Care & Support West28th May 2014

Commissioning relationships in the context of less Funding

How to avoid and “us and them” scenario

Bridget Warr, Chief Executive

United Kingdom Homecare Association

UKHCA’s Vision and Mission

Our vision is of a United Kingdom where a choice of high quality, sustainable community-based care is available to all.Mission

Vision

Our mission, as a member-led professional association, is to promote high quality, sustainable care services so that people can continue to live at home and in their local community. We will do this by campaigning and through leadership and support to social care providers.

Issues for the homecare sector

Operating environment: Commissioning of state funded care

Media coverage

Public perception

Staffing issues: Supply and churn of workers

Recruiting for values

Training and supervision

Cavendish

Issues for the homecare sector (continued)

Regulation: CQC:

New inspection methods

Quality ratings

Market oversight

HMRC

Charity Commission

Care Act: Information and advice

Assessment

Human Rights

“Responsibility to ensure….”

Market Position Statements

Maintenance of wellbeing

3 slides about

Local Authority commissioning and fees

LA’s Commissioning short visits:73% are 30 minutes or fewer

Providers’ concerns over dignity and safety from short visits

Average Visit Lengths

2 slides about

Costings and minimum prices for homecare

Principles behind our minimum price

Fees calculated solely for “contact time” Workers receive flat-rate NMW for “working time”:

Contact time

Supervision and training

Applicable travel time (and reasonable travel costs)

Provider can cover: NI, pensions, training and holiday pay

Reasonable operating costs

Acceptable profit / surplus

Assumptions used in our minimum price

Minimum Wage: £6.31

Travel time: 11.4 min

Travel costs: 4 miles£0.35/mile

NI: 9.5%

Holiday Pay: 10.8%

Training: 1.73%

Pensions: 1%

Gross margin: 30%

6 slides about

National Minimum Wage and HMRC’s findings and requirements

National Minimum Wage

Increased investigations by HMRC triggered by: Workers contacting the Pay and Work Rights Helpline

Intelligence about non-compliance from 3rd parties

Risk-based assessment of providers by HMRC

Increasing media attention: Alleged non-payment of careworkers’ travel time

HMRC report – November 2013

Recent publicity on zero-hours contracts

NMWHMRC investigations of 224 social

care providersAverage; 45% non-compliance Average under-

payment of £139

HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

Reason(s) for NMW non-compliance in the homecare sector

HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

HMRC may come knocking

HMRC likely to ask for: Pay records

Weekly/monthly rosters

Schedules of pay rates

Workers’ contracts

Evidence of you checking compliance

Be confident and cooperative!

Minimum Wage non-compliance:The risk factors

Low rates: Basic rates around £6.31/hour

Relying on enhancements for short visits/unsocial hours

Not changing rates for younger workers on their birthday

Payment for “contact time” only: Large amount of travel time, relative to “contact time”

Use of very short visits and/or long gaps between them

Other issues: Having insufficient records (eg. travel time)

Deductions for uniforms or accommodation provided

UKHCA’s NMW ToolkitFree resource for UKHCA members

Based on HMRC documents, obtained under FOI

3 main sections: How NMW works in complexity of

homecare services

How to audit compliance (individuals & samples of workers)

Suggested actions to achieve/improve compliance

www.ukhca.co.uk/downloads.aspx?ID=422

2 slides about

CQC regulation and inspection changes

Forthcoming changes in CQC regulation & inspection New “Fundamental

Standards” & regs Specialist inspectors Tougher registration and

action against non-compliance, including vacant manager posts

On-line “Provider Information Return” to be completed in advance

“Market oversight” for largest providers

Inspection themes for each service:

1. Is it safe?

2. Is it effective?

3. Is it caring?

4. Is it responsive to people’s needs?

5. Is it well-led?

CQC’s Quality Ratings

All services to be rated by March 2016: Wave 1 Pilot (ratings won’t be published)

Wave 2 Pilot (ratings may be published)

All other services (ratings will be published as awarded)

Ratings will be: Awarded at location level

Provided as an aggregated score & for each of 5 themes

Determined by a set of ‘rules’, however…

Inspectors have some discretion to deviate from rules

2 slides about

Cavendish

23 DH – Leading the nation’s health and care

Guiding Principles

•The Care Certificate will replace the Common Induction Standards and the National Minimum Training Standards as the fundamental training for the groups of staff in scope

•It will apply to roles which provide direct care to people who receive care and support and in which practical assessment of their clinical/care and support competences can be achieved.

