Homecare in the time of coronavirus

A call for urgent government investment to realise value and prevent multiple provider failure

Summary

People want to live well and independently at home. Preventing unnecessary admissions to care homes and hospitals, where there is currently an increased risk of COVID-19 infection and death, should be a priority. Supporting people at home, as far as possible, would be an intelligent and cost-effective strategy for the nation’s health and well-being.

Instead, the opposite is happening. The majority of public and private funding, as well as media attention, is focused on hospitals and care homes, which between them support only 0.5 million people at a time.

In contrast, over 10 million people at any one time receive or need support and care in their own homes, either from unpaid informal carers or paid-for homecare workers.

Over £152 billion of public funding is directed at the NHS, with only £6.2 billion to homecare, across the UK. So government spend on homecare is only 4 per cent that of the NHS.

Homecare in the time of coronavirus 1

As the poor relation, homecare is usually at the bottom of government and other decision-shapers’ priority lists, perhaps also because it is less visible than services delivered in care homes and hospitals.

State-funded homecare providers entered the COVID-19 pandemic in a severely weakened state, after decades of under-funding by successive national and local governments.

Terms and conditions for the homecare workforce delivering state-funded care are very poor, with at least 50 per cent of careworkers on zero hour contracts and many receiving wages on, or just above, the National Living Wage (NLW).

Many established care providers have given up providing state-funded homecare, either handing back local authority contracts or ceasing to trade altogether. New entrants to the sector tend to eschew council-funded care entirely, planning to supply private individuals willing to pay a sustainable price.

To help mitigate financial pressures due to the COVID-19 pandemic, central government gave £3.2 billion extra funding to local authorities in England. The expectation was that councils would use a substantial proportion of this to support social care providers.

In this article, we report on research conducted by the United Kingdom Homecare Association (UKHCA) up to 7 April 2020, which shows that insufficient amounts of the additional government funding have yet reached homecare providers, who are delivering critical services to keep people safe and well at home.

There are two key sources of increased homecare provider cost pressures:

  1. Rise in NLW of 6.25 per cent on 1 April 2020; and
  2. Exceptional costs due to the COVID-19 pandemic.
Homecare in the time of coronavirus 2

Our data on 131 out of 152 local authorities, collected up to 7 April 2020, show that the median fee rate for homecare being paid by councils was only £16.96 per hour, compared with a median for 2019/20 of £16.43 per hour.

This is substantially below the UKHCA Minimum Price for Homecare of £20.69 per hour. This is the amount we calculate to be needed, in normal times, for compliance with NLW, to meet other regulatory requirements, to operate in a financially sustainable way, and to generate a surplus of 3 per cent for investment, which is low by any standards.

We estimate that it would cost the government an additional £1.5 billion p.a., if every hour of state-funded homecare were to be paid at the UKHCA Minimum Price of £20.69 per hour. It is important to stress that this is based on the legal minimum wage, not on the higher pay rates we believe careworkers should receive to reflect their skill, experience and responsibility. For example, our costing model indicates that for pay rates of £12 per hour, councils would need to purchase homecare at a minimum of £28.50 per hour.

An independent analysis of provider costs, commissioned by UKHCA, estimates that costs due to COVID-19 have increased by nearly 25 percent against the median fee rate. For councils paying as little as £14 per hour, this represents a nearly 30 per cent increase in costs.

Key drivers of rising costs are personal protective equipment (PPE) and staffing costs (sick pay, overtime), with other costs including transport, training, remote working and IT being collectively significant.

The extra costs equate to an estimated additional £3.95 per hour of homecare delivered.

It is important to note that costs of PPE are continuing to rise. This is due to: a) an increased requirement for use, as COVID-19 has spread and guidance has changed; and b) a global shortage of supply, variation in distribution and price gouging.

Homecare in the time of coronavirus 3

From data collected, it is estimated that COVID-19 has had a negative impact of 15 per cent on homecare revenues. This is due mainly to both councils and citizens cancelling care visits, particularly self-funding clients.

Cancellations have arisen from: a) some councils suspending care visits to create capacity for hospital discharge, which did not materialise at scale; b) people shielding or self-isolating from the virus, in some cases exacerbated by fears due to careworkers not having appropriate PPE; c) a reduction in private demand; and d) economic contraction.

