Fee rates for state-funded homecare in 2022 vs 2021 - has there been an improvement and why does it matter?

Unavailability of homecare is having serious consequences for individuals, families, communities, local authorities, and the NHS.

Rising demand and falling supply of homecare is leading to an increase in unmet need in the community and delayed discharges from NHS hospitals. Lack of available hospital beds contributes to increased ambulance response times and longer NHS waiting lists, which adversely affects anyone who needs emergency care, diagnosis or treatment.

Inability of homecare employers to retain and recruit enough careworkers to meet demand is closely related to their inability to offer competitive pay and terms and conditions of employment in a tight labour market. This is because around 70% of homecare is state-funded and the income that providers receive from public sector commissioners with monopsony purchasing power does not adequately cover their costs. In turn, this is because central government has chosen to funnel most of the country’s healthcare spend into acute hospitals, rather than investing in home-based and community support. Allocation of most of the Health and Social Care Levy to the NHS merely intensifies this disparity, whilst local authority budgets remain squeezed.

Pouring money into the NHS whilst starving social care has led to system failure, which is plain for all to see. Public confidence in the ability of the NHS to provide timely care for those who need it has plummeted, which will likely have long-term political ramifications.

For many years, the Homecare Association has campaigned for an increase in fee rates for state-funded homecare so that a competitive employment offer can be made to careworkers, to build capacity and ensure quality and sustainability of services. Many careworkers love their jobs and the opportunity to improve lives, but stark economic realities drive them away reluctantly to stack shelves in supermarkets.

Here, we report on research we conducted between May and July 2022 to investigate whether fee rates for state-funded homecare in England increased after 1 April 2022, in line with recommendations we made in our Minimum Price for Homecare Report in December 2021.

Our findings indicate that fee rates paid by public organisations were an average of £19.01 per hour for local authorities (6.6% increase from 2021-22) and £18.76 per hour (an 8.1% increase from 2021-22) for NHS Clinical Commissioning Groups (CCGs, now part of Integrated Care Boards, or ICBs).

Both figures are significantly below the Homecare Association’s Minimum Price for Homecare of £23.20 per hour. We also discovered that some councils were paying fee rates for homecare that were below even the direct costs of employing careworkers at the National Living Wage, which we estimate at £16.57 per hour.