•Elements of the CC can be achieved by other disciplines but they will not achieve the whole certificate unless they can demonstrate the full range of skills

 

RESTRICTED – NOT FOR CIRCULATION

24 DH – Leading the nation’s health and care

Key timescales and issues

Timescale of pilot to national roll out remains as planned•Fieldwork to commence with review of documents and set up with key organisations in April•September – March 15 refining content and preparing organisations for roll out•Roll out from March 15

Affordability / portability•Tested as part of the pilot•Content and delivery designed introduce quality and consistency with minimal additional burden on employers

Support from stakeholders•GAB and engagement group

RESTRICTED – NOT FOR CIRCULATION

4 slides about

Local Authority Market Position Statements

A market position statement (MPS)

Sets out local authority views on: The local care market How well it works and functions What future demand might look like and why The kinds of services it’s keen to fund and

why.

Should enable a provider to see: What the local market looks like Whether this is a good place to do business What help and support the LA will offer

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Where have we reached in England

Take up quantitatively:Every English authority contacted, programme in essence delivered over one year, project managed through a programme group with ADASS and provider representation.74 authorities now have an MPS publicly available.50 authorities have a draft MPS.14 in process of writing.49 authorities had clear evidence of provider involvement in developing, or in presentations of, their MPS.

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Summary

Willingness to change relationships but still more work to do on understanding how the care market works and responds. Providers need to push LAs to be involved in developing and contributing to their MPS

Need to consider in detail with providers how innovation might be encouraged and the part that providers may play in developing preventative interventions at the health and care interface.

Need to monitor more closely the impact that interest rate and minimum wage changes might have on the market and also jointly review what impact the Care Act changes are having.

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Summary

Providers need to focus more on how they can demonstrate that they deliver worthwhile outcomes and how they can offer an evidence base that proves that.

LAs and providers could cooperate more on consumer research.

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Moving things forward…together

Opportunity like never before Economic challenges face us all LA’s facing massive challenges through Care Act Wellbeing of the individual is paramount for all Needs won’t be met by continuing whingeing and

finger pointing Must find a way of working together to improve

things

Some practical ideas

Ensure own house is in orderMaximise own efficiency and effectiveness

Keep the wellbeing of the individual at the forefront of thinking and conversations

Enter into open dialogue with commissionersUse costing models and emphasise common purpose

Ensure elected members understand the importance of social careTo their constituents in vulnerable situations

and to their working age population

UKHCA’s Engagement with councils and politicians

Council leadersOpposition group leadersSocial care committee members

Council leadersOpposition group leadersSocial care committee members

1268Elected members

1268Elected members

MPs, AMs, MSPs and MLAsMPs, AMs, MSPs and MLAs>650Elected politicians

>650Elected politicians

Chief ExecutivesSocial Services DirectorsHeads of LegalDirectors of Finance

Chief ExecutivesSocial Services DirectorsHeads of LegalDirectors of Finance

Officers of

186Local authorities

Officers of

186Local authorities

Some (more) practical (if challenging!) ideas

Raise the profile with the public (electorate)The importance of social careThe status of care workersThe massive good practise and positive impactThe amount of employment through social care (direct and indirect)

We need to shift public opinion on their (our) responsibility towards people in vulnerable situations if the electorate are to demand a higher priority and better resourcing for social care.

Government is very unlikely to realign resourcing without strong demand from the electorate.

How to contact us

Website:

www.ukhca.co.uk

E-mail:

enquiries@ukhca.co.uk

Telephone:

020 8661 8188

Twitter:

@ukhca