Responding to The Leaders Council’s Special Report on the impact of the Health & Care Bill, Asfana Ali, managing director of Tees Valley-based domiciliary care provider, Prioritising People’s Lives, shares her thoughts on the underlying issues afflicting the UK social care sector at present.
Although the Health & Care Bill has now cleared the House of Commons and House of Lords and gone to Royal Assent, upon reading and digesting some of the views of my fellow care providers, there was much that resonated with me.
In particular, I agree with TimeFinders director Alison Hesketh’s view about delivering safe care. She highlights a very important factor in that carers ought to be required to register with a board or a governing body to hold them as accountable as nurses are. In doing so, not only would we have more robust regulation, but this would also raise the profile of carers.
Right now, carers often move from organisation to organisation without working their notice periods, which comes at the expense of their employer by limiting the services they can provide, leaving vulnerable people at risk. Something that we all know of in this industry also is that some employers do not request references from previous employers, meaning that unscrupulous individuals are free to repeatedly behave in this way. This boils down to a lack of integration in care services, which leads to breakdowns in communication that enable these discrepancies to happen. Something which is of specific concern to me in this respect is that historic safeguarding alerts or barring referrals regarding care staff are not taken seriously.
I can provide a personal example of the issue from my own experience, around an employee who was dismissed from our service provision due to misconduct. We raised safeguarding alerts and still the offending individual went on to work as a personal care assistant [PA] for clients after having poached some of them from our services. As this was happening, social workers were not concerned with care receivers switching package from a registered care provider to a PA, even though the latter is unregulated. This ex-employee then went on to financially abuse the service user, which could have been avoided if our safeguarding alert had not been completely dismissed. When news of their conduct offence reached us, we contacted the police even though the service user was no longer being cared for by ourselves, but nothing came of it. We then sent out correspondence through our solicitors to the ex-employee, but the local authority did not step in to investigate the carer. There needs to be far better cross-sector communication around safeguarding issues to prevent vulnerable people being exploited.
Furthermore, I believe there is a disconnect between services in England. Services in Scotland and Wales work in tandem to avoid service users ending up in hospital. Care homes also communicate with community care providers to enable people to return to their homes or vice versa quickly and efficiently. Community care requests provide valuable respite to stretched NHS services because they help people avoid hospital admissions.
In England now, there is no communication from NHS services around individuals funded through continuing health pathways. Community nurses call local providers to assist with care packages and the care package information is rarely sent to finance. NHS services have no social worker to contact in relation to changes in these package and providers must contact nurses who are already under immense pressure. Added to this, commissioning services from the NHS are often unreachable when you attempt to contact them. I have had to contact my local MP to contact the Clinical Commissioning Group on my behalf since the emails to finance, commissioning, and admin teams have never been responded to regarding a debt of £11,440 for our services. This has now been resolved only because of the involvement of my MP, and I’d been chasing up information on when this invoice would be paid since April 2021.
On the recruitment shortfall, it is well-documented that care providers are under increasing pressure to deliver quality care with a limited and stretched workforce. In my view, the problem here is larger than this; local authorities are also under pressure to sustain care provision with fair rates. For example, Northumberland has had to use two years of reserves to meet the rates increase for 2022. Local authorities and NHS services should be more transparent with care providers regarding rates. There should be a publication of rates for care providers to see on their frameworks and more information should be freely available to providers.
Lack of communication also means that not all care providers are aware that they can take part in the fair cost of care [FCOC] exercise which local authorities have been asked to carry out from February 2022. Care costs vary so much across England to unfair levels in some regions, and providers should be very aware of the fact that their voices can be heard on this matter.
I am also concerned about the volume of agencies and homes that are being acquired by profit-focused equity groups which do not concern themselves with the wellbeing of service users and staff and do not have quality care at the heart of their values and visions. To reveal the scale of this issue, a broker from whom I requested information regarding care companies sold revealed that they’d sold over 200 care companies in 2021 alone. Payment rates, recruitment work required, and the sheer levels of work involved in providing good care are highly unappreciated by these entities that take ownership of care homes.
I fear that longer term, this is going to affect procurement. There will be less choice for service users in terms of care provision because large corporate organisations will have purchased smaller providers and integrated them into their services. For local authorities, there will be less competitive care pricing for provision and larger companies will essentially be able to hold councils to ransom and charge what they like.
Photo by Ani Kolleshi on Unsplash
