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Are we seeing more larger providers leaving domiciliary care services?

Given the current funding situation it is hardly unexpected that larger providers are finding it hard to make profits, let alone invest in social care services. It  therefore comes as no surprise to learn that the fourth biggest provider of home care services, the Mears Group, with 30 branches in the UK, is abandoning its domiciliary care services. “We’re not the first and certainly won’t be the last,” says Alan Long, the executive director. Social care is collapsing because too few people are willing to work gruelling hours in disgraceful conditions for pitiful pay.

Points-based immigration system

The new points-based immigration system announced by the home secretary, Priti Patel, will see many more companies fleeing the sector for lack of staff. With 122,000 vacancies, this decade’s 25% increase in people over 65 means another 580,000 staff will be needed to care for them over the next 15 years. In London, 40% of care staff are from overseas. Median average pay as of last March is a meagre £8.10 an hour, with parts of their hours unpaid: a quarter of staff are on zero-hours contracts.

Here’s the shocking circularity in the government’s position: caring will not qualify as sufficiently skilled to earn a visa, but all that brands this delicate work as “unskilled” is the appalling low pay. Rates for the job are only so low because the government, through local authorities, refuses to pay a fair or even a market rate for the job. The result is market failure, as the care sector collapses. In truth, however, it isn’t a market at all. Care services were outsourced by Margaret Thatcher in the 1980s to cut costs by allowing private companies to pay below public sector rates. But in the end, it was still the state paying for most of it: underpay, and people refuse to take the jobs.

Payments by local authorities

Mears only takes public sector contracts from local authorities: it has no private clients. Whoever buys its care business, if anyone, will have to attract private families and milk them to cover the loss-making state-paid customers. “We can’t do that, we have no expertise in marketing to the private sector,” says Long. What councils pay companies varies widely, between £11 and £22 an hour, mostly the lower end. Staff are not paid travelling time: “Rushing from job to job, paid by the minute. Councils still commission 15-minute visits, against Nice guidelines. Staff stop in car parks to write up notes, unpaid for that.” Long says they need 25% more just to cover travel time.

Half of those who used to get care in 2010 no longer qualify, so staff only deal with “the gravest cases”, says Long, who deserve far longer visits. He’s not surprised they have a 40% staff turnover: similar work in the NHS pays more. Working in supermarkets pays more, without the emotional stress. “My son is an A&E doctor and he sees where these old people end up. That needn’t happen if they were cared for at home by people paid a salary for a fixed eight-hour shift, dedicated and permanent.”

What is the Government going to do about it?

Boris Johnson’s promise to “fix social care once and for all “seems to be like a promise that is dying in the wind. One of the problems the government must fix is that while the NHS is a single employment entity, social care has 18,500 separate employers. Anita Charlesworth, the research and economics director of the Health Foundation, says it would cost £10bn to return social care just to the 2010 level of care. That should be a top priority.

Johnson’s even more expensive care promise was to stop anyone needing to sell their home to pay for care – too afraid of the accusations of a death tax that plagued Theresa May’s plans from the 2017 Conservative manifesto which suggested that people may need to fund care by selling their homes after they’ve died. A mooted cap of £25,000 as the maximum anyone need pay, with the state picking up the bill, thereafter, would cost another £4bn. That wouldn’t add a penny more for care, but just protect home-owning families’ inheritances.

What can we expect from the budget?

The evidence thus far is not encouraging. The budget on 11 March will reveal Johnson’s true political priorities. Where, if anywhere, does social care come in his pecking order? And which comes first – restoring the quality and quantity of care for all, or ensuring homeowners’ families keep their inheritances? The auguries are not good, because one thing we know already: he has put the ideological immigration policy before the urgent need to employ more care workers for millions of people who need social care.

Summary

Larger providers of social care such as the Mears Group will find it hard to operate in the financial climate that continues to exist in social care services. Reliance upon local authority purchasing with pricing forced down to a minimum is not a viable option. Suppliers of domiciliary care services will need to turn to people who can afford to pay privately for their care.

The pre- election promise of Boris Johnson to fix social care appears to have been shunted into the long grass. Only to be replaced by an ideological approach to immigration, rises in the minimum wage and continuing difficulties in recruiting staff. These challenges without some form of positive government intervention will in the end result in more of the larger providers abandoning domiciliary care.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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