Brendan Martin, Managing Director of Public World, asks where care staff figure in a vision that takes in integrated health and care in this guest post. We are addressing the issues around domiciliary care through the Commission on the Future of the Home Care Workforce, chaired by Paul Burstow, MP and supported by Mears. The Commission will publish its findings in December.
The Five Year Forward View (5YFV) published last week by NHS England packs a lot into 36 pages and offers a promising change agenda with resource challenges that should be central to next year’s General Election campaign.
It cannot cover everything, of course, and some omissions are covered by inference.However, the absence of any explicit reference to the home care service is a real concern because its potential role in the approach outlined in 5YFV demands a step change in the way we understand, fund and provide it.
Quite rightly, there is much in 5YFV about improving integration between health and social care through Clinical Commissioning Groups (CCGs), the need for better support for England’s 1.4 million unpaid carers, and the important role of volunteers.
“The traditional divide between primary care, community services and hospitals — largely unaltered since the birth of the NHS — is increasingly a barrier to the personalised and coordinated health service patients need,” says the report (page 16), adding:
“Increasingly we need to manage systems — networks of care — not just organisations.”
That’s right, but when will the crucial role of home care workers in such networks be brought out of the policy shadows? In reality, as statistics from the United Kingdom Home Care Association have shown, they are already the everyday frontline in care of older people.
In one of several examples of a “new care model” to be supported in future, 5YFV refers to ‘Multispecialty Community Providers’, which “would become the focal point for a far wider range of care needed by their registered patients”. The report adds (page 19):
“As larger group practices they could in future begin employing consultants or take them on as partners, bring in senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists to work alongside community nurses, therapists, pharmacists, psychologists, social workers, and other staff.”
But what of England’s home care workforce of around 300,000, whose status and rewards belie a hugely important role that demands a wide range of skills that are vastly underestimated? Most of them work for agencies, many of which would like to improve their terms and conditions but are prevented from raising the bar because the fees they receive from local authorities are simply too low.
5YFV does promise that the NHS will work with the care home sector “to develop new shared models of in-reach support”. But if we want to support older people in staying at home safely surely an enhanced role for domiciliary care providers and their staff is just as important?
According to the 5YFV plans, GP surgeries will serve as hubs of neighbourhood services combining health and social care. Rethinking the role of home care, and raising the service’s status and resources accordingly, could determine the sustainability of that approach.
Is it affordable? Leaving aside the fairness issue (not that we should), the real question is whether we can afford not to raise the status of home care and the service’s staff in line with its already crucial and potentially even more important role. More investment and better service design there will not only enable savings elsewhere in health and social care budgets.
They will also contribute — as international experience such as the Dutch Buurtzorg model has shown — to sustainable increases in the productivity and quality of domiciliary care itself.