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NHS push to recruit domiciliary staff ‘threatens wider care system’

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An emerging practice of NHS trusts employing their own domiciliary care staff risks disrupting fragile local workforce markets and increasing pressure on wider social care systems, councils and independent providers have warned.

LGC has learned that some trusts have begun to hire homecare staff on higher pay and improved terms to those independent providers can offer under council contracts, with others planning to do so in the future.

The intention is to reduce delayed discharges but councils say it will further squeeze the small and diminishing supply of staff in some areas, leading to increased pressure on the bulk of social care services that support people who have not been through the hospital system.

Shrewsbury and Telford Hospital Trust recently published an invitation to tender for the provision of a domiciliary care service to reduce delayed discharges.

Shropshire CC’s director of adults and housing Andy Begley said not engaging with providers through a “single conversation” that includes both health and social care commissioners was “problematic”.

He added: “Separate conversations and separate contract negotiations may lead to an increase in unit cost and a net reduction in capacity.

“As Shropshire is an area of low unemployment and the competition from other sectors is intense, the retaining and recruiting of staff in the care sector is vital to the sustainability of our care market.”

Mr Begley added that Shropshire was now working with the trust on alternative proposals “in order to remove the unintended risk and ensure safe and effective hospital discharge and future service delivery”.

Saffron Cordery

Saffron Cordery

Saffron Cordery

Last year Oxford University Hospitals NHS Foundation Trust hired 60 domiciliary care workers to support people after discharge from hospital. It said this had contributed to the halving of levels of delayed transfers in the county, which were the highest in the country in 2015.

Colin Angel, policy director of the United Kingdom Homecare Association, told LGC a number of other NHS trusts had indicated that employing domiciliary care workers was under consideration.

He said this meant they would place themselves in “direct competition” with care providers and councils.

Mr Angel added: “Councils should be working collaboratively to increase the capacity of their local providers, rather than face competition with the NHS.”

Glen Garrod, vice president of the Association of Directors of Adult Social Services, said the practice could be a temporary measure prompted by pressures to reduce delayed transfers ahead of the winter.

He added: “If that’s what is happening… it runs the risk of destabilising supply at a time when you arguably most need it.

“It is important that we emphasise that local systems should be working together to find solutions to workforce challenge, as opposed to unilateral initiatives that could generate unintended consequences.”

NHS Provider’s director of policy and strategy Saffron Cordery said trusts understood the importance of close collaboration with local government to address pressures across the health and social care system.

“But there may be times when pressing need requires trusts to act independently in the interests of patients,” she added.

“Health providers and local government are facing some extreme and shared challenges. Much more unites than divides us.”

Shrewsbury and Telford Hospital Trust was approached for comment.

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