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‘Radical rethink’ on care at home required – UKHCA

The United Kingdom Homecare Association (UKHCA) has called for a ‘radical’ rethink on the commissioning of services for people receiving care at home. 

Responding to the Burstow Commission’s report ‘Key to Care’ on the future of the homecare workforce, it also states that changes to the terms and conditions of the homecare workforce are urgently needed. 

The latest report says that “if home care is not in crisis yet, it soon will be”. It adds that more people need care and there is less money to pay for it and not enough people willing to do the work. 

Key recommendations from the report include councils being able to ensure that they are paying a sufficient rate for contact hours, which ensures that providers can pay care workers at least the minimum wage. In addition, local authorities should be moving away from time and task commissioning and toward outcomes-based commissioning. 

Former care minister Paul Burstow, who chaired the commission, run by the Local Government information Unit (LGiU), said: “As publicly-funded care continues to be squeezed the danger is that good providers are driven out, and those providers who make a profit by exploiting workers thrive. 

“The price of poor care is paid for by the most frail and vulnerable in our community, and by the care workers they rely on who get a raw deal. We must make care work a career of esteem, where a living wage is paid, staff are trained and recognised as valued key workers who contribute a huge amount to society.” 

The commission’s report has called for a training and career pathway for care workers. It added that those working in both health and social care need minimum standards of training which can be developed into pathways of specialism or the basis for further training and entry into allied care professions such as nursing or social work. 

It also recommends that councils need to be more proactive in ensuring that their use of existing framework contracts is not contributing to the worst practices in home care, such as 15-minute care slots. 

“In reviewing their contracts, councils should consider the impact of their commissioning approaches on the market, and specifically whether framework contracts are creating fragmentation,” the report notes. “Health and Wellbeing Boards should take an active oversight role of how care commissioning is supporting local objectives for preventative spending on care.” 

Commenting on the Commission’s recommendations, UKHCA’s policy director, Colin Angel, said that older and disabled people deserve excellent services from a workforce which is suitably trained, committed and adequately rewarded for the increasingly complex care required to be delivered at home. 

“Homecare workers are our greatest asset and their services already support demands on a struggling health service,” he said. “However, inappropriate commissioning by local councils is self-defeating and carries risks of rushed, undignified services which lack continuity by focussing on limited time for care and a constant pressure to reduce providers’ fees. 

“It is essential that local councils reflect on the Burstow Commission’s findings to move away from ‘time and task’ commissioning and refocus on purchasing effective outcomes for individuals and also value the homecare workforce appropriately.” 

Responding to the LGIU report, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS), stated that many councils work closely with local providers to try and continuously improve services for people who rely on home care and their carers. 

They added that it is important that the workforce is paid a fair wage and have the best possible training and that local authorities understand and take account of the cost of providing this. 

A spokesman for the two organisations said: “This report rightly highlights the extremely difficult financial climate for local government. The backdrop of 40% cuts to local government funding during the current Parliament and increasing pressure from the government to drive down the costs of care, have forced councils to ask providers to run services on tighter margins. 

“Councils need to continue to work with providers to fully understand the cost of care in their area and make sure that staff are fully supported to put the people they care for at the centre of decisions about their needs.” 

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