What really makes good care?
An important debate is taking place about how to ensure that people who need care and support get that help in a way that enables them to stay safe and well and live the life they want. This conversation has been given momentum by three recent Panorama programmes on social care – the exposé of the appalling treatment of people with learning disabilities at Whorlton Hall followed by a two-part programme about the immense care challenges in Somerset. The fact that there are two All-Party Parliamentary Groups on Social Care, each considering the challenges faced by social care and its workforce, underlines the importance of this debate.
There is no doubt that care is in crisis. Local authorities do not have the money to pay for the real cost of care provided by traditional care agencies. Agencies are struggling to recruit and retain staff, with the loss of care workers from the sector last year being over 25%. Care agencies are giving back contracts and some of the largest household names have gone into liquidation.
The All-Party Parliamentary Group on Social Care (APPG Social Care) launched earlier this year is currently considering ways to ensure the safety and quality of the social care workforce. The recent opinion piece in the Daily Express citing the two co-chairs of the APPG illustrates one important element of the debate. Should everyone working in social care be regulated, trained and qualified – and will that ensure the quality of the care that people get?
Whorlton Hall was a regulated service (with a rating of ‘good’) with trained and qualified staff. It’s clear then that while regulation and training have an important part to play in ensuring the quality of the care and support available to people, they are only part of the story.
A golden thread that has run through government strategies for health and social care for more than 10 years has been the vital importance of people getting high-quality personalised care and support tailored to their circumstances. Think Local Act Personal and the Coalition for Collaborative Care co-produced the Making it Real framework for personalised care and support with people with lived experience and their families. The framework is divided into six themes, each of which is described through I statements.
The first theme called Living the Life I Want, Keeping Safe and Well is self-explanatory and like most of the ‘I statements’ applies to all of us – we all want to live the life we want, to be as independent as possible, to have a place we call home, to have people we love who love us and to feel valuable. There are some though that are particularly important to people who are depending on others for their care for example - I am treated with respect and dignity; I feel safe and am supported to understand and manage any risks.
Other themes of Making it Real deal more directly with how people get the support they need to live their life. My Support, My Own Way is summed up by the first I statement: ‘I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals’. Choice is vitally important: ‘I can choose who supports me, and how, when and where my care and support is provided’.
The final theme deals with the workforce. The focus is on attitude as well as capability. ‘I am supported by people who see me as a unique person with strengths, abilities and aspirations’; ‘I have considerate support delivered by competent people’.
So how can we ensure that people get safe help in the way they want from considerate, empathetic and capable people?
Disabled activists have fought for many years for direct payments from local authorities that will allow them to select and employ their own personal assistants. More recently there has been a recognition that not everyone wants the burden of becoming an employer and that there are different models that can offer real choice and control to people, such as community well-being teams and community micro-enterprise.
These new models require us to think differently about how to ensure that safe support is provided by capable and empathetic people in ways and at times that work for people.
Current approaches to regulation, training and qualifications are designed for more traditional (and larger) organisations and do not fit these new models of care. Innovators are faced with the challenge of squeezing their model into a regulatory framework designed for mainstream care, with the danger that they end up compromising the heart of their offer. Some like the Community Well-Being Teams have blazed a new trail to regulation, and it is heartening that the Care Quality Commission is keen to find ways of building on this to regulate other innovative models of support like community micro-enterprise. Heartening too that Skills for Care are prepared to help organisations like Community Catalysts to design learning programmes that are appropriate to community micro-enterprise.
These new models also require a different way of thinking about ‘risk’. As a recent Kings Fund blog comments:
The word ‘risk can feel loaded in a health and care setting, often coming with negative connotations, but (councils need) staff to start seeing the positives of taking risks, of trying new approaches based on what users told them – and also to see that sticking with the status quo carried its own risks.
People who employ Personal Assistants or who buy support from innovative or mainstream providers are as keen as anyone to ensure that the help they get is provided by safe, capable and compassionate people. They understand, often from bitter personal experience, the risk of the status quo and their voice must be central to any discussion about the quality of social care and the capability of its workforce.
I hope very much that the new APPG on social care is consulting widely with the people most affected by this issue, people needing support and their families, and will give proper weight to their recommendations. If we have learned anything from recent scandals, it is that regulation, qualification and training do not by themselves result in the safe, respectful and considerate support and services that people are asking for and deserve. We need to think differently - and together - about how to make sure everyone gets good care and support.