Addressing challenges in homecare services Colin Angel, Policy Director

@colintwangel 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 cost- cutting / price-fixing by councils Reducing visit times New purchasing arrangements Expectations of transparency Internal 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 Consider electronic monitoring systems Resist “call cramming” Missed / late visits Consider electronic monitoring systems Resist “call cramming” Careworker continuity Inform users of unplanned changes Training for coordinators Careworker continuity Inform users of unplanned changes Training for coordinators Quality monitoring Need for QA Systems Record and act on feedback from users Quality monitoring Need for QA Systems Record and act on feedback from users Staff training Performance review Training & development plans Staff training Performance review Training & development plans

@colintwangel National media increasingly interested in homecare

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

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

@colintwangel Impact of short visits Short homecare visits bought by local authorities Rushed, undignified care for highly dependent people Travel time increases as a proportion of total cost Workers dissatisfied with their ability to provide care High staff turnover drains skills & experience and increases costs Potential non- compliance with National Minimum Wage Dissatisfaction with homecare services and adverse publicity

@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 3 rd party websites

@colintwangel ‘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: 1.Staff stability 2.Staff qualifications 3.Resolving complaints 4.Scheduled visits successfully undertaken 5.Scheduled visits taking 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 United Kingdom Homecare Association A member-led professional association Represents 33% of UK’s independent and voluntary sector homecare agencies We promote high quality, sustainable care services so that people can continue to live at home and in their local community We provide campaigning, leadership and support

@colintwangel How to contact me Website: Telephone: