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“If home care is not in crisis yet, it soon will be.”That is the introductory line of Key to Care: Report of the Burstow Commission on the Future of the Home Care Workforce published on 2 December by Mears and LGiU.The report received national coverage on television, radio and print including the front page of The Mirror – more coverage than home care has ever received.It tells a nuanced story of many fantastic home care workers who are struggling against a system which leaves many with less than ideal status and terms and conditions, and those that need care without the service that they or their families would like.It also outlined how we got into this position – a perfect storm of rising needs and financial pressures driving down the price of care.At the launch of the report, attended by leaders in local government and public policy, Alan Long, Executive Director of Mears group said: “We all need to recognise that care workers are much more than just what the job title might suggest. They are health and well-being Professionals, who are the front line in terms of preventing escalating NHS demands and costs.“Sadly this critical role is not recognised by society. Compared to people working in the NHS, such as nurses and doctors, care workers are hugely undervalued. How have we allowed this to happen?”The report looks to address these concerns and also set out a number of recommendations to make change happen:1. Key worker status for care workersImmediate key worker status for those care workers employed directly by the public sector and investigation into how other care workers could be offered key worker status.2. Minimum payments for contact hoursCouncils should ensure that they are paying a sufficient rate for contact hours which ensures that providers can pay care workers at least the minimum wage. This is likely to be in line with the UKHCA’s minimum recommended payment.3. A living wage for care workersCare workers deserve a living wage.4. Enforcement of the minimum wageAll commissioned care should follow open book accounting procedures and councils should take steps to ensure that care workers are earning at least the minimum wage. HMRC should changes its procedures for how minimum wage investigations are triggered, allowing complaints from third parties.5. Free influenza vaccinations for care workersCare workers should be offered free flu jabs by the NHS to protect both their clients and themselves.6. Working carer tax credits and care creditsPeople with caring responsibilities should have help to contribute to the economy through employment. The Department for Work and Pensions should investigate tax credits for those with caring responsibilities in line with payments for working families to support those with children working outside the home. This should be part of a broader investigation into how care work is subsidised by the benefits system.7. Moving away from time and task commissioningCouncils should be moving away from time and task commissioning and toward outcomes based commissioning. Although this is an approach still in development, councils need to work together to develop new approaches to person centred care and partnerships with providers.8. Better oversight of existing contractsCouncils need to be more proactive in ensuring that the management of existing framework contracts isn’t contributing to the worst practices in home care, such as 15-minute care slots. Councils should investigate whether framework contracts can be altered to reduce geographic dispersity though this will not always be possible. Councils should ensure that they are getting sufficient formal and informal feedback from both care users and care workers as part of quality monitoring. Health and well-being boards should take an active oversight role of how care commissioning is supporting local objectives for preventative spending on care.9. A license to practiceThe Government should take immediate steps to put in place the suitability scheme proposed by the Health and Care Professions Council and investigate ways that licensing could be implemented within a wider scheme of workplace learning and accredited training.10. A training and career pathway for care workersCare workers in both health and social care need minimum standards of training which can be developed into pathways of specialism or the basis for further training and entry into allied care professions such as nursing or social work.11. Innovation and use of new technologiesService design approaches and the use of technology can transform the way we deliver care in the community. The LGiU is working with designers and developers to develop design approaches with councils and care providers.Paul Burstow, MP, former care minister and chair of the Commission said: “The key to delivering great care is a great workforce and we need to get there urgently. There is already great care and there are thousands of dedicated staff doing fantastic work. There are providers that, against the odds, are delivering excellence and councils that have been smart and innovated their way out of crisis.“But to ensure that care works for everybody, we need to challenge providers, local authorities and government to do much more to guarantee great care for everyone who needs it. We need urgent action, before it's too late.”