Winter is approaching fast. There is widespread concern that the rise in fuel prices and the cost of living will load additional pressures on the NHS. Nationally close to 300,000 people are waiting to have their needs for Social Care to be assessed, an increase of 44% in six months and a further 37,000 have had their needs assessed but are awaiting for action to be taken as a result.
In addition, the recent announcement of £50m from the Government – designed to free up 13,000 beds where patients are unable to leave due to a lack of staff or the need for specialist equipment – is reliant on care being provided in the patient’s home. the Care Quality Commission (CQC) has even used the phrase ‘gridlock’ to describe the health and care system.
The care agencies providing this support are often referred to as ‘home care’, ‘domiciliary care’ or sometimes ‘home help’.
In recent weeks there has been a great deal of coverage of Adult Social Care in England. In East Anglia an exclusive investigation by the East Anglia Bylines Spotlight team found that over 400 care agencies that provide home care, close to one in three of the total number, were assessed as Requires Improvement or Inadequate, or they had not yet been inspected.
Staffing is an issue
The cost of living crisis has increased pressure for staff to seek better paid roles elsewhere. This has made it difficult to recruit qualified staff, and it has been widely reported that there are over 165,000 staff vacancies in Adult Social Care across the UK with vacancies up 52% over the past year.
The House of Commons Select Committee on Levelling Up, Housing and Communities (LUHC) was told earlier this year that competition for staff from the leisure and hospitality sector has led to a lack of recruitment. As a result, the quality of care in the patient’s own home is under comparable pressure to the care provided in a care home or elsewhere.
The reality on the ground
The regulation of home care, as with care homes, is carried out by the CQC. Their job is to inspect care facilities, including care homes and companies registered to provide home care. Following each inspection, they publish a report about the service and rate the performance on a four-point scale: Outstanding, Good, Requires Improvement or Inadequate. Across East Anglia our research showed that out of over 1,300 home care providers, around 5% were found to be Outstanding and over 60% were Good. The rest either fell into the bottom two categories or were not yet inspected.
Bedfordshire (including Luton)
At the time of researching, over 40% of the home care agencies in Bedfordshire were classed as Requires Improvement or Inadequate, or they had not been inspected yet. Prime Care Support Limited is one example. It was found to be Inadequate earlier this year. The CQC report found that the provider continued to experience staffing difficulties and told the inspectors this was due to the pandemic.
In this county, around 36% of the home care providers fell into being either Requiring Improvement or had not been inspected by the CQC. While none of the home care agencies were deemed to be Inadequate the same cannot be said for care homes.
Close to one in three, or 33%, of the home care providers in Hertfordshire either had not yet been inspected, or were Inadequate or described as Requires Improvement.
One of the agencies found to be Inadequate was ‘UK International Nursing Agency Limited Dom Care’ in Radlett. The agency is also a care home and provides nursing care. All elements of the service were inspected and the inspectors found that staff were not trained and people’s needs were not met. This was in addition to a number of other serious concerns.
Essex, (including Thurrock and Southend on Sea)
In Essex just under 32% of the home care providers are either awaiting inspection or are in the bottom two categories. An example of this is Ashley Care, which was deemed by the CQC to be Inadequate in terms of the time the staff visiting people in their homes had with each client, a main cause being too many clients and not enough staff.
Essex has the largest number of providers awaiting inspection: there were just over one hundred at the time our research was conducted.
In Cambridgeshire, just under 30% home care providers either still needed to be inspected or were classified as Requires Improvement or Inadequate.
Recently, the vetting of staff at Fen Homecare was deemed to be Inadequate in terms of their qualifications and background. There were also concerns about possible food poisoning.
Just under one in five of the home care agencies in Suffolk fall into the bottom two categories. Cephas Care Limited Domiciliary Care Agency was deemed to be Inadequate earlier this year, having slipped from Requires Improvement last year. The inspectors found continuing shortfalls in the management of medicines, staffing and risk, and while staff were well intentioned, they did not always provide the best care.
Funding and Austerity
The additional funds generated through the Council Tax Precept and the £500m are useful, but the Health Care Foundation estimates that over ten times that sum is needed to stabilise and improve adult social care in England. Equally, freeing up 13,000 beds will assist, but does not alter the fact that 25,000 hospital beds have been lost since 2010/11.
This is at a time when Councils are still facing pressure to cut costs, and this could mean a reduction in staff to carry out vital assessments and in safeguarding of the vulnerable. With the aftershocks of the recent ‘mini budget’ still being felt, it is clear that the staff, and the organisations, cannot endure more austerity, cuts, or financial woes.
Our research has clearly shown that staffing, both in care homes and for care in the community, is a primary concern. The lack of qualified or skilled staff remains problematic and presents a major issue not just for the agencies, local authorities, and the NHS, but for government as well.
We can only hope that their solution will not be Inadequate.
Research by J. J. Jackson and Wendy Boother, and the East Anglia Spotlight team