Changing lives through changing policy

2. Changing lives through changing policy Harold Bodmer Director of Community Services

3. The National Picture Today Care and support affects a large number of people. In England there are… Informal carers People employed in the care workforce 5m People with care at home 1.8m People in residential care 1.1m 380k Statistics from “Caring for our future: reforming care and support”, White Paper July 2012

4. What are our chances?

5. The Picture in Norfolk • Norfolk has the “oldest” population in the region • Whilst the overall population of Norfolk is predicted to increase by 25% between 2008 and 2033, the number of people aged 65-74 is likely to increase by 54%, and the number of people aged 75+ should go up by 97%. • In the same period the North Norfolk district is likely to develop one of the largest proportions of older people aged 65+ in the country

6. Service Delivery to Commissioning • History of social care delivery - Great Hospital in Norwich • 25 years ago - very little social care market • Almost all service in-house, Home Care (helps), day centres, residential care homes, day centres • NHS Long stay hospitals • Little or no choice

7. Revolution 1A market for social care • NHS and Community Care Act - the development of markets • Social care took on contracting, then gradually the concept of social care commissioning • The role of social workers as the gatekeeper of eligibility • Choice starts to be important

8. Revolution 2People in charge • The Direct Payment movement, a social movement, adopted by policy makers • Importance of User Led Organisations • Significant change for local authorities • People in charge, people set the agenda • Followed by Individual then Personal Care budgets, then Personal Health Budgets • Now hardwired into policy

9. 50 – 65 66 – 80 81 - 100 ‘Ageing (living) well’ Keeping independent Care, support and sharing experiences Age is just a number… A shifting concept • A change of response: • Solutions based on local communities • Integration of health, social care, housing, voluntary and independent sector

10. Revolution 3 • Integration with the NHS • Been with us for years/ different models/ joint funding/ joint arrangements • Now firmly in policy, Better Care Fund, pooling of resources • Integration of Commissioning • Integration of Social Care provision • Join up experience for people

11. Revolution 4 The Care Bill • Promote well-being, prevent and postpone need for care • Cap on costs that people have to pay for care • Element of response to Francis inquiry • National eligibility criteria • Equality for carers • Promotes integration

12. Revolution 4 The Care Bill • Providing information and advice • Market shaping • Co-operation

13. The new approach • Numbers up…. Funding down, the perfect storm? • The new contract. A public debate about expectations for health and social care • Positive image for ageing • Beyond personalisation • A new role for councils in this. Whole lives and whole communities • Role of Health and Wellbeing Boards • Challenge established rules in way operate • Change our joint working culture

15. Top issues forhomecare providers Great British Care Show, Norwich Andrew Heffernan, Membership and Marketing Director 2nd April 2014

16. Issues for the homecare sector • Operating environment: • Commissioning of state-funded care • Short visits, “bad news” stories • Workers’ terms & conditions: • National Minimum Wage, Zero-hours contracts • Regulation: • New inspection methods, Quality Ratings, market oversight • Recruitment: • Cavendish Review, recruiting values, supply of workers • Legislation: • Care Bill

17. The operating environment • Council commissioning is getting worse: • Either: Reduction in number of “approved providers”or: Volume spread thinly through framework agreements • ADASS: 15-min visits account for 16% of all purchase • Providers’ over-reliance on state-funded business • Public not aware that social care is means-tested • “Dilnot-style” funding cap in Care Bill • Responsibility between individual and the state unclear • Residential care still seen as the default option

18. Equality & Human Rights CommissionClose to Home Recommendations Review • Links commissioning, workers’ Ts&Cs, staff turnover & quality • UKHCA helped EHRC produce questionnaire, which found: • 1 in 5 LAs with rates of £8.96-£11 • 1 in 3 LAs setting maximum prices • EHRC recommends: • CQC to monitor commissioning • NMW compliance clauses

