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Relentless staff shortage leaves homecare sector struggling

December 18, 2018

Squeezed funding and staff shortages are severely affecting homecare services in some areas, a new report from The King’s Fund and the University of York has found.

Homecare in England: views from commissioners and providers finds that the market for homecare providers is extremely fragile, with squeezed margins and low fees forcing providers to leave. In 2017 providers handed back homecare contracts in more than one in three local authorities, and some of the largest providers have withdrawn from the publicly funded homecare market altogether.

Staff shortages are a ‘relentless challenge’ for homecare providers in many places. The report finds concerns that fees paid by some local authorities are too low to maintain quality services, leading to 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.

The analysis finds that:

  • Four in 10 homecare workers leave their role every year.
  • More than half of homecare workers are on zero hours contracts.
  • In 2016/17 around 500 new homecare agencies registered each quarter and 400 left the market.
  • In a 2017 survey, many council directors of adult social services had experienced homecare providers ceasing to trade in the previous six months (39%) or having contracts handed back (37%).

The findings are published as one major home care provider, Allied Healthcare, is sold and transfers 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 homecare. 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 providers’ profits.

Based on interviews with homecare providers and local authority commissioners, it also found criticism of a simplistic ‘time and task’ approach to commissioning, under which providers are paid per hour to provide care but with no measurement of the outcomes achieved. The report concludes that homecare 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.

Simon Bottery, senior fellow, social care, at The King’s Fund, said squeezed funding and a shortage of workers had left the homecare sector in a fragile state.

“Homecare providers are competing for staff with other sectors paying higher wages, offering more stable employment and better working conditions,” said Mr Bottery.

“The 249 million hours of homecare 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 homecare service is worth having.”

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