’s very specific to the needs of the individual,” says Williams. “If someone needs 45 minutes for personal care that’s how much they need. It’s not about the provider allocating a block of time for personal care for every service user. It’s completely bespoke.”
Does it not focus care managers on cutting costs rather than identifying needs?
The CFC spreadsheet for care managers covers needs alone and not their costs. “It’s not a cost issue,” says Williams. “You are the practitioner who sits down with the home manager and support staff who is specifically asking about the person.”
A separate negotiator’s version of the CFC for commissioners is designed to help them specify a placement fee for the service user with the provider. Costs are generated for each service user by adding up the support hours required each week, and adding office, property and other staffing costs. Instead of providing a precise figure it gives a range to aid negotiation.
Care managers sometimes get involved in cost discussions where there is a dispute between provider and commissioner, she adds.
“Sometimes you need to work with the commissioners to help them understand where the provider is coming from. But you’re not going to get involved in the head-to-head negotiations.”
What effect does the CFC have on relations between councils and providers?
“It can help the provider be very clear about what they are providing and why. They can say ‘we’re providing three hours of key working for this person on Thursday and here’s why”. The CFC acts as a third party: it’s not the council, it’s not the provider.”