Putting homecare on the map
What keeps me awake at night is thinking about how to put homecare on the map. If we, as a society, were to invest in enabling people to live well and independently at home, we could improve quality of life, increase healthy lifespan, reduce pressure on the NHS and save money for the whole health and care system.
What little has been said publicly about social care by senior politicians, has focused almost entirely on protecting the housing assets of older people when they move into residential care. Of course that is an important issue, but it is only one of many.
For a start, social care is not just about older people. Most councils are spending almost half their adult social care budgets on working age adults with disabilities. Furthermore, whilst there are at least 10 million people receiving or needing support and care at home, either formally or informally, the latest data from Laing and Buisson indicate that only 0.39 million people live in care homes. Of these, only 0.17 million are paying for their own care, with a further 0.04 million paying top-ups on local authority fees. So a disproportionate amount of political airspace is devoted to an issue affecting a relatively small proportion of the population.
The spotlight now needs to turn to the majority of people living in their own homes, where 9 out of 10 people want to stay. We need strategic leadership and investment to enable a strong, sustainable, innovative and person-led homecare sector to flourish.
First, homecare providers must be viewed as key partners in the government’s strategy to prevent ill-health. Homecare workers often have daily contact with citizens. They therefore have greater opportunity than GPs or NHS staff to support people with simple activities to protect health and wellbeing, such as eating and drinking, exercising adequately, and connecting with their communities.
Cases of malnutrition in older people have trebled in the last decade and costs of this to the health and care system will reach £13 billion in 2020. Dehydration in older people is known to be linked to infection, illness and injury, which frequently result in hospital admissions. Absence of adequate homecare services in some parts of the country may at least partly explain regional variation in numbers of older people admitted to hospital with bloodstream infections, resulting in avoidable suffering for citizens and higher cost to the NHS.
Second, we need a national care workforce strategy alongside the forthcoming NHS People Plan. Analysis of skills and competencies required to meet population care and support needs must be conducted. Nationally recognised and accredited training programmes must be available, along with funding, to ensure the workforce is confident, competent and appropriately qualified. Clear career pathways, with skill and experience recognised by improved terms and conditions, will help to attract people to work in the sector and encourage them to stay.
Third, we need radical reform of commissioning and funding of homecare. A higher proportion of outstanding rated homecare occurs in the self-funded than in the state-funded part of the homecare market. Self-funding citizens commission their own care and pay enough to cover costs and enable providers to operate sustainably. Councils need to follow suit.
Fourth, we need to encourage innovation in operating models and digital transformation of homecare to enhance quality and efficiency of service.
Government spend on homecare is currently only £3.23 billion annually, with an additional £1 billion from self-funders. This compares with £150 billion for the NHS. When the Prime Minister makes good on promise to fix social care, he would do well to invest first in homecare.
Jane is the CEO of the United Kingdom Homecare Association. She is an experienced CEO, Chairman and leader of a range of businesses in regulated industries from social and health care to housing, and from food production to medical screening, that meet some of the most fundamental human needs. She has extensive experience in the not-for-profit and for-profit social care, health and housing sectors, including homecare, housing with care, supported living, care homes, training, and the NHS. Formerly CEO Somerset Care Group; Chairman YourLife (JV with McCarthy & Stone); and Vice Chairman UKHCA. Jane’s first career was in international leadership roles in research and development in ICI, AstraZeneca and Syngenta, where she was Global Head of Bioscience Research. She then established her own business providing consultancy and training on the link between nutrition and other lifestyle factors and health, working with private individuals and local authorities in the field of public health.