The UK care sector, buckling under the weight of our rapidly ageing population, is driving many older people into residential care before it is absolutely necessary. This is a great tragedy, with a shocking economic cost matched only in scale by its personal devastation on individuals, who naturally wish to maintain their independence at home.
So why is there a growth in residential care, at a time when our policyagenda supposedly wants to see more people supported at home? There are multiple factors, all of which point towards a disjointed care system and a lack of focus on maintaining independence.
To start at the beginning of the process, the current local authority tendering system for homecare stacks the deck in favour of large providers, who generally pursue a volume driven business model that is focused on delivering functional care, cheaply. As a result, niche specialist homecare providers are increasingly becoming isolated from the local authority market and therefore, specialist care is at risk of becoming the province of wealthy self-funders.
But there can only ever be short-term gain in delivering support aimed at only meeting basic, functional needs, like getting out of bed, eating meals or taking medication. It is specialist care, which promotes genuine independence and wellbeing, that will keep people out of expensive residential care for longer — so there is clearly as much of an economic imperative for change as a compassionate one.
Norman Lamb should strive to create a genuinely competitive "marketplace" for homecare providers, where there is appropriate funding in place for specialist services and individuals have genuine choice of providers. People should be provided with individual budgets that reflect the level of support that they require.
The care sector fears that niche agencies won't have the same reliability as big providers, but ultimately, if people hold their own budgets they will be able to take their money elsewhere if they receive substandard care. This will drive accountability, encouraging providers to compete on quality and outcomes, rather than cost.
As one of the UK's biggest care providers, you may think that it is not in interests of Community Integrated Care to want the care market to change in this way, but we would genuinely welcome this challenge and change in focus.
Our organisation has recently launched a new five-year strategy and we are placing serious effort to overhaul our approach, because we know that we need to deliver more specialist, preventative and outcome-focused homecare services, while still working within the same constraints that all other providers face.
Our key objectives include ensuring that we recruit care workers who understand that it is their job to support people to do things – not just do things for people.
This enabling approach is vital. As trivial as it seems, asking someone "Shall we make a cup of tea" and then supporting them to do so, rather than just presenting them with a hot drink, makes a world of difference to that person feeling in control of their life. It is a sense of losing control that is often at the root of so many individuals and family carers, the unsung heroes who save the UK government £21bn a year, reaching the crisis point where residential care is felt necessary.
But even if care providers commit to upping their own game, as we are striving to, the health and social care sector, in its broadest sense, is still underprepared to support people to remain independent at home.
We know from speaking with many of the people we support who have dementia, and their loved ones, that when they first received their diagnosis they felt cut adrift. In many ways, this is because the care system only "kicks in" when needs become so acute that individuals require intensive social or healthcare intervention. This has to change. We should invest resources at a GP level, to ensure that people are given advice and support to maintain their wellbeing at the earliest stage.
This review of homecare needs to consider the frequently unseen or unconsidered barriers to living at home. As one example, presently, if people have ongoing nursing needs, the lack of availability for nursing care at home means that they have no option but to receive residential nursing care. The government should continue to pursue the personal health budget agenda to provide opportunities for people to fund nursing care at home.
This argument isn't to say that residential and nursing care homes for older people are never appropriate. But rather, residential care should only become an option when a person chooses it or when it becomes untenable for them to remain independent at home.
Norman Lamb's consultation with the care sector is welcome and much needed. I hope that he listens attentively, thinks creatively and acts boldly.