Lindsay Rees, Head of Social Care Content at Quality Compliance Systems (QCS), believes there must be radical change in adult social care for the sector to survive and thrive. Here, Lindsay outlines three key areas of the sector that must be prioritised as we look forward to the future.
The Care Quality Commission’s (CQC) annual assessment of the state of health and social care in England, released in October, found that the system is ‘gridlocked and unable to operate effectively.’
In addition, the care provider organisation, The Independent Care Group (ICG), says that chronic neglect and under-funding has ‘left social care on the brink of collapse’ and has called for root and branch reform of the sector.
That is some of the most depressing and damning language I have heard in my 17 years working as a senior leader in adult social care and I find these the reports really upsetting to read. There is no doubt that we are facing a severe crisis. Something has to change and change drastically. The question is what?
I think there are three main areas we need to look at as a sector: funding, the use of technology and collaboration.
Funding the system
The Government has promised social care funding reform for years and years. The problems are well known and established. The COVID-19 pandemic has only brought these issues more to the forefront of the minds of a broader audience. As so many of us in the sector have been saying for a very long time, there needs to be a complete revolution: there is just not enough money to pay for quality social care.
Caring for people ‘well’ costs money because it is time-based. The environment is of course important. However, if you want quality care, then you must pay for the time needed to achieve this. You need well-trained, caring staff and a good ratio of carers to those needing care, so care is not rushed. The staff of course need to be paid a decent wage for their time, but the solution it is not just raising wages.
I have worked in many different care homes from luxury to budget. For me, as long as they are clean and offer a safe, well-run environment, the next single most important thing is the staff and how they are led. Good support, good training, good leadership, staff who feel valued – that is what’s important and what costs money.
Currently, there are 165,000 vacancies across the sector. Why don’t people want to work in social care? Many providers just cannot afford to pay staff much more than the national minimum wage. Many potential recruits (and existing staff) may well ask the question: ‘why should I work in care when I can earn more per hour working in Morrisons or Costa Coffee?’
A report by the Levelling Up, Housing and Communities Committee on the ‘Long-term Funding of Adult Social Care, July 2022’, recommends the Government allocates an additional £7bn increase in annual funding for the sector funding to meet the costs of reforms, rising costs and inflation and unmet care needs.
We need to address the low pay of the social care workforce, but it is not as simple as that. Social care also has to become a place where people want to work and can feel valued in their chosen profession.
The recruitment and retention challenges for the care sector are well documented. In a recent Skills for Care report, it highlighted those employers with high levels of learning and development on average, had better outcomes (such as lower staff turnover and/or high CQC ratings).1
The investment therefore cannot only be focused on wages; training must also include leadership training and accreditation for managers, recognised career pathways for the workforce and high-quality sector-wide training standards.
The Government has also said that, ‘The long-term sustainability of health and social care is dependent on having the right digital foundations in place, and so digital transformation must be the linchpin upon which all reforms are based.’2
Moving forward, the Government has set an ambitious target for digital social care: 80% of Care Quality Commission (CQC) registered providers to have digital records by March 2024.
Digital transformation
There is funding available – at the end of 2021 Digital Social Care announced £150m to drive digitisation across adult social care, with a total of £25m available for Integrated Care Systems in 2022-2023. This funding, in theory, will allow providers to adopt and scale digital social care technologies to transform the sector.
The challenge here is not so much around digitisation as a concept – it is the challenge of implementation. This is particularly true of smaller providers, but even the larger organisations will find it difficult. That’s because it’s not just about putting in a new system, it’s about implementing and using it. That’s no mean feat when you have hundreds of residents with paper-based records.
I have personal experience of this, where a care planning solution had been deployed unsuccessfully. We had to unpick what had been done, pause the implementation, retrain the staff and fix the gaps in the system, whilst still giving safe care, before we could continue the roll out.
It’s a very complex undertaking. Each individual might have 15 or more different care plans in use, as well as numerous daily interactions such as washing, dressing, eating and drinking. Each care plan will have a risk assessment attached and the information changes regularly. It all needs to be manually entered into the new system.
People also still need care 24hrs a day throughout the implementation, so there is a real risk of the wrong care/poor care if staff cannot locate the correct record during the changeover. Providers will need dedicated resources to move to a digital system as quickly and safely as possible – and implementation is really challenging. As with the care itself, to do this takes time and time cost money.
The move to digital care records is a concern for many providers in England in particular. This is because the Care Quality Commission (CQC) is to change the way it assesses care services in early 2023.
Collating the evidence
The new way of working will alter the relationship between the CQC and providers, as the regulator moves from an inspection-based framework to continual assessment. Providers will be expected to show how effective their care is through sharing data and information.
Digital systems open a new level of exposure, which is brilliant from a quality point of view. But the organisation must have the resources to use them and be able to complete the ‘so what?’ piece to make improvements needed that the live system highlights.
Having worked in the industry for a long time, I believe the tide has now changed following an initial reluctance to adopt new systems. Now it’s the carers who are really pushing for change, particularly the ‘app’ generation.
They like the convenience of hand-held devices, because they can record the care they are giving, as they are giving it. Mrs. Jones had a drink, had a wash – tick, tick, no writing. They don’t want to sit at a desktop, they want to use their devices as it saves time.
Although at workforce level it’s popular, there is some reluctance at the senior management level, mainly due to the difficulties of implementation I have mentioned. In order to have the app that records Mrs Jones’ activities, you have to have Mrs Jones’ data in the system and it has to be up to date.
With the lack of resources and severe staff shortages adult social care is suffering from, it’s a very challenging proposition to make the changeover effectively.
There are clear benefits to adopting digital technology. It will drive quality upward; it will save time. By making it quicker and easier to record care, carers can spend more time caring, rather than spending hours and hours writing reports. When implemented well, when managed well, it will allow people to have more quality interactions with those caring for them.
There is something of a myth that digitisation makes life easier. Yes, it does in the long run, but what is does so well is immediately display all the work you have to do. I can sit at my desk and do the audit, see the gaps, solve the problems and provide improved quality care quicker.
Leaders have greater visibility and will be able to improve the service they provide. They will be able to see problems, see them live and fix them quickly. In a paper-based environment, you don’t see the issues until you choose to do the audit.
Building a bright future
More funding and the drive towards digital care records are positive initiatives. But the real challenge is: How are we going to make it work?
This is where collaboration becomes essential. The current lack of collaboration and shared data between health and social care can lead to delayed transfers of care, poor discharge planning, and a high level of readmissions.
The aspirational goals for Integrated Care Systems (ICS) launched in July this year is joined-up care, where records are easily shared and transferred between different health and social care services. If we can achieve what ICS’s aim to deliver, then we will be really changing things for the better.
According to the Government, ‘Digital transformation of health and social care is a top priority for the Department of Health and Social Care (DHSC) and NHS England (NHSE). The system’s long-term sustainability depends on it.’
I could not agree more with this sentiment, but we also need the funding, resources and commitment to a long-term plan that elevates social care as a priority, not an afterthought.
How the sector and its workforce are perceived must be elevated to a place of value and respect alongside our NHS colleagues. If we don’t achieve this, then we will not be able to retain or grow our workforce. The call to arms for digital transformation and other new initiatives will go unanswered if we won’t have the workforce, we need to implement the bright future these initiatives promise.
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