When 96% of councils believe there is a ‘major national funding problem’ it is clear that the tough financial climate for social care is set to continue. We see this all the time in our work with local authorities in relation to specialist care placements and adults with disabilities.
It isn’t just uncertainty over funding that is looming over care services. With last month’s Supreme Court giving leave to appeal the previous decision on payment for sleep-ins, there is uncertainty over costs too.
Across the UK, thousands of care staff work sleep-in shifts looking after vulnerable adults and children, many with significant and challenging needs. When the Minimum Wage was introduced back in 1999, the advice was that ‘sleep-ins’ do not count as ‘work time’. Since workers were deemed to be asleep and not working, they were paid a flat rate ‘on call’ allowance which had been the norm across the sector for decades.
Following a number of tribunal cases, the Government (BEIS) issued new guidance saying that time spent asleep did in fact qualify for NMW payments. Subsequently, HMRC took enforcement action demanding care providers were paid six years back pay. This had been estimated to cost at least £400m across the sector.
With the potential impact on the cost of care, it is more important than ever to understand whether a fair price is being paid for a package of care that is fair to the service user. Yet we see that commissioning/contract management teams often don’t have the capacity or the skills to effectively manage the cost of care. This is usually due to cuts in team sizes over the years. If placements aren’t set up at a fair price in the first place, then the challenge of ongoing reviews and management of costs becomes too big to manage. It needs a conscious decision to stop fire fighting and move to a well-managed approach with appropriate resources.
There’s a long overdue but welcome move to adopt more in the way of assistive technology. This isn’t always high tech – it can be as simple as water level sensors in the bath, or pressure mats at entrance to bathroom. This can help reduce staffing levels and costs, while actually improving dignity for service users, so ‘win-win’. Some of the more intelligent systems have reduced the need for staffing by as much as two thirds.
Bringing together the best of technology then, could see us rethinking what the service user needs in terms of night support, for example shared waking nights staff over several nearby care settings, with suitable tech to alert them to user needs.
So, with the right investment in both commissioning and enabling technology we see the opportunity to not only deliver a fair package of care at a fair price but with fair wages too.
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Dr Andrew Larner is chief executive of the Improvement & Efficiency Social Enterprise (iESE), which supports public sector transformation
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