On 5th November, instead of going to a fireworks display, I went to the WMAHSN Patient Safety Symposium. And what a fascinating day it was, to spend a day with so many committed, inspiring, and open minded people, was genuinely exciting.
From my perspective on planet Social Care, the thing that stood out was the genuine desire to engage and work with my sector. In his opening remarks, Professor Gavin Russell said: “We need to get into social care,” and no one dissented.
However, in the many conversations that I had with attendees during the day, I found a surprising and profound lack of knowledge about what social care is, how it is structured and what we actually do.
One of the issues seems to be that both sectors use the same regulator and appear to speak the same language, so there is an assumption that we all understand each other and already know what we all do. After all we have all been around for ages, so we must know, mustn’t we?
Unfortunately, the truth is rather different. Just like the UK and the USA, we are divided by a common language: we both think we know what the other one means, but we don’t really and no one checks.
We have a fantastic opportunity to positively impact on the quality of life of our clients, our patients. Working together creatively we can, in line with the priorities outlined for the Patient Safety Collaborative, reduce the number of hospital admissions for conditions such as pressure ulcers, by focusing on nutrition and hydration in the vulnerable, isolated elderly.
The cost to the NHS of frequent admissions that are directly attributable to social isolation is immense. Interventions through collaboration with the social care sector can change this both from a financial and qualitative point of view.
If we are to work together constructively, and believe me we want to, then we need to understand each other. If we are to overcome the obstacles to integration then we need to know where they are hidden; so much seems to be based on assumptions which, while understandable and reasonable, do not reflect the reality of the social care environment.
In this, the first of a short series, I will try to give an idea of the size and makeup of the social care industry and workforce, and also attempt to highlight some of the difficulties that will have to be overcome. In future articles I will describe the many and disparate parts of the sector, and how care is regulated, commissioned and paid for.
It is estimated that social care in England currently employs 1.5 million people, in 38,900 different establishments, but only about 17,500 of which are actually regulated by CQC.
There are in the region of 17,300 different social care organisations managing those establishments, and only around 400 of these employ more than 250 people. Almost 85% of organisations employ fewer than 50 people.
Only 14% of the workforce is directly employed by the NHS or local government; up to 76% work for independent businesses. The voluntary sector accounts for no more than 19% of the total.
The split between residential and domiciliary workforces is roughly equal, with 640,000 in residential and 630,000 in domiciliary. (The source for all the above is The size and structure of the adult social care sector and workforce in England 2014, Skills for Care.)
According to UKHCA’s Overview of the Domiciliary Care Sector 2013, approximately 500,000 people received home care from a local authority, and it is estimated another 150,000 have made private arrangements. There are thought to be 376,000 people living in care homes, of whom something like 40% have a diagnosis of dementia.
89% of publicly funded home care is provided by the independent sector. As recently as 1993 this was only 5%, so in the last twenty years there has been an unnoticed revolution in homecare provision.
Note the use of “approximately”, “estimated”, “almost”, and “in the region of”; it is remarkably difficult to establish hard factual information.
According to Skills for Care, social care has been described as a “data desert”. And it is a big problem when it comes to providing measurable and academically reliable data. For example, the majority of the employment figures mentioned above are derived from the National Minimum Data Set for Social Care, which is managed by Skills for Care on behalf of the Department of Health. They began collecting data about social care providers and their staff only as recently as 2006 and while the volume and quality of its data has improved, its single biggest weakness remains that it is voluntary.
This is important to recognise when you are used to dealing with facts that are researched and proven – facts that have been measured, challenged and peer reviewed. In social care, it could be said that we are to some extent running on anecdote.
We need new thinking and new ways of thinking to work together. The disparate and often competing social care providers cannot speak with one voice nor can they be spoken to collectively.
To integrate effectively, we need to produce methodologies that accept “we are where we are” methodologies that do not rely on hard factual data as a starting point but rather use an experimental approach, testing hypotheses and exploring possibilities.
There is a great future for integration. Together, we can make serious inroads into unnecessary admissions and the general health of vulnerable people and the huge costs that that entails, both financial and personal. But it won’t happen easily, and if we do not have a realistic understanding of each other it won’t happen at all.
One step would be to stop referring to us as “and social care” it’s a lot more complicated than that.
Nick Smith is National Training Manager at Home Instead Senior Care