In particular I want to talk about Residential Care Homes and Domiciliary Care (care in the home), as both are facing broadly similar challenges.

To illustrate the points I’m making I will be drawing on my experiences of working with Healthwatch, although I do want to say that the views I express are entirely my own and are not the views of Healthwatch.

When I first joined Healthwatch queries from members of the public about social care formed just over a third of all queries. Last year that figure stood at a fraction under a half of the contacts we had, and the figure currently stands at just over 60%. The trend is clear.

Within that trend there appear to be growing concerns about nursing and residential homes and about domiciliary care (in addition to the normal concerns about the complexity of the system and the lack of clear information)

But before I go into more detail about these concerns let me ask one simple question:

Who is looking forward to their first day in residential care???

The response I get to that question is always the same. We feel negatively. It makes us feel uncomfortable to think about it.

If we reflect on that we have to ask another question:

If it’s not OK for us, why do we, as a society, think it’s OK for other people to be placed in those Homes?

The people in those places do not come from some foreign place, they are not strangers. They are us, all of us. They are the people we love and care for.

Our challenge is to make the changes which mean that we no longer fear the prospect of Residential Care. We embrace it as the next stage in our lives. One that we can live in dignity and respect.

But before we can begin to think about those changes we have to think about the challenges that Care Homes, their owners and staff are facing.

And I want to start by stating very clearly that I have seen some fantastic examples of good practice being delivered by caring and committed people. In fact the majority of Homes that I have seen reflect that to a greater or lesser extent

But the reality is that Care Homes are facing some serious challenges:

The level and complexity of needs has risen exponentially. Dementia, frailty and complex co-morbidities are now normal in many Care Homes but the way services are commissioned, organised, and funded has simply not kept up with what is happening. Independent audit indicates that in some care homes the cost of care exceeds the available funding by up to £200pw for some residents. It has been said that the introduction of the Living Wage will be the final nail in the coffin for many care homes

If we think what that means!!!

People who are caring for some of the most vulnerable people, with complex and enduring needs, are being paid so little that an increase on to a half decent wage places the solvency of the entire business at risk!

It is no wonder that we get issues regarding the quality of care. It is no wonder some Homes can’t recruit or retain skilled staff. We clearly do not value the role of carers any more than we do the role of nurses. It also reflects the fact that Social Care funding has declined by 8% in real terms since 2010 whilst at the same time the volume and complexity of needs has continued to increase. It has been estimated that Councils now need an extra £700m pa just to stand still on Social Care. The Living Wage will add a further £920m to that bill. It is simply impossible to square the circle. At some point the trade-off between quality and resources has to reach a tipping point and from what I have seen we are at or near that tipping point. We cannot simply look to more and more efficiency savings – that will not solve the problems I have seen. We must have the courage to make a greater investment.

You know I have visited many Care Homes and seen for myself the practical impacts of all of this:

  • Real challenges in recruiting and retaining a trained, qualified good quality workforce

  • Very high turnover of Registered Managers. It is amazing how often a CQC Inspection is the final straw for a harassed Registered Manager

  • Lack of investment in maintenance and decoration

  • Lack of investment in vital equipment

  • Bed vacancies co-existing with waiting lists as Care Homes struggle to make ends meet

The impact hits everyone involved. Owners, staff, but above all the vulnerable people who live in those homes.

I have seen vulnerable people living in conditions that are not acceptable. The stench when I have walked in some care homes, the lack of good hygiene. A minority of cases, but I have seen them for myself as some care homes struggle with deteriorating finances and growing demands. This simply cannot go on. 

I must also say that we have heard a great deal about progressive ideas and fairness from the Liberal Democrats. I say to them that all of this happened on your watch. Shame on you for that.

Similar challenges exist for Domiciliary Care agencies. The reductions in Social Care spending have impacted there as well. The onslaught of 15 minute visits, zero hours contracts, unpaid travel time has decimated the Dom Care workforce. Nationally the number of viable agencies is shrinking, and fewer people are receiving services. Overall the number of people receiving adult social care has declined by a third. Meanwhile the number of people living with multiple Long Term Conditions is projected to increase by 50% between 2008 and 2018.

This simply cannot go on. Doing nothing is no longer an option. The Labour Party must say very clearly:

Social Care is fundamental to our vision of a modern, fair and compassionate society. The way in which we relate to the most vulnerable people in our society defines who we are and what we believe

I stood in the Hall in Manchester a year ago, like so many others, and listened to Harry Smith. He talked about his childhood in Barnsley. He described it as a barbarous time, an uncivilized time He warned us that if we are not vigilant his past will become our future. If we do not tackle the hidden crisis in social care funding I fear that his sombre warning will come true.

This is the text of Chris Bain’s speech at our fringe meeting at the Labour Party conference.

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2 Comments

  1. Brian Cox says:

    Great article. Thank you Chris.
    I think we need to have a more fundamental shift in our thinking about what care in old age should look like. Residential care would be a much smaller part of the service mix if we designed our services on what people want, Your question – who is looking forward to their first day in residential care? – is a great way of breaking into the issues.
    Best wishes
    Brian

  2. What people “want” isn’t always the main issue here. A true story: Betty has Alzheimers, and wants to stay at home. It is being enabled, but in order to keep her safe between visits she has to be locked in her bedroom between carer visits, as she has no idea about the safety of gas, drowning in the bath, road safety, or anything else. You wouldn’t leave a 2 year old home alone? She is not being socialised, she has limited human contact, and little stimulation. Another true story: Joan had Alzheimers, was living with her daughter, who she also put at risk turning on the gas burners,and leaving them, and locking the daughter in and hiding the keys to “keep them safe”, between periods of lucidity when she attempted suicide. Mary is sure she can walk in her flat, rather than wait for a carer to fetch something, but it seems that every time she does so she ends up in hospital with fractures etc, Despite that she wants an ordinary council flat, with no on site care. We may all want to stay at home, but it may not be what is best for us, or indeed our families. Would good care be more affordable if it was brought back “in house”, with no profit margin to consider, and we all shared the cost via taxation? It would save worrying about that cross over between health and social care too. For myself I would prefer the extra care model to the “circle of chairs round the TV and a room the size of a cupboard scenario, but recognise if I needed intensive watching and care the second model would be the right one for my own, and my families, good.

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