A lack of both funding and staff is resulting in the homecare sector struggling to stay afloat in some areas, according to a new report from The King’s Fund and the University of York.
Home care in England: views from commissioners and providers has found that the market for homecare providers is extremely fragile, with squeezed margins and low fees forcing providers to leave. In 2017, providers handed back homecare contracts in more than one in three local authorities, and some of the largest providers have withdrawn from the publicly-funded homecare market altogether.
Staff shortages are a ‘relentless challenge’ for homecare providers in many places. The report highlights concerns that fees paid by some local authorities are too low to maintain quality services, resulting in high turnover of providers and staff, which has negative impacts on continuity of care, as well as potentially wider effects on care quality. Researchers also uncovered fears that some staff are being paid below legal minimum wage levels.
The report has also found that:
- Four in 10 homecare workers leave their role every year.
- More than half of homecare workers are on zero hours contracts.
- In 2016/17 around 500 new homecare agencies registered each quarter and 400 left the market.
- In a 2017 survey, many council directors of adult social services had experienced homecare providers ceasing to trade in the previous six months (39%) or having contracts handed back (37%).
The findings are published as Allied Healthcare, is sold and transfers many of its contracts to other providers. It highlights how the homecare sector is struggling, affecting more than 400,000 older and disabled people who rely on it for support with daily living.
Faced with reductions in their central Government grant, council spending on social care was 3% lower in 2017/18 than in 2009/10. Part of this reduction has been achieved by holding down the amount local authorities pay providers for care. Analysis suggests a link between prices paid by councils and the quality of homecare. Despite this, some local authority commissioners are sceptical that increasing fees will boost quality or staff wages, fearing the extra funding will go into care providers' profits.
Based on interviews with homecare providers and local authority commissioners, it also found criticism of a simplistic ‘time and task’ approach to commissioning, under which providers are paid per hour to provide care but with no measurement of the outcomes achieved. The report concludes that homecare needs to move away from ‘time and task’ payments to commissioning services based on achieving outcomes for people, integrated more closely with health care services.
Simon Bottery, Senior Fellow for Social Care at The King’s Fund said, 'Squeezed funding and a shortage of workers have left the homecare sector in a fragile state. Homecare providers are competing for staff with other sectors paying higher wages, offering more stable employment and better working conditions.
'The 249 million hours of home care delivered each year, much of it publicly-funded, has huge potential to improve people’s health and promote their independence. The system needs a fundamental overhaul, beginning with the upcoming Green Paper, but the prize of a better, more effective home care service is worth having.'
Glen Garrod, President of the Association of Directors of Adult Social Services said, 'These findings reinforce our calls for new money to be immediately injected into adult social care to give the sector much-needed stability and provide the vital daily support that older and disabled people rely on.
'Councils continue to work hard to commission high quality services but as our recent snap survey found, directors of adult social care have serious concerns around whether they have enough funding to enable them to meet their legal duties to provide care and support for older people.
'Without new money, we risk seeing more providers either cease trading or hand back contracts to councils.
'...Government simply must consider funding beyond 2018/19. We need long term, sustainable funding whether through the promised Green Paper or otherwise. Without an appropriate package of recognition and reward for the skilled and dedicated workers in social care we may find little success in the national adult social care recruitment campaign which is looking to attract more people with the right skills and qualities to work in the care sector.'
Nadra Ahmed OBE, co-convenor of the Cavendish Coalition and Chairman of National Care Association, said, 'It is vital the Government gets its new immigration policy right if we are to keep health and social care services open.
'If we do not address the issue of the social care crisis we will be letting down some of the most vulnerable members of our society and creating additional challenges for the NHS by forcing those, who could be cared for within the social care setting, into overcrowded emergency services in local hospitals.
'The social care sector cannot survive without a migrant workforce from EU countries: we are hugely disappointed it has taken so long for staff to be given reassurances about their future in the UK.
'If the Government follows the guidance of this autumn’s Migration Advisory Committee report, as it has indicated it will, there could be yet more pressure on the ability to deliver care services based on vacancy rates of 110,000 at any given time in the UK.
'Vital and valued lower paid colleagues would be effectively cut-off by a salary threshold of £30,000 with no special allowance unlike that recommended for seasonal agricultural workers.
'It would be completely unacceptable to allow social care services to close under the strain of not having the workforce required to provide the necessary care and support to vulnerable citizens when they most need it.
'We look forward to engaging with the Government over the coming months to ensure the final proposals in the immigration white paper meet the requirements of the health and social care sector.'