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Warning Over ‘Damaging’ In-House Home Care Plan

A North Yorkshire health trust’s decision to create its own ‘in house’ home care service could backfire and leave vulnerable local people without care, providers have warned.

Harrogate and District NHS Foundation Trust has launched its own home care service citing concerns that there isn’t enough existing provision to enable people to be discharged from hospital.

But a body representing care providers across Yorkshire says creating an in-house service isn’t the answer and might well result in reduced care.

The Yorkshire and The Humber Care Association Alliance (YHCAA) says the move is a backward step.

YHCAA member Mike Padgham, said: “Whilst we understand the health trust’s concerns about delayed hospital discharges, setting up an in-house service isn’t a viable, long-term solution.

“The trust will promise the most attractive pay, terms and conditions and future career progression opportunities that a role in the NHS can offer and create very severe recruitment competition for independent and local authority homecare providers.

“That could lead to these other providers struggling to recruit and, in the worst-case scenario, ceasing to operate – which would lead to an overall loss of home care provision and vulnerable people going without the daily help and support they rely upon.

“Or, the health trust will find itself having to provide more and more homecare to make up for that loss of provision and the cost of that to the NHS purse would be enormous.

“That isn’t a long-term solution, and it is better that the trust works with the local authority and local providers to help meet demand.

“If existing homecare providers were funded adequately there would be adequate provision to meet current and future demand. We have to work together to make that happen rather than introduce measures that might ultimately make the situation worse.

“The bulk of home care in the area is delivered by the private or not-for-profit sector, which has the track record of delivering it efficiently and effectively. When, in the past, home care was delivered by the public sector ‘in house’ it has not worked as well.”

And James Creegan, CEO of Kirklees Care Association, added: “Rather than talking about offering better terms and conditions to people who work for the trust, it would be more valuable if the trust worked with the wider social care sector to improve the terms and conditions of everyone, thereby ensuring equity and parity for all staff working in our social care and health system.

“The NHS and Local Authority are currently underfunding the social care sector by 20/25% less that the calculated Fair Cost of Care (2022/3) and this is the real barrier to recruitment and retention and therefore service provision. If providers were paid the fair cost of care for the services they provide they would be able to match the enhanced terms and conditions paid by the NHS.”

Louise Bestwick, CEO of Bradford Care Association, said: “The trust’s decision to establish NHS home care provision to support discharge only further undermines the sustainability of the social care sector already at risk as result of continuous underfunding. Instead of seeking to compete for workforce with the social care, we should be working in partnership as a health and care system to ensure we have the skilled workforce in place to meet the increasing health and care demands of our communities.”

Historic under-funding of social care, exacerbated by the impact of the Covid-19 pandemic, crippling fuel and utility bills and now chronic staff shortages have left all social care, including home care, in difficulty.

Mr Padgham, who is chair of the Independent Care Group, one of the founder members of the YHCAA, added: “It is doubtless these pressures that have resulted in a shortage of private sector home care provision in Harrogate, prompting the Trust’s decision to run a six-month trial. But we would prefer the Trust to work with us and local home care providers to see if there is an alternative to an in-house service.”