Addressing challenges in homecare services

1. Addressing challenges in homecare services Colin Angel, Policy Director

2. 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

3. Today’s challenges External Internal Recruiting, retaining and training the right workforce National Minimum Wage compliance Ensuring quality is delivered and demonstrated • Aggressive cost-cutting / price-fixing by councils • Reducing visit times • New purchasing arrangements • Expectations of transparency

4. Recent reports into homecare

5. Priority issues in homecareCQC Themed Inspection Report • Missed / late visits • Consider electronic monitoring systems • Resist “call cramming” • Careworker continuity • Inform users of unplanned changes • Training for coordinators • Quality monitoring • Need for QA Systems • Record and act on feedback from users • Staff training • Performance review • Training & development plans

6. National media increasingly interested in homecare

7. Commissioning short visits:73% are 30 minutes or fewer Source: Angel, C (2012) Care is not a commodity

8. Providers concerns over dignity and safety from short visits Source: Angel, C (2012) Care is not a commodity

9. Impact of short visits Shorthomecare visits bought by local authorities Rushed, undignified care for highly dependent people Dissatisfactionwith homecare services andadverse publicity Workers dissatisfiedwith their ability to provide care High staff turnoverdrains skills & experience and increases costs Travel time increasesas a proportion of total cost Potential non-compliance withNational Minimum Wage

10. Compliance with National Minimum Wage • Risks increased through maximumprice 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

11. 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

12. Workforce recruitment and registration • Cavendish Review into workerrecruitment 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

13. 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)

14. 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

15. 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

16. ‘Transparency measures’ for homecare • Self-reported, voluntary indicators • To be published on NHS Choices • Issues: • The measures aren’t perfect and not outcome focussed • Can’t measure continuity of worker Homecare: • Staff stability • Staff qualifications • Resolving complaints • Scheduled visits successfully undertaken • Scheduled visits taking place on time

17. A return ofquality 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

18. 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

19. How to contact me Website: www.ukhca.co.uk E-mail: colin.angel@ukhca.co.uk Twitter: @colintwangel Telephone: 020 8661 8152