3 Promoting diversity and quality in provision of services
This clause places a duty on local authorities to promote diversity and quality in the market of care and support providers in the local area. Providers of care and support may be of all types, including private sector organisations, not-for-profit and social enterprises, and mutuals. They may also be of different sizes, such as small and medium size enterprises and micro-providers.
Local authorities must also consider this duty when providing or arranging services to meet the care and support needs of adults (including carers). This is because local authorities’ commissioning practice can influence the local market of providers.
(1) A local authority must promote the efficient and effective operation in its area of a market in services for meeting care and support needs with a view to ensuring that any person wishing to access services in the market—
(a) has a variety of providers to choose from;
(b) has a variety of high quality services to choose from;
(c) has sufficient information to make an informed decision about how to meet the needs in question.
(2) In exercising that duty, a local authority must have regard to the following matters in particular—
(a) the need to ensure that the authority has, and makes available,
information about the providers of services for meeting care and
support needs and the types of services they provide;
(b) the need to ensure that it is aware of current and likely future demand for such services and to consider how providers might meet that demand;
(c) the importance of ensuring the sustainability of the market (in
circumstances where it is operating effectively as well as in
circumstances where it is not);
(d) the importance of fostering continuous improvement in the quality of such services and the efficiency and effectiveness with which such services are provided and of encouraging innovation in their provision.
(3) In meeting an adult’s needs for care and support or a carer’s needs for support, a local authority must have regard to its duty under subsection (1).
(4) A local authority may exercise the duty under subsection (1) jointly with one or more other local authorities in relation to the authorities’ combined area; and where they do so—
(a) references in this section to a local authority are to be read as references to the authorities acting jointly, and
(b) references in this section to a local authority’s area are to be read as references to the combined area.
(5) “Services for meeting care and support needs” means—
(a) services for meeting adults’ needs for care and support, and
(b) services for meeting carers’ needs for support.
As commented on re clause 2, a website enabling purchasers and providers to engage and agree terms would greatly assist the development of an effective market. Similarly a greater number of people with Direct Payments would encourage providers to enter local markets. So possibly add the requirement for a website with an auction function, similar to ebay etc, to be provided by LAs by a specified date, or one to be set by the SoS
Ref. 1 a, For some clients a website such as described above would undoubtedly be of benefit, however it offers nothing new for those whose decision making ability is impaired by capacity issues or cognitive difficulties. I have genuine reservations about the comments above pertaining to what appears to be a suggestion of micro tendering, which I fear is open to untold abuse. The many years of payment freezes to suppliers in many local authotrities have simlpy led to a rise in top up fees which undoubtedly disadvantage those without any ability to pay additional premiums. A need to ‘undercut ‘ competitors in a micro tendering culture, or agreeing to something in principle to secure a contract only to reduce this after admission are real concerns for businesses already struggling with stagnating fees.
There should be something about the option of personal assistants and direct employment as a option which the LA has a duty to oversee
Local Authorities have been culpaple in creating a market where large organisations with many shareholders and providing the minimum of service at a n artificially set price flourish thus leading to ’15 minute visits’ and poor quality services. Small organisations dedicated to providing quality care and support are forced out of the market. Any register of services should be transparent with good information about how the provider plans the provision, about continuity of service and staff, about number of staff and qualification levels, about the number of complaints received in specific 12 month periods, and with the basic pricing structure so that the users can make informed decisions on who to purchase from.
I feel that a local authority is not the body to be prime control of care.The ILF
success shows that high quality care is achieved when client has full control in all respect. LA FUNDING can and does get reduced , with no warning or consultation. Care costs are higher, quality not controlled.
All too often certain local authorities are now supporting poor care providers when clients or their representatives make a complaint about substandard services leading to victimisation and abuse. Complaint management has to be robust, more professional, transparent impartial and effective. Without this unscrupulous providers will continue to act focussing more on their financial targets than care quality.
Financial priorities and quality care really do not go well together.
Local authority Social Services Contract Monitoring Teams and CQC inpection teams need to be FULLY tained and appreciate that they need to “scratch well below the surface” and fully evidence all details on inspections. Where financial targets have to be met the truth is handled somewhat carelessly by some care home management who tell inspectors what they want to hear and sadly inspections are so flimsey that major flaws are not evidenced purely because verbal evidence is accepted.
