'Gobsmacking': Lancashire County Council invites homecare providers to ask for more money, as warning goes out about changes to services amid staff shortages
Lancashire County Council has asked the companies that provide care in people’s own homes if they want to be paid more for their work – in an attempt to help ease a staffing crisis in the sector.
The authority took the unusual step of writing to the 48 main firms that supply homecare services on its behalf in order to remind them of a clause in their contracts under which they are able to request a so-called “price review” - if they have encountered increases in their costs which could not have been foreseen when they originally bid for the work.
In the letter, which has been seen by the Local Democracy Reporting Service (LDRS), the providers are actively advised by adult services director Tony Pounder to consider seeking such a review and to explain how they would use any uplift in the hourly rate they are paid “to improve recruitment and retention of staff”.
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Mr. Pounder said that the authority thought it “reasonable for...providers to argue [that] the current combination of factors which are making staff recruitment and retention so very difficult” was justifiable grounds for making a request for more money. He added that there are “major challenges” in staffing homecare services, both in Lancashire and nationwide.
The boss of one homecare service, which looks after residents in parts of Central Lancashire and the Fylde coast, told the LDRS that he was “gobsmacked” by the invite.
Meanwhile, County Hall has also contacted all of the people who receive homecare in Lancashire to warn them that staffing difficulties faced by the firms contracted to support them could mean that their care times may have to be changed or that they will be visited by different carers. The authority also told residents that some of them may be asked by their homecare provider if relatives or friends could assist them “for a temporary period” if the firm had staff shortages.
However, there is no suggestion that anybody will go without the care they need and the letter stresses that people should not be “anxious or concerned”. It adds that the county council and the homecare companies working in Lancashire are doing all they can to avoid any disruption to normal routines.
The correspondence comes amid a surge in demand for homecare services as fewer families seek residential care for their loved ones. Last month, the number of hours of care delivered at home to residents in the Lancashire County Council area leapt by 15 percent compared to December 2019, before the pandemic struck.
In September, the authority was forecasting a £7.1m overspend on "care at home services" this financial year.
Speaking to the LDRS about the two letters, which have been sent out in recent weeks, Conservative cabinet member for adult services Graham Gooch said that was important to be candid with those receiving care - and fair with those who provide it.
“We want to keep the providers on side, give them what they need, and keep the service there for everybody,” he said.
The authority has what is known as a “framework” agreement with the 48 companies it uses for homecare services. That means that they are the county council’s first port of call when it needs to secure packages of home help for residents.
The price to be paid to them is agreed when the companies are put on the framework. However, if those firms are unable to meet all of the authority’s ever-changing needs, County Hall is forced to turn to other providers, which can name their price and so sometimes offer their staff better terms - putting more pressure on those firms on the framework.
“Some of their workers have been enticed away by offers of better money. They have been losing staff to [companies] outside the framework - and because there haven't been [sufficient] places with the framework organisations, we’ve had to look [elsewhere] to provide care.
“Of course, [non-framework firms] have got the control of the market and they charge us an awful lot. Some of the framework contractors didn't know about this clause in their contract [to seek a price review], so we thought it was only fair to remind them of it and invite them to consider their position.
“We put in the clause in case things became difficult and their costs increased for reasons over which they have got no control or which they are unable to manage. It can only be [triggered] in those circumstances, to make sure nobody puts in a low tender to get the job and then immediately says, ‘We need more’,” County Cllr Gooch explained.
Jimmy Anyon, director of the Central Lancashire branch of SureCare, which is a framework homecare provider for the county council in South Ribble, said that the option of asking for a price increase from the authority was a welcome one - although being reminded of it was rather unexpected.
“I was gobsmacked - I think every provider was. I've always known there was a clause in the contract, but to have a very strange webinar [at which the council says] ‘challenge your prices’ was a bit of a relief, [as for] the last six or seven years we have had minimal increases,” Mr. Anyon said.
SureCare - which also has a branch operating in Fylde and Wyre - intends to use any increase it receives in order to increase staff pay and help it to retain its workers. The firm has sought a 20 percent uplift to ensure that it can pay its staff a “bare minimum” of £10.50 an hour.
Mr. Anyon says that while his company is not experiencing the recruitment difficulties of some operators, the homecare sector is “underpaid”.
“We have still got to be competitive with the likes of Tesco and Amazon. If I can get the right staff and offer them the right hourly rate or contract, it’s easier to keep those people.
“We had to [fill in a spreadsheet] about how much we want to pay our staff and about pensions, holiday pay, overheads, tax and national insurance. It then gave you a sum at the bottom of how much you need from the county council [to meet that cost] - but I think the original [amount] will get trimmed down a little bit,” Mr. Anyon added.
The authority is considering each request on its merits and has not set aside a specific sum for any increases to which it may agree. Providers are being advised of the council’s decisions this week.
Margaret MacDonald, regional operations manager for Guardian Homecare, which provides services for the county council - including “crisis” care in Central Lancashire - said that recruitment challenges were putting the firm under “a lot of pressure”.
“There just doesn't seem to be a lot of people coming through and the demand for services is really increasing.
“Our retention is good - we have got support workers who have been here 15 years, but you always seem to get this turnover where people don't want to stay.
“Homecare is a tough job - you are driving around to people’s homes, you work unsupervised and so, in terms of responsibility, it is tough and I think it takes a certain kind of person [to do it]. Not only do they have to be caring, they have to be confident to drive and find their way around,” Ms. MacDonald said.
She added that she would also expect the majority of any increase in fees to go on improving staff pay, which the firm has already recently put up.
While she praised the county council for its support and “doing its best” throughout the pandemic, she said that local authorities “need to be supported by the government”.
