Domiciliary Care Workforce: Improving the Recruitment and Retention of Domiciliary Care

Domiciliary Care Workforce: Improving the recruitment and retention of Domiciliary Care workers in Wales

Introduction

1.The Welsh Local Government Association (WLGA) represents the 22 local authorities in Wales, and the three national park authorities and three fire and rescue authorities are associate members.

2.It seeks to provide representation to local authorities within an emerging policy framework that satisfies the key priorities of our members and delivers a broad range of services that add value to Welsh Local Government and the communities they serve.

3.The Association of Directors of Social Services Cymru (ADSS Cymru) is the professional and strategic leadership organisation for social services in Wales and is composed of statutory Directors of Social Services, and the Heads of Service who support them in delivering social services responsibilitiesand accountabilities; a group of more than 80 social services leaders across the 22 local authorities in Wales.

4.The WLGA and ADSS Cymru welcome the opportunity to comment on the domiciliary care workforce consultation. Domiciliary care is an essential part of the care and support system. The service helps to make sure people’s needs are addressed as they emerge and they can be supported to continue living in their own home. The service helps to prevent inappropriate admissions into institutional care.

5.The consultation sets out a number of proposals that seek to recognise the important work done by domiciliary care workers, raise their profile and improve the quality of domiciliary care in Wales by having a positive impact on the recruitment and retention of domiciliary care workers. The proposals touch upon areas such as zero hours contracts, call clipping and payment for travel time. This follows on the back of the recent announcement from the Minister for Health and Social Services that under the Regulation and Inspection of Social Care (Wales) Act all domiciliary care workers in Wales will need to be registered before they can work in the social care sector from 2020.

General Comments

6.The challenges facing social care have been well documented. As a result of demographic changes primary and community care services are facing increasing and more complex demands; more people are diagnosed with one or more preventable health condition; and frail, older people increasingly have more complex needs. This comes at a time when we will continue to experience severe austerity in funding for public services across the UK. Given the challenges being faced by public services it is appropriate that there is a serious reflection on the impact these issues have on the social care workforce, including the domiciliary care workforce.

7.We fully support the need to ensure that we have a workforce that will enable us to deliver high quality care within the context of increasing demand. However we also need to ensure that the system we have in place is sustainable. Local authorities are facing significant financial and demand pressures which will have long standing implications. In 2012 the Institute for Fiscal Studies report on local government expenditure in Wales showed that, until 2009-10, spend had been increasing in real terms by around 5% each year. This kept pace with inflation and service pressures. From 2009-10, spend has been reducing in real terms, but if expenditure had kept pace with general inflation, it would now be over £7bn. The resulting gap of £720m represents a conservative estimate of the cuts and efficiency savings achieved so far by local government. From April, councils in Wales face budget pressures of just over £200m due to inflation, demography and unavoidable financial pressures, e.g. the introduction of the single tier pension.It is likely that by 2019-20 there will be a cumulative budget shortfall of around £800m. The submission by WLGA and ADSS Cymru to Welsh Government on Social Services budget pressures in August 2015 indicated that social services departments in Wales faced unavoidable cost and demand pressures that will increase from £68m in 2016/17 to £234m by 2019/20. Clearly the ability to absorb any additional costs is virtually non-existent.

8.Across the care sector the general principle of increasing the financial rewards for care workers is welcomed, with the National Living Wage supporting this. The principle of care staff being appropriately paid for their efforts is endorsed and may go some way to assisting with the significant challenge of recruitment and retention of care staff who are needed to care for increasingly frail people.This is particularly important due to demographic change and the increasing number of people living with long term, complex conditions. However, this requires significant investment. Many of the issues highlighted within the consultation, e.g. low pay, call clipping and payment of travel time, have been further affected by the financial pressures being faced by public services and in parallel by providers. Whilst the consultation covers a number of issues to improve standards and conditions, unfortunately it does not take into consideration the financial investment required to make the changes and how best this can be achieved. Appropriate resources will be required to ensure changes can occur. We also need to be mindful of the fact that the National Living Wage will apply to all sectors including retail and hospitality. There is a risk that its implementation will significantly increases costs (by also causing a ripple effect in terms of pay differentials for supervisors and managers) without any improvement in recruitment and retention if there is no increase in relative pay for the role.