Procedures, policies and laws do not abuse, neglect and kill the vulnerable. Poor behaviour, supervision and ruthless management lead to serious failings that impact on care quality, until more robust standards and more professional and detailed monitoring are introduced nothing will change.
I
I would agree. All the more reason for a national body, in the same
structure as the existing ILF TO BE IN CONTROL.
The assumption is that a market is the appropriate mechanism, though with fixed budgets the market will inevitably simply drive price down, irrespective of quality. The duty laid upon authorities should be to promote a range of services, sufficient in quality and quantity for it spopulation.
The way in which contracts are operated by many local authorities is seriously flawed and do not allow for the provision of a quality led care service. The constraints imposed by these contracts means that care becomes task-based rather than focusing on the needs and dignity of the individual. I have believed for some time that the current system of care is broken as it constrains many providers to such a point that compromises in delivering care, for traditional home care providers, are almost inevitable. Providers, such as ourselves at Home Instead, are often excluded from local authority preferred provider lists as we will not enter in to block contracts. This list is frequently used to signpost older people who are looking for a care provider to use their direct payments with, and also by individuals who do not qualify for funded care. Therefore despite excellent CQCs scores our (and other quality care providers) exclusion from such a key document restricts the diversity and quality in the provision of services. I would like to see this addressed.
The local authority should ensure that care provision contractors take cognisance of need for male carers, they should demonstrate an active recruitment campaign for a diverse staffing base as appropriate for the area in which they operate, taking into account religious, cultural and gender related barriers . i.e. a muslim lady should not have to put up with male carers, and my husband should not have to put up with female carers.
Please make it law that a persons needs are put firmly in place before a financial assessment is looked into. This is supposed to happen now, but some are subjected to this invasion of their finances before their assessment thus basing their needs on ability to pay. Therefore some are getting totally unsuitable care.
my husband had carers after brain operation . will need at end of life he wants to be at home it is all down to money -can we afford it or not
all things should be in place prior to needing home care when inevitble
We adopted three boys with vroaius forms of autism and appreciate those who would blog on such an important subject. People more than ever need to be informed about autism and what life is like for those so affected since this debilitating condition seems to be on the rise.
High Quality services are essential for service users and carers. I receive homecare for my elderly mother.I have found a huge difference in the quality of this service.Some care workers are very good,others are poor at best. More needs to be done nationally and locally to make the job of care worker a profession not just a casual job on the minimum wage.Service users in my area have poor choice in services available,this needs to change.
Richard, I totally agree.
Caring is a highly skilled role which is one of the most undervalued jobs in our society and it is long overdue for formal recognition. The accepted sector wage does not reflect the skill and knowledge required to do the role and at the same time never notices the amount of unpaid goodwill that carers put into their care of vulnerable adults.
In my experience as a training and improvement manager for a domiciliary care provider I can confirm that our carers personally care about their clients and often go the extra mile for them without additional pay or recognition and never moan about it. Often some don’t even recognise their extraordinary value to society because they still feel the stigma attached to being what is still seem as an unskilled support worker.
It seems to me that nationally we want to care for our vulnerable adults on the cheap but expect exceptional performance in return for poor wages. Yet we pay investment bankers phenomenal salaries to ‘play chicken with the economy’ fine them for breaching the rules and turn a blind eye when they resume the same activities.
The people we are caring for now went through austerity during the war years for our freedom today and yet accountants dictate their care needs and the miserable hourly rate for their carers. Something must be done nationally before we have to care for the yearly increasing numbers of elderly people and find we have no one prepared to undertake such highly skilled and demanding work for such low wages.
Goverment and local authorities long ago gave up their true responsibilities to care for the vulnerable in our society and have tendered everything out to contracters. There’s lots of money to be made out of the poor, disabled and infirm. It’s time to take the profit out and foster further relations with voluntary sector and non-for profit organisations so the top line can once again be CARE!
