Councils risk quality by contracting with too many care providers, warns union

Research by Unison finds one in six councils have at least 50 home care providers on their books.

Concerns have been raised about councils’ ability to monitor the quality of home care after research found one in six had at least 50 providers on their books.

Research published by Unison found nine councils had over 100 providers they were prepared to do business with while 31 had at least 50. The union’s Freedom of Information request was answered by 196 of the 212 councils or health and social care trusts that have social services responsibilities in the UK.

The union warned that doing business with so many providers undermined councils’ ability to effectively monitor quality.

Councils have ‘no proper insight into how services are run’

“Councils no longer have proper insight into how home care services are run,” said Unison’s head of local government, Heather Wakefield. “Privatisation, huge budget cuts, a proliferation of providers, and a situation where councils can commission care from hundreds of different organisations has been synonymous with drastically declining standards. This all adds up to putting elderly and vulnerable people at risk.”

The numbers given to Unison do not necessarily refer to the number of providers councils actually use but those they are prepared to do business with. Unison’s research found that Hampshire council had 234 providers on its books though, in response, the authority said it actually had 150 providers on its preferred provider panel.

Executive member for adult social care Anna McNair Scott said it had one of the largest populations of older and vulnerable residents in the country, meaning it had “a large domiciliary care client base whose care needs are individual and in many cases complex”.

‘Need for capacity and flexibility’

“We need to have the capacity and flexibility to meet these individual care needs through the delivery of quality care services, and do this without unnecessary delays in finding a suitable provider,” she added. Therefore, we have established a preferred provider panel comprising 150 potential providers. However, we are currently using only 70 out of these 150 providers, and of the 70 providers, 15 account for over 50% of all the home care delivery in Hampshire.” She said the council employed a “rigorous selection process” for providers wanting to be on the panel and it had systems in place to check quality.

However, the union also attacked the vast majority of councils for using contracts that did not guarantee a volume of work to all providers they did business with, saying this fuelled the controversial use of zero-hours contracts for staff. It found that:

  • 3% of councils had an entirely in-house home care service or used block contracts that guaranteed work to providers;
  • 16% used a mixture of block contracts and other contracts that did not guarantee work, such as spot contracts or framework agreements;
  • 81% did not use block contracts at all.

Zero hour contracts

“This uncertainty is passed onto already low-paid care workers in the form of zero hours contracts,” said Wakefield. “Care workers on these terrible contracts don’t have any idea how much money they’ll take home from one week to the next. This fuels high staff turnover which has a hugely detrimental impact on service quality.”

The development of personal budgets and extension of direct payments have been accompanied by a decline in block contracts as councils are less able to guarantee volumes work to providers if service users are given more choice in who should provide their care.

It has also seen an increase in the use of framework agreements, under which councils agree in principle to use one or a number of providers for a period of time, following a tendering exercise, but do not guarantee volumes of work. Authorities then enter into contracts, known as “call-offs”, with one or more of these organisations during the course of the framework agreement, offering them a level of work without the need for a separate tendering exercise.

“Severely constrained public spending would make an argument for a return to block contracts, however this is out-of-step with central and local governments’ commitment to choice, including choice of provider,” said Colin Angel, policy and campaigns director at United Kingdom Homecare Association.

“In the absence of additional spending, the key to making better use of public money on home care is to commission services which promote the optimum economic ‘efficiency’ of the workforce, maintaining choice of providers within sensible geographic areas, reducing unnecessary travel time for care workers created by placing packages of care out to the lowest bidder.”

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