Care Minister Norman Lamb has announced that there is an urgent need to transform care in the home – highlighting the fact that, according to CQC, 25% of care is failing to meet basic standards. He’s right that this is an accident waiting to happen, but the solution is tricky.
The economics of the problem are quite simple. Carers get the minimum wage or just above, and the margins for care agencies are very slim. Local authorities are under pressure from central government to cut costs and so will look to cheaper providers and also make requests such as half hour or even quarter hour slots. Providers are in the position where if they don’t accept the local authority work on offer, then they have a serious hole in their income so they have to oblige. It also means their training and management costs are under pressure and there is no spare cash to invest in developing staff.
The upshot is that despite the local authorities and care agencies wanting to provide quality home care, they are forced to concentrate on the money rather than the people – and against their natural inclinations, clients can become “units” and care staff can become “resources”.
In terms of looking at the long term treatment of clients, it is also a false economy: by spending more time with clients and providing consistent care, the person receiving the care feels better, is happier and therefore more able to cope with life in general. This in turn means that any decline in health and well-being is slowed – which means that the costs to the local authorities for residential and nursing care are reduced. The current system is just storing up trouble for the future.
We need care providers to have the income to be able to employ and invest in staff, giving them the quality time with clients but also meaning that the care agencies are viable. In turn, local authorities would need to have clear contracts for the services they are funding and a high standard of inspection – none of this is difficult to achieve, and is largely what agencies and local authorities want to do anyway. The issue lies in where the money comes from . . .
However, it is no good just going to the Treasury and asking for more money – that is not going to happen. So the challenge here is how does Mr Lamb deal with the financial constraints on the one hand and the political and social care pressures on the other.
It is the difference between treating the symptoms or dealing with the cause. Tinkering around the edges and asking the care providers to work in different ways will only deal with the surface issues – the Andrews Salts to provide a burp of relief in the system. But this will only put the crisis off – what we need, and what I hope the Minister is going to look at, is a transformed way of paying for home care, because only a better financial diet will mean that we finally get dignity and proper care to those who really need it.