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Healthcare Provider or Direct Employment

As a Case Manager, when taking on a new client with Complex Health, Rehabilitation or Social Support needs, one of the decisions that you will need to make upon completion of your own Initial Needs Assessment is whether to meet the needs of your client by utilising a Healthcare Provider such as ourselves, or by sourcing and employing a directly recruited care team.

There will be many factors that influence this decision, such as:

• The financial constraints that you are working within.
• Your own workload.
• The recommendations of the “care expert” who is also providing advice for your client’s case.
• The stability of the family dynamics the care team will be working within.
• The availability of the right clinical skills in the location you require.
• The longevity of the support your client may require.
• The location of your client, particularly in relation to public transport.

All these factors will need to be taken into account when making your decision.

The most predominant factor in this decision making process however, is one of cost. We find that there is a popular misconception particularly emanating from some “care experts” that utilising a healthcare provider is significantly more expensive than directly recruiting. In the majority of cases, this is simply not the case.

When examining this, we need to look at three keys areas:

• The initial package set up.
• What charge and pay rates comprise of.
• The on-going maintenance of that package of care or support.  

Initial Package set up

To set up a directly recruited care package all of the following elements will need to be taken into account. Where these are not easily quantifiable as monetary costs, you will need to try and place a value upon them in terms of time.

• Advertising Costs
• Application Screening
• Interviewing Time
• Reference Checking time
• Enhanced CRD Costs
• Mandatory Training Costs
• Bespoke Training Costs
• Clinical Nurse delegation of tasks
• Assessment Costs
• Care Plan Production
• Contingency Planning

The key thing to remember is even when a care team has been established the first 8 elements in the list above will need to be repeated for every member of the care team who needs to be replaced over time. With Interserve Healthcare all of the above is included in your client’s hourly charge rate.

Pay Rates and Charge Rates

“I’m thinking of paying a Support Worker 9.89per hour direct and a Healthcare Provider is quoting me 18.02ph for the same provision, therefore they must be making a profit of 8.13ph”.

Charge rate – Pay rate = Does not equal profit.

Based on a pay rate of £9.89ph the actual cost of employing that member of staff directly per hour is £12.61.

Calculations always need to include:

• Holiday Entitlements
• Employers National Insurance Contributions
• Employers NI on Holiday Entitlements

The remaining 5.41 per hour provides all of the elements of the initial package set up and all of the elements of recurring tasks discussed below, no matter how many times they are required.

Recurring Tasks

When managing a directly recruited care package there will be a number of recurring tasks that will need to happen on either a weekly, monthly or quarterly basis and there will be other ad-hoc tasks that will need attention probably when you are at your busiest.

Recurring tasks:

• Payroll Processing
• Rota Management
• Staff Supervisions
• Staff appraisals
• Weekly / Monthly reports for the Deputy
• Training updates

Adhoc tasks:

• Recruiting and training new workers
• HR Disciplinary Issues
• Care Plan Updates
• Peer Group Meetings
• Ordering of Consumables

Interserve Healthcare manage all of these recurring and ad-hoc tasks at no additional expense to your client.  

By using a healthcare provider your client’s deputy is able to be extremely accurate when forecasting the next 12 months care costs, if seeking interim payments from the courts.

Other points to consider

Annual Leave

An Average 24/7 2:1 package will require a team of at least 10 Support Workers. If each Support Worker has an annual leave entitlement of 20 days pa. Then that is 200 days annual leave per annum that a family is paying for and no one is working. In fact, it’s actually 400 days, as they will not only be paying the person that is off, but also the person covering their hours.

A Fresh Approach

There is often a need in Care packages to freshen up a team and bring in new ideas and experience particularly as a client progresses on the path of rehabilitation. The skills required in the first year of their care may not be the skills required now. Using the Healthcare Provider model allows you the flexibility to acquire the right skills at the right times, without incurring the expense of re recruiting and retraining.

Complete Flexibility

Changes in funding, settlements, client rehabilitation, clients relocating and family dynamics are all factors that can bring about an increase or decrease in hours required or bring about the requirement for a whole new care team. Decreasing a care team when workers are on contracted hours is a costly process, as is recruiting new workers. A healthcare Provider enables you to meet the ever changing demands of your client’s needs without incurring significant expense.

When asked to directly employ and run a care team on behalf of your client, Case Managers often feel that their time is being taken up solely with organising, recruiting and training that care team. This is often an on-going process and takes up a large amount of the case management hours that they have been authorised to provide.

By entrusting the responsibility of the care team to Interserve Healthcare, you will be able to provide more time and attention to the long term objectives of your clients and achieving the best possible outcomes for them.