Together, this combines to give an average 35 to 40 percent financial hit to homecare.

Analysis of our initial data indicates that a 10 week outbreak would equate to £273m in additional costs for the homecare sector.

When providers approached councils to ask for financial help with increased costs due to COVID-19, our data show that 37 per cent responded positively and 36 per cent responded negatively, with the remainder giving mixed responses; 8 per cent did not respond at all.

Many of the councils who agreed to pay for some extra costs, or for planned care in advance, have constructed burdensome bureaucratic audit processes for invoicing. Some have also made it clear that they will be clawing back as much as possible later, potentially storing-up financial failures once emergency funding ends.

Councils are, themselves, facing huge financial pressures after years of austerity and have to balance their books. Extra costs for councils due to COVID-19 far exceed their income, even after additional central government funding.

Approximately 80 per cent of the UK’s homecare sector is comprised of small businesses, with fewer than 50 employees. Some large homecare companies operate as franchise models which are also made up of small companies.

Decline in revenues and rise in costs increases insolvency risks for the sector.

It is estimated that most small companies will run into solvency risks after 8 to 12 weeks if they have one month’s savings on hand to cover costs. Those with smaller reserves may face insolvency sooner.

Multiple insolvencies, particularly happening simultaneously, would pose an immediate problem for citizens, care providers and local authorities during the COVID-19 emergency. Local authorities are responsible for safeguarding and sourcing alternative placements. In normal times, other providers have absorbed the capacity when companies have ceased trading. It is less likely they will be willing or able to do so in the middle of a pandemic, particularly if provider failure happens at scale.

In addition to putting up to 500,000 jobs at risk, multiple provider failure could also create longer-term structural risks to the care sector, as homecare capacity could substantially diminish.

In turn, this could result in more people having to be placed in care homes or ending up in hospital unnecessarily. This would have a negative impact on people and their families; add unnecessary pressure to the NHS; and be more costly in the longer term.

Homecare in the time of coronavirus 4

According to NHS data, there are 34,456 patients in the NHS system awaiting transfer to home care.

Moving c. 8,600 patients (25 per cent of total) to the homecare sector would free up 8,600 beds in the NHS to support the response.

To fund this at an hourly rate of £24.63 per hour (UKHCA Minimum of £20.69 per hour plus £3.95 per hour of “COVID19 costs”), the homecare sector would require approximately £424K per day to support 8,600 new patients moved from the NHS compared with £2.9m in the NHS system.

It is critical that additional funding reaches homecare providers without delay to prevent simultaneous multiple provider failure within 8 to 12 weeks.

Given the pressures on local government and the nature of the emergency, we call on central government to:

  1. Mandate and fully fund, in a ring-fenced manner, a 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. It goes without saying that pay rates higher than NLW are required.
  2. Pay for additional costs incurred during COVID-19, particularly PPE and sick pay, regardless of the size of employer.
  3. Change the treatment of VAT from exempt to zero rated for social care, so that providers can recover input VAT costs. This would have limited impact on HM Treasury but would make a substantial positive difference to care providers.
  4. Exempt homecare agencies from business rates to create parity with care homes, which are not required to pay business rates.
  5. Consider payment of an emergency lump sum directly to providers, based on a common formula, as the Irish government has announced for care homes.
  6. Offer business grants to small and medium enterprises in homecare to enable them to survive the challenges of COVID-19.
  7. Cover the costs of the Care Quality Commission (CQC), to enable temporary suspension of regulatory fees paid by providers, while the CQC is performing roles other than inspection during the COVID-19 pandemic, as the Scottish Care Inspectorate has done. It should be noted that in Wales and Northern Ireland, providers are not required to pay for regulation. They do have to pay for registration of careworkers, which does not exist in England. In Northern Ireland fees for new registrants have been waived for 6 months.

Value of homecare

Preventing unnecessary admissions to care homes and hospitals, where there is currently an increased risk of COVID-19 infection and death, and supporting people at home as far as possible, would be an intelligent and cost-effective strategy.

Indeed, Italian doctors in Bergamo, at the epicentre of Italy’s coronavirus crisis, reflected that a focus on homecare and community health outreach, rather than on hospitals, would likely be a more successful approach to a pandemic. They wrote:

Homecare and mobile clinics avoid unnecessary movements and release pressure from hospitals. Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment.