I would endorse the comments of other consultees about the blind faith in the market, and the poor skills of contracting staff, and the effects of rigid management without regard to the legal framework in the area of market shaping and commissioning. Years of case law have shown that commissioning has been disastrously marginalised as a career path, under resourced in terms of training, and encourage by management consultants to be separated from the very assessment and planning function that it was supposed to serve, in the interests of that thing called value for money; and in the last year the development that providers are now able to seek judicial review against councils for failure to take account of the highly relevant consideration that the providers are shouting into the wind, has shown that seeking vfm, without regard to the duty to meet need ADEQUATELY AND APPROPRIATELY AND IN ACCORDANCE WITH RESPECT FOR HUMAN RIGHTS will only bring in bullying and disregard of the public sector equailty duty in a monoposonist market and over-reliance on computerised resource allocation systems – precisely because they enable these ground down staff to avoid thinking about the human beings affected by an automated change in the figures at the beginning or the end. We get what we deserve in my view, and personalisation and pushing the responsiblity and risk of running direct payments at people who do not all want them would not ever have been necessary if we had got the contracting and commissioning culture right. This provision will not change that culture, on its own.
I would endorse the comments of other consultees about the blind faith in the market, and the poor skills of contracting staff, and the effects of rigid management without regard to the legal framework in the area of market shaping and commissioning. Years of case law have shown that commissioning has been disastrously marginalised as a career path, under resourced in terms of training, and encourage by management consultants to be separated from the very assessment and planning function that it was supposed to serve, in the interests of that thing called value for money; and in the last year the development that providers are now able to seek judicial review against councils for failure to take account of the highly relevant consideration that the providers are shouting into the wind, has shown that seeking vfm, without regard to the duty to meet need ADEQUATELY AND APPROPRIATELY AND IN ACCORDANCE WITH RESPECT FOR HUMAN RIGHTS will only bring in bullying and disregard of the public sector equailty duty in a monoposonist market and over-reliance on computerised resource allocation systems – precisely because they enable these ground down staff to avoid thinking about the human beings affected by an automated change in the figures at the beginning or the end. We get what we deserve in my view, and personalisation and pushing the responsiblity and risk of running direct payments at people who do not all want them would not ever have been necessary if we had got the contracting and commissioning culture right. This provision will not change that culture, on its own.
What about people without means or caperbility?
What about people that are in prison or detained under the mental health act?
After thirteen years helping nursing my wife in nursing homes I can say that 95% of staff are underpaid and exceptionally kind and caring.
CQC say homes must provide staff to meet the assessed needs of the residents.
The way they check this at inspections is to ask the Home do they have enough staff. CQC use the number of residents to verify this answer and not the assessed needs of the residents. Not enough care staff are provided to meet the needs.Using the NHS Scotland review of hours needed for basic needs the average is 20 hours per week without special needs or nursing input. Care staff work 11 hours per day after breaks therefore a home of 60 residents needs 15 care staff on duty.You will find that the norm will be 8 or nine so there is no way that the basic need of residents can be met so some will fail to get the care they need with the best will in the world.Also those who make the most fuss get the most attention even if this attention is more than a resident with additional needs.
If staff have to be provided dependent on needs how come most nhs and social servcies pay the same rate for everyone. Each persons needs should be assessed and a set time alowed to meet those needs eg help with wash and dress 30 minutes, when each item is added to sum up the hours needed then the rate per hour should be applied to calculate the fee that the nhs or social services will pay the Home for that resident.When CQC inspect they must look at the assessments and not just the total number of residents and not rely on asking the Home whether they have enough staff. Also the assessment would help in resdients and their relatives knowing what the home is expected to provide and not expect more than that.
Where is the money coming from? Parliament has said that the 12 billion for foreign aid allocation is ONLY .7% of GDP which they say is negligable. What does it say about out politicians when they say that the 1.5 billion needed for elderly care is more than we can afford. Help our own elderly before helping other countries .
Most nursing homes specify in their complaints policy that if satisfaction is not ontained refer to CQC.
CQC do not attend to individual complaints but on inspection do not point this out to nursing homes therefore people who make compalints are left in limbo.
If the NHS pay funds they are responsible for complaints
If SOcial Servcies pay then they are responsible
If an individual pays privaetly then the Parliamentary and Health Servcie Ombudsman will investigate.
PALS only helps those in hospital. LINK do not investigate complaints
There needs to be ONE organisation,prefaerably independent of any provider,who will investigate complaints quickly and without bias.
Carers these days are underpaid, they are expected to take on things that were considered nursing at one time but now are quite complex care needs. So when are they going to be recognised as highly trained, and paid accordingly. If you pay peanuts you get monkeys!!!!
The NHS is expected to achieve more on a smaller budget.
