Care Revolution: Time to Act
This is a personal blog, reflecting on my experiences working in the care at home sector.
When you hear the word “revolution”, what springs to mind? Is it the image of the storming of the Bastille as part of the French Revolution? Or perhaps the information and telecommunications revolution which started latter years of the 20th century?
Not surprisingly there are a plethora of definitions of what a revolution is, but the one that struck me as most relevant to a care revolution – and which chimes most with the theme and intention of today’s conference – is:
“Dramatic and wide-reaching change in conditions, attitudes or operations”
Why is a revolution needed across the care at home and housing support sector in Scotland – and why is it time to act now?
I was a director of my family run care at home organisation in Edinburgh for many years, along with my mum and sister. I often reflect on what was undoubtedly one of the most rewarding, fulfilling, fun and life changing experiences of my life thus far, but it was incredibly challenging as well as emotionally and physically exhausting.
Those were the days when meaningful, close relationships existed between providers, social work teams and commissioners; where timely dialogue and true multi-disciplinary team working often generated transformative outcomes for people supported in their own homes – no matter where they lived. The term ‘postcode lottery’ did not exist (yet).
In other words, that was during what could be described as the ‘halcyon days’ of care at home!
Those were also the days when there was transparent accountability and proportionate legislative and scrutiny measures; when social care organisations and their respective workforce were trusted, empowered, and enabled to deliver care and support in a flexible, person-led way. Social interaction and community activities were considered as important as medication prompts and personal care – and funded accordingly.
It was a time when the commissioning system resulted in fair pay, reflecting the skills, knowledge, and professionalism of the workforce. As a result, recruitment campaigns were usually highly successful, facilitating provider choice and discretion. Care workers stayed with the same employer for many years – developing skills and gaining professional qualifications during that time.
It was a time when care workers and management teams had the freedom and space to care for others and – just as importantly – care for themselves.
But enough of my reminiscing… what do we need to do now? Here are some of my thoughts.
Conditions and Operations
I know I am not alone in feeling that we don’t have to wait until the NCS is established to create conditions for meaningful, wide-reaching, revolutionary change. Indeed – some of the changes we need to make aren’t that dramatic at all.
I would argue that we already have robust legislation, most notably the Self-Directed Support (Scotland) Act 2013, which provides the levers for much of what the NCS purports to achieve. We do however need to be much better raising awareness and increasing knowledge of this Act – because it truly does create the choice and control for individuals eligible for funding, as well as their families who are more often than not, providing significant levels of care and support.
I also believe this legislation is inextricably linked to the establishment of a framework for a much-needed (and much talked about) human rights-based commissioning framework, designed to meet expectations of the National Health and Care standards and be flexible enough to adapt to organisational and individual needs. Only then will we have a real chance of the care sector gaining parity in terms of pay and conditions with NHS colleagues undertaking similar roles.
And this is really important. There are just over 59,000 adults living at home who currently receive a funded care at home package, and latest PHS figures indicated that there are a further 10,000 people who are either waiting for a care package to start, or for a care assessment to take place. These are sobering statistics when one considers the ‘critical and essential’ commissioning criteria widely adopted across HSCPs as they continue to manage fiscal challenges.
How will this current system enable people to live their best lives and have choice and control?
It’s therefore critical that decision makers view expenditure across the social care sector not as a ‘cost’ – or even worse, as a discretionary expense – but as an investment in the health and wellbeing of all Scotland citizens, and in society more widely.
On so many levels, can we really afford not to?
Attitudes
I am constantly inspired by the innovative and entrepreneurial spirit that exists across the social care workforce; individuals and organisations who exude professionalism, creativity, bravery and who have the appetite to take informed risks and drive forward with original approaches to care delivery.
From using the latest digital care planning software to enhancing people’s lives by using person-led technologies – there is a huge amount of activity taking place across care at home services that can (and should) be scalable across the integrated health and social care sector.
I also continue to be in awe of the kindness, dedication and skills of the care at home workforce. I speak from personal experience, not just as somebody who worked in the sector, but as a daughter. I will never be able to express my gratitude to the care workers who were part of a multi-disciplinary team (led by my incredible mum) that enabled my dad to live his best life at home while living with Alzheimer’s Disease.
Over the past couple of years, alongside dedicated community, and primary care NHS teams, they made it possible for Dad to die at home, with my mum, as he had wanted to do. I still grieve my dad’s death, and I miss him terribly – but I take solace from the love and care Dad received in his own home, and what we all experienced because of this.
The care revolution I envisage therefore demands an attitudinal change towards care at home services. This change must start from a renewed place of trust, respect and positive regard for providers, the social care workforce more broadly and an understanding of their critical role in the care of people and the co-ordination of that care, and the contribution this makes to the NHS. This will require honest, collaborative, brave and sometimes uncomfortable conversations and actions, and perhaps respectful dismantling of many of the (sometimes unhelpful) hierarchical barriers and attitudes which currently exist across health and social care.
Even with the acknowledgement of enduring financial challenges, there are too many risks in accepting the status quo and naively believing the halcyon days of care at home and housing support will magically reappear.
They won’t.
Like all revolutions, change needs to be intentional. Let today’s conference therefore be an opportunity to have the brave, bold and honest conversations needed to enable change to happen – and for action to be taken now.
As John F Kennedy said:
“If not us, who?
If not now, when?”
Katharine Ross has worked in the social care and integrated sector for over 20 years. She is passionate about championing co-production and participation across health and social care systems and services, enabling people to live their best lives through having their choices and human rights upheld, and their voices listened to. Her care at home organisation won the Scottish Care Company of the Year Award in 2011, an achievement which is still a source of great pride to her and her family.
