For
far too long the health and social care sector has been Inadequately funded and
undervalued. In this national crisis the impact and
contribution the sector makes to the welfare of us all has been appreciated by
the public and recognised by the government.
Care
staff and the businesses that provide this invaluable service whether they are care
homes or home care providers are truly unsung heroes – “Hats off” to you all.
This
is general advice piece written with the basic aim to assist with the pressures
that our Health and Social Care Providers are facing from the COVID-19
situation and it is aimed at Leaders within the sector.
In
the past Care Providers have experienced many threats and challenges and
generally are known to be very resilient in nature. The situation as a sector we
now face is very much different, and we all need to be able to support each
other as much as possible and truly work together to move forward.
So,
let’s begin with the first thing to consider.
1.Communication,
in fact, I will go far as to say:
Communication
first, second & third!
At
all level’s individuals need the ability to raise issues and get answers
quickly, and to be able to solve problems where possible,
collaboratively,
both internally across your business and externally.
Health
and Social Care Leaders should support collaborative working by ensuring that
there is frequent and easy flow communication,
My
general advice is that this needs to be practical, pragmatic as well as
positive.
I
would suggest you need to encourage all individuals:
that
they need to take responsibility
that
they know where to access and refer relevant information,
and
what the state of play is at all times,
In
addition to what the focus and the priorities are so that we can all ensure that
we are all doing our bit!
2.
Business Continuity Plans – this is No Longer about a “Tick Box” exercise
Good
business continuity planning assists resilience and should therefore be in place.
The business continuity plan (BCP) need to be updated and worked on in a
collaborative way rather than in Silos.
Every
Leader within the business should have their own action and Business Continuity
Plans that is produced as a working document and not as a “Tick Box” Document.
I
would suggest and generally encourage Board Members and Executives within a
business that they should if possible, avoid routine information requests
unless there is an intention to analyse the plans and offer constructive
guidance.
We
need to recognise that some aspects of the plans rely on support from others
such as Heads of IT, the Finance Team and possibly outside partners as well.
Where
it’s deemed possible – a provider should also offer help to peers – other care
providers by discussing/sharing their own local resilience plans and discussing
any wider considerations such as transport or school closures.
3.
Cashflow is King:
We
need to recognise that reduced cash flow will especially impact home care
providers, as they are usually expected to submit itemised invoices of hours
delivered for each person.
In
such cases there may be a time lag of up to eight weeks between delivery of
support and payment to the provider.
Delays
in invoicing, invoice disputes and non- payment of invoices will have a serious
negative impact on providers’ cashflow – The providers finance Team need to
plan quickly and manage in detail daily and weekly activity.
In
this period there are some local authorities that have offered some structured
upfront payment
If
you as the provider are lucky enough to get an upfront payment then this needs
to monitored to ensure the hours delivered tally with the hours paid as this
can easily get out of sync.
Cashflow
can also affect Residential Care Homes, it
may be possible that local government will offer support by paying on the
planned support for people in given care homes and the reconciling for any
adjustments due to deaths or other factors. This is even more important as
occupancy levels may become more volatile, with potentially more voids due to
infection control measures possible offset by extra demand.
4.
Retrospective reconciliation – It’s going to happen!
Any
payments overpaid will be reconciled - Where the time comes this needs to be
handled transparently and with open and frank discussion.
Reconciliation
is likely when actual levels of support differ markedly from what was planned
and these needs to managed in the budgets of all providers.
All
Health Care Providers should be mindful of all the extra costs they are incurring
during this period, and of problems they may face in reducing variable costs in
such a volatile operating environment.
As
a Provider you should also be mindful that, where actual support levels are
significantly below plan, then the commissioners may have needed to fund
support elsewhere.
5.
Sick Pay- the changing landscape
Health
Care Providers face increased cost pressures due to higher sickness absence
rates among their workforce: you may need to pay staff Statutory Sick Pay (SSP)
or make sickness payments at a higher level than SSP because they have a
contractual sick pay scheme (also known as an ‘occupational scheme’), which
offer workers payments above the basic minimum amount of SSP, which is £94.25
per week.
When
emergency legislation is passed, employers’ liability for SSP will start at day
one rather than day four, and requirements for workers to self-isolate will
further increase financial pressures. Given that in virtually all cases
providers will have to backfill sickness absence to ensure continued delivery
of support, this represents a real cost pressure on providers.
Please
note that care provider employers are unable to reclaim payments for SSP from
Government, except for some temporary arrangements announced in the Spring
Budget, which will only be available to organisations with 250 or fewer
employees.
Our
suggestion is that Health Care Provider should lobby to mitigate this by
requesting funding for these extra costs and push for either a lump sum payment
or through increasing the fee rate.
It’s
possible that the local authority can assist with cash flow by agreeing a
reasonable amount based on an assumed average sickness absence rate and paying
upfront, rather than awaiting detailed records of actual sickness taken and
backfill provided and agree reasonable and proportionate ways of later
reconciliation. Each Local authority will have their own approach and this issue
needs to be highlighted to get this resolved.
6.