19. UKHCA’s minimum price of £15.19/hour • BBC Radio 4 finds: • 97 of 101 councils pay prices below £15.19 • Average minimum rate £12.26 • Coverage on: • BBC Breakfast • BBC News Channel • BBC Radio 4 & 5-Live • BBC Local Radio

20. Assumptions used in our minimum price Minimum Wage: £6.31 Travel time: 11.4 min Travel costs: 4 miles £0.35/mile NI: 9.5% Holiday Pay: 10.8% Training: 1.73% Pensions: 1% Gross margin: 30% Based on fee of £15.19 per hour to provider for contact time only

21. How can you use UKHCA’s Minimum Price? • Support discussion with local commissioners • Send to local councillors asking why council paying below UKHCA’s rate • Use UKHCA’s Costing Model to calculate actual costs: • www.ukhca.co.uk/CostingModel • Challenge council to open-book costing exercise

22. Quality and flexibility:15-minute visits • Debate about short visits is helpful for highlighting commissioning issues • Media now understand that inadequate care is part of a wider problem • Prepares argument for why keeping head of NMW is challenging • Guardian/EHRC etc alsoidentify inflexibility of visitsand choice of worker

23. National Minimum Wage • Increased investigations by HMRC triggered by: • Workers contacting the Pay and Work Rights Helpline • Intelligence about non-compliance from 3rd parties • Risk-based assessment of providers by HMRC • Increasing media attention: • Alleged non-payment of careworkers’ travel time • HMRC report – November 2013 • Recent publicity on zero-hours contracts

24. HMRC investigations of 224 social care providers 45% non-compliance Average under-payment of £139 HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

25. Reason(s) for NMW non-compliance in the homecare sector HMRC (2013) National Minimum Wage Compliance in the Social Care Sector

26. Why’s this importantfor you? • Reputation of entire homecare sector at risk • Workers’ rosters make compliance hard to check • Commercial damage for non-compliant employers • Repayment of arrears to workers at current rates • Fine of 50% of arrears (minimum £100, maximum £5k) • New rules to “name and shame” in public

27. HMRC may come knocking • HMRC likely to ask for: • Pay records • Weekly/monthly rosters • Schedules of pay rates • Workers’ contracts • Evidence of you checking compliance • Be confident and cooperative!

28. Minimum Wage compliance(Highly simplified) Basic rate(s) of pay are used. Do not rely on unsocial hours premiumsor enhancements for short visitsto achieve compliance with NMW Average pay over reference period of up to1 month Total pay before enhancements >=£6.31 Total contact time + Travel time + Training Time spent providing care in the service user’s home Includes: Travel between visits and time spent on training approved by the employer Excludes: Journeys to and from worker’s home and other ‘non-working’ time

29. Minimum Wage non-compliance:The risk factors • Low rates: • Basic rates around £6.31/hour • Relying on enhancements for short visits/unsocial hours • Not changing rates for younger workers on their birthday • Payment for “contact time” only: • Large amount of travel time, relative to “contact time” • Use of very short visits and/or long gaps between them • Other issues: • Having insufficient records (eg. travel time) • Deductions for uniforms or accommodation provided

30. UKHCA’s NMW ToolkitFree resource for UKHCA members • Based on HMRC documents, obtained under FOI • 3 main sections: • How NMW works in complexity of homecare services • How to audit compliance (individuals & samples of workers) • Suggested actions to achieve/improve compliance www.ukhca.co.uk/downloads.aspx?ID=422

31. Forthcoming changes in CQC regulation & inspection • New “Fundamental Standards” & regs • Specialist inspectors • Tougher registration and action against non-compliance, including vacant manager posts • On-line “Provider Information Return” to be completed in advance • “Market oversight” for largest providers Inspection themes for each service: • Is it safe? • Is it effective? • Is it caring? • Is it responsive to people’s needs? • Is it well-led?

