The care sector has been under pressure for close to two decades, but there has been little collective action to transform the health and social care system. Despite the enormity of the task, there are some promising signs that ‘a bold reform agenda for adult social care’ can be delivered.
According to the November 2019 Institute for Public Policy report the main political parties have pledged to provide greater spending on the NHS, and different options are being actively debated to settle the argument about how social care should be funded.
We know we need to act now. A decade ago a report commissioned by the Alzheimer’s Society on ‘the prevalence and economic cost of dementia in the UK’ predicted that by 2025, one million people in the UK would be suffering from the effects of dementia and that the cost to the UK would be in excess of £17bn per year. Latest data confirms those predictions – by 2014, the figure was already put at 850,000 sufferers.
A 2019 report from the Institute of Fiscal Studies (IFS) exhorts central government to allocate more revenues to social care for the elderly. It warns that unless this happens, the financial pressures from population ageing will exceed increases in revenues from local taxes, leaving local authorities no choice but to make even further cuts. David Phillips, an associate director at the IFS, said the government faces a ‘big choice’ between giving councils additional revenues from central funds or accepting a decline in service levels.
As the IPPR report noted, as a result of cuts to local authorities their strategic and management capacity has been diminished. The report urges ‘an active partnership approach’ to commissioning services, rather than simply overseeing transactions. That’s an approach that good care home providers have been and will continue to be seeking to encourage through a collaborative and transparent open-door policy.
Collaboration with local authorities is a must
As CEO of a care home provider, and someone with 23 years in the sector, I believe that there is an opportunity to work more collaboratively between the different agencies, and work together to innovate how services are commissioned, residents’ quality of life assessed, and what care services and options are offered to those who need it.
There is an opportunity for the sector to agree a set of quality outcomes, which will provide more equal opportunities for providers to be assessed, in addition to the CQC ratings, and offer better ways for prospective residents and their loved ones to decide where they would like to reside. There are many areas where the sector needs to do better. Whether it is continuity of care, access to fresh air, or meaningful stimulation of residents, it is important to move away from commissioning services simply based on price, we must link value for money to quality of provision and quality of life.
While care home providers cannot directly influence such decisions, what we can do is offer our expertise, advice, our skills and an open invitation to local authorities for the maximum level of contact and co-operation between us, leading to the most responsive, high-quality service at best value.
At the micro-level, cost of individual care placements often go beyond a simple weekly fee. Funders may be faced with additional costs of medication for those with dementia, 1:1 care or need for specialist care due to the resident’s complex needs that can no longer be managed in a care home. In these cases it is reassuring to know that new, evidence-based models are showing how more meaningful engagement with the residents can reduce both challenging behaviours and the need for antipsychotic medication, and ultimately the overall cost to local authorities.
There is more good advice to be had. Local councils have been encouraged by various bodies, including in 2016 the Local Government Association, in its report ‘Dementia Friendly Communication’, to work in partnership with their local communities in developing new ways which enable people with dementia to take part in everyday activities and retain their independence for as long as possible
Upskilling our workforce in the provider community
Workforce is one of the most challenging aspects for any care provider. The Kings Fund suggests that there are 110,000 vacant positions in the sector, with providers often relying on agency care. Like local authorities, our staff are our greatest strength. Like them, we draw the vast majority of our staff from a small pool of people living locally, and our residents mirror the characteristics, background and life experience of the communities that local councils serve.
As a sector, we all must do our bit to shift opinions of what care work is. Many people who are thinking about their next career move want opportunities to learn and advance their career and to feel a sense of purpose, whilst being supported by an experienced, professional senior management team. Yet, they often perceive the care sector an unattractive, low status work, with poor pay and job security.
Working in the care sector, we get to make a difference to people’s lives every day, we put smiles on people’s faces, and we are there when families experience the loss of their loved one. It is a very person-centred job, that is often demanding, but so rewarding. Many care staff can’t imagine doing anything else. The joy that they provide to people, mixed with their professionalism, exemplifies a fulfilling sense of purpose.
For experienced staff, and those joining the profession, there are learning and progression opportunities, mentoring available, paid training and professional development and career pathways that are geographically unlimited.
New technology will bring benefits, innovation can transform lives
Technology has transformed many aspects of the care industry, and it has a great potential to go further. We have used technology to improve many aspects of care, and allow staff to spend more meaningful time with residents, avoid duplication and improve the quality of reporting on residents’ care. We have also seen some excellent results by using technology to better roster staff and reduce the use of agency staff. In one home, agency use reduced from 250 hours per week to just 22 hours, with the aim to reduce it to 0. Replicating this kind of result across all care homes and the sector would inevitably deliver a more stable, affordable business model alongside higher levels of dedicated personal care.
Other developments, particularly in dementia care, are opportunities for local authorities to observe the ways in which residents are able to reconnect with their families and enjoy a more fulfilled quality of life. What we all want for our loved one, is to maintain quality of life, whilst living in a care home.
An innovative, evidence-based approach to care is now providing a fundamental shift in the everyday priorities and introduces a further example of collaborative working – between residents, care staff and their families. Residents are more actively encouraged to take part in activities they would do at home, they are supported to do things for themselves and make decisions – activities that are often lost when a person moves into a care home. By being involved, and homes providing meaningful opportunities to be part of the community, challenging behaviours can be reduced, antipsychotic medication often used in those living with dementia eliminated, and the need for specialist or 1:1 care avoided. Approaches like these will provide long term cost savings for funding care.
Towards a brighter future
Whilst we know that more sustainable funding for the sector is a must, we support the call to adopt more collaborative working – whether we work in local authorities, within the NHS, for a charitable organisation or as a private provider. We – as everyone running a care facility - want to ensure that people in care can and do maintain their independence, purpose, meaning and social connections. The challenge is undoubtedly an imposing one but this simply reinforces the argument that we must work in partnership to produce effective, comprehensive and sustainable solutions.
The people in our communities deserve nothing less.
Hayden Knight is the CEO of Orchard Care Homes