15 Oct 2022

High fuel costs – the ongoing impact on homecare

High fuel prices are leading to a reduction in homecare capacity, as homecare workers and their employers are struggling to cover increased costs of driving, without adequate additional income. The resulting exodus of homecare workers, inadequate availability of homecare to support people in communities and the NHS, and significant worry about the long-term sustainability of care businesses, ought to be a wake-up call to the Government for immediate action.

In a new survey of 509 homecare providers conducted by the Homecare Association, representing over 69,300 careworkers supporting over 118,700 people in their own homes, more than half stated that staff had given notice or already left, whilst 59% said that staff intended to seek work elsewhere, as they cannot afford to pay for petrol or diesel for their cars – a situation that has worsened since our previous survey in March 2022. Nearly all providers asserted that their staff had expressed anxiety about the increase to current or potential future cost of living.

The resulting shortage of careworkers has led to 57% of the providers surveyed declining new clients. Indeed, almost two-thirds (65%) were declining accepting any new clients where visits were predominantly rural – 17 percentage points higher than that for providers of mainly urban-location visits. Other than Greater London, most providers in every region of the United Kingdom have refused new clients.

Approaching a fifth of the sample (17%) noted that they had ended care to any current clients. A quarter of respondents who operate mainly in the state sector had stopped the delivery of care to some existing clients – a figure is that 13 percentage points beyond that recorded in the private-pay part of the market.

The effect of the increase in fuel prices on the sector is made even more acute by the fact that 87% of careworkers use either their own vehicles or company vehicles (whether powered by petrol or diesel), with more than four-fifths (82%) alone driving their own vehicles. 5% apiece use either public transport or walk to clients’ homes.

Less than a tenth (9%) of respondents determined that additional funding had been supplied by either the local council or NHS to help with the fuel price rises. Meanwhile, only 6% knew of contingency arrangements produced by their local authority so that careworkers can obtain fuel in the event of queues or shortages. Nine-tenths (90%) of the sample described themselves as either concerned or very concerned by how the increase in fuel prices could affect the financial viability of their organisation.

More than three-quarters (78%) noted that their careworkers had requested a rise in the mileage rate being paid. Over half (54%) of respondents were reimbursing their staff for mileage at a rate of between 21p and 35p per mile. Alarmingly, 2% claimed that they do not even pay mileage rates to their careworkers. On the flipside, more than a fifth (22%) were offering reimbursement between 41p and 50p per mile. The data also reveals a difference of 14 percentage points between predominantly state[1]funded respondents and their private-pay counterparts regarding payment of 30p per mile or less for mileage. There was also evidence that mileage rates are lower in the North compared with the South of England, reflecting the disparity in fee rates received for homecare. In our previous survey in March 2022, most providers were paying mileage rates of 30p or less, so mileage rates in homecare appear to have increased, though remain well short of the rate of 56p per mile paid to NHS workers.

Proposed expansion of the Ultra Low Emission Zone (ULEZ) in London, and Clean Air Zones (CAZs) in other cities, will likely also result in increased costs for homecare workers. A handful of providers surveyed told us that commissioners have indicated there will be no extra funding to cover clean air charges. In some cases, this has already resulted in homecare agencies ceasing to provide care to people living within these zones, due to the extra cost of entering these zones multiple times a day.

Tackling the rise in fuel prices to ensure continuity of service is a short-term aim, but the Government must also recognise the bigger picture – namely, the inextricable link between health and care systems, and that greater investment in homecare would relieve pressure on the NHS. Historically, central funding for homecare has only been a fraction (4%) of the spend on the NHS. And yet, a high proportion of delayed discharges from hospital are due to people waiting for homecare, while councils now have waiting lists for assessments for care of more than half a million.

The Homecare Association continues to urge the Government to:

1. Provide temporary grant funding of £107 million p.a. as a fuel allowance to cover increased costs of fuel for vehicles needed to deliver homecare.

2. Add health and care workers to the national list of exemptions for chargeable Clean Air Zones (or variants thereof) and support the lease or purchase of electric fleet vehicles for homecare services to enable a reduction in emissions in homecare in the longer-term.

3. Provide £1.7 billion p.a. of additional funding for homecare to ensure that fee rates cover costs and careworkers receive fair remuneration, including full recompense for work-related expenses such as mileage. Such investment is needed to build workforce capacity and reduce unmet need, recognising that NHS hospitals will never succeed in reducing their waiting lists if they cannot free up beds by discharging people back home.

Read the full report here: