- Living well at home
NED Care Community led home care organisation
NEDCare was established in May 2015 to meet an immediate and pressing need for care at home in north east Dartmoor. We now provide support and regulated personal care services in the area and aim to:
- Put the people we support at the heart of what we do;
- Deliver flexible, responsive and person centered services of the highest quality;
- Focus on the employment of local carers under the best possible terms and conditions; Build an engaged and committed workforce; Promote an open and empowering culture of transparency and improvement.
- Increase community capacity to meet local care needs and build local resilience in the face of demographic and other pressures.
What is the problem this innovation solves?
In 2014 the north east Dartmoor area was struggling with issues of so-called ‘market failure’ in social care, meaning that there was insufficient provision of regulated social care services to meet local authority demand. This was in part due to the rural and dispersed nature of the population – around 13,500 people spread across over 200 square miles, with poor transport and road links.
Some private individuals and people on Direct Payments were able to take on self-employed or directly-employed carers, but there were not enough of those to meet demand and access to them was haphazard, usually by word of mouth.
The situation was seriously impacting on the health and well-being of an older than average population as people struggled without the care and support they needed to stay safe and well. Some people were getting stuck in hospital, delayed due to a lack of care, and some were prematurely or regrettably transferring in to residential care some distance away.
Believing that something could be done, a passionate local resident approached the local Development Trust and together they embarked on a programme of work to engage the wider community with the issues, to hear peoples’ stories, to develop joint solutions and garner widespread support - all completed alongside further research to estimate demand and business planning for viable options.
At this point NEDCare founders knew that a regulated service was required (to meet the needs of people whose care local authority managed,) but that this would take significant time and funds. So whilst the founders began the fundraising process, they also established a fast, effective Carer Introduction Service, helping people to recruit self-employed carers themselves.
Following a successful campaign that raised the required start-up funding entirely from local donations, NEDCare achieved registered status with the CQC in July 2017 and has delivered regulated care since then.
NEDCare was established on a substantial evidence base that was built up, for example, through local consultations and surveys, demographic data, local authority and NHS data and mapping, market research, meetings with social services, care brokers and others - all of which informed a detailed demand analysis.
Thanks to regional press interest, NEDCare was also latterly approached by other communities and groups including social entrepreneurs, small voluntary groups, a GP surgery and a hospice charity. This broad range of individuals and organisations were interested in the Introductions Service model and wondering how they could replicate the approach, either in their locality or for their community of interest, such as in learning disability support or end of life care. This evidence of need has since attracted funding for a replication ‘toolkit’ for Introduction Services, which is currently in production. (Spring 2019.)
The positive impact of NEDCare’s core service on individuals cannot be underestimated. NEDCare’s work has improved the physical and mental health and well being of individuals, improved nutrition, social and physical activity levels, enabled individuals to remain at home for longer, reduced GP visits and hospital admissions, prolonged and improved peoples quality of life.
NEDCare has filled a gap in community level infrastructure and as such has had a wider impact through enabling access to services, providing information and advice and signposting people to other support and services in the locality.
The toolkit replication project also has the potential to scale up these impacts by supporting other communities to establish local services (regulated or otherwise) that address scarcity in care and that also build local capacity to respond to care needs.
Stage and spread (where it is/how much is there?)
North East Dartmoor Care was established to meet need in a well-defined geographic area and continues to expand to meet local demand, which currently outstrips supply. Meeting demand will depend upon attracting new recruits to the care workforce.
Initial Business Planning for NEDCare showed that the minimum viable level of service was at around 1,800 hours of care per month and a growth trajectory towards that point was forecast over NEDCare’s first 18-24 months.
In practice, the growth in care hours is currently just trailing behind the forecast at 80% across the year to date - but the rate of growth is becoming more rapid.
In June 2019 NEDCare supported 27 individuals through c 700 hours of care and 58% of current care hours are provided to Local Authority clients, who would have no alternative service without NEDCare.
The replication toolkit will soon be ready to scale up and this spin-off project is not restricted by geographical limitations.
What would councils/health organisations/local areas need to do or have in place to enable it to develop?
Initial funding through the Our Place programme (DCLG funding) was instrumental in NEDCare’s pre-start phase, enabling us to complete vital community engagement and business planning activities.
Open and honest communication and sharing of data with the county council and health authority supported business planning and informed development of operational plans and service delivery.
North east Dartmoor has close knit communities and a good level of social and community capital, which has supported the evolution of NEDCare.
NEDCare has received social investment in the form of working capital whilst building services to minimum viability levels.
An effective county wide (or UK wide) strategy and campaign for recruitment in to the social care workforce would be of major benefit.
What would kill it?
NEDCare promotes and shares the Personal Social Services Research Unit’s costing model. However, fees for local authority work fall short of the unit cost of care. For every hour of care provided to a local authority client, NEDCare is out of pocket by around £5.80. As a social enterprise NEDCare is committed to continuing to meet care needs for this client group, but a longer term solution is urgently needed. NEDCare currently subsidises the local authority rate through a restricted legacy fund donated for this purpose, but this fund is diminishing month on month.
NEDCare’s projections of current and future demand within the resident population make it reasonable to expect that the business will reach it’s minimum viable level of service. This suggests that the regulated provider model may not be viable for smaller populations, or that operations would need to be delivered in a different way, such as by sharing Registered Managers between smaller providers.