Approach to calculation of the median

Hounslow feel that the median calculation is more suitable for larger data sets, whereas for small sample sizes the addition or removal of a single value can significantly impact the median. The method does not give weighting to relevant factors such as the actual number of clients supported by a provider – costs submitted by a provider supporting one Hounslow client would have an equal impact on the median calculation as a provider supporting 100 Hounslow clients. Additionally, the median calculation method diverges from current practice, whereby Hounslow uses a mean average calculation method to determine the iBCF rates.

As the median rate simply selects one value in the middle of the range of prices submitted by providers, this does not guarantee that a median rate will correspond with an accurate whole market rate. The median cost is derived from a sample of the care market that chose to provide data, so risks not being fully representative of the cost of care.

However, for the purpose of this exercise Hounslow considered three methods to calculate the median values:

Medians calculated using end per resident per week costings from each submission (table A)
Medians calculated at category subtotal level then summed (table B)
Medians calculated at line level, summed at subtotals, then subtotals summed (table C)

In line with the above, the calculation method used for Annex A is option 3. Option 1 was inappropriate as some category sample sizes were lower than 3. Option 2 was skewed by 2 abridged submissions. Option 3 gives the highest median calculations across such a small sample size. However, this method also maximized the data set available for inclusion. More evidence, submissions and benchmarking are required to fully achieve a Fair Cost of Care across 9 homes. 0/blank values have been excluded from the calculations of the medians.

Table A

Cost of Care Quartiles 21-22 – Bottom Line Median

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£931.64	£1,100.55	£1,338.74
Care Home occupied beds without nursing with dementia: Final Total	£931.64	£1,100.55	£1,338.74
Care Home occupied beds with nursing: Final Total *includes FNC	£1,107.68	£1,212.19	£1,400.68
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,107.68	£1,212.19	£1,400.68

Cost of Care Quartiles (Uplifted to 22-23 Figures) - Bottom Line Median

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£1,1006.17	£1,188.59	£1,445.84
Care Home occupied beds without nursing with dementia: Final Total	£1,1006.17	£1,188.59	£1,445.84
Care Home occupied beds with nursing: Final Total *includes FNC	£1,196.29	£1,309.17	£1,512.73
Care Home occupies beds with nursing, dementia: Final Total *includes FNC	£1,196.29	£1,309.17	£1,512.73

Potential Gap - Bottom Line Median

Bed Type	Hounslow Current Average Paid Rates	Median FCOC 22-23 (inflated using agreed method)	Gap
Care Home occupied beds without nursing: Final Total	£974.43	£1,188.59	22%
Care Home occupied beds without nursing with dementia: Final Total	£974.43	£1,188.59	22%
Care Home occupied beds with nursing: Final Total *includes FNC	£1,036.12	£1,309.17	26%
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,036.12	£1,309.17	26%

Table B

Cost of Care Quartiles 21-22 - Subtotal Median

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£950.28	£1,123.87	£1,339.39
Care Home occupied beds without nursing with dementia: Final Total	£950.28	£1,123.87	£1,339.39
Care Home occupied beds with nursing: Final Total *includes FNC	£1,074.63	£1,305.47	£1,602.49
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,074.63	£1,305.47	£1,602.49

Cost of Care Quartiles (Uplifted to 22-23 Figures) - Subtotal Median

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£1,026.30	£1,213.78	£1,446.54
Care Home occupied beds without nursing with dementia: Final Total	£1,026.30	£1,213.78	£1,446.54
Care Home occupied beds with nursing: Final Total *includes FNC	£1,160.60	£1,409.90	£1,730.69
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,160.60	£1,409.90	£1,730.69

Potential Gap - Subtotal Median

Bed Type	Hounslow Current Average Paid Rates	Median FCOC 22-23 (inflated using agreed method)	Gap
Care Home occupied beds withour nursing: Final Total	£974.43	£1,213.78	25%
Care Home occupied beds without nursing with dementia: Final Total	£974.43	£1,213.78	25%
Care Home occupied beds with nursing: Final Total *includes FNC	£1,036.12	£1,409.90	36%
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,036.12	£1,409.90	36%

Table C

Cost of Care Quartiles 21-22

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£910.67	£1,156.70	£1,526.29
Care Home occupied beds without nursing with dementia: Final Total	£910.67	£1,156.70	£1,526.29
Care Home occupied beds with nursing: Final Total *includes FNC	£1,035.02	£1,338.30	£1,789.39
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,035.02	£1,338.30	£1,789.39

Cost of Care Quartiles (Uplifted to 22-23 Figures)

Bed Type	Lower Quartile	Median	Upper Quartile
Care Home occupied beds without nursing: Final Total	£983.52	£1,249.24	£1,648.39
Care Home occupied beds without nursing with dementia: Final Total	£983.52	£1,249.24	£1,648.39
Care Home occupied beds with nursing: Final Total *includes FNC	£1,117.82	£1,445.36	£1,932.54
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,117.82	£1,445.36	£1,932.54

Gap - Cost of Care

Bed Type	Hounslow Current Average Paid Rates	Median FCOC 22-23 (inflated using agreed method)	Gap
Care Home occupied beds without nursing: Final Total	£974.43	£1,249.24	28%
Care Home occupied beds without nursing with dementia: Final Total	£974.43	£1,249.24	28%
Care Home occupied beds with nursing: Final Total *includes FNC	£1,036.12	£1,445.36	40%
Care Home occupied beds with nursing, dementia: Final Total *includes FNC	£1,036.12	£1,445.36	40%