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Review of home care workforce issues

Following the publication of a review into the structural issues affecting the home care industry, we provide a summary of the key findings and the employee centred recommendations.

The NHS Five Year Forward View emphasised the importance of out of hospital care in re-shaping the NHS so that it is more able to cope with the challenges that it faces in the 21st century. However, in taking a holistic view of the system, it is important to consider the weaknesses of the components which go together to make up the whole. Failure to rectify shortcomings means that the whole machine will not function properly.

The Key to Care report

A recently published report "The Key to Care", commissioned by local government think-tank to Local Government Information Unit and chaired by former Lib Dem Care Services Minister Paul Burstow, has highlighted several key weaknesses in the provision of home care, particularly but not exclusively around workforce issues. The report echoes many of the conclusions of the Kingsmill Report, published in May 2014, which was concerned with a broader review of structural employment issues affecting care services as a whole.

It is apparent from both of these reports that, at a time when there is considerable pressure on performance and savings, it is often the employees who get squeezed. This is of particular concern in the context of domiciliary care, due to:

  • the extent to which it relies on its employees: There are an estimated 685,000 people employed in providing front-line home care. It is estimated that this number will need to be doubled to cope with the additional demands on the system over the next decade.
  • the significant role this type of service plays in providing care: It is estimated that 500,000 people currently receive home care services and this is expected to grow significantly as life expectancy increases but the proportion of the population which needs this type of support grows.
  • the contribution it stands to make to reshaping the care system.

If there are fundamental problems with the key resource used to deliver services, it brings the sustainability of the service as a whole into question.

Key employee-centred recommendations include:

  • Wage levels: The use of zero hour contracts and the exclusion of travelling time from the pay calculation is often a serious issue for care workers. The impact can be that not all receive the minimum wage. The report recommends that in in order to ensure that care workers are properly valued and do not have to seek government support from benefits, they are paid not only the minimum wage, but a living wage which takes into account the time they can fairly be regarded as being "at work" and not only when they are actually caring for service users.
  • Professionalism, training and careers pathways: The absence of professional accreditation for workers involved in providing home care has two impacts. The first is that there is no independently assessed quality standard. The second impact it that it  reinforces the low status of home care workers, dissuading potential employees. Introducing a professional accreditation would help to raise standards, and if it was linked to a system of training, it would help facilitate the development of a profession and a career pathway.
  • Key worker status: The report found that care workers were often undervalued when compared to other workers in the public sector who enjoy "key worker" status. This status gives them access to the HomeBuy scheme and, in some areas, assistance with rental payments. Extending this classification, whilst probably only of symbolic significance initially, would go some way to redressing this imbalance of perception.

Although it is unlikely that changes to address the issues will be forced through before the election, it will be interesting to see what voluntary changes are made by that time. Many of the recommendations require not only a change of approach, but also additional funding for what most people would classify as a “Cinderella” service. The Autumn Statement allocated additional funds to the NHS as a "down payment" on the View. However, none of these additional funds will make their way towards addressing the issues which were highlighted in the two main reports. As such, the main question remains as to how these reforms will be paid for?

This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.

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