Yesterday I was having a discussion with a colleague about the various bits of research we are currently undertaking within the social care sector and the privilege we’ve had of leading various focus groups with front line staff working in services across Scotland.
“Have you ever done it?”, she asked.
“Done what?” I enquired.
“Worked in a social care service?”
My answer was no, and I explained that this means you can feel like a bit of a fraud spending your days researching and advocating for a sector you’ve not worked in, never mind forged a career in doing so.
But we both went on to reflect that it was a job we didn’t actually think we would be able to do, recognising that it requires a particular set of skills and personal attributes in order to be able to deliver the high quality, personalised and complex care we’ve come to expect, not least of home care provision. We shared our mutual sense of admiration for the thousands of individuals who do undertake these roles and make a huge difference to people’s lives on a daily basis.
At the same time, I’ve been thinking about an exercise we have been conducting with home care providers and workers in recent weeks, asking them to reflect on something that stands out to them about the year they entered the home care sector, as well as something that comes to mind about the reality of home care provision in 2018. Whilst we’ll be publishing this data more fully in Spring 2019, initial findings are already showing the huge changes that have been experienced within the home care sector, not just over the past few decades but even in very recent years – something we’d already begun to explore through Bringing Home Care. With the pace of change, it means that those not directly connected to this sector (but who are reliant on its existence and success) may have no real idea what working in home care looks like or entails in 2018.
In terms of policy around home care, we’ve seen a real drive towards supporting people in their own homes for as long as possible, including those who would traditionally have accessed medical and residential care, based on the knowledge that most people would want to remain in their own familiar environment if at all possible. Policy changes relating to Health & Social Care Integration, Self-Directed Support and changes to service regulation through the new Health and Social Care Standards have also emphasised the importance of individual choice and control, independent living, self-management and prevention.
Hopefully, these reforms will progress us towards a new age for home care – where services are planned for and commissioned in a sustainable way which reflects their criticality to our communities and infrastructure, and where services are empowered to be flexible enough to deliver the support that individuals want in order to achieve their personal outcomes. Those are the ambitions, I think, that make a policy drive towards supporting people in their own homes for longer truly worthwhile.
However, these positive drivers don’t necessarily mitigate the reality of extremely limited resource – financial, human and sometimes, imagination around the commissioning, planning and delivery of home care which, in effect, makes it the Cinderella service of health and social care. And given the exercise we’ve been conducting alongside Scottish Care’s previous research, we know that that challenging reality is biting. But is the speed of reform sufficient to alleviate the very serious pressures on the sector now? We know that home care services are concerned about being here in a year’s time, we know that recruitment and retention is more difficult than ever, we know that hospitals and care homes don’t have the capacity to deal with additional demand and we know that care packages and associated home care hours are increasingly hard to get and maintain at required levels.
My concern, therefore, is that the consequences of positive ambitions yet slow reform coupled with an already overstretched sector creates a reality where the policy becomes skewed. With a drive towards more care in the home but without the pace needed to protect, sustain and develop this sector and its workforce, it means that not enough home care can be delivered to meet demand. It puts the responsibility on relatives and informal carers to step into the gaps to provide often intimate and complex care at what can already be a distressing, emotional and exhausting time for them.
It also undermines the truly professional and highly skilled role of home care workers who do their utmost to deliver care without the access to the wider support that they should have. Even if you have a care package to support you in your own home, it’s regularly commissioned around task and time for the lowest cost – almost saying ‘this is an unvalued job that anyone can do’. This is an unhelpful message to reach people considering working in home care who, in reality, need formal qualifications, require to be registered with the SSSC and will be delivering complex care to people living and dying with co-morbidities.
We need to turn this on its head quickly and loudly. We need to be emphasising that radical reform needs to take place in this sector because its sustainability is absolutely vital to the lifeblood of our communities, the NHS and all services involved in integrated health and social care delivery in Scotland. We need to be ensuring that people can positively choose to stay at home safe in the knowledge they will have holistic support that’s predicated on their needs and ambitions rather than minimum cost. We need everyone to know that the image they may have of home care in years gone by – mopping, shopping, cups of tea – is not the home care of 2018. It’s not even recognisable to that delivered 5 years ago.
And we need to be celebrating the fact that not everyone can be a home carer (including me) because they are truly special individuals who we need to admire, reward appropriately, and value.
We simply cannot afford to be without them, or to shy away from brave thinking and radical changes in the home care sector.