Where will the next body blow to Health and Social Care Businesses come from?
As the focus on the sector increases so do the expectations, but what next for providers?

For many providers of services in the Health and Social Care sector the mindset these days must simply be what can Authorities throw at us next to make life even more difficult than it already is? For all the effort is it worth it? Simply consider some of the recent changes;
·Increasing CQC fees and the demands of regulation
·Increasing staff pension costs
·The Apprentice Levy and the implications on training
·Increasing insurance costs
·The difficulties of recruiting staff
·Implications of the National Living Wage and HMRC
But what else?
Of course, there are the obvious financial reasons , many Local Authorities do not understand the costing of the services that they procure and want providers to take all of the risk. This can survive in the short term, but eventually it will fail. It is a difficult job for any Local Authority trying to meet both increasing demand and its legal obligations without the proper funds being in place, but it is unfair for the providers of care to carry all of the burden. It is an old debate, which despite periodic flashes of Government interest, has not really made any progress towards a longer-term solution. But ignoring the direct funding question what else frustrates providers and what will it be next?
Bureaucracy
Whilst large providers are handing back unsustainable contracts on financial grounds, smaller providers are feeling to a greater extent the impact of ever increasing bureaucratisation. As small businesses they don’t have the resources and skills to meet all of the ever-increasing demands of the likes of the CQC, HMRC, Data Protection, Health and Safety etc. It is a slow torture, but it does wear small businesses out.
Zero Hours Contracts
The topic of zero hours contracts is often an emotive one, and clearly one that is portrayed in the media as a negative exploitative tool used by greedy employers. In many cases that is undoubtedly the case and the treatment of staff is unfair. In view of this zero hours contracts are seen in a very negative way, and as a result some Local Authorities have jumped on the bandwagon and are demanding as part of contracts that they procure, that they be limited to a small number of staff or not used at all. Unfortunately, whilst from a Council point of view it is a nice soundbite, they are not willing to pay for it to be funded. However, what do carers themselves actually want with regards to contracts?
Interestingly for many employees in Health and Social Care, zero hours contracts are actually preferred, this is not based on dramatic newspaper headlines about exploitative employers but on actually talking to carers. This is based on my own personal experience when a clear majority of carers when quizzed on the topic were very much in favour of retaining zero hours contracts as it suited their own personal circumstances. The reality is that if new legislation was introduced around the use of zero hours contracts, it would undoubtedly benefit many who are exploited, but it may well have a negative effect on some parts of the care industry, as for many of these people this is the way they prefer to work.
The Sleep-in fiasco
If this was not such a serious issue it would be laughable. The legal challenges are ongoing and what the eventual outcome will be anybody’s guess. The whole process quite frankly has been shambles.
Once again, the historical practice of the industry has been based on the circumstances of the majority and the legal claims have been based on the modern opportunistic claim culture and the minority. Historically “Sleep-ins” commissioned by Local Authorities were paid at flat rates for a night, at levels that would pay carers some £30-£40 a night. Obviously at these levels of cost LA’s were paying say £50 a night, in line with the costs of the service. For many years this has been the accepted practice with additional wages being paid where certain night time disturbance criteria were met. Again, based on personal experience I don’t think in over 25 years of working I ever encountered a complaint with regards to the pay for sleep-in work, because it suited most employees and it was seen as relatively easy and the number of actual disturbances were quite few and far between.
However, funding pressures have had an impact on the service, with commissioning bodies trying to impose sleep-ins (in order to save money) on large packages when the circumstances really require 24-hour care. In these cases, providers are put in a difficult position, but they should still meet the legal responsibilities with respect to their staff irrespective of the commissioning practices. The funding situation has undoubtedly helped to crystallise a problem which for the clear majority of cases of genuine sleep-ins was not really a problem.
Travel time and the gaps between calls
If the sleep-in issue was caused by some differences in the law and how HMRC regulated employers, then this is going to be the next chapter from the same book, as it has the same problems, with employers not sure where they stand legally and how they are treated by HMRC. This issue will make the sleep-in clarification look easy.
By its nature, domiciliary care is generally procured in units of time, but because new packages start, service users go into hospital or die, the work pattern of a carer will be ever changing, and until the whole commissioning process is re designed this is always going to be the case. Because of this, from a business sustainability point of view with current funding levels, zero hours contacts are the employers contract of choice, not because they exploit employees but because they are consistent with the way in which care is commissioned.
Therefore, with staff rotas being so dynamic how can employers be sure that they are meeting all of the rules with regards to paying staff? The simple answer is they cannot as there are no clear rules, and just like the sleep-in saga this at some point is going to descend into a mess for many providers. If providers are not to breach HMRC rules with regards to National Living Wage legislation, then the rules with regards to this must be made clear and more importantly be consistent with the law. Then and only then will employers be able to operate confident that they are meeting all pay obligations to employees in both the eyes of HMRC and from a legal claims point of view.
PJT Consultancy Services Ltd is based in Shrewsbury and run by Phil Talbot ACA, a Chartered Accountant and Glenn Foster ACMA, a Chartered Management Accountant.
Both specialise in the provision of business advice with regards to the Health and Social Care Sector. Other services range from basic accounting advice to part time Finance Director or Non-Executive Directors roles. If you have a business in the Health and Social Care Sector and are considering selling, then please feel free to give us a call for a no obligation discussion.


