Our withdrawal from providing care on the Wirral
Recent media interest has inclined me to write a piece on why we made this decision. It’s purely observational and borne out of personal experience of delivering, managing and leading care services for the last twenty years. I’m not a writer or commentator and this is clear from the flow. However, it’s important that aspects of current public sector commissioning are highlighted by providers like us, who in general keep our eyes focussed on delivering care first and foremost. Sometimes however, it’s critical to state your point and stand your ground.
In June we took the decision to voluntarily withdraw from our home care contract with Wirral MBC. We had been awarded this contract in 2014 and at the time we were thrilled to have been recognised for our experience, skills and commitment to delivering great care in the North West. This was a significant expansion for us in our then 18th year of care delivery on Merseyside.
Since then, we have seen several dramatic and unforeseen cost increases applied to the basic employment and training of our employees. To be clear, these are categorically unavoidable costs and applying minimum wage, travel and pension costs are non-negotiable and have to be evidenced. Adjusting further for an over 300% increase in fees for CQC, an expectation that employers now pay for all SSP as well as general increases in compliance and operating costs and...well you get the picture.
We support these changes as they are materially beneficial for staff that by consequence aids retention, recruitment and the recognition of care workers as the skilled and dedicated teams they are. We want good terms and conditions for our staff and to see the care sector workforce professionalised and recognised properly.
We therefore have a basic but firm expectation to be paid a fair price by our service commissioners to do this. No ifs, no buts. Just a fair price for delivering an effective service to a vulnerable person.
Over the last few years we have seen zero % fee increase and in some cases reduced fee levels imposed by public sector commissioners. In times of austerity we have all taken the pain of cutbacks and belt tightening, social care especially. But there is an absolute bottom line, below which you question why you would continue if you risk being a very busy fool and/or not meeting all your obligations, legal or otherwise. In some areas, the lack of insight into this or more worryingly, lack of interest in solving this is creating the conditions for market failure through lack of capacity or provider withdrawal.
Perversely, there is growing available evidence that Authorities in fact do recognise these costs, they accept that they are purchasing at subprime levels, state this in their risk registers yet still go ahead and enforce fee levels 10-30% below recognised fair pricing.
Why is this? How can one council fund fairly, yet another evidentially fails to do this? Is it funding and government cuts? Is it political or officer pressure to toe the line and not upset or inform Councillors adequately? Because the market continues to say we can do it for that price? Perhaps. All we know is that because we work across the North of England we can see materially similar councils (population, deprivation, rurality, demographic, choose your index) behaving and paying in utterly polar opposite ways.
The one unifying aspect is they all blame central government cuts. Odd then, how despite this, some councils do deliver adequately and reasonably against their statutory obligations. And guess what, when they do, they also show better commitment and desire to innovate and take their market forwards.
Many public sector commissioners get this point. We work across the North of England and many have engaged and take seriously the need to engage with their care market and find the funds to respond to a growing demand and demographic increase over the coming decades. Many of these authorities rightly see beyond the incorrect headlines and TV programmes that give the impression of widespread profiteering and poor care. They see the good care and long standing providers (yes, large and small) delivering in their localities. Don’t forget that these providers are also adjusting to a logistically challenging, dynamic care and economic landscape and struggling with an increasingly survivalist and strategically thin experience of business. Providers and informed commissioners should start to work more closely together to create better outcomes for those receiving services. This starts with ensuring a stable trading environment in the first instance, which is regardless of private, public or third sector status frankly.
Fail to do this and you can expect to see many more service failures and contract withdrawals in the coming months and years.
In the North of England we do see areas of forward thinking, strategically sound and intelligent commissioning. In these areas we see capacity in the market appearing, higher staff retention levels and innovation in practice. We see better integration of health and social care, evolving models of intermediate care at home, longer term contracts designed to partner rather than just outsource.
This is not a coincidence.
So, we’ve chosen to withdraw our services in an area that initially showed so much opportunity to get things right. It’s not a decision we made lightly, nor without enormous regret for the service users and staff affected. We care very much about the services we provide.
We have thriving and effective service in many areas, including other parts of Merseyside. We support hundreds of people each week and have a wide portfolio of services for many people (young and old) and also many non-public sector funded services. We can therefore operate successfully despite this difficult decision and we can safely move forwards with our services elsewhere.
That said, we expect to be labelled (by some) as a provider leaving for profit motive alone. If making a reasonable profit allows a service to develop and thrive for the twenty years we have delivered great care then yes the profit motive is true. But look closer at the market (and many interested parties quite rightly are), and the gaping chasm that exists between the actual costs for providing a skilled person to deliver a dignified, safe, well trained and supported care visit and what some public sector commissioners are actually willing or able to pay can almost be seen from space - it is that stark.
The test of course, is could these Authorities provide the service for the rate they stand so strongly in defence of? The answer is of course they can’t. Which is why a healthy independent sector has emerged, offering better value and more efficient use of the public purse. Just don’t conflate this with care on the cheap just because you have the ability to control and manipulate the market.
We will now refocus our dedicated and tireless care worker and office teams to deliver care in areas where our definition of a care service is valued and has a sustainable future. We will no longer work with Authorities that can and do use their market managing and price making status to artificially downgrade and devalue such a critical service.
We wish those commissioners all the very best of luck, they have a hard job. But a final question, If we are really too costly, why do you then ring us up and pay the fair market rate when your contracted providers fail to deliver?
NOTES AND CONTEXT
Domiciliary care is a service to look after people with care needs in their own home. It requires well trained, consistent and fairly employed people to deliver this essential service.
Much of the home care required is purchased by Local Authorities and organisations are contracted with to provide these services. This has largely been the case since the early 1990s and the Community Care Act (as was).
Over recent years, story after story has been reported about substandard care, scandals in social care and concerns raised over how social care is funded. More recent issues relating to fair terms and conditions, adherence to national minimum wage legislation and latterly the living wage and travel time have placed many responsible and long standing providers in positions of jeopardy and questions over fundamental sustainability have been asked by these providers.
Where providers have contractual relationships with public sector commissioners there has to be an acceptance that rates payable for these services are able to cover these critical areas of legal compliance, operating costs and yes, a reasonable contribution to profit to support the organisation to fund investment, expansion and service innovation.
Over the last few months the United Kingdom Home Care Association (UKHCA) has predicted that if these costs are not met, then provision will shrink and providers will exit unviable contracts.
Optimo Care Group employs several hundred people across a number of areas in the North of England. Our services have a combined trading history of over 40 years.
Chief Executive Richard Walker, is a non exec board member of the UKHCA, the home care professional body. He is single minded in his view that home care delivered effectively can revolutionise the way that care and support is deployed and can influence and improve how people are prevented from entering hospital but also how people are deconditioned as a result of hospital admission, particularly those with dementia. He sits on the Re-imagining Homecare Group which includes Department of Health representation as well as thought leaders from across the health and social care sector.