Wednesday 23 November 2011
This morning I had a great business networking meeting in Lyndhurst in the New Forest, followed by a successful meeting with a local company that specialises in the installation and maintenance of care related products, such as hoists.
Driving back I turned on the radio, tuned in to BBC Radio 5 Live only to find yet another radio phone in show that was generally heavily critical of the services delivered through home care. Initially I thought I was suffering a bad case of Déjà vu and had tuned in to the similar phone-in’s following the Panorama investigation into Castlebeck and the collapse of Southern Cross.
Listening on, it became apparent they were discussing the new report that had been published by the Equality and Human Rights Commission which had highlighted a number of incidents that had occurred in Council funded home care services. Sadly, the phone-in seemed to miss the fact that “Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. They most valued having a small number of familiar and reliable staff who took the time to talk to them and complied with their requests to do specific tasks. Home care workers said their job satisfaction came from improving the quality of older people’s lives.” and was very much focused on the bad experiences of care that people were phoning in about.
Don’t get me wrong, I’m not condoning the fact that there are problems in the delivery of care, far from it, we promote good practice and want to help care providers (our members) deliver as high a quality service as they possibly can, within the resource constraints that they have, but in our opinion the issues that have been highlighted really lie at the feet of the Council’s commissioning the services and CQC, who are supposed to be regulating the services.
The previous government poured millions of pounds into Adult Social Care between 2008 and 2011 to support the transformation of services to implement Self Directed Support/personalisation of care services and give people choice and control of their care services. Unfortunately, many Council’s seem to have really missed the boat with the opportunities this presented and either did very little until the 2011 or concentrated so heavily on the implementation of personal budgets that they forgot or only paid lip services to preventative services such as reablement, telecare and the development of community initiatives to alleviate social isolation that are the cause of the financial pressures now being experienced by councils. There also seems to have been a complete communications breakdown between the teams implementing and supporting the ideas of Personalisation and the people commissioning care services from external agencies who are supposed to deliver those services. Commissioners seemed to have little or no interest in personalisation and were extremely worried that they would “lose control of the marketplace”, where in reality, it’s not their marketplace to control. If personalisation worked properly, people would have the choice of buying lots of a lower quality service or less of a higher quality service, just as they have with the choice of shopping in a budget supermarket, shopping somewhere more expensive such as Waitrose or having a once a year treat to visit Harrods.
This year, Councils have taken a typical short term approach to cutting the adult social care budgets by changing the criteria for qualifying for state funded care and squeezing the external providers of care. There are rumours of councils looking to provide care for between £10 and £12 an hour – simple maths will tell you that you won’t get a high quality service for that price – take out the statutory minimum wage from that amount and there isn’t much left to pay for training, equipment, travel expenses and the costs of running back office services and infrastructure. Councils are also forcing providers to cram as many actions as possible into 15 minute visits, so it’s not surprising that the providers who agree to this have a high level of staff turnover and a poor level of service quality being provided.
CQC haven’t helped the situation either. Their decision to stop doing inspections in 2010, moving to a new outcomes related set of standards and then delaying their new services has meant that services have been allowed to deteriorate. They are now in the process of implementing a series of unannounced inspections, but it will take time to turn around all the problems that this has created.
How do we fix this?
There are lots of things that can be done to help fix the care system – councils need to be more realistic in what they are expecting providers to do, they need to pay a realistic rate and they need to invest heavily in the preventative strategies that have been proved to work, such as reablement.
Providers need to do their bit too – be realistic in saying no to councils if you are being asked to do the impossible. Look into the self funding market too. As Council’s change their eligibility criteria and the post war baby boomers reach retirement age this will grow at a tremendous rate. I know it’s not as easy to find, but it is out there. In all areas of the country between 30% and 70% of the population are self-funding their care.
The government also needs to act faster in its social care reform. Personally, I think centralising the management of state funded care will help as this should make it easier to make big changes more swiftly, but this goes against the current government’s localisation bill, so I don’t expect it to happen.