CSSIW Domiciliary care review

CSSIW Domiciliary care review

Most people ‘happy’ with home care in Wales, despite ‘fragile’ market – report

Care and Social Services Inspectorate Wales (CSSIW) has published its all-Wales review into domiciliary care.

The review concluded that:

  • Care and support arranged for a set time with fixed tasks is more likely to be inflexible and rushed.
  • Care purchased at low prices tends to lead to problems with recruiting and keeping care workers.
  • At its best, domiciliary care is centred on relationships between care workers and people who receive care.
  • Most people, most of the time, are happy with and appreciate the care they receive.
  • However, a small proportion of people experience poor care, especially regarding poor care worker continuity and unreliable visits.
  • Despite poor pay and working conditions, most care workers are very motivated and often go ‘above and beyond’, giving care in their own time.
  • However, there is a lack of workforce capacity, and the market is very fragile. Current approaches are not sustainable.

David Francis, Assistant Chief Inspector of CSSIW said:

“This report is based on an extensive piece of work and provides a comprehensive perspective on domiciliary care in Wales. We are extremely grateful to all the people who have helped us and have contributed to its findings. It provides a rich evidence base, a unique analysis and a wide range of suggestions which will support improvement to the lives of those receiving domiciliary care.

“Plans are already underway to register care workers in Wales and our findings have been used to shape the five year strategic plan for domiciliary care in Wales which has been commissioned by Welsh Government. This is being prepared by the Care Council for Wales and will be published later in the autumn.

“As in other parts of the UK, the domiciliary care market in Wales is fragile, which is clear in the report. Going forward it will be important to commission sustainable services; increase the number of people working in domiciliary care; and recognise the importance and value of care workers who go ‘above and beyond’, providing care at all hours, week in, week out.”






CSSIW sent out a number of surveys to different groups of people and received:

  • 283 responses from service users and their families
  • 213 responses from care workers and spoke to 196 staff during inspections
  • 215 responses from providers
  • responses from all 22 local authorities and 2 health boards.

 As part of the review, they inspected:

  • 6 of those local authorities and met members of local domiciliary care provider forums.
  • 70 agencies, undertaking in-depth assessments of the care being provided and the pay and conditions for staff.

 They used:

  • focus groups
  • their stakeholder reference group
  • their own regional workshops
  • some individual meetings to explore issues in more depth.

 This review was prompted by a number of concerns:

  • the sustainability and reliability of domiciliary care in some parts of Wales;
  • the use of 15 minute visits;
  • calls being rushed, shortened or crammed in without travel time;
  • investigations by HMRC in respect of the national minimum wage;
  • the introduction of web-based systems to source care for individuals.

Domiciliary care in Wales is a complex operation, with some 14 million hours of care commissioned each year at a cost approaching £0.25 billion. This does not include care paid for privately, provided directly by councils, or purchased using direct payments.

  • Councils in Wales commissioned 13,266,981 hours of domiciliary care for 2014–15. This is in line with the 13,185,254 hours of domiciliary care reported to the Welsh Government for home care provided by councils and independent agencies.
  • Based on information from two health boards, it is likely that an additional 20 per cent of domiciliary care is commissioned by the NHS.
  • In a typical seven-day week, councils commissioned a total of 214,317 hours – an average of 9,742 hours each.
  • On average, each council in Wales commissions care for more than 900 people a week.
  • Information from providers suggests that around 15 per cent of domiciliary care is privately purchased.
  • On 31 March 2016, 426 agencies were registered with CSSIW to provide domiciliary care in Wales. This number has increased slightly from 422 agencies registered for the two previous years.
  • CSSIW recorded 673 concerns about domiciliary care agencies in 2015–16. This increased slightly from 638 concerns in the previous year.
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