Professor Martin Green OBE, Chief Executive, Care England
There is often much talk about the quality of services, but in truth, what people want is a quality life, and we need to shift the agenda in social care away from thinking about services and processes and start reminding ourselves that people need to live well, rather than receive care.
This is not easy to achieve. It requires us to think creatively about how we deliver support and very intricate knowledge of the person and their likes, preferences, and desires. Only when we understand the person can we start to construct truly personalised support.
One of the biggest impediments to delivering truly personalised care is the current way in which it is commissioned. The focus is always on time in the task, not on people and outcomes, and services that respond to people’s needs have to be flexible and responsive, and this is not the current approach that is taken in commissioning. Older people get a particularly bad deal from the current system, which is riven with ageism. If you look at how local authorities commission care, they demand personalised care packages. However, they all commission on block contracts and deliver the same amount of money, regardless of a person’s needs. If we are going to move towards truly personalised care, this has to stop.
The Care Act clearly defines a personalised approach to care and shows citizens what they should expect from the care and support system.
The Care Act is very much about personalisation and flexibility. It creates a good framework that should enable people to live well and have fulfilling lives with the right amount of support when needed.
There are big challenges to delivering on the aspirations of the care act because the current approach to commissioning has also produced a one size fits all approach to providing care. If we are going to truly give people a life rather than a service, we will have to radically change how we deliver care. This would be difficult at the best of times, but it seems all but impossible when we are starved of resources and have enormous workforce challenges.
However, history tells us that it is at times of the greatest challenge when the burning platforms are created that allow us to reconfigure services and think differently about the future. We are also lucky to be at a time when technology is developing at a real pace, and we see a range of new technological innovations that help us to deliver care and improve efficiency. This is not in any way to negate the fantastic work that care staff do, and we will always be a relationship based person to person service. However, we should still use technology where we can improve outcomes.
This brings me to the most important thing about using technology, which is a must to improve the life of the person receiving support. Technology is not an ending in itself; however, incredibly creative and innovative. It seems the measure of success when we deploy technology is the service user’s experience and how it improves their lives and increases their choices, autonomy and control.
As well as deploying technology more effectively, we also need to think about how we deploy staff and create situations where people can receive support in the most flexible way. I recently had a very interesting conversation with someone developing an Uber-type response for home care services. The premise of this new approach is that people draw down on care and support when they need it, and you have a complex system of people who are all known to the individual and who can deliver care and support at various times.
The great thing about this innovation was that the person who uses the service decides when they want it and what it will deliver. Contrast this with how services are commissioned by local authorities, which tell citizens how long and when they will get it. Services are commissioned by local authorities, which tell how long you will get and when you will receive it.
In residential care, we have seen increasingly personalised support which enables people to live their lives. They want to live and have much more flexibility in receiving support. We’ve seen some great examples of the deployment of technology in residential care, which helps to improve the quality of people’s lives. I recently saw the new Alexa for care homes, which enabled people to access support when they wanted to and use their voice to control things like the television, radio, lighting, or ask for food or drinks. It also allows people to keep in contact with family and friends because the technology is so simple to use that you have to ask the system to phone your loved one, and the whole process is very easy. Whilst the workings of technology may be very complicated, the important thing for people who use services is to keep it simple and easy to use.
Whatever our challenges, we never stop innovating and developing care to enable people to have a life rather than a service.