Homecare in the time of coronavirus 5

Despite decades of talking and numerous reports, we still don’t have a credible national social and health care strategy.

Scientific evidence is clear that healthy lifespan depends more on the social determinants of health than on healthcare per se. Yet government, particularly HM Treasury, and the media, continue to focus attention and resources on the NHS.

National wealth and health, though, are intimately entwined. If we want the economy to thrive, we need our people to thrive.

And our people will thrive if they can live in the place they call home; connected to those they love; contributing to their communities; deriving purpose and meaning, as well as creating economic value, from work or voluntary activities they enjoy; with enough nutritious food to eat; opportunities and encouragement to keep body and mind active, through regular exercise and life-long learning; and receiving support and care when they need it.

Investing in helping people to live well at home, rather than simply focusing resources on acute healthcare, would pay dividends in the longer term.

Right now, the opposite is happening.

Homecare as the poor relation

Over £152 billion of public funding is directed at the NHS, with only £6.2 billion to homecare, across the UK. So government spend on homecare is only 4 per cent that of the NHS.

The state-funded homecare sector entered the COVID-19 pandemic in a severely weakened state, after decades of under-funding by successive national and local governments.

Terms and conditions for the homecare workforce delivering state-funded care are very poor, with at least 50 per cent of careworkers on zero hour contracts and many receiving wages on or just above the National Living Wage (NLW).

Many established care providers have given up providing state-funded homecare, either handing back local authority contracts or ceasing to trade altogether. New entrants to the sector tend to eschew council-funded care entirely, planning to supply private individuals willing to pay a sustainable price.

Far more people receive or need support and care at home than in residential care or hospitals, at any one time.

Due to the numbers involved, even a small change in the percentage of people able to remain at home leads to a substantial impact elsewhere in the system.

Homecare in the time of coronavirus 6

Hospitals and care homes have dominated news outlets for weeks. Headlines about deaths create more traction in the media than stories of the silent suffering of millions of families, struggling without required support and care at home.

According to NHS data, there are 34,456 patients in the NHS system awaiting transfer to homecare.

Moving c. 8,600 patients (25 per cent of total) to the homecare sector would free up 8,600 beds in the NHS to support the response.

To fund this at an hourly rate of £24.63 per hour (UKHCA Minimum of £20.69 per hour plus £3.95 per hour of “COVID19 costs”), the homecare sector would require approximately £424K per day to support 8,600 new patients moved from the NHS compared with £2.9m in the NHS system.

Homecare in the time of coronavirus 7

Government funding for social care during COVID-19

On 19 March 2020, central government announced £2.9 billion additional funding to strengthen care for the vulnerable, of which £1.6 billion went to local authorities and £1.3 billion to the NHS.

On 18 April 2020, government pledged a further £1.6 billion funding for local councils, as they respond to the coronavirus pandemic (COVID-19).

The Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) issued guidance to local authorities on 13 March 2020 and 9 April 2020 aimed at ensuring care provider resilience during COVID-19.

They recommended the following, which evidence suggests is completely inadequate:

  1. Increase in fee rates of 5 per cent to account for the rise in National Living Wage (NLW, which increased by 6.25 per cent, plus on-costs);
  2. Extra funds to assist with increased costs during COVID-19, of up to 10 per cent, to be reviewed after one month; and
  3. Advance payment on planned care, rather than payment in arrears on actual delivery, to assist with cash flow.

Despite this guidance, to date, insufficient amounts of this additional funding have reached homecare workers and their employers, who are delivering critical services to keep people safe and well at home.

Furthermore, opinion appears to be divided within local government on whether any of this money will be used to support the self-funded care market.

The self-funded homecare market has long been essential, as local authority eligibility criteria are now so high that many people of only moderate means, who need care, have to pay for themselves. Without vital homecare, more people would have to sell their houses to pay for care homes and pressure on the NHS would further increase.

The income from self-funded homecare enables many providers, particularly small and medium enterprises (SMEs) who often deliver to a mix of state and self-funded clients, to remain financially viable, as many local authority fee rates don’t cover their costs.

Costs of homecare in normal times

The United Kingdom Homecare Association, which represents and supports over 2000 providers of support and care at home, has long been championing the need for greater investment in the homecare sector.