Thus the more positive suggestions the better, bearing in mind that some groups will be more in need of others speaking up for them.
With an ageing population dementia is a big problem.
Who will take care of those with learning difficulties, when their parents have gone.
MS sufferers.
Many require much care, whom gives the carer a break so they do not crack under the strain.
If more folk tried to help out, as best as they can, in whatever way they can fewer would be hit so hard by all the changes and cut backs.
Inividuals with power and/or riches should try to show more compassion to those whom do not, as life can be hard for many.
To sum up the NHS are trying to provide a good service on a restrictive budget, lets do what we can to help.
It is vital that any “person wishing to access services in the market” “has sufficient information to make an informed decision about how to meet the needs in question.” It follows that the market should include a wide variety of providers, quality and costs for people to make the best decision for their needs. Finding the right service is a difficult process and people need good support to be able to do this – independent support is preferable – and we would like to see the role of independent advocacy being provided to meet this need for all those vulnerable people who require it.
I am unconvinced that using economic market principles of supply and demand and applying them to health and social care, like a commodity you might purchase in a shop for example, has and continues to be deemed the way forward. It is interesting that clause 3(2) refers to demand and effectively the only responsiblity any government agency has is to ‘regard’ or consider – to as great or as little degree as the local authority decides – service provision. It is also important to note that using market principles does not necessarily provide choice or options to meet people’s needs. It may essentially mean that choices are limited, the ‘market’ governed by large scale private providers which are driven by financial profit. These are able to undercut the competition and force smaller, perhaps more personalised services, out of the market. This is particularly crucial when budgets have been/are being cut and essentially the notion of ‘choice’ may become a financial rather than personal decision.
Having come back to this, I would comment that I am not able to tell what this provision is supposed to DO, in legal terms. It is hardly rocket science, but it is not enforceable. It is a fillip to good commissioning, but without any sanction for non-performance. It is unreviewable, in terms of what a council would be entitled to say was in its mind, against the list of things that it must consider, as most would be aiming to do this anyway.
There is no clue as to how negotiating fees down and down, thereby utilising the subsidy from the private sector paying consistently higher prices, and without ever being seen to be accountable for reducing the content of care plans for the individuals could POSSIBLY be consistent with promoting quality.
How are you going to have ‘quality’ services when support workers are often paid less than the living wage. Surely if you want to attract and retain ‘quality’ staff then you need to pay them a decent wage.
Our LINk supports the principle that people should be able to choose from a variety of care and support options. We think it is important that local authorities permit and encourage innovation in service development and commissioning – for example by encouraging Direct Payments recipients to pool their budgets to purchase some support collectively (especially where this could provide improved support for the same cost).
In order to make sure this meets local need, we think it is important for service users to be involved in defining and assessing quality standards and to be clear about where responsibility for scrutiny and oversight lies. This should include some flexibility in the way that statutory regulators’ standards are applied – to ensure they reflect local circumstances. Assessment of quality should encompass real-time data collection with swift analysis and feedback. It is also important that assessments of quality of service include an element of independence – feedback from our members indicates a general fear of recrimination if negative messages about quality are given direct to service providers.
We welcome the duty on local authorities to promote diversity and quality in the provision of services. We welcome the recognition that commissioning practice affects the market of providers. To achieve a diverse market and for adults to have a choice it means a number of providers and a variation in size and specialty of providers. Contract management inherently leans towards bigger fewer contracts and can disadvantage smaller local and often voluntary sector providers. We would urge any guidance to ensure that the quality indicators are proportionate for smaller local voluntary organisations in order to ensure diversity of provision.
In relation to companion animals (and our expertise is cats) the advantage of cats is that no provision of regular services such as help with walking the animal will be needed but care shoudl be taken in selecting providers of services such as cattery services (if an adult goes into hospital) or cat feeding (if an adult become immobile). Cats Protection, vets and welfare charities can assist with advice re provision of these services. Payment for this is a valid care payment to support the ongoing presence of the animal and prevent anxiety in the adult etc/provide peace of mind about the cat’s care.
Output from discusion groups at Soroptimist International central Birmingham
2-7 There must be high quality options for care available.
Stron regulation of Care Providers imperative
Good systems are required to ensure accountability, reporting, feedback and enforcement of standards.
