Maggie Dowe, Care and Support at Home Development Officer who is leading on the Care at Home Reform project, shares an update on her findings for Home Care Day 2017. The final research report will be launched in late November.
The project and research aims to improve the understanding of the issues impacting the care and support of people at home across Scotland. Working across sectors and with national and local partners, it will support an improved understanding of the challenges and the reasons behind them. It will produce an evidenced based, informed set of recommendations to address these challenges. Throughout it aims to identify and evaluate innovative and sustainable models of care and support at home, workforce compositions and commissioning and procurement methods.
Throughout the study some key principles have emerged. The research has shown that Health and Social Care Partnerships (HSCPs) and providers are struggling to deliver services where there is a continuing increase on demand both in terms of volume of people and more complex needs. The evidence suggests that services for older people are much less outcomes focussed and personalised and that if things to do not change this pressure will only result in reduced quality services for older people in Scotland
In order to alleviate pressure on the system whilst delivering the best quality and outcome focussed support we need to start thinking a little differently. Although a lot of the principles outlined in the research are not new, it is about ensuring we deliver consistent quality services across Scotland.
Services and systems which focus on prevention and promoting independence deliver better quality support. Some of the evidence suggests people with individual budgets or just more choice and control actually have reduced packages of support. A one size fits all approach is much more common in older people services compared to other adult social care. This is unfair and unnecessary.
Services which are joined up and include a holistic assessment process also produce better outcomes for individuals and reduce resource requirements. This assessment process should also have Technology Enabled Care embedded into it. It is not about replacing the human aspect or cutting costs. Although evidence shows TEC can provide cost savings. It is about promoting self-management and independence.
We need to empower the frontline staff to be able to make decision and have level of autonomy to make services flexible. This does reduce pressure on the system and ensures people receive the most appropriate support at the right time.
We also need to have a strength based approach to assessment, support planning and managing ongoing support. Understanding someone’s own capabilities, their networks and the community provisions can change their life whilst providing clear efficiencies in the system
These things are not easy – otherwise we would all be doing it.
There are financial challenges and in some cases change will require upfront cost and restricting a system. However, long term a focus on prevention, self-management and strengths will provide savings whilst continuing to meet people’s needs. But the whole thing works when we recognise each stakeholder’s role and value their contribution.
We need to be brave – think differently. Share information and best practice. We also need to understand we can deliver personalised support in the current financial climate if we all work together. Care and support at home services are literally changing lives and will continue to do so. The value of the work being carried out cannot be underestimated and I hope we continue to create a system that delivers on more people’s outcomes.
Quotes from individuals when asked, 'what difference does your care and support at home service make to you?':
‘It has been phenomenal’ – Carer for elderly mum and partner
‘I couldn’t have managed at all’ – Individual in older person’s service
‘I really appreciate every day they are here’ – Individual in older person’s service
‘Everything! No way I could do without it’ – Individual in older people’s service
‘I wouldn’t be able to get washed, dressed or even do my make-up. Stuff other people take for granted’ - Individual with physical disability
‘It cheers me up’ – Individual in older people’s service
‘It stops you having to go back to hospital. It keeps you sane’ – Individual in mental health housing support service
‘I wouldn’t be here without it -’ Individual in learning disability service.
Care and Support at Home Development Officer