Home Care – the challenge

Cllr Ketan Sheth

“For every complex problem, there’s a solution that is simple, neat, and wrong,” wrote the American journalist Harry Mencken. It is an aphorism which is now often quoted by organisational thinkers.

Well, home care is just such a complex problem. Having chaired Brent Council’s overview and scrutiny task group on home care, I learned something of the difficulty of finding solutions to the problems facing the provision of this service.

Home care, also called domiciliary care, is a vital service in the lives of many older people as well as adults with physical and learning disabilities, who without it would struggle to live independently. The service allows them to do day-to-day tasks with the help of a care worker, meaning that they can stay in their own homes instead of going into residential care. For me, this assistance to our most vulnerable residents is the essence of local government and public service values.

We are all familiar with the perfect storm which is heading towards adult social care as demand continues to rise while central funding for local government is reduced. In Brent, this situation is particularly severe. The pressures on adult social care budgets are extreme even though home care, unlike healthcare, is not free at the point of access and many people are assessed as having to contribute towards their care.

Brent Council, like many local authorities, commissions home care externally rather than providing it directly in-house. So, there is a marketplace and we are dependent on agencies to whom we pay an hourly rate. In turn, they recruit and pay their workforce who delivers the front-line service. This means that there is a complex chain of commissioning and contracts at the end of which are some of the borough’s most vulnerable residents. Furthermore, all of this is being provided in the midst of the biggest financial crisis for local government in a generation and national concerns about the sustainability of the home care market.

Having reviewed the existing home care provision, it is clear that there are no simple answers, but there are some solutions we should explore to help improve the service. One such solution my task group explored and recommended to Brent Council’s cabinet is that in future the commissioning should ensure an incremental introduction of the London Living Wage for the local home care workforce. This will of course be difficult financially and we estimate that it will result in an extra £5.3million in costs for the council over a period of three years, but in the long run we think that it is part of the solution to the local sector’s issues.

Our home care workers, who are largely women and from black and ethnic minority communities, typically earn above the national legal minimum wage, but too few are paid the London Living Wage. These are people who do demanding, caring and skilful roles to look after our vulnerable residents. We found that agencies too often experience a high turnover of staff, meaning that provision is often disrupted. Undoubtedly, poor pay is at the heart of this problem, as workers move between agencies in search of better terms and conditions. If all the agencies in Brent were paying the living wage for London, it would reduce this disruptive turnover of staff. Consequently, I am convinced that productivity would increase and employers’ recruitment and retention costs would fall. Paying the living wage for London would help to stabilise the local market and support this dedicated workforce. It is what they thoroughly deserve.

It may be simple, but it’s not wrong.

To read the home care task group report here


Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

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