32. CQC’s Quality Ratings • All services to be rated by March 2016: • Wave 1 Pilot (ratings won’t be published) • Wave 2 Pilot (ratings may be published) • All other services (ratings will be published as awarded) • Ratings will be: • Awarded at location level • Provided as an aggregated score & for each of 5 themes • Determined by a set of ‘rules’, however… • Inspectors have some discretion to deviate from rules

33. Worker recruitment and training • A Certificate of Fundamental Care • Proposed by Cavendish Review • Possible duplication with Common Induction Standards • Emphasis on recruiting for “values” • Materials from the National Skills Academy • Increasing interest in profiling workers • Councils attempting to limit zero-hours contracts • If your councils do this, can you afford the Ts&Cs?

34. Legislation: The Care Bill

35. How to contact us Website: www.ukhca.co.uk E-mail: andrew.heffernan@ukhca.co.uk Twitter: @ukhca Telephone: 020 8661 8152

36. Principles behind our minimum price • Fees calculated solely for “contact time” • Workers receive flat-rate NMW for “working time”: • Contact time • Supervision and training • Applicable travel time (and reasonable travel costs) • Provider can cover: • NI, pensions, training and holiday pay • Reasonable operating costs • Acceptable profit / surplus

37. NHS Choices and Transparency • NHS Choices (www.nhs.uk) • All CQC registered social care providers listed • Likely to become main info source for self-funders • Free advertising for your business • Government appetite for transparency • Possible introduction of “Friends and Family Test” • DH want providers to publish “transparency measures” • Third party “Trip Advisor” style comments are included

38. 5 “transparency measures” for homecare services • Staff stability (Low turnover) • Staff qualifications • Resolving complaints within agreed timescale • Scheduled visits successfully undertaken • Scheduled visits taking place on time

39. Minimum Wage:What you need to know • NMW is averaged over a reference period • Your payment period or 1 month (whichever is shorter) • “Working time” includes: • Contact time and applicable travel time • Training and supervision • It is lawful (but risky) to pay “contact time” only • But you must achieve NMW over the reference period • Deductions from pay and non-reimbursement of costs (eg. mileage/fares) are taken into account

43. Impact of short visits Shorthomecare visits bought by local authorities Rushed, undignified care for highly dependent people Dissatisfactionwith homecare services andadverse publicity Workers dissatisfiedwith their ability to provide care High staff turnoverdrains skills & experience and increases costs Travel time increasesas a proportion of total cost Potential non-compliance withNational Minimum Wage

45. Terry Cotton, Executive Board Member Norfolk Independent Care INTEGRATION – PARTNERSHIPS FOR SUCCESS

46. NORFOLK INDEPENDENT CARE • Umbrella group representing hundreds of care providers • Residential and Nursing Care Homes, Home Care and Day Opportunity Organisations • Vision to enhance quality, develop sustainable services, share challenges and solutions

47. Challenges for Norfolk • County Council budget cuts 2014 – 2017 • Highest proportion of people aged 65 – 84 across Eastern Region • Second highest proportion of people aged over 85 • By 2033 people aged 65 – 74 expected to increase by 54% • By 2033 people aged over 75 expected to increase by 97%

48. INTEGRATION • Range from relative autonomy – co ordination, joint appointments, enhanced partnerships and structural integration • Integration between service sectors, professions, settings, organisations and types of care (Reed 2005) • Macro, meso and micro leve ( Ham and Curry 2010)

49. CURRENT PIONEERS • 14 Across Country • Barnsley – centralised monitoring centre • Cornwall and Isles of Scilly – 15 Organisations working together • Islington – CCG and Local Authority Integrated Care Organisation at Whittingdon Health • South Devon and Torbay, already well integrated and working to 7 day provision

50. INTEGRATION • Local Government Association Value Case for Integrated Health and Social Care • Has to be person centred, actively supporting individual in co delivery of their care, removing defined boundaries between professionals and recipients to develop partnerships working towards shared goals • Increased efficiency and relieve pressure on acute providers