What can we do to improve care in the home?

At its worst, the current system encourages neglect and poor care. But we need help to spread great homecare across the UK

Homecare staff

‘We have to ensure that care and support is built around the person – what they need, how they can best be cared for, what they want,’ says Norman Lamb.

We currently have a system that at its worst can reward and promote poor care, encourage low wages and allow neglect to flourish. While we know that homecare, for the most part, is carried out to a good standard – it still leaves far too many cases of poor and unacceptable levels of care in the home.

One of the most common complaints I come across is where care is carried out by the clock. Carers will come to the house and have a time slot of around 15 minutes to get everything done and be off to the next appointment. But 15 minutes may not be enough to do what is needed. So appointments are rushed through – trying to get everything done – in or out of bed; getting washed; trying to bolt down food or take medication. It is no wonder that these visits can be stressful and unpleasant.

Or people see a different face every time a carer walks through the door – who would want to have intimate care tasks carried out by a total stranger every time? This is an assault on people’s dignity. And if we wouldn’t want to be cared for in such a way ourselves, how can we accept it for others? I have also found that there are too many examples of employers paying people less than the minimum wage by not taking account of travel times to and from people’s homes.

I am deeply concerned that the next big scandal we see – something even as serious as the failings in Mid Staffs and Winterbourne – could very well happen in homecare. Homecare is under a great deal of pressure right now. Even without public spending restraint, those pressures will only increase as our population ages. So what can we do to tackle this?

We have to ensure that care and support is built around the person – what they need, how they can best be cared for, and what they want. We have to change the confusing and often archaic social care laws – a task that is being carried out by the care bill going through parliament now.

We have to give people better information about what good care looks like and let them comment openly and honestly about the sort of service they receive. We know there is nothing like some forthright customer feedback to bring about change. This is why we have set up the new online information profiles on the NHS Choices website, which will help people to choose, compare and comment on care homes and homecare services. A place where people can post comments about the type of care they are getting – both positive and negative. A fully open, transparent and comprehensive service like this will leave bad care nowhere to hide. This means better standards and quality of care across the board.

We are bringing in stronger regulatory powers and a new dedicated chief inspector of social care will have widespread powers to crack down on poor care and hold councils to account for buying services with a short term vision that creates poor service.

Of course, we have to find a way to fund all these changes. That is why the £3.8bn announced in the spending review settlement to bring together health and social care budgets and make sure everyone gets a properly joined up service is so important.

But it is not just about money and integration between health and care services. We also need to find new ways to improve homecare now, for the sake of the 300,000 people currently receiving homecare and for the millions more who will need it in years to come. This may be by improving the way councils buy care, or the way in which care companies deliver it, improving the role for the social care profession, better using technology to support individuals and their families and friends to organise their formal and informal care and linking services to community groups to tackle loneliness and isolation.

We are inviting ideas and experiences from everyone who is interested – from care workers, managing directors of care companies, communities, councils, to people who rely on homecare and their family and friends, to help drive this spread of great homecare across England. That is why the Department of Health is today launching a homecare hub with the Guardian. Please add your comments and ideas from July to December 2013, and help to improve homecare for older people and disabled adults in your area.

An edited version of the article appeared in Society Guardian on Wednesday 3 July 2013

http://www.guardian.co.uk/social-care-network/2013/jul/03/how-can-we-improve-homecare