UKHCA calculates a Minimum Price for Homecare. This accounts for the cost of compliance with National Living Wage and the other costs of running a homecare business. Much of the latter is related to the cost of compliance with regulatory requirements, which cannot be avoided.

Homecare in the time of coronavirus 8

The UKHCA Minimum Price for Homecare from 1 April 2020, when NLW increased to £8.72 per hour, is calculated to be £20.69 per hour, based on actual provider costs in normal times.

A number of councils and NHS commissioners will state that local conditions influence the costs of care in their area. Although this is true, local conditions are likely to mean that the costs are higher, rather than lower, than UKHCA’s Minimum Price for Homecare. This is because our rate is calculated on the minimum legal pay rate, NLW, which is unlikely to enable employers to recruit sufficient careworkers from their local labour market.

The costs of meeting regulatory requirements and other costs of running the business are shown in the graphic below.

Homecare in the time of coronavirus 9

In 2018, UKHCA made Freedom of Information requests to local authorities to ask for data on fee rates for homecare and hours commissioned. Only 1 in 7 councils were purchasing at or above the UKHCA Minimum Price for Homecare.

Homecare in the time of coronavirus 10

The position in 2020 has not materially changed since 2018 and the state-funded homecare sector has entered the new financial year and the COVID-19 pandemic in a highly fragile and barely sustainable state.

We estimate that it would cost an additional £1.5 billion p.a., if every hour of state-funded homecare were to be paid at the UKHCA Minimum Price of £20.69 per hour.

It is important to stress that this is based on the legal minimum wage, not on the higher pay rates we believe careworkers should receive to reflect their skill, experience and responsibility. For example, our costing model indicates that for pay rates of £12 per hour, councils would need to purchase homecare at a minimum of £28.50 per hour.

Costs of homecare during COVID-19

Independent analysis, commissioned by UKHCA, of additional costs incurred by homecare providers due to the coronavirus pandemic reveals an estimated extra cost of £3.95 per hour of homecare delivered.

Key drivers of the COVID-19 related cost increases are PPE, sick pay, overtime, training, transport, remote working and IT.

Homecare in the time of coronavirus 11

This represents a nearly 25 per cent increase in costs compared with normal, against the median fee rate paid by councils in 2019/20 of £16.43 per hour.

For councils paying as little as £14 per hour, this represents a nearly 30 per cent increase in costs.

Homecare in the time of coronavirus 12

It is important to note that costs of PPE are continuing to rise. This is due to an increase in items needed, driven by changing guidance, and a global shortage of PPE supplies, which together with price gouging, is fuelling rampant price inflation and price variability.

Staff absence

At the end of March, staff absence due to the need for self-isolating, shielding and illness was averaging 25 per cent, compared to normal sickness absence rates just below 3 per cent.

In the week commencing 13 April 2020, staff absence among a sample of larger homecare providers was between 11 and 16 per cent, with substantial regional variations. Absence levels appear to have remained at this level over the last week.

Government’s commitment to cover the costs of Statutory Sick Pay (SSP) does not apply to employers with more than 250 staff. In either case, homecare providers will be paying the careworker who covers the visit, who may also require an overtime payment. This means that many have at least double the staff costs whilst only receiving income for a single visit.

The Coronavirus Job Retention Scheme (CJRS) may be used to furlough employees who are shielding. In general, few social care employees have been furloughed to date, typically ranging from 0 to 0.5 per cent of their total workforce.

Despite staff absence rates being higher than normal, providers are reporting spare capacity for delivery. This is because people receiving homecare are cancelling or suspending care visits. This is discussed further below.

PPE

In normal times, only a minority of homecare providers working with complex care clients require the use of face masks and eye protection.

Now, due to COVID-19, government PPE guidance indicates that fluid repellent face masks and eye protection are required for almost every homecare visit.

Homecare in the time of coronavirus 13

Each day across the UK, we estimate there are over 2 million homecare visits (1.5 million per day in England alone).

Prior to COVID-19, face masks were available at an average of 12p each. In January, they cost c. 23p each; in February, c. 37p each; in March, c. 45p each; and the business as usual suppliers are warning that the next deliveries are likely to be c. £1 each or more. Some suppliers are already trying to charge £5 to £8 each for a standard IIR face mask and we saw one example of a retailer advertising face masks at £35.99 each.

