Another Wiltshire Council home care provider gets a damning report from the regulator
LATEST NEWS: BBC Radio 4 Today programme reports (May 13) that several Mihomecare care workers in Devon and Surrey have said they are not being paid properly. Reporter Zoe Conway spoke to a Mihomecare care worker: "...I think this lack of caring for our clients as people is just not acceptable." You can hear the short clip of her interview here.
Last week, as election officials were sharpening those HB pencils and big political beasts were bracing themselves to face the consequences of ballot paper crosses, a group of ten former health service 'big beasts' laid down a stark marker about the future of our NHS.
Led by former NHS Chief Executive David Nicholson, they wrote: "Social care is at the heart of the problem. Queues in A&E, delays in discharge, the lack of community services and joined-up care are due to the savage cuts in social care."
Two days earlier Wiltshire Council's Health Select Committee confronted the reasons for another black mark recorded against the Council's Help to Live at Home (HTLAH) scheme - another provider of adult social care was in trouble with the regulator.
After the tribulations and changes in uniform and the Care Quality Commission's (CQC) damning report on Mears (which has the HTLAH contract for the south of the county), the CQC had found another contractor 'requiring improvement' on three counts, 'good' on caring, but 'inadequate' on safety.
This damning report came after an inspection of Mihomecare's service in the west of the county. Mihomecare is part of Mitie - the 'Strategic Outsourcing' giant - which in 2012 had bought up the Enara Group which held this HTLAH contract. Mitie announced: "Enara is the fourth largest provider of home care services in the UK and will give Mitie a scalable platform to compete in the growing outsourced health and social care sector."
Mihomecare has 46 branches delivering home care in various parts of the country - and six more of those branches (including Newbury) have been deemed by the CQC to be 'requiring improvement'.
Before the health Select Committee were two of Mihomecare's senior managers Martin Staunton, deputy chief executive of Mihomecare, and Karen Sherwood who was brought in last September to manage the Wiltshire contract.
They were asked whether the CQC judgment came as a surprise to them: "I don't think it did - we were aware the service was not where we wanted it to be."
Councillor Mary Douglas (Conservative) outlined what had been found wanting and asked: "It's not rocket science - how come it wasn't all in place?" "That's why we made management changes."
The Committee's discussion was somewhat constricted. As it already has a Task Group making a top-to-toe investigation of the whole HTLAH scheme, some questions about the CQC report were ruled out of order by the Chairman because they were considered to come under the Task Group's remit.
So when Councillor Douglas asked the key question: "Was the initial commissioning asking the provider to do things for too little money?" The Chairman said the question was one for the Task Group.
As so often with CQC reports, it was claimed by Karen Sherwood that by now everything had been put right. When Councillor Chris Caswill (Independent) asked whether the CQC would now find their service 'safe', he was assured: "The service is safe."
But then Council officer James Cawley (associate director for Adult Care Commissioning and Housing) intervened: "We need to ask the CQC what they mean by safe." Councillor Caswill pointed out that the CQC had explained exactly why the Mihomecare service was not safe. But no one asked why Wiltshire's HTLAH contract did not lay down precisely what a safe service meant.
(We do not get sight of these contracts because they are deemed to be commercially sensitive.)
Mihomecare were then asked about another black mark against their name. They are in dispute with Her Majesty's Revenue and Customs who say their workers in Wales are owed about £80,000 because they have not been paid travelling time between visits - which has meant they have ended up being paid below the minimum wage.
This problem - it was not clear whether it spread beyond Wales - was going to be resolved at a meeting with HMRC in May 15.
None of the Councillors asked whether this was true of Mihomecare's Wiltshire operations. And no one asked why council contracts do not require providers to pay their staff the minimum wage - or even the living wage.
There is always on these occasions talk of 'capacity building' and creating a better workforce. How can that be done when councils seem oblivious to how much staff working in outsourced services are paid?
But the Task Group appear to have decided already that none of the problems with HTLAH are down to the Council. Its chairman, Councillor Gordon King (LibDem), asked a rhetorical question: "What extent is the Wiltshire model to blame? We are clear the faults live with the organisation."
He continued with a statement that seemed to pre-empt his Task Group's final report: "This organisation is lax in management and supervision. When it was acquired, they failed to put in a changed model. There is a huge disconnect between people on the ground and the back office - unless this is addressed the problems will go on and on. It does not impact on the Wiltshire model."
As we have reported, the government's Better Care Fund is a move towards integrating health with social care. It relies on sustainable social care as it seeks to prevent the old and frail from unnecessary hospital admissions, which cost the NHS dearly.
In Wiltshire this means that the HTLAH will be called on to take more of the burden with new tasks and more capacity. But if you commission service providers who are profit-making or have large central organisations to support, building capacity and improving staff numbers and quality needs to become a two tier and two way process.
The contract has to acknowledge the need to grow capacity - and the provider has to grow the staff and, as circumstances change, be given the resources to meet the quantity and quality of care required.
The senior and now former NHS managers - not be equated with the hated and mysteriously difficult to locate 'bureaucrats' - who wrote that polling day letter, almost certainly had greater intimate knowledge and experience of the NHS than every MP in England put together. They know that social care is crucial to maintaining the NHS as an efficient and caring organisation.