Outsourcing health and social care

  • The outsourcing of adult health and social care services is a major aspect of the public sector’s current transformation
  • Independent providers face a number of challenges when taking on responsibility for the delivery of these services
  • With 76% of adult social care workers now employed by independent providers, we look at some of the challenges this brings

Councils spend more than a third of their budgets (35%) on adult health and social care, making it their largest controllable spend.

Since 2010, demand for such services has increased by 14%, but, in the wake of government cuts, spending has seen a 12% reduction in real terms.

With increasing demand and diminishing funding, councils are having to transform the way they work in order to achieve ambitious savings targets, with 2015/16 predicted to be the toughest year yet.

Outsourcing of adult health and social care services is playing an increasingly important role in local government transformation, with 76% of adult social care workers now employed by independent providers.

The scale of this outsourcing offers major opportunities for independent providers. However, undertaking public service contracts also presents a number of challenges.

We look at some of these challenges and how independent providers can respond to them.

Blurring of boundaries

To relieve pressure on the NHS, more adult health and social care services are being delivered at individuals’ homes, or at independent providers’ facilities, including some assistance for service users with complex needs.

Recent reforms have increased local government’s responsibility for providing such services, and therefore what they may be looking to outsource.

“It has long been a challenge for the sector that the boundaries are blurring between what is care and what is nursing,” says Vivien Gumble, Risk Consultant at Zurich Municipal.

“Many functions that are now being outsourced demand more experienced staff, or those that hold formal nursing qualifications.

“It is therefore important that independent providers carefully consider the types of staff suitable for their needs.”

Not doing so could have important implications for service quality, regulatory compliance and reputation.

Recruitment and retention

Staff turnover rates in social care are higher than for all other industrial, commercial and public sector fields.

In addition, despite the creation of 200,000 additional jobs since 2009, organisations still face a shortage of skills, in terms of both quality and quantity, making it difficult to recruit and retain the right mix of staff. Many providers frequently have to turn to expensive agency staff to meet pressing needs.

As the effectiveness of health and social care relies so heavily on the quality and continuity of its workforce, this is an important challenge for providers to tackle.

It has long been a challenge for the sector that the boundaries are blurring between what is care and what is nursing.

Vivien Gumble, Risk Consultant at Zurich Municipal

Low pay coupled with demanding work is a major factor in the sector’s staffing issues, with the Centre for Workforce Intelligence calling it “just another symptom of the low profile and status of social care work.”

Gumble recommends that providers should make attempts to enforce the vocational nature of work in their organisations, to assist recruitment and retention of staff.

“Some businesses are doing simple things such as offering extended induction programmes to further support staff and to promote the long-term development and training opportunities in their organisations,” she says.

“It is also very beneficial to develop a team of bank staff, who you can call upon to meet temporary staffing needs. This will not only reduce the costs associated with continuous recruitment and training, but will also limit the need to resort to costly agency staff.”

Regulatory compliance

Adult health and social care is delivered under the watchful eye of an intensifying regulatory framework. Recent measures, such as duty of candour and wilful neglect, place increased pressures on care staff, with significant penalties for organisations that fail to meet their requirements.

Independent providers therefore need good risk management functions, in order to effectively deliver on council contracts.

“It is all about good governance,” says Gumble. “Recruitment, training, record-keeping, efficient back-office systems, and a strong audit and supervision structure.

“All of this will help to support staff in their roles, help organisations navigate their way through the various regulatory requirements, and, if anything does go wrong, assist in defending a claim.”