More staff are needed (therefore more money)
West Anglia Crossroads on behalf of carers agrees with the principles of this section, especially informed choice.
However, as a quality provider of services, we are aware of the conflicts between provider choice and limited social care budgets, until more progress is made with people self funding care or support at earlier stages.
There is a crisis regarding the shortfall in a Care Workforce. More must be done in recruiting and rewarding people to care. This is more likely when valuing services against outcomes, rather than rationing services per lowest cost minute. However, the demographics and austerity budgets mean that commissioning will continue to focus on price, leading to zero hours contract uncertainty and poor recruitment.
I totally agree with your comment. I feel that the recruitment and training of carers and a proper pay system which reflects their qualifications and commitment could possibly be the most important outcome of this bill. Compassion must be an outstanding element of the care as well as efficiency and other caring skills. Carers should become an important part of the nursing profession not just low paid workers with little self esteem.
I absolutely agree with you and this needs to be one of the top 3 priorities of this bill- to prevent the devastating impact of a shortfall of carers for the future.
Again, clearly a ‘Duty of Care’ applies and should be included in the wording of the legislation
Agree with the principal of not simply using one type/size of provider for services and local authorituies will need to look at a range of services from large-scale to micro-providers. However, commissioning of services needs to be based on quality and cost, rather than focusing on size and type of provider; being mindful that micro-providers would not be appropriate for larger-scale services.
Local authorities also need to ensure they are happy with all providers of services, as not all providers, particularly micro-providers, come under CQC etc so there needs to be appropriate mechanisms to monitor and deal with complaints
A combined comment on 2. Providing Information and Advice and 3. Promoting Diversity & Quality in Provision of Services: It seems to me the plan to provide information and advice on services in a particular area is key — PWD and carers need to know what their options are in terms of care provision. However, often authorities only promote the care agencies, etc., that already have contracts with the authority. These two points will only be important if the authority provides information on a wider scope of services available, etc., and is clear about the costs of these services so that families can plan ahead. One idea could be to have a central website where all services are listed and people using them can ‘rate’ them based on satisfaction — sort of like trip advisor — so that the public can get a sense of which service provides value for money. This could create some competition and encourage services to work harder! Health has developed a similar website in the south (granted this is only one aspect of it) called our health (www.ourhealth.southwest.nhs.uk)
It is also necessary for the Local authority to, in some way register, and know how many deafblind individuals are living in their area so that they can gauge demand for services like interpreters. This knowledge is not just about DB people born in their area but living – resident. So what is wrong with the concept that individuals register. In theory the analyses undertaken electronically to assess how well GP’s are servicing say their patients with blood pressure problems (amongst other things for hitting targets) there should be/ may be a medical code to register DB people – this is all logical stuff if there is the will to do it but we are not there yet.
The information needs to document the cost implications of the different services, like interpreters. There must be up to date information about how the individual can establish that any provider, be that an individual, or a care provider, is legitimate, properly trained, properly updated, has a proven track record and relevant experience and the multitude of other facts to enable choices to be made.
I believe that the bill states elsewhere that local authorities have the option to provide state facilities along side private facilities and direct payments. I was relieved by this.
A market makes sense when those with health and care needs have the mental capacity and financial power to influence the care they receive, which is correct for some with care needs and for them a limited market model makes sense.
However, for the mentally incapacitated/severely ill it is a nonsense. At the moment assessment of need and the level of money to supposedly meet the need are both determined by the LA! In the case of direct payments the LA decides how much it is supposed to cost to provide services for a need but generally does not provide this service. The amount of money awarded prevents choice as the LA will choose what they imagine is the minimum level to meet need, but since the provider is outsourced there is no reality check. This cannot drive up standards and so far there is no mechanism to proactively quality control/meet basic human rights on a daily basis.
For me the model should be successfully meeting needs: success would be needs being met following regular quality assurance checks. As well as being more humane it would sometimes be cheaper. At the moment a huge amount of money is wasted while basic human rights fail to be met e.g. people dying of hunger because they are unable to feed themselves – food is placed in front of the person but since s/he cannot speak it is taken away again. The fact that a monetary value on the food was established did not equate with a need being met. The monetary value should not be the food it should be the fact of a fed person – the need.
LAs are tiny compared with the national and sometimes multinational organisations providers they are charged with policing. I agree with other comments and from personal experience about worries of how small, quality providers are disadvantaged in the bidding process. However, the most disadvantaged are those with the health and care needs themselves.
