How to fix the care industry – a conversation with Andrew Burton (Part 2 of 2)
Updated: Nov 18, 2021
Last week, we heard how Andrew started a care agency. The immense challenges he faced, as well as the inspiring stories he shared of his carers and clients (read here).
During the four years Andrew ran his care agency, it was a constant challenge – an adventure. In 2019, he finally decided to leave the care industry. “The challenges of working with the local council and CQC on compliance matters ended up making me want to leave the care industry. We had brilliant care, but we were so wrapped up in this bureaucracy. It was driving me insane. Some people can live with it. I couldn't.”
Following the sale of his care agency, Andrew remains passionate about making a positive change in the care industry. Since then, he has shared his views on how to improve care with the CEO of the UK Homecare Association (UKHCA).
Proposed changes to the care industry
We asked Andrew: ‘what he would do, if he had a magic wand?’
1. Increase carer pay significantly
After acquiring the care agency in 2016, Andrew increased carer pay by 20%. Despite the increase in carer pay, he managed to convert the business from loss-making to profit-making. “We gave our carers bonuses that could take them to 20% above minimum wage.” However, he reflects: “But even that increase didn’t reward them sufficiently. For the work that they do, they deserve more pay.”
2. Social & Medical Care
“Imagine the difference between giving a client a sandwich; versus having to care for a client who has just left the hospital for end-of-life care.” The first scenario is social care, whereas for me the second should be classed as medical care.
Andrew says we need to recognise “it’s not just social care. It’s social and medical care.” When he entered the care industry, it was far more medical-oriented than he expected. There is a lot of medical skills that care workers require: administering medication, turning them to prevent bedsores, first aid, etc.
“At times it didn’t feel like we had 70 clients in 70 homes. It felt like we had 70 individual hospital wards.”
“To me, the name of the industry is wrong. We should stop calling it social care and instead, call it social and medical care provided at home.”
3. Single standard of audit
Currently, there are two standards of audit - one for the CQC, and another for local councils. “Two government organisations, doing two sets of audits with different criteria. It’s nonsensical. The government could save tens of millions of pounds by having one standard of audit across both organisations.”
From Andrew’s perspective, he would prefer if the local council rather than the CQC lead the audits. “Because care agencies are constantly in touch with the local councils, the local councils would know if an agency is providing good care. Whereas, the CQC’s audit is a tick boxing exercise – if you completed the right forms, it’s a ‘tick’; if it’s the wrong forms, it’s a ‘cross’.
“One audit, council led – would be my magic wand.”
4. Refine the rating system
Currently, the CQC has four ratings – Outstanding, Good, Requires Improvement, and Inadequate. Based on Andrew’s experiences of the audit process, he recommends that if it is a minor administration mistake that can be remedied easily (such as completing the wrong form or wrong field), that care agencies be allowed 30 days to rectify, before finalising their rating for the year.
“When clients see an ‘Inadequate’ or ‘Requires Improvement’ rating, it looks like you’re offering bad care. But sometimes it’s not – it’s just that you didn’t fill in a box properly.”
“There needs to be refining of the rating system. What does ‘Requires Improvement’ look like – because some areas of “failure” are serious, and some are not. I would also redefine ‘Inadequate’ – you need to be offering terrible service to get ‘Inadequate’.”
5. Rating system should be based more on client feedback
The current rating system is disproportionately based on bureaucracy and reporting rather than the actual quality of care service provided to clients. Andrew recommends that the rating system should be based more on client satisfaction - feedback of the service provided by the carer, and less on using and completing the correct forms.
“The truth is – you’ve got companies offering great care who are using the wrong monitoring forms, or inadequately documenting what is going on and will therefore be rated ‘Inadequate’. On the other hand, you’ve got agencies rated ‘Good’ who filled in all the right forms. But if you went in-depth on the care they offer to clients, it’s actually not good quality care.”
6. Local councils should stop giving clients to care providers rated ‘Inadequate’
“It should be illegal for councils to keep supporting inadequate care companies. On the one hand, the government via CQC determines that a service is inadequate (sometimes because the service isn’t deemed “safe”) whilst on the other hand; the local councils are providing these very same “unsafe” providers with clients (service users). On the one hand - they're saying that your service is so terrible, it's inadequate; but still decide to give you vulnerable people to look after. It is completely illogical.”
“I'd be furious if a loved one was getting care through the council from a provider rated Inadequate.”
7. Local councils should pay care providers above the UKHCA recommended minimum rate
“There was a big outcry when the news reported that homecare companies only do 20-minute visits when they're paid for 30 minutes. This happens because the council pays for visits at unprofitable rates.”
Andrew recommends that it should be illegal for local councils to pay care companies less than the UKHCA’s minimum price for Homecare Services (£21.43 per hour from April 2021). This rate is the minimum cost to deliver sustainable homecare services by care companies, calculated by the UKHCA.
“Every few years, the UKHCA does a financial analysis on the true cost of providing care. And it's a very fair method. Even then, it's basically at break-even price. Sadly, there are many councils giving out contracts below this rate. So, what you have is a situation where the government is rightly insisting care companies provide a very high standard of service on standards of service and then saying, ‘Please provide this very high level of service at an unprofitable rate?’ This, at its core, is a major problem in the industry.”
Long-term hopes for the care industry
Andrew’s long-term hope is for funding to be fair and clear - “At the moment, it’s confusing. We had an incident where a client owned a £750,000 home, and the government funded their care because all their savings had run out. On the other hand, we had another client who lived in a council housing, but had to pay for his own care because he had £40,000 in savings.”
“Theoretically, it’s possible for someone to own a million-pound house and have no savings, and have the government pay for care. And for someone else to be in rented accommodation with £30,000 in savings, and have to pay their own care. This anomaly needs to be sorted out.”
Advice to aspiring care company owners
If Andrew were to go back to the start of 2015 and provide advice to his past self, he would say:
“Like, any business, make sure you’re properly funded. Expect it to be tough and stressful – because it will be.”
1. Do more research
“Look before you leap. I thought I'd done a lot of research. But actually, I didn't do enough research. If you haven’t been in the industry, I would go and work for a care company and do care for a week. Try to shadow someone who is experienced in care to find out what it is really like i.e. a highly regulated business that provides medical care and social care at home through a network of underpaid lone workers.”
2. Recognise that it’s medical care
“I didn't. I thought it was more ‘meals on wheels’, but it was far more medical than I ever thought. Medical care is a totally different product and service – imagine all the different standards of safety and risk assessment that are required if you are running a hospital. We didn’t have 70 clients; we had 70 hospital wards with clients being cared for by a remote workforce.”
3. Go down the franchise route
“Personally, I wish I'd gone down the franchise route rather than purchasing an independent care agency. If you go with a franchise operator, you will be much better trained and supported. They’ve been doing this for years, so they know exactly how it should operate. They’ve got all the systems and forms you should use. I would have had a much faster head start on learning. There are some really good ones including Bluebird, Home Instead and Right at Home.”
What inspires Andrew
Andrew has immense admiration for the 90% of carers who do their job well, and it gives him a lot of joy to see his clients receiving good quality care.
“My faith is fundamental to what makes me tick. So, I tried to build the business on the core values that I have. One verse that regularly came to mind was ‘love your neighbour as yourself.’ And your neighbour is whoever that person is: be it your client, your employee, and even your regulator.”