Special Pleading

I thought this piece of nauseating special pleading from the private sector in the Guardian was interesting and ably demonstrates what happens if they're not able to make a big enough profit. It's happened in the NHS, could it be where we are heading?  

Why my company is handing homecare contracts back to councils

In the last few months, my company – Mears – has taken agonising decisions to hand back a number of homecare contracts to local authorities, especially in the north of England.As painful as this has been for the people we have been providing care for – and for our care workers – we hope others will follow our lead and help to end commissioning practices that should have no place in 21st-century Britain.

Exiting contracts in this way is always the last resort and follows many months of trying to develop a different solution with a commissioner. But, ultimately, it may be the only means to drive the essential change in services that are life-critical to our most vulnerable citizens. We are not happy with the disruption this creates, but we feel that we have to take a stand to lead positive change in the absence of leadership from elsewhere.

The contracts we have exited are those where simple mathematics shows that the charge rate a council wants to pay will result in a provider either not meeting the requirements of the “national living wage” for care staff, or not delivering the service needed by the user.

In the homecare world, generally, councils only pay for “contact time” – the time a care worker spends with a service user. They don’t pay for the time it takes the worker to get to the property or move on to the next. They don’t pay for any of the time the worker must spend on training, or for the worker’s “on-costs” to ensure they are looked after if they fall sick. Nor do they help pay into their pensions. In recent years, councils have also shortened call lengths in order to cut costs, and many people have lost a service altogether.

The “national living wage” is, of course, the bare minimum we need to pay – and rightly so. Being a care worker is an increasingly skilled job, requiring staff who can provide highly intimate personal care as well as support with medication. It is not for the faint-hearted and requires talent, dedication and strength. It is no surprise then that there is a national shortage of care staff. In the last 12 months alone, a lack of homecare capacity in the community has caused delayed discharges from hospitals to increase by 40%.

At a time when the NHS is creaking at the seams, there is an inherent short-sightedness in a system that focuses on cutting support for individuals, reducing call lengths and keeping charge rates for providers below sustainable levels.

Unfortunately, many care providers still choose to accept very low charge rates from councils. This could be due to a lack of understanding of the minimum wage law, but is often simply caused by local businesses feeling they have no choice but to accept the terms offered, or risk going under. These businesses are often small and rely on a single contract just to exist.

I have huge sympathy for councils on this issue, especially as many have been forced to cut other services to protect social care budgets. However, there is no excuse for setting charge rates that will almost certainly lead to breaches of the minimum wage or poor service. The last few governments have talked about reconsidering how we, as a society, fund social care – but nothing material has happened. Ultimately, this means we are failing to examine how we want to look after older and vulnerable people who need our support. All demographics point to an increasingly elderly population over the next 10 to 20 years, many of whom will be living with multiple long-term conditions. Surely it is a measure of a good society that we provide proper care for those people, at a time when they need it most?

If we had given even 1% of the time spent discussing Brexit on trying to reach a solution to the social care crisis, we might have one by now.

Real integration of health and social care is important, but it is a long way off in most parts of the UK. In those places where it has been achieved, it is not all plain sailing. Our first priority should be ensuring that the care system is sustainable.

We must move away from a system that pays the provider for the minutes spent with a service user, to one that rewards quality and the impact on that person’s life. Having due regard for those we rely on to carry out that work is just as essential; care staff should command the same respect as doctors and nurses, and a career in care should be rewarded appropriately.

There are councils, such as Torbay and Wiltshire, that are moving to fundamentally different ways of working that are positive and take these factors into account. At Mears, we are doing everything we can to support positive changes to working practices, better conditions for the workforce and greater focus on the service user. At times, however, we feel like a lone voice.

It has been said that to care for those who once cared for us is not just a responsibility but an honour. Now is the chance for society to prove that.

Alan Long is executive director of Mears Group PLC

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The first two comments:-

We also need to consider the specific circumstances of the organisation i.e. validate their contention rather than simply accepting it as fact. A quick check via Companies House beta service indicates Mears Limited agreed £20m in dividends which was in excess of the profit they made for the FYE 31/12/15.

To what extent should we expect social care operators to cut their cloth according to market conditions? Would they have paid £7.20 if it wasn't mandatory? Is it unreasonable for us to expect them to display social responsibility i.e. dip into their reserves whilst LA's are experiencing unprecedented financial pressures.

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I worked many years ago in care management roles, when most of our domiliciary support was an inhouse homecare service. The business game, the discredited business models with microcommissioning, any qualified Provider imposed by the Department of Health were starting to fragment services, frequently taken away clinical judgement from Social Workers and Occupational therapists.

Under the unnecessary Town hall austerity cuts of George Osborne and the failure to ring fence, protect and fully integrate Social Care budgets with Health care, our nation has been largely indifferent to the crushing blows to the frontline carers in domiciliary support and care homes. I hope history will judge the perpetrators harshly. Cuts of 30-40-50 % to town hall, as well as robbing of the very vulnerable members of our communities of vital support, as support centres, community projects, shopping services close, the race to the bottom, to get it all at the cheapest possible price has brought in horrendous work practices. 

The Local Government Association has warned, the ADSS has warned. UNISON put together the ethical care charter, with little interest, sadly not even strong Labour Councils like Liverpool sniffed at it. Here Councillors know all to well the consequences of failing to pass a balanced budget.

I plead with all influential people and politicians of all persuasions, to do the sums, to integrate health and social care, to look at the basis of the Ethical Care charter and build it into all social care employment contracts, to ensure a transparency by all providers in their pay conditions, travel. Local Authority commissioners, desperate to stretch out what money they have, brutally treated domiciliary care agencies and care homes, who in turn have been forced either to walk away from contracts or impose shameful working conditiions. It is in the public record that HMRC named and shamed a Crossroads service in the East Midlands, a non for profit charity group with a long history of public service, with not even paying the minimum wage to its front line staff.

Please all politicians left, right or Centre, can we look again at the Ethical Care Charter developed by UNISON. We as a nation owe it to frontline careworkers, which will give stability in recruitment and retention, less of a turnover of staff, retaining well trained, motivated staff, which will greatly assist the tens of thousands of people who rely on that support and care hour by hour, day by day.