Paying the price for commissioning in social care? The minimum wage and domiciliary care work in the UK

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Chris Forde
Chris Forde is Professor of Employment Studies at CERIC.

@CERIC_LUBS

When The Low Pay Commission’s annual recommendations were released a fortnight ago, most attention focused on the 12p and 5p rises in the minimum wage for adults and 18-20 year olds. As in previous years, these recommendations have attracted headlines about the level of the minimum wage, and the effects of the NMW on employment. Yet, whilst there is broad consensus over the importance of setting a floor for wage levels, the focus on a minimum wage may detract attention away from the more fundamental problem of low paid jobs in the UK economy. Why are there so many low paid jobs in sectors such as hospitality, retail, social care and personal and protective services? There is a need for a clearer understanding of how a diverse range of factors, including employer strategies, government commissioning regimes, and sectoral norms combine to institutionalise low pay in particular sectors.

In this respect, it is worth focusing in on one of the LPCs supplementary recommendations in their 2013 report. The Commission has recommended that contracts issued by public bodies which commission the provision of social care should contain a clause requiring at least the NMW to be paid.  One in 12 jobs in social care were paid at or below the minimum wage by 2011 and there has been much interest from the LPC in whether the commissioning of social care by local authorities is a contributory factor.

Within social care pay in domiciliary care has attracted most attention, and it was this sector was the focus of my report with colleagues Ioulia Bessa, Sian Moore and Mark Stuart from the Centre for Employment Relations Innovation and Change (CERIC), for the LPC this year. Almost 700,000 workers are now employed in the UK providing care for people in their homes, with the number of jobs expanding rapidly as the population ages. As commissioning of public service delivery of domiciliary social care has increased, so the number of directly employed care workers has fallen sharply. A decade ago, most domiciliary care workers were employed by local authorities, whereas now they are much more likely to be employed through one of the 6000 registered home care providers in the UK. The vast majority of publicly funded home care is provided by these private and voluntary organisations through contracts commissioned by local authorities. A recent survey found that there was increasing pressure on providers in terms of what they can cost in contracts. Local authorities may effectively pay only for workers’ ‘contact time’ with a client, rather than including any provision for ‘travel time’ between visits, which can be considerable.

Our research was able to shed light on the realities of work and pay for those in front-line domiciliary care roles. First, we analysed a unique national dataset on employment in the domiciliary care sector, the National Minimum Dataset for Social Care, gathered by Skills for Care. This dataset contains information on pay levels for domiciliary care workers, although, critically, it does not allow us to identify directly whether travel-time is included in hourly pay. Nonetheless, even without adjusting for unpaid travel time, we found that between 2008 and 2012, 1 per cent of domiciliary care workers were paid below the minimum wage, a figure which rose to 2.5 per cent in 2012.   Our case studies of five local authorities all revealed that none currently specified payment of the NMW in its contracts or actively monitored compliance, although two had undertaken research on provider pay rates as part of budget scrutiny exercises and quality assurance. One local authority representative argued that it was not their responsibility to monitor compliance amongst its providers, noting: ‘That is their business, that’s not something that we would get involved in.  It is up to them how they deliver’.

We do make it clear in our report that these percentages should be seen as a lower-bound estimate of those paid under the minimum wage, as they do not take into account the significant amount of travel time that domiciliary care workers undertake within their working day. In our case studies, commissioning documentation sometimes explicitly stated that tenderers would not receive any separate payment from local authorities for workers’ travel costs and that they should cost travel time into their tender prices.  Yet providers typically set charge rates that did not incorporate travel time between visits. With tender contracts awarded on the basis of clear price and quality criteria, Commissioners were acutely aware of the potential impact of including travel time. As one noted:  ‘….we know the impact of not paying travelling time.  However, if it were to be included, it’s probably going to make the service unaffordable for us.  It’s a dilemma.  It doesn’t sit comfortably.… In terms of finance, I can’t give you a figure because we haven’t done that piece of work.  But yes, it would be significant, it would make a significant difference to the cost of the service at a time when we’re having to make huge cuts’.

The other factor that is crucial to understanding hourly pay for the domiciliary care worker is visit length. Most homecare visits being commissioned by local authorities are for periods of 30 minutes or less. For workers this may result in their work being arranged so that they have too many visits too close together or ‘call cramming’, resulting in their having to rush their work or leave a client early to get to their next visit on time.  Clearly, there are implications for compliance with the minimum wage, if extensive travel time is sandwiched between a series of short 15 minute visits, which are only paid for contact time. Some local authorities had begun to move away from commissioning 15 minute visits, and some paid enhanced rates for shorter visits. At one local authority in a semi-rural location, there had been a consultation of the cost implications of paying for travel time. This had revealed that additional allowances, including travel time, might add as much as £2 per hour to costs for providers, and the local authority was considering changes to its commissioning practices as a result.  It also highlights how much unpaid time is borne by the domiciliary care worker as a standard, typically non-negotiable part of their job, and suggests that the numbers paid under the minimum wage will be much higher when travel time is taken into account.

To begin to tackle these issues, Local authority contracts with care providers should explicitly state that external providers pay care workers an hourly rate for all working time, including the time required to travel between visits. There should also be transparency in procurement processes and contractors should be required to state what hourly rates comprise in terms of working time and specifically whether travel time is included, and whether there are enhanced rates for short visit lengths. Only then will it begin to address the realities of travel time, visit lengths and unpaid labour that currently characterise work in domiciliary care.

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