Home Care in Barnet

Healthwatch Barnet carried out a major review of home care services in 2017, building on an earlier survey of service users conducted in 2015-16. The study aimed to understand the experiences of home care agencies and home carers in Barnet, identify what was working well, and highlight challenges affecting the delivery of care. The research involved interviews with six home care agency managers and surveys completed by 46 home carers. 

The report found that demand for home care in Barnet was increasing, but agencies were struggling to recruit and retain enough carers to meet that demand. All six agencies reported recruitment difficulties, particularly in finding experienced and high-quality carers. Low pay, limited recognition of the profession and the costs associated with training staff were frequently identified as major barriers to recruitment and retention. 

Pay and employment conditions emerged as some of the most significant concerns. Only two of the six agencies interviewed paid the London Living Wage, while many carers reported that travel time between visits was unpaid. More than 60% of carers said they did not receive payment for travel time, and the most common suggestion for improvement was better pay and reimbursement for travel costs. Many carers felt their wages did not adequately reflect the skills, responsibilities and commitment required by the role. 

The report found that home carers generally received good support and training from their employers. All agencies provided mandatory training, including safeguarding, moving and handling, infection control and medication management. Most carers reported feeling more confident after training, and over 90% had been given an opportunity to shadow experienced colleagues before working independently. Home carers also spoke positively about support from office staff, supervision arrangements and access to out-of-hours advice. 

Despite these strengths, carers reported challenges in delivering high-quality, person-centred care. Tight commissioning arrangements and short visit times often made it difficult to meet service users’ needs fully. Agencies reported that some care packages funded by the local authority did not allow enough time for carers to provide safe and personalised support. Travel demands, traffic and closely scheduled appointments also made it difficult to keep to rotas and sometimes contributed to late visits. 

Continuity of care was identified as an ongoing concern. Previous Healthwatch research had found that many service users experienced frequent changes in carers, and agencies acknowledged that maintaining continuity was challenging. Both agencies and carers felt that having regular carers who knew an individual’s preferences, needs and routines was important for delivering better quality care, particularly for people living with dementia or mental health conditions. 

Communication between home care providers and health and social care professionals was another area of difficulty. Several agencies reported delays in receiving responses from social workers, occupational therapists and healthcare professionals. Agencies also described situations where changes to care arrangements were not communicated promptly, affecting their ability to provide appropriate support.

Home carers were overwhelmingly positive about the impact of their work. Many described themselves as providing not only personal care but also vital companionship to people who otherwise had little social contact. Carers frequently reported that they made a meaningful difference to service users’ wellbeing and independence. 

The report concluded that many aspects of home care in Barnet were working well, including training, supervision, support from agencies and quality monitoring. However, significant improvements were needed in workforce planning, pay, travel arrangements, continuity of care, commissioning practices and joint working between health and social care services. 

Healthwatch Barnet made eleven recommendations. These included developing a workforce strategy to address future demand, improving recruitment, ensuring home carers are paid fairly including for travel time, moving towards more flexible and outcomes-based commissioning, improving complaints procedures, strengthening continuity of care through regular carer teams, and improving collaboration between commissioners, providers and frontline care staff when reviewing care packages. 

The London Borough of Barnet welcomed the report and stated that it would consider the findings and recommendations as part of its future commissioning and engagement work with home care providers.