Homecare Association comments on RQIA’s report on the Southern Health and Social Care Trust area
The Homecare Association welcomes the Regulation and Quality Improvement Authority’s (RQIA) report of a system inspection in the Southern Health and Social Care (HSC) Trust area, published on 17 January 2024. The findings did not surprise us.
For years, independent domiciliary care providers in Northern Ireland have raised concerns about the approach of the Southern HSC Trust.
Providers report that staff from the Southern HSC Trust follow their domiciliary care workers around with stopwatches, hiding in hedges and counting the minutes they are in a person’s home. Then they send them invoices for ‘minutes not spent’ in a person’s home. The Regional Contract currency for care is 100 percent care, not time. If indeed it were time, then the rate they pay is grossly inadequate to meet the National Minimum Wage, never mind the Real Living Wage.
Data from an inquiry we conducted under Freedom of Information legislation showed that the Southern HSC Trust pays an average of only £18.08 per hour for domiciliary care from independent providers, which is among the lowest in the UK. The Trust delivers 42 percent of the total domiciliary care hours itself, at a cost per hour which is far higher than that of independent providers. We question the ethics of this disparity.
Our calculations on the Minimum Price for Homecare for Northern Ireland show that direct staff costs at the Real Living Wage of £12 per hour (announced in October 2023), plus statutory employment on-costs, are an average of £20.77 per hour. On top of this, providers must cover the other costs of homecare delivery, including wages for managers and office staff, recruitment, training, insurance, IT and telephony, PPE and consumables, rent, rates and utilities. This is an average of £8.60 per hour. The total cost of delivery of domiciliary care at the Real Living Wage is thus £29.37 per hour.
Current average fee rates of £18.08 per hour are thus only 62 percent of the actual cost of delivery and the Trust still seeks to claw back money for minutes.
CEO of the Homecare Association, Dr Jane Townson OBE, said:
“Imagine nurses in a hospital being paid only for minutes by a patient’s bedside. No pay when walking from one bed to another, or whilst training or being supervised. Imagine nobody asking about the outcomes for patients of their care or treatment, just counting minutes spent by the bedside. There would be an outcry.
But this is the everyday reality for domiciliary care workers in the Southern HSC Trust area, whose poor pay and terms and conditions of employment result from this approach to commissioning and contracting.
It’s no wonder there are challenges in retaining and recruiting care workers and that domiciliary care has become a critical constraint to timely hospital discharge in this area, adversely affecting the health and well-being of many.
We call on the government of Northern Ireland to invest adequately in homecare and put an end to the minute-by-minute monitoring and payment of domiciliary care workers, which makes Victorian factories appear progressive”.
--ENDS--