Homecare on a shoestring is damaging our health

Homecare fee rates paid by councils and the NHS remain too low to ensure adequate availability of homecare

New research from the Homecare Association shows that the average price being paid by public organisations for homecare in England after 1 April 2022 remains significantly below the cost of recruiting and retaining a skilled workforce and delivering high-quality, sustainable homecare services.

1.   The average fee rate paid for homecare in England by local authorities was £19.01 per hour.
2.   The average fee rate paid for homecare in England by the NHS was £18.76 per hour.
3.   Both figures are substantially below the Homecare Association’s Minimum Price for Homecare for 2022-23 of £23.20 per hour, which is calculated as the minimum needed to ensure compliance with the legal minimum wage and provision of high-quality, sustainable services. The Homecare Association is clear that the legal minimum wage (£9.50 per hour) is inadequate for this skilled work and homecare workers must be paid wages at least equivalent to Band 3 NHS Healthcare Assistants (£11.85 per hour).

Worryingly, seven councils were paying below even direct staff costs, calculated at £16.57 per hour, never mind covering other necessary operating costs. Direct staff costs consist of pay at £9.50 per hour (National Living Wage, national insurance and pension, and other wage-related on-costs (such as holiday and sickness pay, travel and mileage).

Excluding Greater London, there was evidence of a North/South divide among councils in the research. The North East average was £1.36 per hour below the average for all of England. Our Homecare Deficit Report 2021 found that lower fee rates were paid in areas of higher deprivation.

It is particularly concerning that, at a time of spiralling costs, many employers are simply unable to increase pay for careworkers due to the low fees rates paid by councils and the NHS.

Around 70% of homecare is purchased by the public sector, so central government funding for social care has a direct impact on the fee rates that councils and the NHS pay. In turn, these fee rates and the way homecare is commissioned and purchased, determine pay and terms and conditions of employment of the care workforce.

Rapidly rising fuel costs, alongside the increase in cost of living, means that homecare workers are moving to jobs in retail and hospitality. Skills for Care has reported a decrease in filled posts of 50,000 in the social care workforce in 2021/22 compared with 2020/21. The homecare vacancy rate has reached 14.8% this year, the highest ever recorded.

Without an increase in the workforce, demand for homecare cannot be met. This has an adverse impact on council waiting lists for care, which are over half a million, ambulance response times, and waiting lists for diagnosis and treatment by the NHS, which now exceed 6.8 million.

Shortage of homecare is leading to a deterioration in health of people living in the community, adding to pressure on the NHS and is reducing access to medical treatment for those who need it.

Official statistics indicate that the number of people who are economically inactive due to long-term ill health is the highest ever recorded. The nation's health and wealth are closely linked and if the government wants to support economic growth, it needs to invest in homecare and the wider health and care system.

Commenting on the findings, Homecare Association’s CEO Dr Jane Townson said:

These low fee rates from councils and the NHS lead directly to homecare workers experiencing poor pay and terms and conditions of employment. It’s hardly surprising there is an exodus of homecare workers, as fuel prices remain high and they are struggling to pay their household bills.

Without investment from the Government, the social care workforce will continue to shrink at a time of rising need. Older and disabled people are already having to sit on council waiting lists, unable to receive the care they need. NHS trusts are struggling to ensure rapid ambulance response times and to reduce waiting lists, as discharge from hospital is hampered by inadequate capacity in social care and community services.

We need adequate funding for homecare, so we can enable people to live well at home, extend healthy life expectancy, reduce inequalities, take pressure off the NHS and reduce costs for the health and care system.

The Homecare Association calls on:

1. Central government to invest an extra £1.7 billion p.a. in homecare so that careworkers are paid fairly for the skilled roles they perform.
2. Councils and the NHS to pay the true cost of delivering high-quality, sustainable care services and end the practice of purchasing homecare “by-the-minute”, alternatively focusing on achieving the outcomes people want, enhanced by technology solutions.

You can read the full research report here.

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Councils and the NHS must pay a fair price for homecare to cover costs and enable providers to retain and recruit enough careworkers to meet need.

Notes to editors

The Homecare Association is the UK’s membership body for homecare providers, with c. 2,300 members nationally. The Homecare Association’s mission is to work together to ensure that homecare is valued, so that all of us can live well at home and flourish within our communities.

The Homecare Association takes the lead in shaping homecare, in collaboration with partners across the care sector, and provides hands-on support and practical tools for its members. As a member-led professional association, the Homecare Association's members agree to abide by the Association's Code of Practice.

We asked some homecare providers in England to provide details of the contracts they hold with local authorities, clinical commissioning groups (CCGs) or both. (NB. Since starting this work, CCGs have been abolished following the creation of Integrated Care Boards). Specifically, when contracting with each council or CCG, we wanted to know:

•   Main contract held (e.g., regular homecare, extra care, supported living etc.).
•   Purchase type (e.g., framework, guaranteed purchase, spot etc.).
•   Standard 2021-22 fee rate per hour.
•   Whether the provider had been informed of their fee rate for 2022-23.
•   If so, the standard 2022-23 fee rate per hour.

The full research is published on our website, please click here.

For further information please contact: Homecare Association Ltd, Telephone: 020 8661 8165. Mobile: 07393 012 113. www.homecareassociation.org.uk