Like other counties in Wales, Flintshire faces the interlinked challenges of austerity, an ageing population and a care sector struggling to meet the rising demand for care. With help from Welsh Government’s Foundational Economy Challenge Fund, Flintshire County Council has been piloting the development of community-based ‘micro-care’ to help grow the supply of care; create well-paid sustainable jobs; expand choice and deliver high quality care services.
The Covid pandemic has highlighted the importance of social care to vulnerable people and yet, compared to other professions with similar skills requirements, this work is often poorly paid, with challenging conditions and limited opportunities for training and progression. The recruitment and retention of care staff therefore is a challenge, particularly in rural areas.
The Council’s strategic review of the care sector in Flintshire in 2019 highlighted ‘micro-care’ as a potential solution to some of these challenges. Micro-care is defined as care delivered either by a small team or an individual, to a small number of clients, usually at a localised level.
Micro-care offers a number of benefits to both carers and those receiving care services. The smaller caseload allows micro providers to deliver a more personalised, flexible service to those in their care. It also removes the need for lengthy travel times between multiple clients – for which carers are often not paid – making the work less stressful and more financially rewarding.
Micro-provision also offers an opportunity for self-employment, potentially attracting those wishing to work for themselves – such as informal carers or those in part-time employment- who may not otherwise have thought about joining the care profession.
The Council therefore approached the Challenge Fund to support a 2- year pilot project to grow and support micro-care in Flintshire, with the aim of increasing the number of carers in the county and providing sustainable, well-paid, local jobs to help meet rising care demand.
Funding was awarded in 2019 for a project to directly support micro-carers to start-up, with advice, seed funding and marketing. The grant also enabled the Council to develop networks of micro-providers and to create structures that ensure their practice is safe, legal and high-quality and which will enable the local authority to directly commission services from them.
Micro-care at this scale is new for Wales. While Flintshire County Council was influenced by work undertaken in Somerset and elsewhere in England to support micro-care, because there are differences in legislation and models of care between England and Wales, it was necessary to build a model from scratch that suited the circumstances in Flintshire.
Rob Loudon, one of 2 Micro-Care Development Officers at Flintshire County Council, explains: “In England there is a greater percentage of people needing care who receive a Direct Payment to purchase their own care. In Wales more care is provided by local authority commissioning care agencies. This has influenced how our model has been developed”
The key aim of the Flintshire project was to expand the overall supply of care available. Fundamental to achieving this was to find a way of developing the micro-care market without jeopardising the existing supply of care provided by care agencies and Personal Assistants (directly employed by people in receipt of a Direct Payment).
In England there was evidence to suggest that the growth in micro-care enterprises was creating supply issues for the care agency and personal assistant sectors, as significant numbers of people left those sectors to become micro-carers. This may have been due to a number of factors including a desire to “be your own boss” but also due to significantly higher hourly rates that micro providers were able to charge.
To address this challenge, and to help ensure the best possible outcomes for all stakeholders, the Council decided to take a pro-active role in micro-care commissioning, setting hourly rates for micro- providers providing care either via a direct payment or a direct commissioning arrangement.
The rate decided upon was £12.63 per hour for 2020/21– well above the minimum rate of £9.50 per hour advocated by the Living Wage Foundation – sufficient to attract new people to the care profession without micro-care jobs being taken exclusively by people already working in other parts of the care sector. Council control over the rates for charging out services also prevented ‘over-charging’ compared to traditional services. This proved a delicate balance between ensuring that micro-carers were paid fairly for their work and not creating such a disparity with wages in other parts of the care sector that there was a mass exodus from one to the other.
A combination of all these measures has contributed to the creation of 14 micro-care businesses in Flintshire, 9 more than initially anticipated. An additional 6 are also in the process of being set up as a direct result of the Challenge Fund project.
As of yet, none of the staff for these new micro-providers have come from other care agencies and, although it is early days for these ventures, Rob believes this is a great sign that the active role the Council is taking in micro-care is bringing more people into the care sector overall.
This in turn is having a positive impact on the people needing care services. As Rob explains “the bottom line is that if we didn’t have these micro-carers in Flintshire there would still be a number of people potentially on our waiting list for care.” In other words, micro-carers have been able to fill the gaps, particularly in rural areas, where care agencies did not have capacity to meet care demands.
The Council is rightly proud that the development of these new enterprises has not only attracted more people to the care profession but has done so in a way that is building local economic resilience through increasing well-paid and sustainable employment options, particularly in rural areas.
Although the project has laid a firm foundation for micro-care in Flintshire, the Council is still navigating challenges in the system – one being the issue of cover if a micro-carer is absent, for example through illness or holiday.
Currently legislation limits the number of people that micro-providers can care for before they need to register with Care Inspectorate Wales as a domiciliary care agency – a step that many small providers are not set up to do. This makes it more difficult for micro-carers to ‘cover’ each other if the number of people that will receive their services, even temporarily, exceeds the registration threshold.
Helping micro businesses develop robust contingency plans is therefore a challenge but one that the Flintshire team are determined to solve through continued cooperation and dialogue with stakeholders.
As the pilot draws to a close, Rob is confident that work will continue to grow micro-care in Flintshire, potentially serving as a model for sustainable foundational economy employment that can be adapted and replicated across Wales.