The variability of needs and how to meet them
A reasonable assumption is that the requirements for people being cared for at home will increase. The Better Care Fund submissions assume reductions in admission both to hospitals and to nursing and care homes.. So in one sense segmentation comes to mind – support for long term conditions; palliative and end of life needs; intermediate care, re-ablement; dementia; complex health and social care needs – co-morbidity, mental and physical health..
So how do we maintain care continuity and consistency for service users? How do we incorporate the individual choices offered through personal budgets? Are the users view of quality the starting point for service design?
Many commissioners don’t give providers a clear and specific understanding of what they want in terms of outcomes and quality. However variability of practice is necessary whilst at the same time having a consistent approach to quality. We also need to demonstrate how the softer factors can be built into commissioning – maintaining independence; choice and control. Is standardisation the present and inappropriate focus for commissioners and regulators ?
Increasingly there is an emphasis about the importance of support networks. As well as looking at what works in Britain and Ireland can we learn from (but not copy) some international examples?
There are diverse approaches – Finland, Hong Kong, Japan, the United States . The interaction between home care workers , other health and social care providers and the users support network is a critical area. We are all familiar with the stories about the numbers of different workers intervening with an individual service user. However, how do family, friends/neighbours and volunteers fit together? Many needs could be met by simple forms of support – often insultingly the professionals call them low level. For the individual they are anything but.
A healthy old age
Longevity in itself is not the problem – maintaining healthy life expectancy is. We know that isolation and loneliness contribute to greater ill health. As a home care worker is in close contact with a service user they could provide an early warning system based on their concerns – but this raises ethical and individual freedom issues. Over 30% of all households in Stockport are single person, but the proportion increases with age.
Employment conditions and staff development
The considerations listed for the Commission bring out the importance of treating the workforce well- there is certainly evidence that employees with high morale will provide better care. Employee organisations will I’m sure provide many opinions and, I hope, evidence .However I would emphasise the need to understand how to refocus and develop staff learning , training and development for very variable roles.
Barriers to high quality care
Finally on the topic of the barriers that may prevent high quality care in peoples homes I would mention just two of the many.
One is the silo nature of meeting health and social care needs. Issues we joked about 40 years ago such as the health v social bath continued into this century. Resistance to assistive technology stemming from professional prejudice has been slow to go. So professional barriers are high on my list.
The second is the fragmented nature of the provider market.Entry costs are low. However there is considerable variability in organisation and management of providers. A system must provide enough of a financial incentive, encourages new providers but give the support needed to schedule, supervise , train — and keep down overheads and admin costs.
Cllr John Pantall, Executive Member Health and Wellbeing, Stockport MBC
The call for evidence for the Commission on the Future of the Home Care Workforce is open until 12 June 2014. The Commission is chaired by Paul Burstow MP and supported by Mears Group and LGiU.