The State of Homecare: a Social Care Provider Perspective

Valuing our Workforce and Unlocking the Potential of our Colleagues and Communities

Social care and more specifically, homecare funding and the sector is broken. This is nothing new but the pandemic has exaccerabeted and brought to the surface, the many issues that were already in existence. Local Authority funded homecare is a sector that runs on the goodwill of kind, caring and compassionate people, people that are on minimum wage and work more hours than what they are paid.

The Cost of Care: Accept the Reality

Providers are pushed to the brink of survival by the ever increasing requirements and expectations of CQC, HMRC, commissioner expectations and the Ethical Care Charter. As a provider, we cannot say it loud enough, we cannot deliver what is commissioned, meet HMRC minimum wage and employment terms and conditions, and meet CQC requirements within current commissioned hourly rates. The recent Homecare Deficit Report published by the UK Homecare Association highlighted that only 1 in 8 (13%) of councils are paying an average price at, or above, the Homecare Association’s Minimum Price for Homecare of £21.43 per hour, which is calculated as an absolute minimum to ensure compliance with the national legal minimum wage of £8.91 per hour, care regulations, and to enable sustainability of services.

We cannot deliver what is commissioned, meet HMRC minimum wage and employment terms and conditions, and deliver against CQC requirements and the Ethical Care Charter within current commissioned hourly rates.

Only 28% of public organisations were able to provide a calculation demonstrating a rationale for the fee rates paid for homecare. Some authorities involve providers in understanding their costs to build their calculation, but as a provider that has been involved in local cost of care exercises, we can demonstrate that these exercises, despite being conducted by external consultants, are skewed only to justify the commissioning of lower hourly rates of care and place increased pressure on providers to deliver against unrealistic expectations.

The Immediate and Short-term Challenges

As a provider we’re doing everything we can to retain our existing workforce and attract new Care Workers. We welcome the recent announcement to increase the Nationanal Minimum wage to £9.50 per hour, but urgently call on the Government to use the Spending Review to adequately fund this increase, along with increases in the National Insurance to fund the Health and Social Care Levy.

The Homecare Association’s recent submission for the Comprehensive Spending Review have requested a number of measures including a request for funding that is sufficient to allow for care to be paid at a fair rate that allows public sector commissioned care providers to pay fair and competitive wages to careworkers, without reducing the amount of care being delivered.

Local Authorities and providers are being squeezed and we cannot sustain any further cuts in real terms. We need an additional 7.5% to fund the increase in National Insurance and National Minimum Wage.

The government must increase funding to local authorities to ensure a minimum increase of 7.5% in the hourly rate is passed on to homecare providers.

Recent reports from the CQC (State of Care Report), Skills for Care (State of Care Report), and the House of Commons Inquiry (Workforce Burnout and Resilience in the NHS and Social Care) have highlighted the impact of the Covid-19 Pandemic:

  1. Our homecare workforce is exhausted, depleted, and employed on poor pay, terms and conditions as a result of insufficient government funding and poor commissioning practices. Turnover and the number of vacancies unfilled is increasing. Levels of staff sickness have nearly doubled over the course of the pandemic. Providers are facing staff shortages caused by burnout and increased competition for staff from retail and leisure sectors.
  2. Demand is outstripping supply and there is substantial unmet need. Local Authorities have more people requiring and waiting for care services as a result of the current staffing crisis. Occupancy levels in care homes have fallen, with more people wanting care at home, this shift has been accelerated by the pandemic and mandatory Vaccination policy

Providers like ourselves are planning for policy and legislation changes that will take effect from the 1st April, but without government commitment to adequately fund these policies, including the additional costs of PPE, our ability to deliver services will be untenable.

We are asking the Government to adequately fund these short-term challenges, and indoing so, help stabilise the sector while designing a better system of care for the future.

A Future Homecare Model

We believe, and can demonstrate, that valuing our homecare workforce, paying people on a shift basis, is key to unlocking their potential and meeting the needs of people and communities. We invite policy makers, commissioners and other key stakeholders to talk with us, to listen to what we’ve learned and commission care differently. We need to move away from the hourly rate of commissioning, create a system that promotes trust, co-operation and flexibility, and uses data and performance metrics to understand what good looks like.