Why Care Can't Wait

Panorama has discovered a series of cases in which elderly people have been unsafe and unprotected in nursing homes. Instead of being looked after, vulnerable, elderly people were insulted, neglected, roughly handled or physically assaulted.

Sound familiar?

Yet it is not the episode aired on 23^rd April this year where Fiona Phillips exposed the treatment of Maria Worroll at Ash Court. It is an episode that was aired on 12^th February 2007. So, in five years, why has nothing been done to prevent these things occurring?

We have had other exposés in between most notably the abuse of people with Learning Disabilities at Winterbourne view but none of these seem to be able to make politicians care enough about social care to take real action on improving the lives of the most vulnerable.

We cannot solely blame the politicians, the national media must take some responsibility. Such events soon disappear from the news agenda and while Panorama will provide us with regular exposés they seem to lack the inclination to ask WHY is this still happening?

I was reminded of that Panorama episode when I was flicking through my copies of the magazine I used to write for. Ironically my column in that same edition focused on the success in care training that had been achieved as had been highlighted in that years “State of Social Care” report from the CSCI. At that point the National Minimum Standards required all care providers to have at least 50% of their staff with NVQ level 2 and real progress was being made on that. Unfortunately that requirement was dropped in 2010 and, in fact, there are no specific requirements at all for care providers to have qualified staff.

In that same column I also raise concerns about whether the level of success in training care workers can be sustained because of diminishing fee increase from Local Authorities and question the effect that proposed registration of care workers may have on the sector. Five years later those fees have continued to be lower than inflation (in the last few years there have been no increases at all) and the registration of care workers has evaporated into thin air.

My reason for looking through those back copies was to try and find when it was that Ivan Lewis faced a question from a backbencher on the practice of local authorities not raising fees to care providers or, if they were, at a rate below inflation. This was in March 2008 and he condemned the practice stating that care providers should, at the very least, expect an increase in fees that kept pace with inflation. Of course this has not happened and the amount being paid to provide care and support has fallen behind in real terms.

So, in essence, nothing has happened to tackle the issues facing social care over the past five years, now we face another delay to action on care.

In five years we still have Panorama exposes on care, we still have no actions on care worker registration and the amount paid to provide care and support to the vulnerable continues to fall behind and while we have had tinkering around the edges with changes in regulator etc no substantive political act has been taken in that time. 


We have had a consultation in 2008/2009 which led to a Green Paper in July 2009 followed but another consultation and a White Paper in March 2010. Then, with the change in Government, we had the Dilnot Commission launched in July 2010 and the Dilnot Report published in July 2011.


Surely we have had enough talking. 

This is why care can’t wait and we need action NOW not later

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.