There are also many now who fall through the net. It is unfeasible for social services to provide individual assessments of all those with care needs with the result that people remain unassessed suffering extreme hardship as blind eyes are turned on all sides, not through malice but through underestimation of the scale of need on the part of central government.
We would know there was a vibrant market when service user and family feedback was being welcomed instead of as at present the real need for safeguarding adult boards to be set up. (Thank you for that) Inability to listen to users is a clear sign of a market failing to function.
Defining Quality
1. JRF welcomes the breadth of the definition of ‘good quality’ care and support as presented in the White Paper, and in particular, the inclusion of being involved in one’s own care the freedom to take risks.
2. However, JRF would like to point out that this list combines both outcomes (e.g. I feel I am part of a community, I am supported to be independent) and processes (e.g. I am involved in decisions, I have a personalised services). It is important to remember that processes are needed to achieve good outcomes, but are not ends in themselves, and as such, are not reliable indicators that care is of good quality. It might be useful to clarify this thinking and differentiate between processes associated with good quality care (e.g. codesign and coproduction, a risk enabling approach, person-centred thinking and focus on outcomes) and outcomes that people value which are achieved by good quality care.
3. While these outcomes include being supported to remain independent and to be part of one’s community, these are not the only two outcomes people value and should not be the exclusive indicators of quality care (Katz et al 2011). JRF research with older and disabled people has identified a range of other outcomes which they value: several studies have sought to identify a common set of outcomes that different care service users tend to want to achieve in different care settings. Many people simply express the wish for an ‘ordinary life’, with ‘sufficient’ and secure income, social and intimate relationships, stimulating and interesting activities, accessible and timely information, support to manage things that pose difficulties, a comfortable, clean, safe environment, and a sense of belonging to and participating in communities and wider society (Godfrey 2004).
4. A JRF study by the National Development Team for Inclusion (Bowers, et al., 2009) found that the things most commonly mentioned by older people who live in care homes associated with good quality care:
• people knowing and caring about you;
• the importance of belonging, relationships and links with your local or chosen communities;
• being able to contribute (to family, social, community and communal life) and being valued for what you do;
• being treated as an equal and as an adult;
• respect for your routines and commitments;
• being able to choose how to spend your time – pursuing interests, dreams and goals – and who you spend your time with;
• having and retaining your own sense of self and personal identity – including expressing your views and feelings;
• feeling good about your surroundings, both shared and private;
• getting out and about
5. Clearly, then, older people have a wider view of what they want and value from the care and support services they use. By conflating processes and outcomes in the White Paper’s definition of quality care, there is a risk of over-emphasising the importance of processes as a proxy for quality, as well as overlooking other important outcomes (such as those above) which have not been identified in the list in the White Paper.
6. Similarly, while JRF is delighted that the White Paper has set out a plan to improve information on the quality of care providers which includes the My Home Life eight themes, the range of quality standards mentioned (e.g. National Institute for Health and Clinical Excellence (NICE) quality standards and the Dementia Care and Support Compact) might be enriched by quality measures identified and produced by older and disabled people themselves (such as those outlined by the NDTI study above) in order to develop a more user-defined measure of quality. The concept of Healthwatch – championing consumer rights in care homes and using volunteers to visit homes to review quality – is very encouraging in this regard, as it helps bring the voice of users of care and their families into the centre of inspection and quality review. Having a user-defined set of quality indicators would be a valuable tool for these organisations to use during inspection. A good example of this can be found in the achievements of the Scottish Dementia Working Group (a group of and led by people who live with dementia), which has been involved over the last two years in shaping’s Scotland’s National Dementia Strategy, with two members of the SDWG participating in each of the strategy’s five work streams (see page 13, Weaks et al 2012).
7. The government will need to ensure that the findings from these local organisations are treated as credible and hold weight relative to the work of professional regulators, and also that this additional level of inspection and regulation does not add a further level of complexity and bureaucracy to an already heavily regulated field. JRF is currently exploring how the regulatory burden on care homes can affect the quality of care, and in particular, the quality of relationships formed (Mitchell et al 2012).
