Southwark council, like all councils, faces the huge challenge of increased demand for services, combined with reduced spending power. The former is a result of growing numbers of older people, and greater numbers of people born with disabilities living into adulthood. The latter is down to funding pressures.
For homecare services in particular, many councils have tried to meet these challenges by cutting costs through commissioning – booking care on the basis of time and tasks. This means any risk is being passed to providers, and then on to care workers through the terms and conditions on which they are employed.
While this does make savings, it is less certain whether this provides the best service for people who rely on care services to remain living independently in their own homes.
It was this that led Southwark council to review its approach to commissioning homecare and it culminated in the adoption of our own, ethical care charter. The charter aims to change, among other things, the problem of zero-hours contracts, introduce training programmes to ensure a skilled workforce and pay home care workers for travel time.
In 2012, we began to move away from a time and task approach, ending the commissioning and use of 15-minute care visits other than for medication checks. The reasons for this were simple. Based on discussions with care workers and service users, and observing homecare services at work, it was clear that unduly short visits meant workers are not able to carry out their duties with compassion. They did not have time to relate to the people they are caring for and so did not help people feel safer and more supported in their homes.
Feedback from care workers and service users showed that short visits prevented a more flexible, responsive approach to homecare being adopted. Allowing care workers to focus on the user and pick up on the small things that matter to an individual helps in delivering the best support possible.
This was further demonstrated by Southwark’s re-ablement pilot. Re-ablement is helping people to relearn how to do things following an illness or hospital admission, allowing them to live independently for longer. Care workers were given the flexibility to spend time with service users and improve relationships with them. They were better placed to notice gradual changes in their health and well-being and report back to the re-ablement team, so they could adapt the level of care provided and give better support.
But what about the cost? Some councils that have embraced electronic monitoring and focused on billing by the minute may think a more flexible approach – one that does not constantly monitor the money and amount of care commissioned – must cost more. But when we looked at our homecare activity and reviewed the profiles of our service users, it showed higher levels of care were needed among our older residents. Average visit lengths were around one hour and many people’s needs required several visits each day.
It was clear that keeping older people healthy in their own homes and out of hospital or residential care was essential. The amount saved by keeping people in their home rather than in more expensive settings far outweighed any small savings that might be achieved by cutting back on how care was commissioned and paid for.
There was one other important factor that formed part of our review of homecare – the working conditions of the workforce. Over time much of the risk had been passed to them through use of zero-hours contracts and a paring back of other terms and conditions.
This is why we will underpin re-commissioning of homecare services with our ethical care charter. The council already ensures care workers within contracted services are paid at or above London living wage and are paid travel time. And by October 2014 we will be offering a level of guaranteed hours of employment, eliminating zero-hour contracts.
The benefits of such an approach are clear. If homecare services are to help reduce unnecessary A&E use, enable speedier discharge and prevent or delay placement in residential care, then a better skilled, more stable workforce is essential.
Nearest tube – Elephant & Castle underground station (Northern and Bakerloo lines).
Nearest Railway Station – Elephant & Castle
Buses from Elephant and Castle – ask bus driver for Burgess Park. Bus numbers: 12, 171, 148, 176, 68, 484, 42, 40, 45