Download - Care & Support West 28 th May 2014
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.
27
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:
Telephone:
020 8661 8188
Twitter:
@ukhca