For change to happen, the old ways of doing things must first be ‘unfrozen’. Perhaps the white heat of Brexit and the political turmoil it triggered could be the catalyst for a much needed revolution in our creaking domiciliary care system.
The domiciliary care sector has long been heading for a crisis. Mushrooming demand, intense pressures on cost and high vacancy rates and now the potential impact of Brexit, mean the sector is near breaking point.
Each day in England hundreds of thousands of domiciliary care workers visit vulnerable people to help them with basic daily activities. Up to one in three of these care workers are migrants. It is estimated that there are tens of thousands of vacancies in the sector and many local authorities who commission these services are experiencing serious challenges in finding the numbers of carers they need. This demand for domiciliary care is only going to grow in response to increases in life expectancy and the widespread drive for care to be home based, rather than in institutions.
Following years of downward pressures on the price of care, facilitated by local authorities’ input-based ‘time and task’ contracts, pay has been pushed down to the legal minimum for many workers. As a result of these low wages and work that can be highly pressurised and unsatisfying, the sector suffers from high turnover. The average is 25% and providers in employment hot spots can experience annual staff turnover above 100%. On top of this we now have post-Brexit fears that current migrant workers may choose, or be required, to leave the UK and future workers may be refused entry or opt not to come.
All these factors mean we should now step back and take a hard look at the way our domiciliary care system works. Commissioners and providers of domiciliary care services need to recognise that they are co-dependent. They should try to build collaborative relationships and work towards jointly identified goals and make more effort to understand what each side is looking for from the relationship. If they can agree on some common goals then they will be in a better position to come up with solutions to help make the sector more sustainable.
For example, commissioners could pay providers to achieve agreed outcomes for clients, such as the ability to prepare a hot meal or dress unaided, rather than for the time the worker spends in the home. This would mean providers could deploy fewer, but higher qualified care workers who understand how to achieve good outcomes in creative ways. The job would then be focused on achieving the agreed results for the client, rather than simply delivering a list of tasks as quickly as possible. This would make for a more interesting and rewarding role for the care worker, attracting more people into the sector.
Additionally, if providers are incentivised to use care technology to replace visits where no personal care is provided, this would reduce the logistical challenge and cost of getting staff to multiple locations for fleeting visits. For example, pop-in visits to remind people to take medication, or to provide reassurance that they are okay can be replaced with remotely monitored medication dispensing devices or phone calls from a dedicated monitoring centre. While technology cannot replace all personal interaction and care, it can complement it and reduce the pressure on services.
We have an opportunity to harness the jolt of Brexit to help us take a fresh look at the domiciliary care sector and its perennial challenges. If we can break away from ingrained approaches that have made the sector low pay, low status and uninviting as a career choice, then the challenge of attracting and retaining a motivated and secure workforce, whatever their nationality, could become more manageable. We will then be much better placed to drive up quality and deal effectively with the challenges ahead.
Steve Carefull is an adult social care expert at PA Consulting Group.
