It’s been an interesting transition from local authority chief executive, responsible with my Director of Adult Social Services for commissioning homecare, to now sitting in the hot seat as the senior civil servant responsible for the legal and policy framework.
In the hard light of continuing media scrutiny of the homecare sector it’s too easy for commissioners and providers of services to become defensive. In reality, we all, including national government, have a part to play in the failures and successes of homecare. We all need to be open and reflective about the realities of people’s experience and the lessons to be learnt. In the wake of Mid Staffordshire and Winterbourne View, the Department of Health is determined to spread a culture of openness – of listening to what goes wrong and to search for ways to make things better.
So in reaction to the problems in homecare, and on the very day that an example of poor homecare was caught on film and shown by the BBC, the Minister for Social Care, Norman Lamb, held a summit to launch the Homecare Innovation Challenge in partnership with the Guardian on the Homecare Hub. The purpose was to get people talking about homecare, to share examples of good homecare and to crowdsource ideas about how we all can contribute to improving homecare standards.
Yesterday the Guardian published the quantitative findings of a survey conducted by the Guardian Social Care Network on behalf of the Department of Health. 1443 people took the time to share their views. Their priorities won’t come as a surprise. Over 1000 people said the most important factor was either:
- friendly, respectful, capable care workers
- sufficient time for care or
- choice about services e.g when visits happen, who visits and what care workers do
This might seem obvious and straight forward to deliver. However, the answers to further questions are also revealing:
- Overall, 66 percent of the respondents said it was quite difficult or very difficult to choose how homecare services are delivered e.g time of visits, who visits and what care workers do to do this. When we broke it down, by those who are involved in homecare, we could see that friends and family, councils, care workers and care providers all agreed this is simply very difficult to do at the moment.
- We also asked people how easy it is to change care provider or care worker if someone is not happy with their care. 56 percent of respondents reported this was quite or very difficult.
- We asked people how easy it is to make a complaint. Interestingly, we found that different groups thoroughly disagreed on this point. Councils, care workers and homecare providers ranged from 48-61 percent of respondents stating it was very or quite easy to make a complaint. But only 24 percent of friends and family and only 17 percent of people receiving homecare stated it was very or quite easy to make a complaint.
We must ask ourselves, why is that? And what can I do to change this? For me, it suggests a number of things.
First, as a sector, have we got ourselves into something of a ‘groupthink’ about services and service delivery? Perhaps too often we have imposed our perspectives on service users, certainly that would be one way to explain the difference in how people view complaints systems.
Second, I am struck about how the things that people value most are really basic – respect, time, choice. Perhaps commissioners need to work harder to build their service specifications from the perspective of what people value most, spending limited resources on making sure those priorities are protected first.
And third, the survey results can also be read as a prompt to drive further personalisation. Giving people more control and choice over how they spend the resources allocated to their care should help make sure those service users and their carers can access the services they value most.
This isn’t easy. No single individual or organisation can change this by themselves. But no change can happen if individuals and organisations blame others in the care sector and refuse to look at what they can do to change this. We all have a part to play.
5 comments
Comment by pam edwards posted on
how about employing local people as carers, obviously they abide by the same rules,to look after local clients? for example,i was a qualified nurse until my husbands death 13 years ago .I looked after my children and my qualifications lapsed.i cannot get a carers job as I cant drive yet part time work would suite me if I could be considered for work close to where I live.i could give a better service as I would not have to rush to my next appointment. in these times it could be mutually beneficial,an etra income for better care
Comment by shanethegunner posted on
Staff
Home care care workers need a living wage,
and security of hours so that they have confidence in what theuir take home salary will be at the end of the month.
Providers
Home care service providers need a rate per hour that will allow them to pay a living wage move from Zero hours contracts defined contracts
The continued cuts to budgets means that these fundamental basic requirements are unlikely to be fulfilled.
care planners/ social workers
need to respond quickly to identified changes in need so the revised care plans can be put in place
acceptance
That not every individual needs to be got up at 7 am
and that care staff have families too
Comment by Peter Adams posted on
It's not surprising that care receivers and family/friends differ from councils etc regarding making complaints. Whilst the process of making a complaint has probably become easier, the personal and emotional aspects of making a complaint are often very considerable, particularly for the care receiver - and thus they will answer the same question very differently. Complaining is much more difficult (whether in reality or by perception) the more vulnerable one is.
Of course the ease of making a complaint is less an indicator of the quality of service than what is done following it.
Comment by Ann Heath posted on
Signing up for personalisation must mean more than simply a fashionable phrase.
We need to focus on getting the right people in the right job.
A more rigorous process for recruitment of domiciliary carers needs to be introduce.
A formal qualification should be required not just someone who says they are caring has a clear crb and has satisfactory communication skills.
Comment by Adrian Westwood posted on
Quite simply, good care comes at a price that local authorities are not prepared to pay. They do not seem to realise that by slashing charge rates to care providers costs are actually increased as care standards inevitably reduce. As a result, for example, clients may return to hospital as a result of poor care or their care packages are extended way longer than they might have been with better care. Individual departments work to individual budgets and no-one seems to take a view of the bigger picture where in fact an overspend in one department might actually save in another.