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:bridget.warr@ukhca.co.uk

Telephone:020 8661 8188

Twitter:@ukhca