Adult social care directors have been urged to examine the home care services they commission for the use of zero-hour contracts, minimum wage compliance and whether short visits are undermining quality of care.
The call comes in advice issued by the Association of Directors of Adult Social Services to help directors improve the commissioning of home care services, to improve the treatment of service users and staff alike.
The guide comes amid mounting concern over the use of 15-minute appointments and zero-hour contracts for staff by home care providers, and the failure to pay staff for travel time, reducing pay below the minimum wage in many cases. Providers have linked all these issues to the way in which councils commission services, including a lack of funding. This view gained support from the Equality and Human Rights Commission in a report in October, which warned that local authority commissioning practices were increasing the risks of human rights abuses among service users due to rushed visits and high staff turnover.
The government has rejected campaigners’ calls to reintroduce routine Care Quality Commission inspections of council adult care commissioning in order to address the problem. However, ministers say regulations under the Care Bill would allow the CQC to inspect councils where poor provision of care can be attributed to poor commissioning. It has also promised that councils will receive statutory guidance to ensure providers comply with minimum wage laws. Also, from April 2014, the CQC will examine the impact of commissioning practices in its inspection of home care providers, including in relation to short appointments and zero-hour contracts.
The Department of Health has provided Adass with funding to develop a framework for improving the commissioning of adult social care, which it plans to publish this Spring. However, given the focus on home care, it has published its “top tips for directors” on commissioning the service ahead of the framework “to assist colleagues with an immediate review of commissioning practices”.
It includes advice on improving care management, relationships with providers and contracting, and ensuring that people who use services exercise maximum choice and control and are involved in shaping services more generally.
Issues that directors are advised to consider include:-
- Are you satisfied the price you are paying for care is sufficient to meet costs and ensure the stability of providers’ businesses?
- Is the length of time commissioned from providers adequate to ensure dignity and safety in care and perceived to be appropriate by service users and carers?
- Is the focus of commissioning shifting from contracting by time to contracting for service user outcomes, with an increasing focus on reablement?
- Do rates offered to providers ensure that they can meet the full costs of the minimum wage, overheads and costs of sale?
- Is travel time paid to staff?
- What is the proportion of zero-hour contracts within local home care services and are you satisfied with the rationale for this practice?
- Are you satisfied with the level of investment in training by providers?