While care homes have faced incredible challenges over recent months, one thing has been unwavering – their commitment to supporting people during the crisis.
Amid the difficulties, it is important to recall that prior to the pandemic some councils were making real progress in terms of helping vulnerable people to remain independent. One metric to evidence this philosophy is a reduction in residential care placements, in order to improve outcomes and reduce costs. A number of our clients were able to reduce numbers by up to 10% during the last financial year.
Our vision is for local areas to have an adult social care system that builds on a person's strengths and maximises their independence through community-led support. We believe the focus should be on helping people to make more informed decisions about their support needs, embedding early intervention that builds on people's natural networks of support, and on putting people with long-term support needs at the heart of decision making.
Making this vision a reality requires changes across both the health and care systems, and IMPOWER's EDGEWORK approach enables the mindset shift and provides the tools needed for working across organisational boundaries in a complex system. A key element is working with frontline practitioners to help change the way citizens engage with services; transforming conversations to focus on outcomes, strengths and assets. Changing the mindset across a council and its partners allows professionals to focus on their vocation – improving people's lives.
We have worked with councils to support their response to COVID-19 and have closely followed the impact of the pandemic on residential and nursing care homes. The challenges faced are well known – the inconsistent supply of personal protective equipment (PPE), the lack of a responsive and co-ordinated testing programme, the prioritisation of funding flows based on building capacity and resilience in the NHS rather than in social care, and the limited infrastructure of small and medium sized independent sector providers, hampering their ability to respond.
The impact of these challenges was unfortunately that COVID-19 spread quickly in care homes and in some cases led to a higher than normal rate of mortality. In addition, a reduction in people being admitted to homes (due to families being able to support them during lockdown as well as fear of becoming infected) resulted in an unprecedented sudden drop in the numbers in care homes – a reduction of up to 9% across April and May.
The repercussions of COVID-19 have been profound and every death is a tragedy. At the same time, the recent reduction in placements and the likelihood of continuing reluctance to place people into care homes has created an opportunity to fast forward positive change and benefit generations to come – albeit one that needs careful steering.
Firstly, any reduction in residential and care market capacity needs to be managed very carefully, in order to ensure that the right level of quality and access remains available to respond to changing levels of need and demand, and at the right price. Minimising disruption to people living in care homes will be absolutely crucial.
Secondly, there needs to be an investment in alternative provision, in parallel with the re-shaping of the care home sector. One of the most critical elements is a robust home support market, with the capacity and skills to support people to live independently at home. In a number of areas, years of austerity has impacted on the ability to recruit and retain a care workforce. Going forward it will be important to ensure that terms and conditions of employment are competitive against typical alternatives, and that the social value of the sector is emphasised as a differentiator.
Thirdly, there is an opportunity to invest in building communities, harnessing the goodwill and relationships developed with the voluntary and community sector during the pandemic. This requires empowering communities to develop their own offer based on the needs of their populations, with social care providing the infrastructure. This should be bolstered by investment in assistive technology.
Finally, there is a need to accelerate support for strengths-based conversations, in health and in social care. The cornerstone of successfully reducing residential care placements in the year before the pandemic struck was enabling frontline staff to change the conversations they have with people, and focus on the assets and strengths of individuals and their support network. A personalised response to the person and their support network is crucial.
While the care sector has witnessed great tragedy over recent months, IMPOWER's experience of working with councils and their partners shows that positive change is possible. Here's hoping we can all build on that.
Stuart Lindsay is assistant director at IMPOWER Consulting
