Home care market 'extremely fragile'

The King's Fund calls for fundamental overhaul of system

Published on 17th December 2018

Home care services in England are being "severely affected" in some areas due to funding and staff shortages, the King's Fund has warned.

A new report from The King's Fund and the University of York said that the market for home care providers is extremely fragile, with squeezed margins and low fees forcing providers to leave.

Simon Bottery, Senior Fellow, Social Care, at The King’s Fund, said: "Squeezed funding and a shortage of workers have left the home care sector in a fragile state. Home care providers are competing for staff with other sectors paying higher wages, offering more stable employment and better working conditions."

"The 249 million hours of home care delivered each year, much of it publicly-funded, has huge potential to improve people’s health and promote their independence. The system needs a fundamental overhaul, beginning with the upcoming Green Paper, but the prize of a better, more effective home care service is worth having," he added.

In 2017 providers handed back home care contracts in more than one in three local authorities, and some of the largest providers have withdrawn from the publicly funded home care market altogether. Fees paid by some local authorities are too low to maintain quality services, the report warns, which is leading to a high turnover of providers and staff. This has negative impacts on continuity of care and potentially wider effects on care quality. Researchers also uncovered fears that some care staff are being paid below legal minimum wage levels.

Other findings include:

-    4 in 10 home care workers leave their role every year.

-    More than half of home care workers are on zero hours contracts.

-    Around 500 new home care agencies registered each quarter in 2016/17 and 400 left the market.

- In a 2017 survey, many council directors of adult social services had experienced home care providers ceasing to trade in the previous six months (39 per cent) or having contracts handed back (37 per cent).

The findings are published as a major home care provider, Allied Healthcare, has been sold and transferred many of its contracts to other providers. It highlights the fragile state of the sector, which supports more than 400,000 older and disabled people with daily activities such as washing, dressing and eating.

Faced with reductions in their central government grant, council spending on social care was three per cent lower in 2017/18 than in 2009/10. Part of this reduction has been achieved by holding down the amount local authorities pay providers for care. Analysis suggests a link between prices paid by councils and the quality of home care. Despite this, some Local Authority commissioners are sceptical that increasing fees will boost quality or staff wages, fearing the extra funding will go into care provider’s profits.

The report concludes that home care needs to move away from ‘time and task’ payments to commissioning services based on achieving outcomes for people, integrated more closely with health care services.

Glen Garrod, President of the Association of Directors of Adult Social Services, said: “These findings reinforce our calls for new money to be immediately injected into adult social care to give the sector much-needed stability and provide the vital daily support that older and disabled people rely on.

“Councils continue to work hard to commission high quality services but as our recent snap survey found, directors of adult social care have serious concerns around whether they have enough funding to enable them to meet their legal duties to provide care and support for older people.

“Without new money, we risk seeing more providers either cease trading or hand back contracts to councils.

“The government needs to act urgently, partial and inadequate allocations of temporary funds does little to address the critical issues facing social care in general and home care providers in particular.

“Government simply must consider funding beyond 2018/19. We need long term, sustainable funding whether through the promised Green Paper or otherwise. Without an appropriate package of recognition and reward for the skilled and dedicated workers in social care we may find little success in the national adult social care recruitment campaign which is looking to attract more people with the right skills and qualities to work in the care sector," he concluded.

Home care in England: views from commissioners and providers


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