Residential Care Providers Outperform the NHS.

Residential Care providers outperform the NHS.

That is, of course, a blanket statement but backed up by the State of Care report published by the Care Quality Commission last week. The headline figure when the report was published was the fact that 15% of hospitals failed to meet the standards on making sure patients had the right food and drink and the help they needed, yet for residential care – i.e. non-nursing care - the figure was 11% of homes failing to meet these standards.

It was not just this standard that saw a difference. On meeting standards on respect and involvement 9% of NHS hospitals failed to meet this standard compared to 7% of residential care homes and on meeting standards of effective care, treatment and support 19% of NHS hospitals failed to meet the standards compared to 18% of residential care homes.

Obviously this is a very simplistic and selective view, in general, nursing homes were worse than hospitals and the complexity of health service provision is different from that of a residential care home.

Yet these figures should not be totally ignored and lessons must be learnt.

The health service must, for a start, consider what it can do to improve performance and what it can do too learn from the residential care providers which outperformed it in a number of areas. Why are residential care providers better at providing food and drink, what lessons can be learned in improving respect and involvement. There has to be a system in place where the NHS can draw on the best practice of social care to improve its performance with its patients.

There must also be a look at the significant difference in performance between nursing and non-nursing residential care where the contrast is quite startling. In nursing homes 20% failed to meet the nutrition standards, 15% failed on respect and involvement and 28% failed on effective care, treatment and support. In just about every standard nursing care fell behind residential care the most surprising of which was management of medicines where 33% of nursing homes failed to meet the standard compared to 26% of residential homes – surprising because nursing care should have trained nurses on their staff whereas this is not necessary in purely residential care.

The Care Quality Commission report gives us a snapshot of the state of care but we need now to act upon its findings and this is where we need national leadership to make improvements.

The fragmented nature of social care provision, around 25,000 different nursing and residential care homes providing services across 152 councils with social services responsibilities, means that there is little coordination over the country to draw together what lessons can be learnt from the report, how to implement the changes needed and how to engage with the vast myriad of providers to ensure ‘best practice’ becomes the social care standard.

The fragmentation of social care means that those at the top can frequently pass the buck and abrogate responsibility but with the increasing need for social care as the population ages and the increase in the complex needs of social care users we, as a nation, need those in Westminster to take full responsibility for the services provided to the vulnerable in the country.

The route to improvement is learning, learning where the failures are and learning the best way to decrease those failures. The system is never going to be perfect but we need national leadership to reassure the public that all possible action is being taken to ensure health and social care provision the best it can be and the lives of ALL those who need care services are paramount in that.

Dear MPs - Why Social Care IS Important

Anyone catching the Future of Social Care debate in the House of Commons yesterday must have been struck by the lack of MPs bothering to turn up to discuss on of the most important issues facing the country at the moment.

Perhaps every MP should look to their own constituency and take a real look at the demographics and data of those  they are paid to represent  in order to  realise the importance of social care  in their community.

I live in the district of Shepway and delving into the data makes startling reading. I would hasten to add that the local MP (Damian Collins – Folkestone & Hythe) did attend the debate and make a contribution through an intervention, but I think it is important to share some of the facts and figures to demonstrate why MPs need to look to their own constituency to  realise the importance  of focusing on social care.

Shepway has an estimated population of 101,200, not a major metropolis but it does have one of the largest care sectors in the county of Kent and, despite persistent rumours of affluence in the south east, is in the top 100 most deprived districts in the country.

Of that population 15% is over the age of 70 & 6% over the age of 80. Many of these will be recipients of some form of social care services either at home or in care home settings, of which there are 110 in Shepway (the same number as registered in Brighton & Hove despite the huge population difference). Obviously with a huge amount of care provision there is an equally large social care workforce, all of whom are affected by social care policy set out by Westminster and the policies of Westminster therefore have an impact on the local economy.

Naturally paid for social care provision is not the only aspect of social care. Data from 2001 suggests that around 10% of the districts population are providing unpaid care to family or friends, with 279 of these being under the age of 18. Again decisions made in Westminster have a direct impact on the lives of these people and on those people they care for.

Around 10% of the people who live in Shepway claim Disability benefits (2011 figs) the majority of whom have physical disabilities but it also includes 1365 people with learning disabilities and 1071 with mental health issues.

Social care should be about people not about facts and figures but it is important that those  we pay to represent us  are aware of the importance on social care and just how much social care impacts on the lives of their constituents.

There may be many demands on an MPs time and there may be many areas of policy the promote or prefer to be associated with but the bottom line is they  are paid to represent us  and they should especially be representing the most vulnerable section of the community they have been elected to represent.

There has been much emphasis on leadership in social care of late and one key element of leadership is acting as a role model. Members of Parliament need to act as role models in supporting the vulnerable in society, that means visibly showing active interest and that means turning up for debates in the House!

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.