bridget warr

1. Home and Community Care Ireland
Conference
Bridget Warr, Chief Executive
United Kingdom Home Care Association
28th May 2015

2. • About UKHCA
• About the current UK homecare situation
• About future challenges
• The way forward?
• Some relevant links; and
• How to contact us

3. UKHCA
Mission and vision
Strategy Sector leadership
Improving
quality
Alerts
Help Line
Workshops
Conferences
•Own
•Others
Interest
groups
Membership,
funding and
structure
2,200
members
14 FTE
Elected
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

4. 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 billion
o 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

5. 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

6. People who use services tend to
be 65+ years of age
≥ 65
18-64
Source: Composite of UK Government data

7. 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

8. 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

9. 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)

10. The number of people receiving
state funded homecare is
declining
0
50
100
150
200
250
300
350
400
450
500
2009 2010 2011 2012 2013 2014
ServiceUsers(Thousands)
England
Scotland
Wales
Northern Ireland
Total
Source: Government data

11. How UKHCA’s minimum price
is calculated (2014-15 rate)
Contact
time
£6.50
Travel
time
£1.24
Travel
costs
£1.40
Pension,
training,
holiday,
NI
£1.88
Running
the
business
£4.25
Profit /
surplus
£0.46
Minimum Wage: £6.50
Travel time/hour: 11.4 min
Travel distance: 4.0 miles
Mileage rate: £0.35/mile
National Insurance: 9.5%
Holiday Pay: 12.07%
Training time: 1.73%
Pensions: 1%
Gross margin: 30%

12. Rates vs UKHCA’s Minimum Price (£15.74)
(Current NMW is £6.50 per hour)
Worker
costs
£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

13. There is a national trend toward
independent sector delivery of
homecare
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009 2010 2011 2012 2013 2014
Local Authority/HSC Trust
Independent
Source: Composite of UK Government data

14. In Wales the majority of care is
delivered by the independent
sector
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Local Authority in-house team
Independent sector providers
Source: Welsh Assembly Government data

15. Northern Ireland has a growing
independent sector
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009 2010 2011 2012 2013 2014
HSC Trust in-house team
Independent provider
Source: DHSSPSNI data

16. Independent sector in Scotland is
growing at a slower rate
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009 2010 2011 2012 2013 2014
Other
LA and Voluntary
LA and Independent
Voluntary
Independent
Local Authority
Source: Scottish Government data

17. Impact of short visits
Short
homecare
visits
bought by
local
authorities
Rushed,
undignified care
for highly dependent
people
Travel time
increases
as a proportion of total
cost
Workers
dissatisfied
with their ability to
provide care
High staff turnover
drains skills &
experience and
increases costs
Potential non-
compliance with
National Minimum
Wage
Dissatisfaction
with homecare services
and
adverse publicity

18. 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
Domiciliary Care Sector
Female
Male
Unknown
Source: Skills for Care

19. High staff turnover is a challenge
0%
5%
10%
15%
20%
25%
30%
35%
Care Workers Senior Care
Worker
Registered
Nurse
(Community)
Personal
Assistant
Registered
Manager
Whole Sector
Annual Staff Turnover
Source: Skills for Care

20. 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.

21. Demographics: 15% population increase
(Most growth is people >=60 years)
0
5
10
15
20
25
2012 2017 2022 2027 2032 2037
Millions
60-74 years 75-84 years 85 years and above
National Population Projections 2012

22. The number of people with dementia
in the UK will double over the next 40
years
Source: Alzheimer’s Society – Dementia Statistics Infographic

23. • Sort out commissioning
• Improve resourcing
• Let the client direct
• Learn from the client
• Monitor what works well
• Innovate
• Work together

24. • 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+Out
comes+A+route+map/8f18c36f-805c-4d5e-b1f5-d3755394cfab

25. How to contact UKHCA
Website:
www.ukhca.co.uk
E-mail:
bridget.warr@ukhca.co.uk
Telephone:
020 8661 8188
Twitter:
@ukhca