A homecare company (lets call them ACME Care) that I got chatting to at a conference recently get quite a lot of referrals from Continuing Health Care (which often means the service user has a terminal condition and isn’t expected to live too long).
They told me that few months ago (in the middle of the financial year) they were referred a service user along with another company (who I will call OTHER Care). Each company was allocated a certain number of visits of a few hours per week. The service user found she had a very generous assessment, and after a couple of visits where their care workers were being asked to clean the windows (which were already clean) ACME care told the purchaser that there was over-provision and that they should cut back. CHC responded by taking 30 minutes off each ACME Care visit, and adding it to the OTHER Care visits (and presumably the windows were very clean indeed).
We have now moved on several months, and are approaching the end of the financial year. ACME has been referred another case from CHC. The service user is very sick, getting frequent home visits from a district nurse and must not be left on her own. In the periods where there is no homecare provision and no district nurse visiting she is looked after by her husband, who has significant health needs of his own, and has frequent appointments at the local surgery to have dressings renewed (though presumably renewing dressings is within the capabilities of the district nurse, who visits the house often).
Unfortunately there is not quite time for the husband to get to the surgery and back within a home care visit, and (remember) the service user must not be left on her own. ACME asked for a 15 minute extension to the visits on the days when the husband has to go to the surgery. The request was refused. The husband asked if the district nurse could change the dressings. The request was refused.
Apparently these sorts of things happen all the time…