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@colintwangel@ukhca
The professional association for homecare providers
Homecare:Meeting the challenge
Colin Angel, Policy and Campaigns Director
February 2017
@colintwangel@ukhca
UK home-based support at a glance
873,500people per year supported by homecare
157,942people receive adirect payment
4.6 millionhours of homecare care per week
629,400homecare workers employed by providers
10,176locations registered to provide homecare
Source: UKHCA (2016) Overview of the domiciliary care market in the United Kingdom. Figures for 2014-15.
75%of regulated homecare bought by the state
@colintwangel@ukhca
What we do…
Our mission, as a
member-ledprofessional association,
is to promote
high quality, sustainablecare services
so that people can continue to live at home and in their local community
We will do this by
campaigning, through
leadership and supportto social care providers
@colintwangel@ukhca
How we do it…
For the sector
Represent providers with
government & regulators
Campaign for a better
operating environment
Shape thinking through
special interest groups
Inform the public
through media relations
For individual providers
Update providers with
accurate information
Provide guidance
through resources and
factsheets
Inform practice through
conferences & workshops
Resolve problems
through our helplines
@colintwangel@ukhca
The operating environment & market stability
@colintwangel@ukhca
Current themes - overview
Government:
• Planning for Brexit negotiations
• Delayed transfers of care
• Pressure to increase funding of social care
Regulation:
• Quality of services
• Using its enforcement powers
• Market stability
Local Authorities:
• Inadequate budgets / Precept
• Market stability / market shaping
• Reducing and deflecting demand
Workforce:
• Recruitment, retention & Brexit
• National Living Wage
• Evolving case-law (sleep ins)
@colintwangel@ukhca
Scale of the social care problem
Funding gap (King’s Fund)£2.4bn
Fewer people receive state-fundedsocial care compared to 2009-10 >400k
“Delayed transfers of care” (DTOCs) attributable to social care services34.8%
Of UK’s GDP spent on social care<1%
@colintwangel@ukhca
Recent reporting onsocial care markets
ADASS Budget Survey 2016
>90% directors say providers face financial & quality problems
“There are also now next to no further efficiencies to be made
from squeezing provider fees paid”
Kings Fund “Home Truths” (September 2016)
Large-scale provider failures: Not ‘if?’, but ‘when?’
CQC State of Care report (October 2016)
Social care is at a “tipping point”
Concern that quality will suffer as a result of underfunding
@colintwangel@ukhca
Social care pressures within councils
Funding pressures, budget savings and increasing demand:
Job losses and capacity issues inside councils
Whether to continue to raise the Social Care Precept
Instability of the local care market and Care Act duties:
Market shaping, oversight, deprivation of liberty safeguards
Integration of social care and health:
Sustainability and Transformation Plans (STPs)
@colintwangel@ukhca
UKHCA: The Homecare Deficit 2016Prices councils pay for homecare
• Freedom of Information enquiry to every council in the UK
• Weighted average prices in a sample week in April 2016
• Information used by DH, Treasury, councils and King’s Fund
@colintwangel@ukhca
People affected by market instability: ADASS Budget Survey 2016
Ceased
tradingCeased
trading
Contract
handed
back
Contract handed
back
Homecare Residential
In 6 month period in 2016:
65% of councils affected
10,824 people affected
@colintwangel@ukhca
Market exits and sales ofstate-funded businesses
Care UK reports operating loss on its homecare business
Sells to Mears Group in June 2015
Saga plc writes-down value of Allied Healthcare
Sells to Aurelius Group in December 2015
Housing and Care 21 announces exit from homecare market
Starts looking for a provider to take over in September 2016
Mitie Group plc writes-off value of MiHomecare
Announces withdrawal from homecare sector
Mears Group’s accounts show that homecare is loss-making
They go public when terminating unviable council services
@colintwangel@ukhca
What does this mean for providers?
Chasing volume at marginal prices not always a good plan
Dependence on state-funded homecare is high risk:
Increase self-funded vs state-funded business, or:
Take a strategic view to exit all state-funded work
Councils will be under increasing pressure to find
alternative supply as providers hand-back contracts:
Take on additional work on terms that are acceptable to you
Know your costs and lowest price you will accept
Be willing to say “no” if the price is too low
@colintwangel@ukhca
Handing back local authority contracts
Understand the terms of any existing contracts
Take legal advice, if necessary
Give proper notice
Explain rationale for termination
Allow adequate time for replacement provider
Indicate willingness to cooperate with transfer
Outline any terms which, if met, would change decision
Think about who is copied-in
Portfolio holder, council’s CEO, Local MPs, local press
@colintwangel@ukhca
What’s happening at the moment?
