Addressing challenges
in homecare services
Colin Angel, Policy Director
Why is homecare so
important?

1.1m people already use homecare

Increasingly frail and disabled users

Care and Support White Paper:
 Services delivered in the community

Massive cost-savings delivered by
independent & voluntary sector
 They deliver 89% state-funded homecare, but…
 Threats to sustainability through public spending cuts
 Population not yet planning for their future care needs
@colintwangel
Today’s challenges
External




Aggressive costcutting / price-fixing
by councils
Internal

Reducing visit times

New purchasing
arrangements

Expectations of
transparency
Recruiting, retaining
and training the right
workforce
National Minimum
Wage compliance
Ensuring quality is
delivered and
demonstrated
@colintwangel
Recent reports into
homecare
@colintwangel
Priority issues in homecare
CQC Themed Inspection Report
Missed / late visits
Careworker continuity
• Consider electronic
monitoring systems
• Inform users of
unplanned changes
• Resist “call cramming”
• Training for coordinators
Quality monitoring
Staff training
• Need for QA Systems
• Performance review
• Record and act on
feedback from users
• Training & development
plans
@colintwangel
National media increasingly
interested in homecare
@colintwangel
Commissioning short visits:
73% are 30 minutes or fewer
63%
10%
<= 15
minutes
16-30
minutes
11%
10%
31-45
minutes
46-60
minutes
Source: Angel, C (2012) Care is not a commodity
6%
Over 1
hour
@colintwangel
Providers concerns over dignity
and safety from short visits
Dignity and safety at risk
Dignity at risk
87%
6%
7%
4%
27%
21%
19%
England
Wales
Scotland
Source: Angel, C (2012) Care is not a commodity
Northern
Ireland
@colintwangel
Impact of short visits
Rushed,
undignified care
Short
homecare
visits
bought by
for highly
dependent people
Workers
dissatisfied
with homecare
services and
adverse publicity
High staff
turnover
with their ability to
provide care
drains skills &
experience and
increases costs
Travel time
increases
Potential noncompliance with
local
authorities
Dissatisfaction
as a proportion of
total cost
National
Minimum Wage
@colintwangel
Compliance with
National Minimum Wage




Risks increased through maximum
price bids, real-terms price decreases and
fragmented purchasing
A payment system almost exclusively based
on “contact time”
Lack of guidance on how to apply/audit with
complex working patterns of homecare
Fines/back-pay from non-compliance risks
business closure for many SMEs
@colintwangel
Action to ensure NMW
compliance

Providers:
 Audit wage bill to ensure continued compliance
(Guidance being produced by UKHCA’s solicitors)

Councils:
 Understand and pay the actual cost, including travel
(The UKHCA Costing Model is available)

Government:
 To identify and control inappropriate commissioning
 Rule-out commissioning by the minute
@colintwangel
Workforce recruitment
and registration


Cavendish Review into worker
recruitment and training underway
Longstanding support from sector for
compulsory registration, but
 Insufficient funding and/or political will?

White Paper refers to a voluntary register

HCPC subsequently propose to:
 Create “positive” register managers, but
 A “negative” register of careworkers
@colintwangel
Implications of a negative
register

Benefits of compulsory registration are lost:
 Assurance for the public over the suitability of workforce
 Recognition of the status for social care workers
 Levers to encourage post-registration development

A negative register…
 Overlaps with DBS Barred Lists
 Adds an extra level of checking and reporting
(and therefore increases risk of failures to check)
@colintwangel
New purchasers:
Getting noticed

Until recently most homecare has been
commissioned directly by councils
 Providers (especially SMEs) not equipped for marketing

Increasing use of self-directed support
 Personal budgets (theoretically) offer greater choice

Growing numbers of self-funders
 Created by tightening eligibility criteria

“Approved provider lists” provide partial picture
 Councils required to promote a varied market
@colintwangel
Provider Profiles on
NHS Choices

Provides a free directory listing:
 NHS Choices receives >19 million visits / month

No additional charges to enhance profile:
 A text description of the service
 Images and videos; biographies of key staff
 Types of services offered
 Membership of organisations and quality schemes

Already / will include:
 “Transparency measures” reported by providers
 User reviews from 3rd party websites
@colintwangel
‘Transparency measures’
for homecare



Self-reported,
voluntary indicators
To be published on
NHS Choices
Homecare:
1. Staff stability
2. Staff qualifications
Issues:
3. Resolving complaints
 The measures aren’t
perfect and not outcome
focussed
4. Scheduled visits
 Can’t measure
continuity of worker
5. Scheduled visits taking
successfully undertaken
place on time
@colintwangel
A return of
quality ratings?

Former quality ratings abolished 2010

Proposed “Excellence Award” aborted
 Overwhelming lack of support from stakeholders
 Proposed definition of “excellence” excluded homecare
providers

Nuffield Trust commissioned by DH to review
feasibility of an aggregated ratings system
 High support from sector
@colintwangel
A quality ratings
“wish list”

Must measure users’ experience
 Not just regulatory compliance
 Needs co-production by users and providers
(TLAP “Making it Real”) offers a good foundation

Provide a graduated scale of quality
 To help providers’ benchmark their performance

Must not add to existing regulatory burden
 Run by CQC (not third parties) funded by fees
@colintwangel
How to contact me
Website:
www.ukhca.co.uk
E-mail:
colin.angel@ukhca.co.uk
Twitter:
@colintwangel
Telephone:
020 8661 8152
@colintwangel