Some smaller providers are incurring additional monthly costs of face masks of £13K, when previously they would have had close to zero cost for these items.

Some larger providers need to source between 50,000 and 600,000 face masks per week. At £1 each, this represents a monthly cost of between £200K and £2.4 million, which is currently unfunded.

As mentioned above, there is wide variation in PPE pricing due to: a) limited supply in the market; and b) price gouging.

Smaller providers have less purchasing power than larger providers to acquire PPE with bulk discounts.

For the purposes of this exercise, the assumption was that smaller providers were paying on the upper end of the cost spectrum and larger providers with better pricing power were on the lower end.

The assumption is based on one mask per visit according to current guidance. Whilst continued use of a mask beyond a single visit may be referenced in forthcoming (but currently unpublished) guidance, the practicality and acceptability of this for the workforce and people using services is uncertain, given the expectation of mask usage set in the guidance at the time of writing.

Local authority funding for homecare providers

UKHCA collected data from a sample of large homecare providers on the action of councils with regard to supporting the sector with rising costs; data collection was up to 7 April 2020. We are tracking payment of:

  1. Inflationary increases to cover the increase in NLW on 1 April 2020; and
  2. Extra costs incurred due to the coronavirus pandemic.

Homecare providers in the sample told us about the current arrangements for 250 homecare contracts they held with 131 authorities across England. There were between 1 and 6 responses per council (median = 2 responses per council).

Inflationary costs

• The median rate paid for homecare in 2019-20 was reported as £16.43 per hour.
• The median uplift up to 7 April 2020 was just 4.6 per cent, compared to an uplift of NLW of 6.25 per cent, plus on-costs.
• 86 councils had offered providers between 0 per cent and less than 5 per cent, suggesting that many are not yet meeting the LGA and ADASS recommendations in a substantive way.
• As of 7 April 2020, a number of councils were paying fee rates below £14.89 per hour. This is the amount required to cover the NLW of £8.72 per hour plus statutory employment on-costs (NI, pension, sick pay, holiday pay, travel and mileage) in normal times. This leaves less than nothing, to pay for the cost of meeting regulatory requirements and other costs of running the business, never mind the additional costs arising from the pandemic.

Homecare in the time of coronavirus 14

• The increase recommended by LGA and ADASS was 5 per cent for the costs of NLW, with a further (temporary) uplift of up to 10 per cent for COVID-19, which should produce an uplift of up to 15.5 per cent.
• The median uplifts offered so far were less than the LGA and ADASS recommendation to cover just the additional costs of NLW, before the costs of COVID-19 are taken into account.
• Based on these data, we calculate a median hourly rate for homecare being paid for 2020-21 (as at 7 April 2020) of £16.96 per hour (or £17.18 per hour where an uplift has been applied and we have data for both last year and this years’ price). This compares extremely unfavourably with UKHCA’s Minimum Price for Homecare for 2020-21 of £20.69 per hour, which was of course intended to cover providers’ costs in normal times, without reference to COVID-19.

Available data on 131 local authorities, up to 7 April 2020, suggests that:

• An uplift had only been confirmed in 56 per cent (141) of the contracts reported, however inadequate the median increase may be, as described above;
• The remaining 44 per cent of the data show that providers have not received a response at all or did not know what increase was coming.
• 30 per cent of councils (39) had not responded on any of the contracts the providers submitting data held with them, creating extreme uncertainty.

COVID-19 costs

We also asked providers to rate their councils’ response to supporting them during COVID-19.

• Only 37 per cent of councils were rated as having given a positive overall response.
• 36 per cent of councils responded negatively to requests from providers for financial help with extra costs due to the pandemic;
• 8 per cent of councils had not responded at all.
• The remainder of responses were mixed.

Many of the councils who agreed to pay for some extra costs, or for planned care in advance, have constructed burdensome bureaucratic audit processes for invoicing. Some have also made it clear that they will be clawing back as much as possible later, potentially storing-up financial failures once emergency funding ends.

Income changes as a result of COVID-19

Data collected from a sample of providers, including small and large, state-funded and private-pay funded, reveal that COVID-19 had an estimated 15 per cent negative impact on homecare revenues.

Lower revenue inflow means that any additional COVID-19 cost impacts are more pronounced.