Workforce availability & Management
There
is no doubt that Health Care Providers will face higher workforce absence
rates, through medically recommended self-isolation, sickness and family caring
responsibilities.
Other
factors, such as the possibility of school closures, may exacerbate this issue.
Care providers will need to be able to deploy their staff flexibly and to hire
new staff quickly. It’s possible that you may face increased cost pressures
from higher use of agency staff.
My
suggestion is that here again the Local authority should be lobbied and made
aware to assist with these extra cost pressures.
Some
Commissioner are allowing flexibility for providers in hiring and deploying
staff, for example allowing recruits to begin working after a DBS Adult First
check has been obtained, rather than insisting the full DBS checks are returned
before a worker can begin providing care, or by allowing staff to be deployed
across different care settings or between care providers.
7.
Rapid Response & Adjustment of
Support
Generally,
support will have to be rapidly adjusted. People will be admitted to hospital,
care visits changed to meet the most urgent needs and some homecare visits will
take longer due to infection control precautions and the availability of staff. In addition, care homes may need to adjust
support in order to meet changing needs and to minimise infection risks.
This
means that rapid decisions will need to be taken by care providers about
appropriate adjustments of care packages. This will likely increase your costs as
it will require extra management time to make these adjustments. There is also
likely to be a higher ratio of travel to contact time in home care due to the
rapid reorganisation of rounds and rosters.
8.
The dreaded ECM…
It’s
become common practice for homecare contracts to use electronic call monitoring
(ECM) to create a system of a “pay-per- minute” billing or to round visit times
into defined bands have a built in ceiling on upwards adjustment of hours,
which may make it more difficult to make these
rapid adjustments.
The
local authorities have on the whole recognised that these need to be removed
for this period and all providers should have received communication from their
Commissioners.
The
“Pay per minute” also carries a significant risk to Providers. In all cases it
reduces the financial viability of shorter homecare visits (particularly those
that are 30 minutes).
9.
Infection Control—The be-all and end-all
As
a care provider you will face extra costs through the need for more personal
protective equipment (PPE), through the need for enhanced cleaning of care home
and other premises or people’s own homes, and through the need to adopt
different working patterns to minimise the spread of infection, for example
zoning some staff within care homes.
Providers
may also face greater difficulty in obtaining infection control products, PPE,
handwash and disposable hand towels, due to increased demand for them.
Leaders
in these business need to issue clear instructions to their teams about how
such stocks should be made available to staff who need them.
All
such pressures need to be communicated regularly internally and externally.
10.
Don’t forget the self-funders!
Health
Care Providers must continue to provide support to self-funders,
It
is important that this is communicated to commissioners so that they have an
overall picture of how the whole market is operating,
rather
just those providers with which an authority contract’s directly.
It’s
possible that Health Care Providers may face pressures from sudden decisions by
self-funders to refuse support and then refuse to pay notice periods.
It’s
important that Health Care Providers keep communicating with Commissioners to
give them a closer view of the issues and challenges so that they can support
all Health and Social Care providers operationally and financially to ensure
resilience through this period.
Thank
you once again to all Care Providers and your teams for your hard work and continued commitment We are certainly in an extraordinary situation
we wish you all the best to be able to mitigate the impacts of Covid-19 on your
staff, clients and your business.
2.
Business Continuity Plans – this is No Longer about a “Tick Box” exercise
Good
business continuity planning assists resilience and should therefore be in place.
The business continuity plan (BCP) need to be updated and worked on in a
collaborative way rather than in Silos.
Every
Leader within the business should have their own action and Business Continuity
Plans that is produced as a working document and not as a “Tick Box” Document.
I
would suggest and generally encourage Board Members and Executives within a
business that they should if possible, avoid routine information requests
unless there is an intention to analyse the plans and offer constructive
guidance.
We
need to recognise that some aspects of the plans rely on support from others
such as Heads of IT, the Finance Team and possibly outside partners as well.
Where
it’s deemed possible – a provider should also offer help to peers – other care
providers by discussing/sharing their own local resilience plans and discussing
any wider considerations such as transport or school closures.
3.
Cashflow is King:
We
need to recognise that reduced cash flow will especially impact home care
providers, as they are usually expected to submit itemised invoices of hours
delivered for each person.
In
such cases there may be a time lag of up to eight weeks between delivery of
support and payment to the provider.
Delays
in invoicing, invoice disputes and non- payment of invoices will have a serious
negative impact on providers’ cashflow – The providers finance Team need to
plan quickly and manage in detail daily and weekly activity.
In
this period there are some local authorities that have offered some structured
upfront payment
If
you as the provider are lucky enough to get an upfront payment then this needs
to monitored to ensure the hours delivered tally with the hours paid as this
can easily get out of sync.
Cashflow
can also affect Residential Care Homes, it
may be possible that local government will offer support by paying on the
planned support for people in given care homes and the reconciling for any
adjustments due to deaths or other factors. This is even more important as
occupancy levels may become more volatile, with potentially more voids due to
infection control measures possible offset by extra demand.
4.
Retrospective reconciliation – It’s going to happen!
