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OPINION: Home care must be at the heart of reforms to adult social care

Kathryn Smith cropped

By Kathryn Smith, chief executive, Social Care Institute for Excellence (SCIE)

The Covid-19 crisis has hit the social care sector hard. This has been made clear in media reports about the huge impact on care homes. The high number of deaths of occurring in these settings has been a huge shock; and has rightly caught the attention of both the public and the government.

But care homes are only one part of the sector, and there is a real danger that we’re overlooking home care, which would be a big mistake, writes Kathryn Smith, CEO of the Social Care Institute for Excellence (SCIE).

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When I was a care worker, I always recognised the huge impact of home care workers. Whilst I worked in a care home I was always amazed by their skills, the compassion they had, their commitment and their energy. But due to lockdown and the terrible news coming from care homes, it’s been harder for people to understand and appreciate home care.

We at SCIE know the truth; that home care is key to a good social care system, providing people, day in and day out, with support, kindness, connection and love. During the lockdown, home care workers have often been the only contact some people have had with the outside world.

Frightened and abandoned

One of our trustees at SCIE is Ossie Stuart. He’s also an equality and diversity consultant; and he uses services. He recently told a virtual roundtable event, where care minister Helen Whately was present, how in March, he had to work out, with his personal assistants, how to provide his own care and support during lockdown.

He told delegates that he’d felt totally abandoned. He was given conflicting guidance, including being told to ask strangers to help; he couldn’t get hold of any PPE for his personal assistants, including via online shopping; and he told us that although he’s a fan of dystopian, futuristic films, he suddenly felt he starring was in one. On the positive side, Ossie says he was suddenly freer to be flexible with GPs and direct payments. But, above all, it’s the passion and commitment of his personal assistants that has seen him through so far.

In a way, this story is remarkable, but it’s also so common, I’m sure, for people who don’t fit into the stereotype of people who receive social care. The roundtable event that Ossie was speaking at was looking at how the future of care and support can be reformed post-COVID-19 and the minister listened and gave feedback. Ossie’s is one of the ‘hidden stories’ of people who have had to rely on themselves to a great extend behind closed doors.

Can’t go back

We’ve run a series of opinion articles, blogs, podcasts and webinars since lockdown hit and, again and again, leaders, service users and carers have told us that we can’t go back to the system that wasn’t working before the pandemic hit. They say we need real reform.

Home care must be at the heart of these reforms. First of all, we need to invest in home care, increasing the funding we are able to provide to home care organisations, and importantly, raising the pay and status of home care workers. We need to support home care providers and staff with the skills and tools they need to work collaboratively with service users – an approach we call co-production. People like Ossie are the experts now.

But this means workers will need to have more time with the people they support. Therefore, we need to move away from commissioning home care agencies on the basis of ‘time and task’ and towards commissioning for better outcomes. In practice, this might mean that agencies are paid to help someone become more independent; rather than on the basis of how many hours they spend each week with someone.

But this is where we could see real change, if we are patient. If a care worker does help someone keep their independence, then the money saved for the local authority and the NHS further down the line could be considerable. We have to think like this: invest in the outcome now, and save money over the longer term.

Another delegate raised an interesting point at the same roundtable event where Ossie spoke. She suggested we have a ‘care at home’ rather than a ‘home care’ service. It might seem a subtle change in language, but we need to make those changes in the way that care and support is perceived; from people being seen as passive recipients who have to be commissioned for, to being a central part of the decision-making process about how they live their lives.

A long-term plan

The Association of Directors of Adult Social Services (ADASS) tell us that, during lockdown, local authorities have often stepped up to the task and showed that community work is vital in a crisis.

The future of social care has got to be what many of us have been reiterating for years; people living their best life in their own communities.

All public services need to work together, because the places where people live, the homes they occupy and their access to leisure activities can have a huge impact on their wellbeing and health.

But ADASS also say that a long-term plan is needed to get social care onto a firmer footing, and that an employment deal for care workers is vitally needed.

The public and sector is waking up to how important home care is. We at SCIE will be promoting, as always, the excellent contributions that home care makes. Let’s make sure that when it comes to developing plans for the future of adult social care, home care is at the heart of our thinking.

Tags : Future of CareKathryn SmithSCIESocial Care Institute for Excellencesocial care reform
Sarah Clarke

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