9.The recent submission from ADSS Cymru and the National Provider Forum (Wales) to Welsh Government in relation to the impact of the National Living Wage on the care sector recognises that there are a series of factors that have increased or will further increase the costs of providing care services, including:

• National Living Wage
• Sleeping in judgement
• Pension changes
• Travel costs
• Impact of HMRC changes

Whilst we acknowledge that in some areas there may have been small increases in fees paid by commissioners, these have tended to be inflationary increases, as opposed to increases that reflect the true costs. On-going financial austerity measures for local authorities mean that there is little scope for cost pressures to be reflected adequately in prices paid for care in the near future. Increases in costs cannot be absorbed by care providers indefinitely (nor cross-subsidised by self funders) and unless a more strategic and sustainable solution is found, there will be significant consequences across the social care market.

10.The provider market within social care has been fragile for some time and all the signs are that the difficulties will increase. For example, UKHCA have indicated that 71% of their members across England and Wales turned down local authority funded packages of care over the last 12 months. For some areas of Wales it can be very difficult to access home care to respond to complex cases or because of the rurality of the area, with the local authority provision having to fill the gap, often with difficulty.

11.We have welcomed the additional £21m funding for social services announced in the recent budget for 2016/17, but also recognise that whilst helpful this will not cover the expected increases in cost and demand facing social services. We believe that we need to seriously look at the future funding of social care in Wales. Whilst an examination of aspects such as commissioning processes may support this by providing efficiencies, we need to look at investing new monies into the sector, to ensure the future sustainability of the social care sector. This includes an examination of the impact of elements such as the £60 per week cap. The effect of the maximum weekly charge has been to inadvertently pull people in to the service who would have previously managed their care independently of the local authority. The WLGA manifesto identifies the key priorities where we believe the Welsh Government can help councils deliver on national outcomes and prioritise services that matter most to the communities of Wales.One of these priorities is a call to lift the £60 charging cap and to link it more clearly to ability to pay.

12.In addition commissioning of services will increasingly be a joint activity between health boards and local authorities and there has to be some shared responsibility in laying strong foundations to begin the shift from secondary and institutional care to caring for people in their own homes. There is also a need for all the relevant departments of government, beyond health and social services, e.g. business development, to play their part in supporting the sector.

13.When looking at the issues raised in the consultation document it is worth noting that the Social Services Improvement Agency (SSIA) will be working with the Care Council for Wales to bring together a high level group of sector, workforce and citizen representatives to develop a five-year strategic plan for the domiciliary care sector in Wales. The plan will seek to support the delivery of successful registration of the workforce in domiciliary care by 2020 and, as well as considering other ambitions such as how to improve workforce development, best practice in the sector, research, commissioning practice etc. it is anticipated that the plan will offer a whole sector way forward, bringing together the capabilities and capacity of the entire sector. While it is still early to know exactly what issues will be included in a strategic plan for the domiciliary care sector, it is clear that workforce issues will be a priority area. It will be vital that this work supports the development of any proposals that come out of this consultation.

14.The HR Directors (Wales) are responding separately to this consultation with a focus on local authorities as employers and we would want to endorse their views.

Response on specific elements of the consultation

Zero Hours Contracts

15.It is important to recognise that zero hours contracts can be beneficial to domiciliary care providers and domiciliary care workers and that whilst there has been much negative publicity about their use, if used appropriately they do bring a number of benefits, including:

• Flexibility for the employer enabling effective coverage during periods of peaks and troughs in demand, annual leave and sickness absence.
• These arrangements can also suit the employee or casual worker. It is not uncommon for people working in this way to already have a main post with their employer or a different one. They are able to undertake additional casual work as and when required.
• Some use casual work as a route to a permanent post, through the opportunity to gain experience. This is of benefit to both the casual worker and the employer, since such workers are better trained and experienced when they are taken on as permanent employees and it creates a bigger pool of suitably trained casual workers.
• Many casual workers want the flexibility of working every now and then, and councils have reported that some have turned down permanent contracts to maintain their flexibility
• A number of councils in Wales which use zero-hour contracts have previously said they often suit employees, and staff still get benefits including sick pay and paid leave.

