Over the last year, the number of local Healthwatch citing improvements to home care services as a priority for their community has doubled. Our new report explains what people have told Healthwatch about their experience of home care.
Across England there are more than 5,500 home care providers, collectively helping an estimated 673,000 people to continue living independently within their communities. Home care services help people live at home for longer by offering support, such as regular visits from a carer to help with personal care, getting dressed, using the toilet, shopping and preparing meals.
Our new report Home care services: What people told Healthwatch about their experiences, analyses the experiences of 3,415 people, their families and front line staff across 52 local areas between August 2015 and June 2017.
Most people had positive things to say about their home care. These services are invaluable to many people, both for the quality of care provided and the support and company of care workers.
Older people in particular said that one of the most positive things about home care is that it enables them to remain in their own home and to maintain as much independence as possible.
However, we also discovered four areas where people’s experiences could be improved.
- Care planning – People spoke a lot about staff who were unfamiliar with their clients’ care plans. In cases where it was a staff member’s first visit to a client, they often didn’t have enough time to read the care plan in advance. A care user speaking with Healthwatch Blackpool said, “Unless they have attended before they do not know what has to be done.”
- Skills and qualifications – Many people said they valued the dedication and experience of staff sent to care for them. However, people said that some care workers lacked experience and basic skills, such as the ability to wash someone or make them breakfast. One resident in her eighties told Healthwatch Bradford that one of her carers was unable to boil an egg or make the bed, while another person said care workers needed to be taught “home care common sense.”
- Consistency and continuity – All local Healthwatch found problems with staff coming at different times and even missing appointments. Healthwatch Staffordshire heard froma number of people who felt that care packages were designed to meet the needs of the service provider rather than the service user.
- Communication and feedback – Providers need to make greater and more regular use of feedback to address problems early and prevent minor issues turning into complaints. Several people who spoke to Healthwatch said they had only communication with the organisations providing their care. Healthwatch Bucks found that all communication with clients of one provider went through frontline staff. This created problems when staff were on holiday or off sick.
Neil Tester, Deputy Director of Healthwatch England, said:
“It’s often incredibly important to people to be able to stay in the familiar surroundings of their own home. One of the most positive aspects of home care is that it enables people to hold on to as much independence as possible.
“We listened to people using home support services and those delivering care and they have given us a clearer picture of how the system works for them. We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards.
“Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard. So if anyone has a story they want to share or an idea they think might help, I urge them to get involved and speak to their local Healthwatch.”
Welcoming an analysis of the views of older and disabled people by Healthwatch England (note 1), Bridget Warr CBE, Chief Executive of the United Kingdom Homecare Association (note 2), said:
“As a society, we should be proud that the vast majority of people receive good support at home, but concerned that this is not always the case.
“Healthwatch’s report adds to the growing body of evidence on the human impact of a fragile care system. UKHCA strongly believes that the solution is properly resourced services, commissioned in a flexible way, so that front-line careworkers have sufficient time meet people’s needs in full.”
UKHCA’s assessment of the findings from Healthwatch’s report supports the Association’s view that an underfunded care system has a direct impact on the experience of people who receive home-based support and their families. In serious cases, this can affect people’s wellbeing, particularly around safe administration of medicines.
In addition to proper funding, local councils (who commission the vast majority of homecare in England) need to address the impact that their contracting arrangements have on service delivery, and care providers’ ability to recruit, train and retain an experienced workforce able to meet the needs of an aging population.
Margaret Willcox, President of the Association of Directors of Adult Social Services (ADASS), said:
“This report provides a welcome insight into a vital service which many of us will need at some point in our lifetimes.
“Home care is essential to enabling older and disabled people to remain in their own homes. They and their families need and deserve it to be of high quality. Every minute of every day dedicated home carers make a difference to over a million people’s lives.
“Most adult social care services in England are providing people with safe, high quality and compassionate care. That they are doing this in the context of rising demand and inadequate funding is a tribute in itself but there is always room for improvement and this report provides helpful feedback that both commissioners and providers can use.
“We look forward to contributing to debates with government about finding a long-term sustainable solution to future-proof adult social care funding and delivery.”
Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said:
“Home care services provide the vital support for some of our most vulnerable citizens to remain independent in their own homes. Councils are committed to driving up standards of care and work closely with local providers to try and continuously improve services for people who rely on home care.
“This report shows that while most people report that their services are good there is a need to improve services. The financial pressure facing services is having an impact and even the very best efforts of councils are not enough to avert the real and growing crisis we are facing in ensuring older people receive the care they deserve.
“The continuing under-funding of adult social care, the significant pressures of an ageing population and the National Living Wage, are combining to heap pressure on the home care provider market. This study shows the strain providers are under, and emphasises the urgent need for a long-term, sustainable solution to the social care funding crisis.
“While the £2 billion announced in the Spring Budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3 billion funding gap by 2020.
“It is absolutely critical that the Government brings forward its Green Paper on the future of social care announced in the Queen’s Speech, and that it works with local government leaders in delivering a long-term sustainable solution for social care. This must address the issue of long-term funding, but it must also create the conditions necessary to ensure the development of the right kind of care and support services.
“This is the only way to protect vital support services, like home care, ensuring older people and those with mental health conditions, learning and physical disabilities live dignified and fulfilling lives.”