@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:

policy@ukhca.co.uk

Telephone:

020 8661 8152

Twitter:

@colintwangel and @ukhca