**Homecare agencies are at breaking point. Reform is long overdue.
As one council starts paying by the minute for homecare visits, adult social care urgently needs more than a quick fix.**
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The face of social care is changing. The steady shift away from looking after older people in residential care to supporting more of them at home is shrinking the care home sector and growing the domiciliary care market. In London, the number of homecare agencies now exceeds the number of care homes for the first time.
This would be a more welcome trend if we could have greater confidence in the quality of homecare services. Although the Care Quality Commission rates 82% of agencies in England as “good”, and a further 4% “outstanding”, there is widespread anecdotal evidence of rushed or missed visits and a constant churn of care workers. According to official estimates, 50% of the domiciliary workforce is on zero-hours contracts and annual staff turnover is 44%, with one in 10 jobs unfilled at any one time.
Care agencies say they cannot improve workers’ pay and conditions, and improve turnover, because most councils do not pay them enough to do so. The UK Homecare Association (UKHA), which represents the sector, says only one in seven councils pays care providers a contract price that is enough to run a sustainable business and meet minimum wage obligations: a price it puts at £18.93 an hour, allowing for 55p profit.
Now the association has a cause celebre. In August, Walsall council moved to a system of paying for homecare by the minute. While this is not unique – one leading national agency reckons that about one in six of its contracts is paid on this basis, using electronic monitoring of care visits – Walsall was already one of the lowest-paying councils. Its current rate is believed to be £14.33 an hour, £4.60 below the UKHA’s benchmark.
Local agencies warned that the change would imperil a fragile system. Sure enough, the regional Express & Star newspaper recently reported that the council had written to its contracted agencies saying it had 70 unallocated cases on its books, “putting at risk vulnerable service users”, and pleading with the agencies to pick them up.
The UKHA has since made a freedom of information request to Walsall, demanding the rationale for what it describes as an “irresponsible” change of payment system. Under the new approach, the association claims, homecare visits lasting longer than 20 minutes are paid by the minute, shorter “check” calls are paid a flat rate, but visits briefer than eight minutes are not paid at all. A care worker who finds that a householder is out, or that they decline a service, perhaps because they have a visitor, appears to trigger no payment.
Walsall, which is Conservative-led, says the changes were made within the terms of agencies’ existing contracts. “The underlying objective is to ensure that public funds are only spent on care that is actually delivered to service users in accordance with their assessed care needs.” Since it alerted agencies to the 70 unallocated cases, it says, the number “has now considerably reduced”. Booked calls are paid a flat rate in the event of “cancellation” by the householder with less than 24 hours’ notice.
There was general dismay at the absence of any concrete proposals on social care in last week’s Queen’s speech setting out the government’s programme. Hopes of a breakthrough had risen, with speculation that a white paper or even a bill would be announced to take forward what the prime minister had described as “a clear plan we have prepared”, but all that emerged was a vague pledge to “bring forward proposals to reform adult social care in England to ensure dignity in old age”. In December, it will be 1,000 days since we were first promised a green paper setting out options for reform.
What is happening in Walsall reminds us that if and when reform proposals do appear, they must address the broken system in its entirety and not just provide a fix to enable people needing care to avoid having to sell their homes to pay for it.