1. Care & Support West 28 th 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

2. 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.

3. 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

4. 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

5. 3 slides about Local Authority commissioning and fees

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

7. Providers’ concerns over dignity and safety from short visits

8. Average Visit Lengths

9. 2 slides about Costings and minimum prices for homecare

10. 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

11. 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%

12. 6 slides about National Minimum Wage and HMRC’s findings and requirements

13. 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

14. NMW HMRC investigations of 224 social care providers Average; 45% non-complianceAverage under- payment of £139 HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

15. Reason(s) for NMW non-compliance in the homecare sector HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

16. 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!

17. 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

18. UKHCA’s NMW Toolkit Free 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

19. 2 slides about CQC regulation and inspection changes

20. 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?

21. 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

22. 2 slides about Cavendish

23. 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. 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

25. 4 slides about Local Authority Market Position Statements

26. 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 26

27. 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

28. 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. 28

29. 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. 29

30. 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

31. Some practical ideas Ensure own house is in order Maximise own efficiency and effectiveness Keep the wellbeing of the individual at the forefront of thinking and conversations Enter into open dialogue with commissioners Use costing models and emphasise common purpose Ensure elected members understand the importance of social care To their constituents in vulnerable situations and to their working age population

32. UKHCA’s Engagement with councils and politicians Council leaders Opposition group leaders Social care committee members Council leaders Opposition group leaders Social care committee members 1268 Elected members 1268 Elected members MPs, AMs, MSPs and MLAs >650 Elected politicians >650 Elected politicians Chief Executives Social Services Directors Heads of Legal Directors of Finance Chief Executives Social Services Directors Heads of Legal Directors of Finance Officers of 186 Local authorities Officers of 186 Local authorities

33. Some (more) practical (if challenging!) ideas Raise the profile with the public (electorate) The importance of social care The status of care workers The massive good practise and positive impact The 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.

34. How to contact us Website: www.ukhca.co.uk E-mail: enquiries@ukhca.co.uk Telephone: 020 8661 8188 Twitter: @ukhca