The Community and Wellbeing Scrutiny Committee will consider a report
LINK on September 4th outlining the issues facing the provision of child and adult social care in the borough. The Council wishes to fund private providers sufficiently to pay their workers the London Living Wage, wants them to move away from zero hours contracts (unless workers prefer them) and comply with Unison's Care Charter. To do this they want to introduce a 'patch model' with fewer providers in particular areas so that there is improved performance and better quality relationships with care recipients as well as support some specialist care providers.
The change will be costly with Adult Social Care costing £10million more if the changes are implemented in 2020-21. The report rejects bringing Social Care in-house (the Council running the service) on grounds of viability and risk.
Key extracts from the report:
Paying the London Living Wage
The
current cost model allows for providers to pay at or above the National Living
Wage, which is £8.21 per hour, but does not enable them to pay London Living
Wage, which is £10.55 per hour. Therefore, there are clear cost implications to
the Council in paying at London Living Wage levels.
The
Council has a clear commitment to paying LLW where possible, and no one would
argue this is not the right thing to do. However, it is worth noting that there
is no evidence, locally or nationally, that paying care workers above NLW has
any impact on the quality of care. Regardless, discussion at PCG and at CMT has
concluded that the Council will offer LLW as part of the new homecare model.
The debate therefore is how quickly this can be delivered.
Within
Adult Social Care we have a strong record of price control, although
expenditure has increased year on year due to increases in complexity of
packages and hours of homecare clients are receiving. However, both the
external price analysis and intelligence from our own commissioning function
has indicated that Brent now pays one of the lowest hourly rate in North West
London. Other boroughs that have re-commissioned services are paying in the
region of £18 per hour. The combination of a lack of available home care
workers (The Institute of Public Policy Research estimates that nationally the
industry will need 400,000 additional carers by 2028) and the fact that Brent
is now one of the lowest paying boroughs in NW London have both contributed to
the need to review our existing model to ensure the market remains sustainable
in the future.
Ending Zero Hours Contracts
Currently
38% of care workers in Brent work on zero-hours contracts. To mandate that
providers don’t use zero-hours contracts and instead offer minimum-hours
contracts would inevitably have an impact on the way that they are able to
organise their staff rotas to deliver care. There are peaks in the demand for
homecare services. Unsurprisingly they are in the morning, lunchtime and
evenings. Providers don’t want to have to pay care workers when they aren’t
delivering care; the council doesn’t want to pay providers more than is
necessary to deliver quality services.
Through
discussion with providers, we are also clear that the biggest incentive for a
reduction in the use of inappropriate zero-hours contracts will be being able
to offer providers a guaranteed level of hours and funding. This can be
achieved through reducing the number of providers and implementing a patch
based model. This would give providers a clear and consistent number of hours
to work with so that they can plan their workforce requirements accordingly.
The more confident the council can be in guaranteeing hours of work, the easier
it will be for providers to plan their rotas and not have to fill in gaps in
provision with zero-hours workers.
However,
it is known that in some instances, zero-hours contracts are the preferred
option of homecare workers. Our aim is that where workers would prefer a
standard contract and a guaranteed minimum number of hours, this is available
to them, but that we allow providers the flexibility to offer other contractual
mechanism such as zero-hours contracts, or casual and short term contracts
where appropriate (for example for when individuals wish to work during term
time only, or to cover extended leave or maternity cover)
Providing Social Care In-house
Consideration
has been given as to whether homecare services could be brought back in house.
The challenges of doing this would be considerable. Firstly, the cost of an
in-house service has been modelled, focusing on staff costs alone (not
including other overheads, such as premises, equipment, etc). Officers estimate
than the annual cost of an in-house homecare service for Adult Social Care only
would be £34.4m per year by 2023/24, compared to £27.9m, which is the modelled
cost of a commissioned service including LLW. More work would need to be done
to model the costs of a Children’s service, but it is likely to be more
expensive than a commissioned service.
The
modelling is based on needing 750 carers, 50 supervisors and 14 additional
managers (Team Leaders up to a Head of Service) which is an extremely
conservative estimate of the staffing required. Staffing ratios would need to
be considered – the service has been modelled on the basis of 1 supervisor to
15 staff. Officers have also assumed that staff would be working on permanent
contracts, and there would be no use of zero hours’ contracts.
There
are a number of factors that make in-house homecare services more expensive
than services commissioned from external providers. It needs to be recognised
that many homecare providers are working with few overheads and little
organisational infrastructure. It is not uncommon for smaller providers to be
led by a manager / owner, who will perform a number of roles within the
organisation, and also directly deliver care when needed. The flexibility that
this gives providers can’t be replicated if the service was to be brought back
in-house.
Providers
are also able to manage their workforce so that they are not working during
parts of the day when demand for homecare is much lower. There are peaks in
demand in the morning, lunchtime and evening, with little demand between times.
Whilst providers use zero-hours’ contracts to help manage this (and it’s agreed
we want to reduce their use), the council would not have this option.
Therefore, an in-house service would be paying for staff
at times when they would not be working to full capacity, adding to the
cost of services.
Market
sustainability would be an issue if Brent was reliant on one, in-house provider
and would bring into question our ability to meet our Care Act requirements
with regard to market sustainability and choice. There would also be
considerable risk in having one provider, and whether we could ensure we could
manage the various issues that arise when delivering homecare, such as
safeguarding issues, quality management and workforce considerations and
customer satisfaction.
Given
that homecare services have been commissioned from other providers in recent
years, the council has no experience in managing a homecare service. This
expertise would need to be brought in to ensure that services were run in line
with rules and regulations, (for instance, the service would need to be CQC
registered before care could be delivered) as well as ensuring it was as
efficient as possible, making best use of staff time and resources. At this
stage, progressing this option is not recommended.
The report argues that the proposed changes would meet Unison's Care Charter but these claims rest on successful re-procurement and will need to be probed at the Scrutiny meeting.
Unison Care Charter
