Thursday, 8 March 2012

Whose Responsible - Unblurring the Boundaries Will Help Care Provision


Much of the debate surrounding social care at present focuses on funding issues, who pays, how much should individuals pay etc. yet there are significant other issues that need to be addressed.

One of these is how the interface between public services and private providers operates.
Yesterday’s report on healthcare in care homes published by the Care Quality Commission has, perhaps inadvertently, highlighted the issue of where responsibility lays at this interface.

The report states “some homes did not adequately demonstrate person-focused care planning” and “just over half of residents (55%) were aware that they had a care plan in place that sets out their needs.”

Yet contrast this with another recent CQC document entitled ‘What standards you have a right to expect from the regulation of your care home’ (see document here) which states that people who use services should “get the care that you and your social care professional agree will make a difference to your health and wellbeing.”
Comparing the two does raise the question – who has responsibility for care planning, the home or the social services professional? And who has the responsibility for ensuring that the person using the service is aware of that plan.

Obviously  it is important  that both work together  with the individual in preparing the plan but where does the ‘final’ responsibility actually lay? Implementing the plan of care naturally falls with the care provider but once a person enters a care home how much monitoring of that plan takes place by social service care management?

Added into this needs to be the role of healthcare professionals in care planning, the demographics of care provision have changed dramatically over the last 20 years, people are likely to be much older when needing care home provision and are likely to have much greater health needs, particularly due to the fact that dementia is not classed as nursing need despite being a disease, so many of those with dementia are in ‘residential’ rather than ‘nursing’ homes.

With older people in care age related medical conditions need addressing in care planning – who is responsible for ensuring that appropriate health professionals are involved in this? In addition there should also be some form of involvement by those health professionals in assessing the health care needs on a regular basis.

Quite rightly there is a drive to ensure personalisation and independence for all those who access care services but at the same time this should not diminish the responsibility of professionals to ensure effective care planning is in place. Unfortunately the current system has an interface between public service and private provision that blurs the boundaries of responsibility and the only people who lose out because of that are the people who use services.

As the debate on the future of social care moves forward we must look beyond the question of who pays and play closer attention to the issues and responsibilities that have a direct impact on the quality of care provided.