Summary of UKHCA comments to Health and Social
Care Board on homecare services in Northern Ireland
UKHCA welcomes the opportunity to make representations to the Health and
Social Care Board about the funding of homecare services in Northern Ireland.
Homecare services in Northern Ireland are a vital component of people’s care
and support.
UKHCA recognises the temporary funding made available by DHSSPS to ward-off
short-term provider failure this financial year, but we urge the Board to take
action to secure the stability and quality of the homecare sector’s services in
coming financial years.
The sector in Northern Ireland has been significantly underfunded by the Health
and Social Care system. The situation has been exacerbated by:
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Increases in National Minimum Wage during the life of existing contracts;
The introduction of the National Living Wage from April 2016;
An apparent lack of engagement with homecare providers to understand
the actual costs of care;
Delays in re-tendering contracts by HSC Trusts;
A disproportionate use of very short homecare visits affecting the delivery
of care and compliance with National Minimum Wage Regulations.
Consequences for care and health system in NI
In our view, the position of the homecare sector in Northern Ireland has a
number of significant risks to people, careworkers and providers:
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A risk that people receiving support experience rushed, undignified care;
Careworkers’ receiving inadequate terms and conditions of employment;
Increasing difficulty recruiting and retaining suitably skilled and
experienced careworkers;
Risks to quality from underfunded training for careworkers;
An increase in delayed discharges from hospital due to lack of capacity in
the homecare sector;
Employers at risk of non-compliance with National Minimum Wage;
Increasing likelihood of planned market exit or financial collapse of
providers.
Evidence of inadequate funding
Rates paid for homecare in NI are significantly lower than the rest of the UK.
Freedom of Information enquiries by UKHCA in September 2014 found the
lowest average prices for homecare in NI, compared to the rest of the United
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Kingdom - £11.35/hour in NI, compared to £13.77/hour in England (see
Appendix 1).
An on-line survey by UKHCA in January 2016 found that median price for 1 hour
of homecare was £12.16/hour in Northern Ireland, compared to £13.57/hour in
England (see Appendix 2).
Northern Ireland’s HSC Trusts commission significantly shorter homecare visits
than the rest of the UK (see Appendix 3). We believe that this is a symptom of
Trusts rationing available funds and it increases the risks of non-compliance with
National Minimum Wage.
We estimated that 87% of homecare visits in NI are 30 minutes or fewer and
28% are 15 minutes or fewer.
The Trusts pay for “contact time” (the time spent in the service user’s home),
but providers must also cover applicable travel time in order to comply with
NMW. Short visits increase travel time as a proportion of “contact time” which
has to be met from fees paid for short visits. When combined with inadequate
rates paid to providers potentially results in visit times being reduced below
those commissioned, in order to meet the additional costs of travel time and
comply with the National Minimum Wage Regulations.
Understanding the costs of homecare
UKHCA publish a Minimum Price for Homecare (see Appendix 4), which increases
to £16.70/hour following the introduction of the National Living Wage in April
2016 (compare this with the median hourly rate of £12.16/hour in NI).
The assumptions underpinning UKHCA’s Minimum Price are published, and have
been previously shared with the Board. The underlying principle is that
providers should cover their costs, including their legal obligations to pay the
National Minimum Wage.
Wages, travel time and on-costs in UKHCA’s Minimum Price equal £11.94/hour,
leaving little for providers to operate and manage the business (including
compliance with regulation) and to make a profit/surplus to remain in business.
We are not aware of any recent exercise conducted by the Northern Ireland’s
Health and Social Care system to understand the actual costs of homecare
services purchased and assure viability of services. In fact, the pricing of
homecare services seems to be determined by what the Trusts are willing to
pay, regardless of actual cost. We believe that this will dramatically increase the
risks of provider failure.
Is a national homecare tariff the solution?
Not necessarily. However, given the unsustainable rates that Trusts are paying,
it might be a reasonable solution.
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Arguments in favour:
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A tariff would require a robust estimation of providers’ costs (and could
therefore generate a more sustainable price);
A tariff would provide a degree of certainty for providers.
Arguments against:
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A single tariff is unlikely to be sufficiently responsive to differences in
careworkers’ travel in urban and rural areas;
A single tariff may not be responsive to wage requirements in hard-torecruit areas (although this could be mitigated for in the calculations, or
the establishment of different tariffs for urban and rural areas).
Risks to market stability
We believe that there is a genuine risk of providers exiting the homecare
market. In a UK-wide survey of 492 homecare providers in 2015:
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69% of providers said they were planning to reduce amount of statefunded homecare they deliver next year;
Only 38% were fully confident they’d be trading this time next year.
UKHCA’s recommendations
UKHCA’s recommendations to the Health and Social Care Board:
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The Board sets a realistic budget that enables the Trusts to fund
homecare in 2016-17 and beyond, which recognises that the costs of
front-line careworkers are likely to be in excess of 80% of the hourly rate
in Northern Ireland;
The Board issues interim guidance to the Trusts on setting sustainable
fees for homecare providers;
The Board and the Trusts contribute to an urgent, independent economic
review, which must include providers and their representative bodies;
The Board considers the relative merits and risks of setting a national
tariff in any advice given to DHSSPS;
The Trusts are directed not to place ceiling prices in forthcoming tenders
which prevent providers from tendering sustainable rates;
The Board considers issuing guidance to the Trusts on the balance
between assessment of quality and lowest price when assessing tenders.
Author
Colin Angel, Policy Director, United Kingdom Homecare Association
colin.angel@ukhca.co.uk, www.ukhca.co.uk
7th March 2016
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£13.68
England
Wales
Scotland
£11.35
£14.28
Weighted average prices paid for homecare services in a
sample week in September 2014
£13.77
Appendix 1.
Northern
Ireland
Source: UKHCA (2015) The Homecare Deficit http://www.ukhca.co.uk/downloads.aspx?ID=458.
Southern
Western
Northern
Ireland
£13.57
Belfast
£12.16
South
Eastern
£10.54
£12.16
Northern
£11.12
£12.18
Median hourly rates reported by providers supplying to
Health and Social Care Trusts in January 2016
£12.50
Appendix 2.
England
Source: Rates reported by 14 homecare providers in Northern Ireland in an on-line survey in
January 2016, compared to a sample of 503 providers in England. Please note that the figures are
not directly comparable to those shown in Appendix 1 0.
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Appendix 3.
Homecare visit duration by UK administration, 2012
6%
10%
11%
12%
12%
27%
22%
19%
24%
4%
3%
6%
59%
63%
38%
31%
28%
10%
4%
England
Wales
15 min or fewer
16-30 minutes
11%
Scotland
31-45 minutes
46-60 minutes
Northern
Ireland
Over 1 hour
Source: Angel, C (2012) Care is not a commodity, page 16. URL:
www.ukhca.co.uk/downloads.aspx?ID=356.
Appendix 4.
UKHCA’s Minimum Price for Homecare
Source: Extracted from Angel, C (2016) A Minimum Price for Homecare, Version 3.1. URL:
www.ukhca.co.uk/downloads.aspx?ID=434.
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