A new report, Caring About Health, published by the Royal Society for Public Health is calling for reform to key areas of adult social care to improve working conditions and widen access to public health skills training for the workforce.
In response, our Chief Executive, Dr Jane Townson OBE, said:
"The Royal Society for Public Health (RSPH) report provides a timely and important analysis of the challenges facing adult social care and its impact on health outcomes. As the Homecare Association, we strongly agree that home-based support and care plays a fundamental role in enabling people to live well in their communities, and we would welcome much greater collaboration between homecare providers and public health services.
"The report rightly identifies many of the symptoms of a system under severe strain. However, we must be clear that many of these problems stem directly from the structural deficiencies in how local authorities and the NHS commission and purchase homecare services.
"The current model of insecure, zero-hours commissioning contracts, combined with chronically low fee rates that only cover client contact time, creates a cascade of problems that undermines quality care. When providers receive inadequate funding that fails to cover travel time, administrative costs, training, and supervision, they cannot offer secure employment with decent wages. This leads directly to the high staff turnover, inconsistent care relationships, and inadequate training that the report highlights.
"The 15-minute visits that the RSPH correctly identifies as wholly inadequate are not a choice made by providers, but rather a direct consequence of commissioning practices that prioritise cost-cutting over quality outcomes. When contracts are awarded primarily on price rather than value, and when fee rates fail to reflect the true cost of delivering person-centered care, the entire system suffers."
We welcome the report’s recommendations around enhanced training, delegated healthcare activities, and improved integration with health services. However, these cannot be achieved without addressing the root causes. Any sustainable solution must include:
- Long-term commissioning contracts that provide security for providers and workers.
- Fee rates that reflect the true cost of quality care delivery.
- Commissioning frameworks that prioritise outcomes and relationship-based care over unit costs.
- Recognition that effective homecare requires investment in the workforce, training, and support systems.
The homecare sector is ready to work collaboratively with public health services, local authorities, and the NHS to transform how we support people in their communities. But this partnership must be built on sustainable commissioning and funding that enables providers to deliver the quality, relationship-based care that people deserve.
ENDS
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