business clinic
How do you solve a problem like homecare?
Leonard Cheshire Disability has announced it is no longer bidding for 15 minute homecare contracts. Added to this, Care Services Minister Norman Lamb MP has declared homecare is in crisis. What’s got to give? How do you solve a problem like homecare? The sector is aware of the pressures on the system, especially homecare. We know that the system is at breaking point and 15 minute visits, although not ideal are, in some cases, the only way to get contracts and achieve what’s needed on available funding. When Norman Lamb MP announced that homecare was in crisis it was acknowledgement from the top that something has to change. Leonard Cheshire Disability has now waded into the debate by announcing that it will stop bidding for 15 minute homecare contracts. But, is there another way to meet demand on an ever-decreasing budget?
Current situation There’s less money in the pot in these times of austerity and local authority funding from central Government is continually being
squeezed. According to ADASS, over the last three years, net spending by adult social care departments has been cut by 20 per cent. With more people requiring care, a Government drive to support people at home rather than in care homes but less money coming through the system to provide that care; it’s no wonder that homecare visits are becoming shorter. The United Kingdom Homecare Association’s (UKHCA) report Care is not a Commodity revealed the ‘very short visit times that councils are commissioning.’ Stating that ‘73% of homecare visits in England appear to be 30 minutes or shorter.’ It goes on to report that 1 in 10 administrations limited visits to no more than 15 minutes.
Government’s approach To address the growing homecare issues,
the Government has launched a Homecare Innovation Challenge to improve homecare through the sharing of ideas and experiences. At the launch, Norman Lamb MP announced, ‘I am very serious about the quality of homecare – of care that happens behind closed doors. I have warned that the next big scandal – as serious as MidStaffordshire could happen in homecare. ‘Whilst most homecare is good, and a lot is excellent, care in a person’s home is too often delivered in 15 minute or 30 minute rushed visits that fail to treat people with dignity and respect. I believe that the way these services are commissioned by councils too often incentivises a system of low-wages, poor care and neglect.’ Despite this, Mr Lamb made it clear that there’s no extra money.‘You all know the huge challenges we face. On public spending;
A valuable tool in the overall kit
Providers must consider costs and quality
Sandie Keene President Association of Directors of Adult Social Services
Colin Angel Policy and Campaigns Director United Kingdom Homecare Association
As President of the Association of Directors of Adult Social Services I would caution against people taking a broad-brush stance against all 15-minute homecare visits that are commissioned by local authorities. Homecare these days has evolved. It is so much more than the traditional tasks of getting people up and dressed in the morning and putting them to bed at night. These homecare tasks also now include prompting people to take their medications on time, ‘just checking’ visits throughout the day to make sure people are all right, and offering support to fulltime family carers for tasks that need two people for just a short length of time. With tightening budgets and less money coming from central Government, local authorities have to spend every penny they have wisely. Why would they schedule an hour’s visit for something that only takes a few minutes? This doesn’t make
economic sense and isn’t a good use of budgets. I would agree with Leonard Cheshire Disability’s suggestion that fifteen minutes isn’t long enough to allow some homecare tasks to be done properly and to maintain people’s dignity. But I disagree that there is no place at all for the fifteen minute visit as long as it is not abused. It can be a valuable tool in the overall ‘kit’ for delivering excellent outcomes for people. This is obviously an issue that needs further consideration and the Association of Directors of Adult Social Services proposes to join with citizens and providers to develop standards for commissioning for excellent outcomes. We want to see how flexible and truly personal approaches can fit into the overall picture of delivering quality care that meets a wide variety of needs and enhances people’s quality of life.
While some larger homecare providers have a degree of choice about where they tender for local authority business, it’s not necessarily an option available to all. Councils effectively operate a ‘monopsony’, using their dominant purchasing power to drive prices and costs down. For many providers there’s a stark choice between accepting the terms that a local authority imposes under contract; reorganising the business to cater solely for self-funders (where there is a market), or ceasing to trade. The decision to tender with a local authority is a commercial one. Providers must consider whether visit times allow sufficient quality of care to be delivered, whether the price is viable to sustain regulatory requirements, and whether the council will pay a sufficient rate to enable the provider to recruit and retain a workforce at market rates. UKHCA’s free Costing Model helps providers and local authorities to identify the necessary rate to cover legal and contractual
obligations and determine whether any maximum price imposed by the council in tenders is sustainable. We encourage providers to share their use of the Costing Model with their commissioners and highlight the inadequacy of funding at a local level, where this is the case. We also suggest providers who are considering moving away from council-funded care make their reasons known in advance, to help authorities understand the implications of their commissioning on their local care market. In the meantime, councils who actively discourage providers from accepting privately purchased care to ‘top-up’ the services available from allocated budgets should cease to do so. Councils should also consider developing Individual Service Funds, which allow the user and provider to negotiate the ‘best fit’ of visit times and services within the allocated budget - giving users greater choice over whether a 15-minute visit is adequate.
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