Any
payments overpaid will be reconciled - Where the time comes this needs to be
handled transparently and with open and frank discussion.
Reconciliation
is likely when actual levels of support differ markedly from what was planned
and these needs to managed in the budgets of all providers.
All
Health Care Providers should be mindful of all the extra costs they are incurring
during this period, and of problems they may face in reducing variable costs in
such a volatile operating environment.
As
a Provider you should also be mindful that, where actual support levels are
significantly below plan, then the commissioners may have needed to fund
support elsewhere.
5.
Sick Pay- the changing landscape
Health
Care Providers face increased cost pressures due to higher sickness absence
rates among their workforce: you may need to pay staff Statutory Sick Pay (SSP)
or make sickness payments at a higher level than SSP because they have a
contractual sick pay scheme (also known as an ‘occupational scheme’), which
offer workers payments above the basic minimum amount of SSP, which is £94.25
per week.
When
emergency legislation is passed, employers’ liability for SSP will start at day
one rather than day four, and requirements for workers to self-isolate will
further increase financial pressures. Given that in virtually all cases
providers will have to backfill sickness absence to ensure continued delivery
of support, this represents a real cost pressure on providers.
Please
note that care provider employers are unable to reclaim payments for SSP from
Government, except for some temporary arrangements announced in the Spring
Budget, which will only be available to organisations with 250 or fewer
employees.
Our
suggestion is that Health Care Provider should lobby to mitigate this by
requesting funding for these extra costs and push for either a lump sum payment
or through increasing the fee rate.
It’s
possible that the local authority can assist with cash flow by agreeing a
reasonable amount based on an assumed average sickness absence rate and paying
upfront, rather than awaiting detailed records of actual sickness taken and
backfill provided and agree reasonable and proportionate ways of later
reconciliation. Each Local authority will have their own approach and this issue
needs to be highlighted to get this resolved.
6.
Workforce availability & Management
There
is no doubt that Health Care Providers will face higher workforce absence
rates, through medically recommended self-isolation, sickness and family caring
responsibilities.
Other
factors, such as the possibility of school closures, may exacerbate this issue.
Care providers will need to be able to deploy their staff flexibly and to hire
new staff quickly. It’s possible that you may face increased cost pressures
from higher use of agency staff.
My
suggestion is that here again the Local authority should be lobbied and made
aware to assist with these extra cost pressures.
Some
Commissioner are allowing flexibility for providers in hiring and deploying
staff, for example allowing recruits to begin working after a DBS Adult First
check has been obtained, rather than insisting the full DBS checks are returned
before a worker can begin providing care, or by allowing staff to be deployed
across different care settings or between care providers.
7.
Rapid Response & Adjustment of
Support
Generally,
support will have to be rapidly adjusted. People will be admitted to hospital,
care visits changed to meet the most urgent needs and some homecare visits will
take longer due to infection control precautions and the availability of staff. In addition, care homes may need to adjust
support in order to meet changing needs and to minimise infection risks.
This
means that rapid decisions will need to be taken by care providers about
appropriate adjustments of care packages. This will likely increase your costs as
it will require extra management time to make these adjustments. There is also
likely to be a higher ratio of travel to contact time in home care due to the
rapid reorganisation of rounds and rosters.
8.
The dreaded ECM…
It’s
become common practice for homecare contracts to use electronic call monitoring
(ECM) to create a system of a “pay-per- minute” billing or to round visit times
into defined bands have a built in ceiling on upwards adjustment of hours,
which may make it more difficult to make these
rapid adjustments.
The
local authorities have on the whole recognised that these need to be removed
for this period and all providers should have received communication from their
Commissioners.
The
“Pay per minute” also carries a significant risk to Providers. In all cases it
reduces the financial viability of shorter homecare visits (particularly those
that are 30 minutes).
9.
Infection Control—The be-all and end-all
As
a care provider you will face extra costs through the need for more personal
protective equipment (PPE), through the need for enhanced cleaning of care home
and other premises or people’s own homes, and through the need to adopt
different working patterns to minimise the spread of infection, for example
zoning some staff within care homes.
Providers
may also face greater difficulty in obtaining infection control products, PPE,
handwash and disposable hand towels, due to increased demand for them.
Leaders
in these business need to issue clear instructions to their teams about how
such stocks should be made available to staff who need them.
All
such pressures need to be communicated regularly internally and externally.
10.
Don’t forget the self-funders!
Health
Care Providers must continue to provide support to self-funders,
It
is important that this is communicated to commissioners so that they have an
overall picture of how the whole market is operating,
rather
just those providers with which an authority contract’s directly.
It’s
possible that Health Care Providers may face pressures from sudden decisions by
self-funders to refuse support and then refuse to pay notice periods.
It’s
important that Health Care Providers keep communicating with Commissioners to
give them a closer view of the issues and challenges so that they can support
all Health and Social Care providers operationally and financially to ensure
resilience through this period.
Thank
you once again to all Care Providers and your teams for your hard work and continued commitment We are certainly in an extraordinary situation
we wish you all the best to be able to mitigate the impacts of Covid-19 on your
staff, clients and your business.
Safaraz
Ali
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