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Curious for what lies ahead in the care sector?

9th February 2024

As a result of my recent Governance & Sustainability insight with Buyacarehome and Ownacarehome, and as the days start to draw out again, I have been thinking about some of the current topics and challenges facing the social care sector and how these might be addressed.

Government strategy – Developing a future ready care workforce.

Following their announcements at the end of 2023 relating to the change in migration policy, the Government is focusing on further developing the domestic workforce. In particular, plans are afoot to improve the career outlook of our domestic care workforce through training, qualifications, and a more defined career path.

As an accountancy practice, training school and college leavers alongside graduates is fundamental as we develop our people and build a sustainable business. Encouraging individuals as they navigate their preferred career paths and aspirations by getting practical experience in the workplace. Why can’t this be a model for the care sector?

Organic employee growth (effectively growing your workforce through training) works – I have seen the impact it has had on our business - and there is no doubt in my mind it can be successfully implemented in a care setting; whether that’s a care home, domiciliary care, live in care, or supported living. With all this choice and potential, it is surprising that caring isn’t seen favourably as a career option.

Let’s hope that the muted changes inspire our future care workforce and lead to them joining a rewarding and valuable sector for the UK economy. With an ageing demographic, we must motivate and encourage them soon!

With the proposed reforms underpinned by a new career pathway, the Government’s plan will include:

  • Accredited qualifications in care
  • Digital training
  • Funded apprenticeships

Some of the Government funding will be applied to a new Level 2 Adult Social Care Certificate qualification alongside a new digital leadership qualification.

Attracting your workforce.

With the migration changes scheduled for the Spring, how does your care home stand out from the crowd? 

Care seekers and their families are increasingly starting their care journey online, reviewing the home before visiting. “Kerb side appeal” is significant not only for residents but also for staff. I am often amazed at how often care homes don’t have a website or, when they do, have not updated it for many years.

Videos showcasing the care home and its staff teams score highly in attracting residents and staff, alongside live feeds to a care home’s Facebook page.

Evidencing a strong employee culture, using social media platforms and your own website also speaks volumes to care seekers and current and future care staff.

Financial sustainability

After a period of high-cost inflation and turmoil on the world stage, any investment decision needs to be based on up-to-date financial information. Managing a care business with increasing costs can be difficult, but by using technology, it is now possible, due to automation, to produce regular information that can allow you to look ahead with greater visibility.

Forecasting the year ahead on a rolling monthly or quarterly basis not only ensures that your care business can weather potential challenges, but also contributes to good governance and control with the capability to monitor the impact of increasing operational costs.

For example, the rise of the National Minimum Wage in April will need to be factored into operators’ considerations around future fee increases.

To offset the ongoing rise in costs, a continuous review of weekly fees per bed should be undertaken to mitigate the potential reduction of profits for reinvestment in the business.

Recent conversations with clients include using management information to review growth plans, benchmarking, and business restructures for succession and tax planning. Funding is also a hot topic due to the rise in base rates.

Average Weekly Fees - Fair Cost of Care

The fair cost of care debate will continue to be increasingly debated across various platforms. When looking at your fee levels, there are a number of supplementary avenues that can be explored, but each will depend on the specifics of the care home. Key components of weekly care fees will include:

Third Party Top Ups

Third party top ups can be sought in addition to a local authority placement as a way of reducing the gap between a private payer and a local authority funded payer.  Legal advice is recommended when drawing up contracts to ensure that your care provision complies with the relevant legislation.  The resident’s family will need to agree to the top up and fully understand its implications. Be clear when setting out the additional cost to reduce any challenges.

For example, the size of the bedroom and amenities can differ within an individual care home and warrant an additional charge. These extra facilities can also justify a fee variation between one care home and the next. Examples being wet rooms, additional dining space and access to outside space from ground floor rooms.

Continuing Health Care (CHC)

The Government sets out the process behind CHC in ‘The National Framework for NHS continuing healthcare assessments and NHS funded nursing care.’  Assessments are carried out taking into account a range of needs under a prescribed scoring system. 

Integrated Care Boards (ICBs) can provide further information on the NHS CHC process.

The NHS covers CHC funding and can be fast-tracked in certain circumstances. Palliative care, for example, should enable you to access CHC funding quickly.

In an election year, the debate surrounding the funding of care continues alongside the challenges of cost pressures. The recent Sector Pulse Check (learning disability charity Hft and Care England) highlights the ‘financial health and workforce of adult social care.’

Within the Report much needed reform in the social care sector continues to be a focus of conversation.

Legal advice from a sector specialist solicitor should be taken to ensure your care contracts meet the relevant regulatory guidelines around transparency and fairness.

Getting ahead - ESG in the care sector

Yet to be assessed by the CQC, it remains evident that care home settings that have already started the Environmental, Social and Governance (ESG) journey are already future proofing their businesses for the longer term.

With ESG and business performance going hand in hand, care businesses adopting an early strategy will reap operational rewards in the longer term, with ESG becoming more important for key stakeholders.

Looking at the easy wins first (with the greatest impact) can immediately impact your care profile within the local community and, encourage an increase in care seeker enquiries and enhance staff retention and recruitment. For further information, visit our ESG Hub here.

Care Quality Commission (CQC) and the New Single Assessment Framework

The CQC has commenced the rollout of its quality statements underpinned by the ‘We statements’ for the care provider and ‘I statements’ from the person using the care service.

The Five key questions remain being Safe, Effective, Caring, Responsive and Well led, and to date, experts in the consultancy care sector are reporting the current inspection trends as:

  • A mix of onsite and offsite assessment
  • Individuals interviewed for feedback and service experience
  • Shorter reports with more concise information

The Care Quality Commission’s (CQC) new scoring system to rate a care service

The CQC have published further guidance setting out their four point scale system looking at the evidence behind each quality statement to inform the Inspector about the care service.

The starting point for benchmarking purposes is ‘good’ with the care service performance compared with this.  Rating a care service is moving away from a single point in time, to one of collating evidence from moving real time data - collected remotely or through an onsite inspection. Hence, continuous improvement and innovation in care provision are important for a sustainable service.

A Spring Budget and Autumn Election!

And finally, as an accountant, I just had to mention the upcoming Spring Budget!

We can’t second guess what the chancellor will announce in the upcoming budget, but we hope this will bring some much-needed tax reliefs for all businesses. 

It’s a really busy time for the Healthcare Team here at Bishop Fleming, and we are proactively talking with our clients about the end-of-year tax planning and looking further ahead at locking in those opportunities before the likely General Election in the Autumn. Join our upcoming spring budget seminar to hear more from our experts – register your place here.

If you want to discuss how Bishop Fleming’s specialist care home accounting, audit and tax teams can help you, please email Tim Godfrey Partner and Head of Healthcare.

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