Trusts entering care market ‘threaten viability of existing providers’

Harrogate and District Foundation Trust last month said it was beginning a six-month pilot providing a domiciliary (home) care service, adding it faced “astronomical” costs from delayed discharges, and that – while providing care in rural areas could be unprofitable for private providers – for the FT it would be more economical. The FT said the NHS could offer better terms and conditions and career progression and is recruiting care workers on Agenda for Change band 4.

But North Yorkshire Council director for health and adult services Richard Webb told HSJ he believed the move risked exacerbating “viability problems” for existing providers and could mean “the overall supply of care in the community stands still or shrinks”.

He said the council had seen a near-doubling in demand for care packages following hospital discharge since before covid, and the large majority of requests were met each week.

The FT has registered its service with the Care Quality Commission but has not so far been admitted to the council’s list of registered providers, and talks are ongoing between the two. It could provide private-paid social care without being listed by the council.

Mr Webb said: “We are one of the highest payers for home care in the country and we have worked closely with our colleagues on integrated care boards to increase the supply of home care.

“In the last 12 months, the council has also invested an additional £600,000 in-year to support home care providers in the Harrogate area alone, which has meant that people have been able to get out of hospital, with the support that they need. Our voluntary sector-led Home from Hospital services have also been expanded.”

He said the council welcomed “any joint work” but added: “The number one thing that the NHS can do to help people who use social care – and councils and care providers – is to continue to develop and expand community nursing and therapy and virtual wards.”

He said the FT and other NHS providers were “doing good work to develop these services, as part of an intermediate care model… in particular, trust-led work on supported discharge has had a positive impact”.

Mr Webb said NHS “investment in community health services means more people can be supported better in the community and that people have the level of support that’s right”, and said the NHS could potentially do more by providing “‘bridging’ arrangements to support someone for a short period when they come out of hospital and may be waiting for a longer-term care package”.

Musical chairs

Mr Webb said trusts “considering a move into home care” should “work closely with your local council to really understand the local care market and to focus on where their intervention might have the most impact”.

“There is a worry that establishing NHS-led home care services, in competition with existing care providers, may simply be a game of musical chairs — care workers move to the NHS, existing providers hit viability problems and the overall supply of care in the community stands still or shrinks,” he said.

Harrogate’s plans follow a similar move by Northumbria Healthcare FT last year.

Harrogate FT said it did not want to comment further.

The number of acute hospital patients deemed to be ready for discharge was about 12,500 in October — down from 13,600 last October, but still more than one in 10 beds, and thought to be more than pre-covid. Many delays are due to waits for social care, although availability of NHS staff, community healthcare, diagnostics and medicines are also often common reasons.