Last July we heard from the Cumbria Registered Social Care Managers’ Network (What can the city banks learn from social care?). At their most recent meeting, Network members discussed issues associated with providing care closer to home. (732 words)

Tim Farron, MP for Westmorland and Lonsdale, braved icy conditions to attend the Cumbria Registered Social Care Managers’ Network on Friday 16 January 2015. The aim of the meeting was to explore from social care mangers’ perspectives some of the challenges of delivering care closer to home. Given the pressures currently facing the hospital acute sector and especially Accident and Emergency Departments, discussions of care closer to home are especially topical as it explores how community health and social care staff can work together to keep people out of hospital where appropriate or to help them come home earlier.

The meeting began with a case study which demonstrated collaborative working between social workers, community health staff and care providers. It related to an older person who was assessed by the hospital as ‘fit for discharge’ on Christmas Eve. However, he had no family close by and an upstairs toilet which he was unable to get to. Community staff worked together to delay the discharge on the grounds that they did not have sufficient capacity to help this person return home without substantial risk of his wellbeing deteriorating necessitating a further worrying hospital readmission.

The Cumbria Registered Social Care Managers’ Network at the 16 January 2015 meeting

For social care managers the ability to support the care closer to home policy is constrained by several factors. First, the underfunding of home care services relative to need (which is acknowledged in research as a national problem) can pose significant additional challenges for providers in rural areas. For example, care providers in Cumbria are paid a flat rate for each hour of care they provide, currently in the region of £13 per hour. However, to reach people living in some of the remoter areas care workers will sometimes need to drive for upwards of an hour each way to reach the person. This is time the care provider will not be reimbursed for (though care workers are now increasingly paid for their travel time). Visits lasting only fifteen minutes are still undertaken in certain circumstances and the need to rush from visit to visit, compounded with the darkness and icy roads in the winter can start to put intolerable strains on care workers and their managers who must ensure adequate staffing. Care closer to home further increases this pressure because of the expectation that social care staff will take on increased responsibilities for ‘health’ tasks such as helping people manage their medicines. The result is that social care mangers can often feel uncomfortable about the levels of risk they are expected to manage and often fear that if something goes wrong they will be made a ‘scapegoat’ or unfairly blamed.

Second, managers of care homes report an additional set of problems which highlight the importance of integrated working in the delivery of care closer to home. As people leave hospital earlier they are often still not well, meaning that care home staff rely on good discharge planning and communication from the hospital and also considerable ‘back-up’ from their local GPs and community nursing colleagues. However, because of the pressures in the acute sector and in community health services there is often little time for the high level of joint working that is needed. For example, one care home manager reported how before coming to the meeting she had spent the entire morning chasing up the medications for one resident who had been discharged home without any of her prescribed medications. There was uncertainty among the group as to whether residents should take their own medicines into hospital or just a sheet detailing their medications reflecting the need for policies to ‘dove tail’ across sectors to avoid unnecessary confusion.

In thinking about how these challenges might be addressed there was discussion of longer term possible political solutions (e.g. some spoke of the need to raise taxation) and in the shorter term, the need for some organisational and cultural change geared toward increasing opportunities for shared learning and putting some ‘good will’ back into the system. With the intense pressure on councils to drive down costs and make savings, it was felt that there was a danger that the ethos of good commissioning (solving problems in partnership with stakeholders including service users and carers) should not lose out to a more reductionist contract culture in which council staff and providers would be increasingly pitched against one another.

The Cumbria Registered Social Care Managers’ Network is funded by the National Skills Academy and is supported by the Social Care Workforce Research Unit at King’s College London. The Network helps the Unit understand practice in social care from managers’ perspectives. For more information contact michelle.cornes@kcl.ac.uk or see: https://www.nsasocialcare.co.uk/registered-managers-local-networks