Pay for domiciliary care workers has outstripped inflation over the past decade and those at the top of the scale in Carmarthenshire can now earn more than £27,000 a year, a report has said. But it added that Carmarthenshire Council still faces huge domiciliary care pressures in common with other authorities – a situation evidenced by the fact that it currently commissions around 9,600 hours of care a week for residents in need, down from just over 12,400 hours in June 2021.
Jake Morgan, the council's director of community services, told a scrutiny committee that a care academy launched by the authority was targeting sixth formers with the prospect of being debt-free and potentially qualified to degree level. Referring to the Care Academi Mr Morgan said: "We have had a set of quite high-quality individuals with the required resilience, confidence, and knowledge to go on a journey to hopefully professional training." But he said getting things going was proving to take time.
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The majority of domicilary care work is normally carried out by external providers commissioned by councils. Councils often have their own in-house care teams. The top salary for those in Carmarthenshire is £27,422, which works out as £14.22 per hour. The committee report said the role was one of the few in the public sector "where pay has exceeded the cost of living in the last 10 years".
Pay is not the only area the council has focused on to address the staffing shortfall. It has also sought to make domiciliary carer contracts more flexible and is looking to replicate a pilot scheme in Pembrokeshire whereby small-scale care start-ups are encouraged in rural areas where recruiting carers has been difficult. The report before the health and social services scrutiny committee said these measures were only allowing the council to maintain the status quo rather than increase capacity.
The committee had asked for a domiciliary care update in the wake of Wales-wide guidance three weeks ago which said hospital capacity must be preserved for those who'd benefit the most. The guidance said some hospital discharges may not be perfect including a care package not yet being in place.
Mr Morgan said this has required "a degree of pragmatism" in the delivery of domiciliary care. He said: "We have had some quite difficult and I guess honest conversations with families and individuals about what practical options are available." This meant people may have to compromise "on what is their ideal model of care", he said, but not on safety.
Mr Morgan said there were around 50 Carmarthenshire residents in temporary residential care – the majority of whom would normally be supported at home. He said that the situation had improved compared to a few months ago.
There are many more people waiting for the start of a domiciliary care package who live at home rather than who are waiting in hospital although the latter group create problems at the hospital front door through no fault of their own. Mr Morgan said there was a constant pressure in prioritising these two groups.
"At the end of the day we are dealing with a finite capacity which can only be spread so thinly and in so many ways," he said. People who were living at home and waiting for the start of domiciliary care were managed, he said, with those deemed in a red category given immediate priority.
Cllr Hefin Jones asked a number of questions including what practical help was offered to family members who stepped up to provide care and how the quality of the care they provided was monitored. Alex Williams, head of integrated services, said family members would receive appropriate training and a manual handling assessment. "It's not unusual for families to provide care for loved ones," she said.
The meeting also heard that step-down care home and community hospital beds were very effective at helping people and preventing the need for long-term support but that a lot of resources were needed. "There's no doing this on the cheap," said Mr Morgan.
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