Funding and workforce – UKHCA’s submission to the Health & Social Care Select Committee’s inquiry

A sustainable and high-quality homecare service will benefit individuals, their families and communities, the NHS and the UK economy. Supporting people at home, as far as possible, is an intelligent and cost-effective strategy for the nation’s health and well-being. For social care to support the ambitions of the NHS Five Year Forward View, the real costs of homecare cannot continue to be ignored and provider’s willingness or ability to contract with local authorities and the NHS should not be taken for granted.

This blog is a summary of the main points covered in UKHCA’s submission to the Health & Social Care Select Committee’s inquiry into Funding and Workforce. UKHCA members can read the full submission at:  https://www.ukhca.co.uk/cons.aspx

UKHCA’s data showed that only 1 in 7 councils and a minority of CCGs were paying at least the UKHCA’s Minimum Price for Homecare of £20.69 per hour for 20/21, and the increased costs to providers as a result of Covid-19 are largely being ignored, especially the additional costs of PPE and covering staff absences through shielding and self-isolation.  We estimated the additional costs to be £3.95 per hour of homecare delivered.

Poor commissioning practices, such as purchasing homecare by the minute, and focusing on time and task is adding to the pressures for providers.  And yet a vibrant and sustainable homecare service is required to cope with forecasted demographic changes. In the short term, demand for homecare will likely increase to support people recovering from Covid-19, winter pressures, or discharge from hospital as the NHS tackles the backlog of elective surgery.  Adequate support for homecare providers is needed so people can be swiftly and safely discharged from hospital

Recruitment and retention of careworkers is the highest risk to homecare providers and a major threat to continuing to provide their service.  Careworkers have extraordinary skills particularly when providing care for people with the most complex needs.  These skills are supporting the NHS, and yet their dedication and expertise is largely unrecognised. The biggest impact on recruitment and retention of the workforce, and the overall financial viability of the homecare sector is the fees paid to homecare providers, by councils and the NHS.  In many cases fees do not cover the cost of paying the statutory requirements of the National Minimum Wage and pensions contributions. The ability of social care employers to recruit and retain staff has been exacerbated by the widening pay differentials between healthcare assistants employed in the NHS, and the pay of homecare workers in the independent and voluntary sectors.

The NHS and social care employers are trying to recruit from the same pool of employees, a pool which will shrink further from 1st January 2021 when the new points based immigration system is introduced cutting off non-UK applicants workers from applying for roles as careworkers. UKHCA have strongly made the case that careworkers should be accepted on the shortage occupation list. 

To begin to address recruitment and retention in homecare, the Government needs to settle the question of how to fund social care over the long term.  That settlement should mandate that commissioners of homecare within local councils and the NHS should be obliged to pay fee rates that allow for a sustainable and vibrant homecare sector which can invest in training, innovate with new technology and develop a more personalised approach to care in partnership with NHS community services.

There also needs to be a workforce strategy for social care that sits alongside the NHS People Plan. What is needed is a mandated, fully funded, and ring-fenced, national minimum rate for homecare, calculated using the UKHCA’s evidence-based model, which enables: a) careworkers to be recognised with terms and conditions on a par with equivalent skills and experience in the NHS; and b) providers to deliver high quality care, meeting or exceeding regulatory requirements.

Homecare providers and workers have been undervalued by national and local government and the general public, though the current pandemic has resulted in some increased appreciation of their worth and contribution to society.  Homecare needs to be recognised not only for its economic value to society but also for its potential to contribute to health and well-being of people by ensuring they remain independent in their own homes for as long as they choose to do so.  That will require:

  • investment in the homecare workforce 
  • Investment in prevention and rehabilitation services
  • minimum of 30 minutes, and preferably 1 hour, for homecare visits
  • prohibit ‘payment by the minute’
  • investment to speed-up the implementation of digital technology
  • funding for research and data collection to assist on development of new models of care
  • oversight by an independent body of local authority implementation of their duties under the Care Act 2014
  • reform VAT so “welfare services” “zero-rated” rather than “exempt” allowing homecare providers to re-claim their input taxes.
  • review fees homecare providers pay to the Care Quality Commission
  • make homecare providers exempt from business rates to create parity with care homes, which are not required to pay business rates.