Outcomes and needs
8. Looking more broadly than the definition of ‘quality care’, JRF welcomes the focus on the wishes and preferences of care users and their families and the outcomes they hope to achieve. In particular, the Draft Legislation states that a needs assessment must include an assessment of:
(a) the outcomes that the adult wishes to achieve in day-to-day life, and
(b) whether, or to what extent, the provision of care and support could contribute to the achievement of those outcomes.
9. This is an unprecedented step forward from a narrowly defined definition of care which ‘meets needs’ with predefined services, to a broader understanding of care as a means of enabling people to achieve the outcomes they value. Consultation with service users as part of JRF’s Shaping our Lives project found that people express their needs and aspirations, and live their lives, in terms of self-defined outcomes rather than services. These outcomes are expressed holistically, covering housing, transport, employment, income and benefits, and broader issues around discrimination and equality (Turner et al 2003; Glynn et al 2008). This really fits in with a pre-defined service, and one will rarely hear an older or disabled person say “I need 7 hours of domiciliary care a week” but rather “I would like to be able to get out into the garden”.
10. As such, JRF believes that a care and support system which starts with a focus on facilitating outcomes will resonate with people’s real lives, and will gain broad public support. Moreover, it will also be more sustainable: it can adapt even if technological breakthroughs or wider social, economic or political transformations have re-invented what we think of as social care. On the other hand, a care system which seeks to meet set needs with predefined existing services is unlikely to deliver personalised support and will become outdated quickly as our understanding and expectations of care services change (Stone and Wood 2010).
11. We know from JRF consultations with older people that the setting of outcomes is subjective and personal, and must place individual service users at the heart of the process (Turner, 2003). Therefore, a system which places the achievement of outcomes at the heart of assessments and delivery will support greater personalisation, as the wishes and preferences of individuals remain central to the process.
12. There are however some points in the Draft Legislation where the focus on outcomes is replaced by an outmoded focus on services – for example, where the following are provided as examples of what may be provided to meet needs:
(a) accommodation in a care home or in premises of some other type;
(b) care and support at home or in the community;
(c) counselling, advocacy and other types of social work;
(d) goods and facilities;
(e) information and advice.
We would rather see a less defined approach, abandoning a menu of options in favour of wording which simply states that any service which can meet the achievement of self-defined outcomes should be used. This allows for greater local discretion over how outcomes are met and is more in-keeping with a care and support system which promotes a wider range of services (including those with delays and prevents needs) and which cross over health, care and housing.
13. With specific regard to quality in residential care: JRF was delighted to see specific recognition of the My Home Life initiative, which is supported by a coalition of organisations including JRF. We welcome the government’s support for this work in reference to helping care providers connect care homes with their communities, as this is an important part of this initiative’s work.
14. However, we should bear in mind that there are in fact eight good practice themes identified by more than 60 researchers in My Home Life, as central to good quality of life in residential care. These are:
• Maintaining Identity
• Creating Community
• Sharing Decision-making
• Managing Transitions
• Improving Health and Healthcare
• Supporting Good End of Life
• Keeping Workforce Fit for Purpose
• Promoting a Positive Culture
15. We are glad these themes will be incorporated within the White Paper’s vision for improving quality of care, however we would also like the government to help care organisations work with their members to achieve these other objectives.
(Research referred to above can be found at http://www.jrf.org.uk)
We need good cost effective services for Service Users and their Carers, it is absolutely crucial to provide a good quality of life.
My working experience of paying the bills on behalf of the Local Authority and the problems caused by providers doing inadequate jobs or not turning up to do the agreed care is not acceptable and needs to change. We need good positive outcomes for all Service Users and their Carers.
Many of the points helpfully made above refer to the pay and conditions of the care workforce and the need for their improvement. Our research at the Social Care Workforce Research Unit has explored a number of these subjects including the Male workforce in social care and the wage levels around (above and below) the National Minimum Wage. However, this section has at its heart the task or the art of commissioning. Our research on this subject points to the under-investment of preparation and support for staff carrying out this role. We suggest that the new Guidance and support materials for the Bill need to be tailored to supporting staff in this role and to providing a framework for understanding the commissioning processes. Duty of care and other legal responsibilites will need to be clarified especially around integrated commissioning and ‘out of area’ services.
There needs to be a stronger relationship between quality as determined by commissioners and providers and the contributory role of person expereinecing the service – Local Authorities should have regard to a quality improvement cycle that is service user and carer driven.