What is the true cost of home care?
The State of Care 2016
The publication today of the Care Quality Commission’s annual State of Care report has seen the independent regulator of the Health and Social Care sector take the unusual step of stating that the systematic under funding of social care services is bringing the sector to a crisis point. The real impact of this is on quality of social care services and increased and unsustainable demands on hospital services.
Adult social care services have been able to maintain quality, but there are indications that the sustainability of adult social care is approaching a tipping point. We are seeing some providers starting to hand back (local authority) home care contracts as undeliverable.
We are concerned about the fragility of adult social care and the sustainability of quality. This is a serious issue for the continuity and quality of care of people using those services, and for the knock-on effects across the whole health and care system: more A&E attendances, more emergency admissions, more delays to people leaving hospital, and more pressure on other services. (CQC The State of Care 13th October 2016)
The report does not cover the huge and under-reported impact on the 1.5 million professional care workers who work in adult social care. They have been the victims of squeezed margins for a number of years with low pay, poor terms and conditions and zero hours contracts sadly the norm. In certain cases further squeezing of margins has been achieved through inadequate training, examples of workers being paid below the national minimum wage, “staff” discovering they are considered as self-employed and therefore responsible for paying their own tax and NI and without rights that are otherwise considered standard by workers in the UK.
A Minimum Price for Homecare
The UK Home Care Association produce the annual A Minimum Price for Homecare report. The report looks at the associated costs of delivering home care services to calculate the absolute minimum price required to cover an hour of homecare that is safe and legal in terms of complying with employment legislation, mandatory training and safety regulations.
The latest report produced in November 2015 calculates that the minimum price per hour for home care if workers are paid at lower levels between the National Minimum Wage and the National Living Wage is £16.70 an hour outside of London. Where workers are paid the UK Living wage the minimum price is £19.03 outside of London and £21.40 if paying the London Living Wage.
The overwhelming majority of care in the UK is commissioned by local authorities e.g. Adult Social Services. A freedom of information request by the UKHCA in 2014 found that just 28 councils out of 203 were paying at or above the minimum safe, legal price with an average price of £13.66 per hour being set by councils and levels found as low as £11.64 an hour in parts of North East England.
Despite significant campaigning to include regulation and inspection by the CQC of council commissioning in the Care Act 2014, this was not included meaning that the commissioning of approximately 75% of adult home care services is done without any oversight by the independent health and social care regulator. It is this commissioning of the majority of home care services at below the minimum safe, legal and compliant price that has forced pricing into a downward spiral and led to the growing crisis we see today.
An austerity culture that has seen a race to the bottom in terms of pricing (in many sectors and services) is alarming in a sector responsible for the day to day health, care and basic daily living of the most vulnerable in our society. Care staff are being underpaid and unfairly treated by providers having their prices squeezed by local councils who, in all but the wealthiest areas, are the monopoly customer for home care providers.
Where people can afford to do so, they will pay for or top up funding to the level required for safe, quality care. However, those people fully reliant on local authority funded or contracted care are obliged to use services operating at below the minimum pricing level. With only 3% profit margin built into the UKHCA minimum pricing calculations, the savings have to come from elsewhere and the only elsewhere is staff costs. In a traditionally low paying sector anyway this means cutting the absolute basics. Pricing below the minimum level means staff paid below the minimum wage, not receiving mandatory training, no paid holidays and substandard terms and conditions on zero hour or “self-employed” agreements of questionable legality. In turn a usually dedicated workforce being inadequately trained, ill treated and demoralised inevitably leads to higher levels of sickness and staff turnover resulting in poorer standards of care delivery to the most vulnerable adults in our communities.
Click here to see the full State of Care 2016 report from the Care Quality Commission http://www.cqc.org.uk/content/state-of-care
Click here for the UK Homecare Associations A Minimum Price for Homecare report http://www.ukhca.co.uk/pdfs/AMPFHC_150719.pdf