16.However, experience has taught us that zero hours contracts are not always used as they should be across the sector, which can result in cuts to wages for staff and the avoidance of holiday pay, pensions and other benefits. There are also some disadvantages in the use of zero hours contracts. The main disadvantage of a zero-hours contract is a potential lack of consistency in working hours and earnings from week to week, as there is no guarantee of work. They can also have a negative impact on retention because domiciliary care workers may leave domiciliary care for jobs which offer regular hours and, therefore, regular pay each week.

17.Guidance on zero hours contracts has previously been developed and agreed jointly under the auspices of the local government Joint Council for Wales (JCW) and, whilst aimed at Councils, contains a number of important elements, which, if adopted in the use of zero hour contracts, would help to alleviate some of the problems in their use. It would also reinforce that it is important that they are not used in a way that is exploitative or seek to minimise employers' obligations. In particular the employer should not:

• Prevent the individual from working for others
• Give insufficient notice of work
• Give insufficient notice of cancellation of work
• Insist that any work offered must be accepted
• Penalise those who turn down work
• Evade obligations on sick pay and holiday pay

18.The JCW recommends that councils conduct a review of their zero-hours arrangements to ensure that they incorporate the following:

• Making it clear to the worker what a zero-hours contract means, including their employment right
• Ensuring comparable pay with staff doing same or similar work on permanent contracts
• Giving reasonable notice of work
• Giving reasonable notice of cancellation of work
• Providing compensation for work cancelled at very short notice
• An effective system of holidays and holiday pay
• Permitting employment with other organisations
• Allowing individuals to turn work down
• Ensuring fair and non-discriminatory methods of selecting workers for work
• Ensuring that new contracts are issued where the employment relationship changes (e.g. from worker to employee)
• Training of line managers to ensure that the reality of the employment relationship is consistent with the contract and associated employment rights of zero-hours workers
• Regular review of the appropriateness of such contracts for the nature of the work and the balance of flexibility for employer and employee

Alternatives to Zero-hours Contracts

19.While zero-hours contracts, if properly used, can be a legitimate means of providing flexibility, it is important to recognise that they are not the only option. Permanent contracts can provide certainty regarding employment status for employers as well as employees and flexibility can be achieved by including appropriate provisions. These would include ensuring that:

• Job descriptions are non-contractual to allow for changes
• Flexibility, mobility and variation clauses are included in the contract itself (though not carte blanche to vary the contract willy-nilly)
• Rotas are used imaginatively to ensure flexible and effective management

20.Other contractual options that can be used include:

• Part-time contracts with minimal hours
• Short fixed-term contracts
• Annualised hours contracts

21.The focus, rather than trying to phase out or restrict zero hours contracts, should be on ensuring that when they are used they are used appropriately. Employers need to be aware of all of the contractual options that can be used, for the benefit of the employer, the employee and those in receipt of their services.

Payment for Travel Time and Call Clipping

22.Paying staff for travel time, particularly within the domiciliary care sector, has been the subject of recent publicity after an internal company review by one of the largest care providers in the UK suggested it had failed to pay the National Minimum Wage. This is because the provider had not been paying staff for travel between appointments with clients.

23.Service users rightly expect to receive the full time allocated to the visit for their care - we agree that it is unacceptable to have practice whereby people in receipt of domiciliary care services receive shortened visits to accommodate care workers’ travel time between appointments. As such employers need to ensure that sufficient travelling time is allocated between home care visits so that workers can deliver unhurried care that meets people’s needs.

24.It is important to acknowledge that this is the employer's responsibility, the consultation document states that:

“where local authorities commission care from the independent sector they will have to tell providers how much time is being purchased for travelling to a client and how much time is for contact with the client.”

Whilst the care plan should set out the care required for an individual, it is unrealistic to expect the local authority to be able to manage how a commissioned provider manages their staff’s travel time. This will be for each employer to determine based on their own workforce and the needs and location of their clients. We need checks and balances in place to ensure that people receive the care and support for which they have been assessed and that domiciliary care workers are paid for both the time spent travelling, as well as the time spent with the client. This may be an area that would benefit from further advice and guidance when looking at commissioning and contractual arrangements.