Our views on The Homecare Deficit Report 2016
On Tuesday 25th October 2016, the United Kingdom Homecare Association (UKHCA) published a report exposing what it describes as the ‘widespread and systematic underfunding of homecare services for older people’. The Homecare Deficit Report highlighted the under-resourcing of state-funded homecare using information obtained from Freedom of Information enquiries to councils in Britain, as well as Health and Social Care Trusts in Northern Ireland.
The report’s key findings were:
- There is an estimated funding gap of £513m in 2016/17 in state-funded homecare, which requires urgent action from the government and individual councils
- If this sum was invested in homecare services, it would stabilise the homecare sector and reduce spending on health services
- Only 13% of councils could explain how they calculated the cost of homecare following the introduction of the National Living Wage
- There are ‘genuine risks’ to the viability of state-funded homecare services for the half a million people supported at home
- Care workers’ pay and conditions are directly affected by low rates paid by councils, who purchase around 80% of all homecare in the UK
- Homecare costs will continue to rise due to the new statutory National Living Wage increasing from £7.20 per hour to £9 per hour by 2018/19.
SweetTree’s Founder Barry Sweetbaum has responded to the report. ‘I would like to acknowledge the report and give credit to the UKHCA for being bold and trying to address the problem by coming up with practical solutions, such as proposing a minimum rate for home care,’ Barry says. ‘The UKHCA has also done a very good job of identifying the scale of the problem by getting a 96% return rate on its Freedom of Information request. It has also identified that 13% of councils responding could not demonstrate a clear method for calculating how they cost out home care in their local area.’
Barry outlines his views on the current state of funding of the homecare sector, including why we have a ‘perfect storm’ ahead…
Those with moderate care needs are being ignored
‘Since 2009 there has been a dramatic reduction in the amount of money spent by councils on domiciliary care,’ he says. ‘However, the average number of hours provided to each individual receiving home care has increased by around 20%. What that says is that, as a nation, we are focusing heavily on the high dependency population living within their own homes. This means that all those with moderate levels of dependency who don’t warrant severe and substantial care needs are being ignored.’
A short-term saving can cause extra costs in the long-term
Neglecting those with moderate care requirements is a short-sighted approach as, in the long-term, those who don’t receive adequate care at home will suffer from problems such as falls, which will increase the likelihood of them going into hospital in the future. In such cases, hospital admissions could be avoided if they received adequate care. ‘They end up in hospital much more frequently and provide a much greater drain on national resources than if they were receiving the right level of care at home,’ says Barry.
The UKHCA report wrongly assumes a pay rate at the National Minimum Wage for all care workers, so the predicted £513m deficit may be conservative
‘Staff in a care home for frail elderly individuals will be paid at the National Minimum Wage, currently at £7.20 per hour,’ says Barry. ‘But the more complex the care, the more people are expected to have specialist skills and training. If they have that training, they should be paid more. The report makes no adjustment for the fact that people with a high level of dependency should be supported by people with greater skills and training experience, who therefore demand a higher salary. At SweetTree, we pay more to specialist staff looking after someone with a specialist need, such as a brain injury, than to staff providing general care for frail elderly individuals. So I would say that the £513m deficit mentioned in the report is understating the problem.’
Councils are using the NHS as a safety net when funds are tight
‘Councils have now reached a point where they have employed rationing techniques to limit who gets care to make sure their money goes to places they perceived to be the most in need,’ says Barry. ‘But they are also making decisions accepting that the NHS provides them with a safety net for the elderly, so when things go wrong, people are transferred to the NHS. This becomes a release valve for council budgets. Basically, it’s forwarding the heat onto the NHS. That’s more expensive, but it isn’t the council’s problem at that point.’
Fair pay is important, but so is overall quality of care
The UKHCA has recommended a rate of pay for home care of £16.70 per hour, which is realistic. ‘I think this rate that the UKHCA has come up with is an absolutely realistic rate for home care,’ says Barry.
Care should also be measured in terms of quality, not just in terms of fair rates of pay. ‘Quality is not only about pounds and pence,’ says Barry. ‘The amount of time allocated to clients in need of care has been significantly reduced to be 15, 30 or 45 minutes and you don’t get the opportunity to make a difference in clients’ lives on that amount of care. To truly provide meaningful healthcare to help people stay out of hospital and live independently in the community, they would be getting more time (per care visit) and the cost of that time would be more in line with the UKHCA’s recommendation of £16.70 per hour than it is the current fees paid by councils. Everybody deserves a reasonable quality of life and the whole pay argument is one that ends up with an erosion of quality of life and then you end up with an exodus of support workers wanting to work in the care sector.’
The solution is to take a holistic approach
‘The report is quite focused looking at very specific areas of the sector, when to solve the problem, we need to be looking at the situation in a holistic way,’ says Barry. ‘You can’t solve the needs of those in the community by changing the rates charged to local councils for care unless you also change the amount that local councils commission in terms of hours per person, per visit, for care.’
If you have any queries in relation to the report or this article please get in touch.