Homecare Association denounces corridor care of older people in hospital
FOR IMMEDIATE RELEASE
The Homecare Association is appalled by new findings from the Royal College of Physicians (RCP), revealing nearly 80% of NHS doctors are now regularly treating patients in corridors, waiting rooms, and other unsuitable spaces. Many are frail, older people.
Neglecting care and support for people in their communities creates dangerous bottlenecks in hospitals.
The Royal College of Nursing warned in January that patients were dying unattended in hospital corridors. Others were waiting for hours in urine-soaked or soiled clothing and “inhumane” conditions.
Dr Jane Townson OBE, Chief Executive of the Homecare Association, said:
The shocking normalisation of corridor care exposed by the RCP is exacerbated by long-term underinvestment in community-based care services. When we fail to support older and disabled people to live independently at home, they inevitably end up in hospital - often with preventable conditions that could have been managed in the community with adequate support.
With Age UK estimating that 2 million people now have unmet care needs and 6 million unpaid carers struggling to support loved ones at home, it's no wonder our hospitals are overwhelmed. While about 1 million people do receive professional care at home, in some areas the quality and safety of this care is poor because local authorities are favouring the cheapest providers who cut corners to survive.
The NHS often blames its woes on a lack of capacity in social care. In most places, there is spare capacity in both care homes and homecare. Many providers avoid NHS work because the fee rates offered are too low and they don’t pay their bills on time.
Dr Townson added:
We are seeing appalling and unethical commissioning of homecare by NHS Integrated Care Boards. Some are purchasing homecare at just £17 per hour - which doesn't even cover the direct staff costs at National Minimum Wage. Many haven't communicated with providers about fee uplifts for the current financial year, despite the minimum wage increasing by 9.8% in April 2024. From April 2025, providers face a further 10% increase in costs from a rise in NMW and employers’ national insurance.
If community care fails, the Prime Minister's pledge to reduce NHS waiting lists will likely fail. With a £22 billion budget increase, it's unacceptable the NHS is making homecare providers subsidise healthcare. The NHS is complicit in creating the conditions for unsafe care, labour abuse and modern slavery. This risks harm to those receiving and giving care and contributes to the hospital overcrowding.
The Homecare Association is calling for:
- Immediate fee uplifts from NHS bodies to meet the Minimum Price for Homecare of £32.14 per hour for 2025-2026.
- Prompt payment of invoices to homecare providers.
- Ethical commissioning practices that recognise the true cost of quality care.
- Greater investment in preventative community-based care to reduce unnecessary hospital admissions.
--ENDS--
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Notes to editors
(1) The Homecare Association is the UK’s membership body for homecare providers, with over 2,200 members nationally. Its mission is to ensure homecare receives the investment it deserves, so all of us can live well at home and flourish in our communities. The Homecare Association acts as a trusted voice, taking a lead in shaping homecare, in collaboration with partners across the care sector. It also provides hands-on support and practical tools for its members. The Homecare Association’s members agree to abide by the Association’s Code of Practice.
(2) The care sector comprises 18,500 PAYE employers, 10,850 of those are non-residential and 7,650 are residential (Skills for Care 2024). Total market value is £35.3 billion (LaingBuisson 2024), contributing £68.1 billion to the economy.
(3) Local authorities and the NHS buy 70-80% of all care services (LaingBuisson 2024).
- 96% of supported living.
- 89% of care homes for younger adults.
- 79% of homecare.
- 57% of older people’s care homes.
(4) NHS funding represents 25% (£1,692 million) of the total funding for homecare (£6,656 million). The rest comes from councils (50%; £3,348 million); direct payments (3%; £212 million); private-pay (21%; £1,375 million); and other (1%; £30 million) (LaingBuisson 2024).
(5) The fee rates local authorities and the NHS pay now are too low to cover costs (Homecare Association). Only 1% meet our Minimum Price for Homecare of £28.53 per hour in 2024-25. This will rise to £32.14 per hour in 2025-2026, as detailed in our new Minimum Price for Homecare report.
(6) Employment costs, representing 70-80% of providers’ total costs, will surge by at least 10% in 2025-26. This is driven by increases in employers’ national insurance contributions and minimum wage requirements. We provide detailed analysis in our Minimum Price for Homecare 2025-26 report.
(7) Providers cannot pass on these increased costs as local authorities and NHS bodies, their primary customers, fix prices. Many councils cannot balance their books and directors of Adult Social Services must cut budgets by £1.4 billion.
(8) Key findings from a recent Care Provider Alliance survey show that without immediate government intervention:
- 73% will have to refuse new care packages from local authorities or the NHS.
- 57% will hand back existing contracts to local authorities or the NHS.
- 77% will have to draw on reserves.
- 64% will have to make staff redundant.
- 92% of providers who also serve people who pay for their own care will be forced to increase rates for self-funders. Many self-funders will be unable to bear extra costs and may reduce care or rely more on family carers.
- 22% are planning to close their businesses entirely.
(9) Profitability in the state-funded sector has plummeted over the past decade (LaingBuisson 2024).
- Homecare average EBITDA margins have fallen from 10.8% to a low of 5.2% in 2019, with some recovery to 7.6% in 2024.
- Care homes for younger adults have seen EBITDA margins halve from 26% to 13%
- Older people’s care homes serving mainly state-funded residents have seen margins fall by 50%
(10) Despite some perceptions, private equity involvement in the care sector is limited. Just 12.2% of older people’s care homes; 10.1% of younger adult care homes; and 12.2% of homecare/supported living services are private equity backed.