Homecare in the time of coronavirus 15

Revenue reduction is due mainly to suspended or cancelled calls. These have arisen from:

a) Some councils suspending care visits to create capacity for hospital discharge, which did not materialise at scale;
b) People shielding or self-isolating from the virus, in some cases exacerbated by fears due to careworkers not having appropriate PPE;
c) A reduction in private demand; and
d) Economic contraction.

People cancelling their own care calls, or not seeking medical help when needed, could be contributing to the 51 per cent increase in deaths from all causes at home.

It is also possible that some of the deaths at home were due to COVID-19 and not recognised. At present, testing for homecare clients has not been made available, though availability of home-testing kits will help.

It is now understood that oxygen levels can fall to dangerously low levels before people experience breathlessness after infection with COVID-19. In some cases, death is preventable if oxygen is administered in time. Simple measurement of oxygen saturation at home, with a pulse oximeter, would highlight the need for hospital admission or mobile oxygen therapy before it is too late.

Financial impact of COVID-19

With an increased cost impact of nearly 25 percent or more and a negative revenue impact of 15 percent, there is a combined 35 to 40 percent financial hit to homecare providers.

Approximately 80 per cent of the UK homecare sector is comprised of small businesses with fewer than 50 employees. Some large homecare companies operate as franchise models which are also made up of small companies.

Decline in revenues and rise in costs increases insolvency risks for the sector.

It is estimated that most small companies will run into solvency risks after 8 to 12 weeks if they have one month’s savings on hand to cover costs. Those with smaller reserves may face insolvency sooner.

Homecare in the time of coronavirus 16

Potential multiple insolvencies, particularly simultaneously, would cause substantial problems for citizens, care providers and local authorities, who are responsible for safeguarding people and finding alternative placements.

In the past, other care providers have absorbed capacity from companies ceasing to trade. It is less clear they would be willing or able to do so in the middle of a pandemic, particularly if provider failure happens at scale.

In additional to putting up to 500,000 jobs at risk, multiple insolvencies could also pose longer-term structural risks to the care sector as homecare capacity could substantially diminish.

In turn, this could result in more people having to be placed in care homes or ending up in hospital unnecessarily. This would have a negative impact on people and their families; add unnecessary pressure to the NHS; and be more costly in the longer term.

Call to action to assist homecare during COVID-19

Urgent action is required to avert business failures, which risk harm to people who need support and care, and to the NHS.

It is critical that additional funding reaches homecare providers without delay to prevent simultaneous multiple provider failure within 8 to 12 weeks.

Given the pressures on local government and the nature of the emergency, we call on central government to:

  1. Mandate and fully fund, in a ring-fenced manner, a 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.
  2. Pay for additional costs incurred during COVID-19, particularly PPE and sick pay, regardless of the size of employer.
  3. Change the treatment of VAT from exempt to zero rated for social care, so that providers can recover input VAT costs. This would have little impact on HM Treasury but would make a substantial positive difference to care providers.
  4. Exempt homecare agencies from business rates to create parity with care homes, which are not required to pay business rates.
  5. Consider payment of an emergency lump sum directly to providers, based on a common formula, such as hours of homecare delivered per week, as the Irish government has announced for care homes.
  6. Offer business grants to small and medium enterprises in homecare to enable them to survive the challenges of COVID-19.
  7. Cover the costs of the Care Quality Commission (CQC), to enable temporary suspension of regulatory fees paid by providers, while the CQC is performing roles other than inspection during the COVID-19 pandemic, as the Scottish Care Inspectorate has done. It should be noted that in Wales and Northern Ireland, providers are not required to pay for regulation. They do have to pay for registration of careworkers, which does not exist in England. In Northern Ireland fees for new registrants have been waived for 6 months.

Conclusion

The majority of people want to remain in their own homes until the end of life.

Investing adequately in enabling people to live well and independently at home, could improve quality of life, extend healthy lifespan, reduce pressure on the NHS and save money for the health and care system.

Right now, during the COVID-19 pandemic, supporting people in their own homes could help to reduce spread of the coronavirus infection and prevent admission to care homes or hospital. Almost half of Europe’s deaths from COVID-19 are in care homes.

Homecare needs to be centre stage in a national social and healthcare strategy, where care homes and hospital are seen as a last resort.

National and local government need to act swiftly to ensure extra funds reach homecare providers, to prevent multiple provider failure within 8 to 12 weeks.