State of disrepair

I changed career direction during the last year. While retaining a consultancy with my law firm, I am now primarily the owner and managing director of a local domiciliary care provider. This is neither a traditional nor romantic step to take, but I believe it has been the right one. Why?

Decimated budgets

The care sector is, with some exceptions, in a terrible state. The reasons are many and varied, both social and economic, but it is probably unhelpful to point the finger at hard-pressed local authorities struggling with decimated budgets, let alone the sector’s many caring and compassionate carers.

The situation is deteriorating rapidly and, while the voluntary sector is valiantly seeking to improve the situation, they are equally thwarted by financial and related issues.

The care sector desperately needs people, not ?only possessed of the vital energy granted by raw vision, but who have the additional benefit of experience in traditional professional services. By that, I mean people who know how to work constructively with other organisations and people of widely different backgrounds to achieve agreed objectives, with the client’s interests and aspirations always coming first, i.e. before ‘the money thing’ and all the ‘dread politics of care’.

At the same time as the unfolding implosion of care provision rumbles on, I have observed that the career paths of many extremely able young people wanting to make their way in the law are being hindered. They are being hindered not so much by any deliberate or obtuse blocking tactics of older established lawyers, many of whom have seen their expected pension pots dwindle, as by the impact of the current economic depression of which there seems no prospect of resolution.

This depression, which is longer than that of the early 1930s, follows a 20-year bubble of debt-fuelled, illusory, growth. That artificial growth included various aspects of legal services. Lawyers were not immune from ‘irrational exuberance’. In any event it is now being exacerbated by politicians’ and bureaucrats’ inability to admit to past economic mistakes, while they also seem fixated with the joint opinions that austerity is good for our souls and that any brand name worth its salt (or maybe selling it) should take up legal services.

False economy

Allowing provision of decent quality care at home to seize up is, in fact, a false economy, a hidden drain on the economy as anyone working in NHS hospitals or in social care can tell us. They tend to face ‘step-up’ and ‘step-down’ related problems, especially relating to our growing population of older people. Both types of problem are potentially very costly for us all.

Step-up problems – unexpected admissions. These can arise from previously ‘unobserved’ older persons developing an avoidable acute condition which is either health related (like diabetes) or incident based (for example, as the result of falls). The solution is to ensure the unobserved becomes observed.

In a time when, for instance, forced council cutbacks are resulting in local facilities closing or being mothballed, along with the older people’s clubs and societies, there is growing invisibility.

Step-down problems – discharge delays. These can arise when a clinical decision to discharge is hindered by lack of available care at home or related social care complexities. Lard Darzi in the Next Stage Review (2008) expressed the desire to ensure that health-related decisions are “locally led, patient-centred and clinically driven”.

In essence, the solution to step-down problems ?is to ensure prompt availability of suitable social care ?at home which is also acceptable to the patient and their family.

The level of acceptability of a ten or 15-minute call by a rushed carer who has to bus in from ?way across town and who has never met the person ?that needs assistance is very low. And sadly, the many providers who have effectively agreed to meet such ?a low basic standard have done neither the people ?in their care, nor our socio-health structures, any ?great favours.

Thus we are in the grim place we find ourselves today – a systemic non-acceptability. I for one ?want to help generate some changes before I get to the stage of needing care myself. So you see my current objective as a care provider is, in many ways, quite selfish.

In terms of step-up care, limited-companionship based provision, often brokered by family, local health-related professionals, signposting agencies or voluntary organisations is really an essential. Once involved, the client’s ‘visibility’ significantly increases and the risks to themselves and the difficulties surrounding unexpected hospital admissions are much reduced.

This naturally also relies upon providers giving proper training and ensuring consistency with low client-to-carer ratios. It also requires them to ensure that any companionship/care package is reviewed and grows to meet recognisably increased needs.

Future gains

There is a cost but also a far greater longer-term benefit. In short, unexpected admissions are headed off, while securing person-centred local care at home with clear quality-of-life advantages and peace of mind for relatives. Companionship, and for that matter the vast majority of ‘home help’, is now only available privately, but it is to be hoped it will be more widely available under enhanced direct payment type arrangements.

Although some local authorities still appear to struggle to introduce effective choices through such arrangements often because of cuts in staffing levels... So it goes.

In terms of step-down care, once again the issue of acceptability to the client, and indeed their family, must be met directly by careful carer-to-client matching and personalisation, with ensuing client-care package development. Once involved, the client retains the essential visibility, and the characteristics of companionship-based care again reduce the risk of an unexpected readmission.

There must, in short, be a deliberate shift from short-term to long-term thinking in the context of care for older people if the demographics of an ageing population are going to be even half manageable. It is sad that there are few providers who not only ‘get’ what is needed, but who are also willing to say no to delivering arrangements that do not provide what is really needed in terms of acceptability.

It is not in their financial interests to displease their paymasters so is it any wonder? If they did say no then maybe the system would be overhauled?

But again, this means we are pointing the finger at someone else. In fact we all have a responsibility – including to ourselves – to decide that if something is important then it just has to be done.

Maybe the way out of the current depression for the UK is to recognise that a New Deal for the elderly is now as much a potential engine of sustainable economic growth, employment and development as the building of state highways and dams was to 1930s America. Demographically driven improvements, such as better care at home for the elderly, have truly sustainable potential if managed carefully.

David Coldrick is a consultant at Wrigleys Solicitors. For more information on David’s new project seehttps://www.homeinstead.co.uk/Rotherham

---