Cabinet Office work on sustainability of social care market
DH commissioned King’s Fund examine market behaviours
Current affairs programmes being made on homecare
Social Care Precept brought forward + New Homes Bonus
@colintwangel@ukhca
The Social Care Precept
The Social Care Precept must be used for adult social care,
but not all of it goes to front-line services
95% of councils used precept in 2016/17, raising £380m
In 2017-18 councils can raise 6% precept over next 2 years
(rather than 3 years), but total amount still 6%
The Precept raises least money where most needed
@colintwangel@ukhca
How councils are changing their commissioning practices
Reducing total demand:
Re-ablement
Outcome-based commissioning and payment-by-results
Reducing total spend:
Contracts/prices which favour larger providers
Reductions in personal budgets
Market shaping:
More use of subcontracting arrangements
More in-house provision due to market instability fears
@colintwangel@ukhca
Outcome-based commissioning
Attempt to reduce demand by increasing independence
Likely to be successful where:
Outcomes are defined which can be understood & measured
Providers are committed to concept and process
There is trust between provider and commissioner
Potential risks:
Monitoring arrangements can be onerous for provider & council
Inappropriate ‘payment-by-results’ mechanisms
More information:
Bolton, J (2015) Emerging practice in outcome-based commissioning for social care
Atlantic Customer Solutions OBC workshops
@colintwangel@ukhca
Brexit
@colintwangel@ukhca
Key Brexit issues for homecare
EU nationals play significant role in the workforce
UK becoming less attractive to non-British migrant workers
Weak pound causing EU & non-EU workers to depart
Providers of 24-hour ‘live-in’ care significantly affected
Self-funders could be hit by reduced returns on savings &
investments (at least in the short / medium term)
Risk of erosion of EU-derived human rights laws, which
protect people using services
@colintwangel@ukhca
Contribution of non-British nationals to front-line homecare services
31%
10%7% 8%
3%6% 4% 2% 2%
14%
8%10%
5%
9% 3%2%
2% 1%
London Eastern South
East
West
Midlands
South
West
East
Midlands
North
West
Yorks &
Humber
North
East
Non-British EEA: 6.4% of workforce
Non-British non-EEA: 9.3% of workforce
Headcount data for
homecare workers in
England from
NMDS-SC, published by
Skills for Care, as at July
2016.
UKHCA’s calculations
assume that workers whose
nationality is not recorded is
consistent with workers
whose nationality is known.
@colintwangel@ukhca
What UKHCA is asking from Government
Recognise that homecare workforce is essential to reduce
delayed transfers of care
Need to secure a workforce to meet increasing demand
A clear strategy for ‘freedom of movement’
Any points-based system should enable non graduate workers
to enter UK employment market
Public messages of support which value EU & non-EU social
care workforce are really important
@colintwangel@ukhca
Recommendations for providers
Continue to value your workforce (wherever they are from)
Record nationality of workers and input into NMDS-SC
Consider how Ts&Cs will attract available workers in UK:
Rates of pay
Working patterns
Career progression
If currently dependent on non-British EEA nationals:
Have a strategy for worst-case scenario
@colintwangel@ukhca
Quality and regulation
@colintwangel@ukhca
Overall CQC Quality Ratings:Residential and homecare, Sept 2016
Requires improvement
19%
Requires improvement
26%
Good78%
Good71%
Ho
mecare
Resid
en
tial
Inadequate Requires improvement Good Outstanding
@colintwangel@ukhca
CQC Key QuestionsHomecare sector, Sept 2016
Good75%
Good81%
Good94%
Good84%
Good73%
Safe Effective Caring Responsive Well-led
@colintwangel@ukhca
Suggestions for providers
Use Provider Handbooks to plan where to focus efforts:
“Well-led” is the question most closely linked to overall rating
Safety – particularly around medication administration
Think about how you can evidence achievement against
5 key questions
Challenge CQC if unjust, but spend more time getting
things right
@colintwangel@ukhca
Links to useful resources
@colintwangel@ukhca
Market shaping, sustainability & contingency planning (Care Act 2014)
Commissioning for Better Outcomes (DH/ADASS/Birmingham Uni)
Framework for councils’ self-assessment to identify areas for improvement
Market Shaping Toolkit (IPC)
Support for care providers and local authorities to engage in market shaping
Market Sustainability Guidance (Cordis Bright)
A guide to light touch oversight of local care markets
Social Care Provider Failure Guidance (LGiU)
Contingency planning resources (publication date TBC)
Understanding Provider Costs (CIPFA)
Guide to the costs for care for commissioners (under development)
@colintwangel@ukhca
Links to UKHCA resources
The Homecare Deficit 2016www.ukhca.co.uk/rates
National Minimum Wage Toolkitwww.ukhca.co.uk/nmwtoolkit
A Minimum Price for Homecarewww.ukhca.co.uk/downloads.aspx?ID=434
UKHCA Costing Modelwww.ukhca.co.uk/CostingModel
UKHCA Market Stability Survey 2015www.ukhca.co.uk/downloads.aspx?ID=486
@colintwangel@ukhca
How to contact me
Website:
www.ukhca.co.uk
E-mail:
Telephone:
020 8661 8152
Twitter:
@colintwangel and @ukhca