1115 bridget warr home and community care ireland conference dublin - may 2015(3)
TRANSCRIPT
Home and Community Care Ireland ConferenceBridget Warr, Chief Executive
United Kingdom Home Care Association28th May 2015
• About UKHCA
• About the current UK homecare situation
• About future challenges
• The way forward?
• Some relevant links; and
• How to contact us
UKHCA
Mission and vision
Strategy Sector leadership
Improving quality
Alerts
Help Line
Workshops
Conferences•Own•Others
Interest groups
Membership, funding and
structure2,200
members
14 FTEElected Board
Membership fees
Sales
Operating environment
Standing committees
Task and finish groups
Campaigning
Survey and reports
Costing model and “Minimum Price for
Care”
Responses to consultation
Introducing UKHCA
Domiciliary Care - The Key Facts and Figures
• Total people to receive domiciliary care last year: 883,000• Total hours of domiciliary care delivered: 326 million• Total expenditure on domiciliary care: £5.1 billion
o State expenditure: £3.9 billiono Private expenditure: £1.2 billion
• Total people receiving a direct payment: 166,000• Total people employed in the domiciliary care sector: 578,000• Total number of registered locations providing domiciliary care:
9,826
Size and regulation of the sector
• In England the Care Quality Commission regulates 8,186 locations providing domiciliary care (Fragmented and immature market; Largest 10 providers have 23% of the market by value)
• In Scotland the Care Inspectorate regulates 887 registered locations that provide care and support at home,
• In Wales the Care and Social Services Inspectorate Wales inspects 449 registered location providing domiciliary care,
• In Northern Ireland the Regulation and Quality Improvement Authority regulates 304 registered Domiciliary Care Agencies.
• Registration: Social workers, Managers, homecare workers
People who use services tend to be 65+ years of age
≥ 6518-64
Source: Composite of UK Government data
Source: Health Service Information Centre December 2014
People who use state funded homecare services in England by primary condition
Physical Disability (Including Frailty)
Mental Health (Including Dementia)
Learning Disability
Substance Misuse
Other Vulnerable People
Most homecare clients will
also be living with dementia
People who use state funded services in Northern Ireland by primary condition
Elderly
Physical Disability
Learning Disability
Mental Health
No Material Handicap
Source: DHSSPSNI data
Public preference for care at home
9 in 10 people aged 50 years or above would prefer their care needs to be met in their own home(Saga / Populus 2014)
7 in 10 of British adults wish to die at home(Dying Matters / ComRes 2014)
The number of people receiving state funded homecare is declining
2009 2010 2011 2012 2013 20140
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
England Scotland
Wales Northern Ireland
Total
Source: Government data
How UKHCA’s minimum priceis calculated (2014-15 rate)
Contact time £6.50
Travel time £1.24
Travel costs £1.40
Pen-sion, training, hol-iday, NI
£1.8
8
Running the business £4.25
Profit / surplus £0.46
Minimum Wage: £6.50Travel time/hour: 11.4 minTravel distance:4.0 milesMileage rate: £0.35/mileNational Insurance: 9.5%Holiday Pay: 12.07%Training time: 1.73%Pensions: 1%Gross margin: 30%
Rates vs UKHCA’s Minimum Price (£15.74)(Current NMW is £6.50 per hour)
Work-ercosts£11.01
Running the business£4.25
Profit/surplus£0.47
• Current NMW £6.50 per hour• 28 LA’s pay average > £15.74• 4 LA’s pay average < £11.01
There is a national trend toward independent sector delivery of homecare
2009 2010 2011 2012 2013 20140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Local Authority/HSC Trust
Independent
Source: Composite of UK Government data
In Wales the majority of care is delivered by the independent sector
2008/09 2009/10 2010/11 2011/12 2012/13 2013/140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Local Authority in-house team
Independent sector providers
Source: Welsh Assembly Government data
Northern Ireland has a growing independent sector
2009 2010 2011 2012 2013 20140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HSC Trust in-house team
Independent provider
Source: DHSSPSNI data
Independent sector in Scotland is growing at a slower rate
2009 2010 2011 2012 2013 20140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Other LA and Voluntary
LA and Independent Voluntary
Independent Local Authority
Source: Scottish Government data
Impact of short visits
Shorthomecare visits bought by local authorities
Rushed, undignified care for highly dependent people
Travel time increasesas a proportion of total cost
Workers dissatisfiedwith their ability to provide care
High staff turnoverdrains skills & experience and increases costs
Potential non-compliance withNational Minimum Wage
Dissatisfactionwith homecare services andadverse publicity
Careworkers tend to be female and 35+ years of age
Age Profile of Care Workers in the Domiciliary Care Sector
≤ 24
25 - 34
35 - 44
45 - 54
55 - 64
≥ 65
Gender of Care Workers in the Domicil-iary Care Sector
FemaleMaleUnknown
Source: Skills for Care
High staff turnover is a challenge
Care W
orkers
Senior C
are Worke
r
Register
ed Nurse (C
ommunity)
Personal A
ssista
nt
Regist
ered M
anage
r
Whole Sector
0%5%
10%15%20%25%30%35%
Annual Staff Turnover
Source: Skills for Care
Homecare providers offer a diverse range of services
• Personal care • Visit based and live-in care • Domestic / practical support • Nursing care • Complex care • Re-ablement services • Companionship • Care with independent housing (‘Extra-care’)• Companionship • Respite services for informal carers
State funding only available for higher levels of need.
Demographics: 15% population increase(Most growth is people >=60 years)
2012 2017 2022 2027 2032 20370
5
10
15
20
25
60-74 years 75-84 years85 years and above
Mill
ions
National Population Projections 2012
The number of people with dementia in the UK will double over the next 40 years
Source: Alzheimer’s Society – Dementia Statistics Infographic
• Sort out commissioning
• Improve resourcing
• Let the client direct
• Learn from the client
• Monitor what works well
• Innovate
• Work together
• Care is not a commodity - http://www.ukhca.co.uk/pdfs/UKHCACommissioningSurvey2012.pdf
• Costing Model - http://www.ukhca.co.uk/CostingModel/
• Minimum Price For Care - http://www.ukhca.co.uk/pdfs/AMinimumPriceforHomecareVersion2120141103.pdf
• The Homecare Deficit - http://www.ukhca.co.uk/pdfs/ukhca_the_homecare_deficit_201502_web_version_in_spreads.pdf
• Article by David Brindle of The Guardian - http://www.theguardian.com/society/2015/may/19/homecare-businesses-collapse-health-system-crisis
• NICE Homecare Guidelines Consultation - http://www.nice.org.uk/guidance/indevelopment/gid-scwave0713/documents
• Commissioning for Better Outcomes - http://www.local.gov.uk/documents/10180/5756320/Commissioning+for+Better+Outcomes+A+route+map/8f18c36f-805c-4d5e-b1f5-d3755394cfab
How to contact UKHCA
Website:www.ukhca.co.ukE-mail:[email protected]
Telephone:020 8661 8188
Twitter:@ukhca