An independent Scottish care home operator is calling for the government to intervene to limit what she says are excessive fees being charged by employment agencies for providing temporary staff at short notice to care homes.

Alyson Vale, Business and Operations Director across the homes in Fife run by Abbotsford Care, says that, with the sector badly affected by high vacancy rates and many people being off sick, including with COVID, the amount of money needed to continue safe operations using agency staff far exceeds income levels set under the National Care Home Contract.

She says it is quite usual for an agency to ask £300 for a care worker to do a 12 hour shift. She explains that she regularly offers incentivised rates starting at £15 per hour for someone in her own team willing to do an extra shift, but she is conscious that the workforce is exhausted from the additional pressures they have faced for the last three years.

In the case of nurses, she says agencies have been charging £600 per shift – with many charging more – already double the highest rate Abbotsford can manage when asking one of their nurses to work extra.

Documents seen by healthandcare.scot show one agency increased its rates for a Sunday overnight care worker shift from £27 to £30 an hour this year compared with last – and from £56 to £65 an hour for a nurse for that shift.

Ms Vale says high agency fees are making the staffing crisis in social care far worse than it is already – and, potentially, making operating a care home unsustainable:

"I appreciate, agencies are businesses, but we have to acknowledge that the National Care Home Contract does not meet the additional costs of covering vacancies. We have seen a rise in agency costs as well as the demand of agency hours increased to meet the pressures on the sector.

"The independent care home sector seems to face criticism and pressure regularly, but we need some scrutiny of these other businesses that have come to have such an dominant role in care – and, indeed, the NHS where the issue of agency fees for staff is every bit as bad."

Ms Vale says she has been trying to get the government to listen to her for months, warning that additional staffing costs are the single biggest immediate threat to the ability of many operators to continue.

Her call for a limit to fees was echoed by another operator, Nadia Latif, Director of Carrick House Care Home in Ayr, who told STV news she is paying up to £1,000 a night for a nurse to cover a shift:

“We’re already paying so much to cover the shifts needing filled – and it’s almost impossible without agency. It’s just not possible financially, it’s very stressful.”

Social Care Minister, Kevin Stewart told healthandcare.scot in a statement:

“In a system as wide ranging and complex as the care system, there will always be a need for temporary staff to provide the care needed. We have funded two pay rises in the last year to improve recruitment and retention in social care and are leading the way increasing minimum hourly pay rates for adult social care workers.

“The recovery of our NHS from the pandemic relies on us making our social care services sustainable. We are working with providers and partners to support these vital services as we design the model for the new National Care Service together with the workforce, and with fair work at its heart.

“We recognise the issues being raised and are working with partners to ensure the effective and safe delivery of care services.”

Alyson Vale argues that, without some sort of intervention, the system will become progressively more difficult:

"The private social care sector is unable to pay the competitive rates we would like to due to insufficient funding from the National Care Home Contract. We are therefore seeing staff moving to work for agencies.

“When staff do move from our employment to agencies there is no remuneration to support this loss of workforce. However, when we have had agency workers who decided to work for us as care providers, we are charged extraordinary 'placement rates' of up to £5,000 for the placement of a carer and £10,000 for the placement of a nurse.

“I am keen for the government to intervene to ensure that we find a way that agency businesses pay back into the system they are profiting from to ensure the sustainability required for the future.” 

And Ms Vale say the Scottish government has already created the precedent for intervening:

“My call for a cap on agency fees came from what happened with the landlords. If the Scottish parliament can pass legislation to cap rents, they can do it with agencies.

“I would also draw comparison with the oil and gas industry. They are having to pay a windfall tax on their unusually high profits. If you were to look at the accounts of some of the big agencies, I am sure you would see significant profits – profits that have increased dramatically through COVID and the staffing crisis that has followed.”

A spokesperson for the organisation representing independent care providers, Scottish Care, says the root issue is the failure to pay appropriate salaries that match the role of people working in care:

“Agencies reflect a reality that we are not able to recruit and retain staff within both the NHS and social care. If you need to cover a shift, whether it’s a nurse or frontline carer, you will pay anything you need to to get someone safely supported. But paying exorbitant agency fees is wholly unsustainable.”

The basic living wage for care workers has increased to £10.90 an hour, now less than paid for equivalent roles in the NHS.

Healthcare assistants in the NHS are on Agenda for Change Band 2 or above. The latest pay offer from the Scottish government proposes that the Band 2 starting salary be £21,814 a year – or £11.16 an hour.

Last month, at a health committee meeting in parliament discussing the government's draft budget, Scotland's Health Secretary, Humza Yousaf told MSPs that funding an increase in the minimum wage to £12 an hour would cost “hundreds of millions”, and meeting Labour’s demand for a £15 an hour living wage would cost “well over £1bn”. The First Minister later in the month put the cost at £1.75bn, adding that meeting that demand would not be the act of a responsible government.

The Scottish Care spokesperson added:

“We need to address the fundamental problem, which is the recruitment, retention, reward and remuneration of essential frontline staff.

“There is a current workforce crisis in relation to the shortage of frontline care workers and nurses in our care homes. We need to attract more people to work in the social care sector and make social care an attractive career path.

“Whilst we have been working with the Scottish government and other partners to address these issues, there remains a failure to recognise those who work in social care with a rate of pay commensurate with their professional registration. We are calling for an immediate financial uplift for social care staff, representative of the skilled role they undertake.”

healthandcare.scot has approached a number of care agencies for comment.

 

Read more: Ministers launch ‘more to care’ campaign; Social care wage settlement branded ‘derisory’; ‘Collaboration’ focus of updated care home oversight 

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