“There just seems to be no focus on social care - I think we’re paying the price for years of underfunding. Then Covid hit and there is [recruitment] competition from other sectors and also Brexit.
“It’s just like a perfect storm - and we are worried.”
Jimmy Anyon also welcomed County Hall’s efforts to bolster the homecare sector, but said that greater certainty about the work that would be offered to firms like his would help even more, especially with the biggest challenge he says he faces - covering sickness.
“We never mass recruit, because if I employed ten staff today and they all wanted 30 hours a week, [I wouldn't know if I would] be able to get those 300 hours off the council.
“The council says there are thousands of hours available, but they might not fit those [employees’] needs. I’ve fought for many years to get a block contract, rather than a spot contract.
“Last week, I recruited three drivers who are covering people who are off sick, but when your [other staff] return, you are then [looking for] more hours. It would be a perfect scenario if [the council said] you have got to do 1,000 hours per week and we will pay you for 1,000 a week - and then I could recruit accordingly with the correct staff on contracted wages,” Mr. Anyon said.
He added that the firm has had to make some of the more minor alterations to its services that the county council alluded to in its letter to people receiving homecare.
“Mainly because of sickness, we have moved some [visits] around. We’re obviously not going to move medication times, but if someone wants a shower at 9am, which is our key time, we'd probably ask to move that to the afternoon - and service users have been very understanding.”
“However, you can't have a priority [order] one, two and three - everybody is a priority - whether you're making them a cup of tea or looking after someone at the end of their life. Some people don’t see anybody else apart from our staff,” Mr. Anyon said.
He also says that there is merit in another request from the county council for providers to help identify situations in which people might no longer need the full package of care with which they were originally provided - saying that, in some cases, needs may have reduced over time.
The county council is going to be prioritising reviews of those who may be in that position.
County Cllr Gooch said that it was possible for people to see their care needs change over time, because of the intensity of initial interventions, such as providing them with help from physios and occupational therapists.
He added that the shift to increased homecare - while currently causing some capacity problems for the authority and its providers - did, nevertheless, chime with the county council’s longstanding aim to reduce its reliance on residential care for vulnerable residents.
“Homecare has gone up quite a lot because of Covid - people don't want their relatives to go into residential care [in the same numbers].
“It’s part of our aim as a council to reduce the number of people in care and keep them in their homes as long as possible - but it’s happened rather quicker [than we were expecting].”
The government published its long-awaited social care white paper on Wednesday, outlining what it described as a "10-year vision" to transform support and care in England by ensuring people "have choice, control and support to live independent lives" and can access tailored care as part of a fair system.
Ministers set out around £1bn of financial pledges over the next three years, including at least £500m to provide the social care workforce with the right training and qualifications and to enable them "to feel recognised and valued for their skills and commitment".
However, the plan was criticised as inadequate by opposition politicians and the Tory former health secretary, Jeremy Hunt, who said it was "a long way off” the £7bn extra per year that the health and social care select committee, which he chairs, had said was needed overall by the end of the current parliament.
He also called for further measures to end the "workforce crisis" in social care which means that hospital wards are "full of people who should be discharged and older people [are] not getting the care they need, because the carers do not exist."
‘IT’S AN INSULT’
Two of the firms delivering homecare for residents across Central Lancashire and the Fylde coast say that there needs to be more recognition of the role played by the individuals providing the service - and promotion of care as a career in order to change public perceptions of the job.
Jimmy Anyon, director of SureCare Preston and South Ribble, says that care workers should receive the training they need to be able to plot out a pathway along which they can progress through their working lives. He also told the LDRS that the common description of care staff as “unskilled” is “an insult” to them.
“Carers get knocked down for being ‘social care workers’, but they're health workers as well. I’ve been fighting for skills for carers for years...where you can start at 17 or 18 and have progression and keep moving on.
“After their 12-week probation period, we always ask staff if they would like to do the level 2 diploma in health and social care - and we usually get quite a good take up on that. Then we push them forward for a level 3 - regardless of whether it's needed [for their role] in our company - because it's a way of giving them another pay rise. It’s not massive, but it's better than nothing.
“But you tend to be stuck then - if you follow a training pathway, then after about year four, [you don't know] what to do next for that person. However, we tend to recruit office staff and managers internally, so there is always a pathway for that,” said Mr. Anyon, who believes that better pay and prospects would help stop care workers thinking that the “grass is always greener” elsewhere and so leaving for another job.
Margaret MacDonald, regional operations manager for Guardian Homecare, says that there is a fine line between a nurse and a carer - but a gulf in public attitudes towards the two.
“Obviously there are things that a carer can't do, but I don’t think it's recognised that a lot of support staff now do have a qualification. The QCS [Qualification and Credit Framework] apprenticeship is quite detailed and in-depth - and it's not that easy to attain.
“It’s an achievement, but it just doesn't seem to be recognised,” Ms. MacDonald said.
Lancashire County Council's cabinet member for adult services Graham Gooch agrees and says that it is difficult to persuade people to stay in care work despite it being such a “worthwhile” role.
“They haven’t got ‘the badge' of the NHS - and people don't seem to have quite the same regard for people working in care. But it’s only [by] getting people out of hospital and into the council’s domain of care that the NHS keeps going,” County Cllr Gooch added.
74,230 - homecare hours delivered in Lancashire County Council area (Dec 2019)
84,689 - homecare hours delivered in Lancashire County Council area (Oct 2021)
800 - "crisis" homecare hours to support people upon discharge from hospital in October 2021, compared to the zero provided in December 2019
15 percent - increase in overall home care hours in Lancashire County Council area (between Dec 2019 and Oct 2021)