Written evidence submitted by Home Instead [ASC 031]

About Home Instead:

Home Instead is an award-winning and worldwide provider of care services for older people in their own homes. We are the only home care provider to be awarded the Queen’s Award for Enterprise for our model of care support to our clients. Our services include home help, personal care, companionship, dementia care, end of life and live-in care.

We have been rated “outstanding” by the Care Quality Commission in over one third of our 224 locally owned and operated offices across the UK, who together delivered over 8.1 million hours of quality care last year to over 21,000 clients. Our offices employ over 13,000 people, including 12,000 CAREGivers.

Home Instead would welcome the opportunity to provide oral evidence to the Committee if appropriate.

Why we are responding to the Housing, Communities and Local Government Committee’s (HCLGC) inquiry:

The care home sector employs more people than any other part of social care but is less understood than its counterparts.[1] For many people home care is a preference, with 71% of people saying they would rather grow old in their own homes[2]. In turn, home care relieves pressure on the NHS, whilst saving money each year [3].

The COVID-19 pandemic has accelerated both awareness of home care as an option, whilst also bringing the benefits of remaining in our own homes into sharp focus. It is important that when reviewing lessons learnt, and planning for the future, in-home care provisions are a core aspect of social care.

We continue to believe that under the right conditions, home care providers can move beyond playing the role of silent partner to the NHS, to becoming Convenors of Change for the care system. People’s homes are a viable and scalable option and, if better integrated into the care system, can significantly increase capacity.

We understand that the financial pressures levied on local authorities by the pandemic have been substantial, whilst the cost of care has increased due to enhanced safety measures such as the use of PPE and cleaning. However, the impact on the recipients of adult social care services has been even greater. Data from Public Health England (PHE) reveals A&E admissions fell 57% from 2019-2020, indicating that those in need are not getting the care they require following unreported accidents[4].

Social care debates have time and again focussed on the mechanics of funding, on commissions and commissioners, and cost efficiencies. We believe that the conversation should re-focus on the service user rather than on institutions. We need to put our clients at Home Instead, the service user, at the heart of an innovative, scalable and high-quality care system that works in tandem with, and not against public provision.

Response to Q.3 - How can the adult social care market be stabilised?

The long-term economic, social and health consequences caused by the pandemic remain unclear. However, securing a sustainable funding settlement for social care to last for years rather than months is essential. Home Instead believes that a high quality and integrated care system that prioritises user need will enable market stabilisation.

In real terms, whilst we welcome recent increases to the social care budget, overall expenditure on provision remains below 2010/11 levels despite ever-increasing demand[5]. In order to address this, Home Instead believes that reliable private care providers can act as key providers and funders as demand from an ageing population increases. To support this:

• The Treasury should re-consider calls from the Health and Social Care Committee to invest £7 billion of additional funding to stabilise the public system[6]. We believe that a stable and secure public social care system will be pivotal to a rounded public-private approach to resolving the challenges of the future. More public funding will be key to enabling a greater proportion of the population to access better care, whilst many of our clients rely on personal top up direct payments to ensure they have access to better products.

• Secondly, in order to incentivise and maximise the capacity of the home sector we propose introducing sector specific financial stimulus such as tax reliefs and incentives. Examples may include corporation tax reductions or exemptions to enable our sector to re-invest in training the carers of the future and developing innovative technology. Additionally, a zero-rate VAT for social care (at a cost of £120 million a year to the UK Government across the industry) would enable businesses to reinvest in recruitment, retention and new technologies.[7]

• Thirdly, we believe that investing and collaborating on research and development will drive future innovation and long-term funding solutions.  We are already looking to the future of home care and through our partnership with the University of York, we are investing over £300,000 in a research programme across three years. The project will help us, and the home care sector, scope out exactly how best to care for people in their own homes. An additional example of how innovation can drive enhanced care exists with the NHS’s Digital Aspirant/Digital Exemplars programme. Home Instead would welcome the expansion of the programme to cover social care providers[8].

• Finally, the establishment of an independent body to determine the future funding mechanisms for the care sector would help to ensure a parity of thinking across the sector, ability to share “best in class” use of funds to drive recruitment and other innovations that contribute towards the better health of the nation. Home Instead are eager for any future body to be cross-party, whilst featuring a mix of public and private providers. We believe that this will encourage collaboration and learning across and outside the sector.

Response to Q.4 - How can the adult social care market be incentivised to compete on quality and/or innovation?

With an ageing population, demand for social care services will only continue to increase. Therefore, it is vital that we continue deliver the much-needed high quality care and support that so many rely on.

We believe that technology should supplement, but never replace, personally delivered care. Home care is evolving at a rapid rate, spurred on by the adoption of technology to support customers 24/7. At Home Instead we recognise the home as a 21st Century care setting that fosters overall health, wellbeing, and independence. We also believe that technology has a vital role to play in prevention, with a holistic approach to tackling the non-medical aspects of ageing, such as loneliness and other changes to habits that can contribute to health deterioration over time.

We are continuing to examine which interventions are needed to allow us to care for more people at home. As a result, we have started to introduce clinical observations such as blood pressure monitoring, pulse rate and temperature checks. Urine analysis, diabetes awareness and insulin administration are now also routinely available through our CAREGivers who have undergone a bespoke training programme to enable them to undertake these interventions.

In 2019 Home Instead became a founding partner of the Care Innovation Hub, a platform created for social care professionals in the UK wanting to discuss the latest issues and possible solutions in the sector[9]. The Care Innovation Hub operates a series of challenges for sector professionals, care staff and students to identify solutions to problems in social care, and then give them the opportunity and resources to develop those solutions into concrete prototypes.

However, in order for a technologically sophisticated care system to develop and increase the standard of care around-the-clock, the Government and industry need to invest in innovation. Home Instead additionally stands ready to be involved in piloting and offering new technologies to the NHS to make our vision of a truly public-private partnership of social care a reality.

Technology and innovation will continue to play a vital role in improving the customer experience and investing in innovative providers will be vital. Future tax exemptions and incentives, such as those outlined above, can help ensure that care is fit for the 21st Century.

April 2021