West Wales News Review — analysis with a sustainability slant

Council homecare service set to shrink

See also the Carmarthenshire Herald, July 22nd, p.6

Long-term council-run homecare services for the elderly and disabled in Carmarthenshire face severe cuts.

Public services trades union Unison is so alarmed that the Carmarthenshire branch organised four meetings for members this week, and four more are scheduled for next week, in Llandeilo, Carmarthen, Llanelli and Ammanford.

The county council has considered three main options for homecare: to outsource; to create a local authority trading company (LATC), owned by the council but separately managed; or to form a social enterprise, a community interest company (CIC). The choices are listed in Carmarthenshire’s Vision for Sustainable Services for Older People for the Next Decade: Promoting Independence, Keeping Safe, Improving Health and Well-Being 2015-2025, a strategy paper prepared by the county council.

The preferred choice is a LATC, because it “offers the best potential in terms of improving the quality of services, allowing lower costs for the council, satisfying democratic accountability and satisfying stakeholder requirements”, in the words of the paper.

However, an arms-length trading company is considerably less transparent and accountable than the council itself.

The option of retaining the current council-run service, which provides about a quarter of homecare visits in the county, is rejected in the strategy paper as “not a cost-effective option”.

Worse service, fears Unison

Unison fears that further commercialisation of homecare would result in a worse service, higher fees for clients, or lower incomes and poorer conditions of work for staff. “Workers who transfer from local government employment to another organisation are protected by TUPE (the Transfer of Undertakings (Protection of Employment) Regulations 2006), but the protection does not apply to new recruits,” said Mark Evans, secretary of the Carmarthenshire branch of Unison. “For that we need TUPE+, which is voluntary and not a legal requirement, and even when given it is normally time-limited.”

“We are all for an efficient service,” said Mr Evans, “but if all homecare becomes a commercial operation, the emphasis will be on profits and not on supporting in the best way possible those who need care.”

The county council says that no decision has yet been made. “Whilst we are continually looking for ways to improve social care services and ensure their sustainability for the future, there have been no decisions on any different models of governance,” commented the council’s press office.

Resources reduce, need expands

The council’s strategy paper highlights the expanding gap between resources and need. Already 28% of all adults in Carmarthenshire are over 65, and by 2030 the proportion is forecast to rise to 34% — more than one adult resident in every three. The numbers living with activity-limiting long-term illnesses is expected to rise by a third, the numbers with dementia by 50%, and those requiring “community based services” also by 50%.

At the same time, the available cash to meet these needs is shrinking.

“We spent £37 million on social services for older people in 2015,” says the strategy paper. “This budget will reduce by at least £2.2 million, because the money that the council receives from central government is reducing over the next three years. When we take into account the growing demand over the next three years, we expect a funding shortfall of at least £3.5 million by 2018.

“This means that in three years’ time, we will have at least 10% less resources available to meet the needs of older people who are currently eligible for services.”

Therefore, says the council, the ways in which services are provided will have to change.

This means less care for many. The council cites the ‘National Eligibility Criteria’ for social care, which came into effect in April, and says in the strategy paper “Under the new criteria, people will be eligible for a care and support package if their needs can and can only be met by social services intervention.

Families and volunteers called on to fill gaps

Instead of council-supplied care being the default option, it will become a last resort if families, friends, and voluntary services can show they are unable to cope with an individual’s care requirements.

A “new contract with citizens and communities” is an important part of the effort to make fewer resources go further. The “contract” would encourage individuals to take more responsibility for their own care and promote healthier lifestyles, but this is the opposite of a quick fix as change would be measured over decades, not single years.

Fewer elderly people can expect home visits by two staff at a time. According to the council’s review, “Research shows that the quality of care is better when it is provided one-to-one.” Also, calls are likely to be less frequent than at present. The council suggests that frequent visits reduce elderly people’s independence and says that “other community services will need to tackle vulnerable users who are at risk of loneliness or isolation.”

Time credits are one way ahead, the council argues. For each hour of volunteering, individuals in the community would receive a time credit which could be exchanged for a form of help useful to them. Volunteers and families, the council hopes, would reduce the impact on elderly people of sparser homecare provision.



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