Recruitment has always been an issue for the care sector and it is likely to endure. The sector forecasts a shortage of 350,000 workers by 2028 assuming no significant changes are made. In reality, slow but steady technology improvements, provided the funding emerges, will chip away at this number. In the short-medium term, though, it will continue to be a problem.
It isn’t hard to detect the sources of the problem. Social care is mostly hard, unglamorous work for relatively poor pay, similar to other sectors such as hospitality. One think tank estimated that as many as half of the social care workforce may be being paid below the real living wage. In an era where young people are constantly comparing and contrasting each other’s lives using social media, spending your days caring for older people is unattractive. Even the potential for quick promotion due to the talent shortage is not enough to counter-balance this fact.
With funding pressures unlikely to be quickly alleviated, wages in the sector are unlikely to increase. The only structural factors that may have a positive effect on recruitment in the sector, ironically, would be an economic recession, releasing excess labour into the market. Unless there is significant economic pain following Brexit, this also seems remote. The job market, despite the problems in retail, has performed well in recent years. Brexit, depending on what deal is reached, may also reduce the ability of providers to source carers from EU states.
Larger care providers, of course, have the resources and freedom to be able to innovate with their recruitment. One provider is planning make more use of social media and capitalising on the real experiences of carers to spread its message. Skills for Care has been discussing the possibility of creating a clearer career pathway for carers, although this feels unlikely to seriously shift perceptions. For smaller providers, it looks like the challenge is going to remain.
2018, as well as an increased emphasis on mental health across all ages, saw numerous campaigns on loneliness among Britain’s older population (and to a lesser extent, in its young people too). Many of those older people who are lonely, of course, are not the types to be on social media campaigning themselves. Change has to come from specialist groups and volunteers.
Loneliness is a real problem. Age UK estimates an incredible 3.6 million older adults live alone, 2 million of which are over 75. They claim that this loneliness can be as damaging to their health as smoking 15 cigarettes a day and more harmful than obesity. The implication is a simple one: if we can put so much resources and attention on reducing smoking and obesity, why can we not do the same to combat loneliness?
It does not take a big leap to see how this impacts on social care. Lonelier adults are more likely to have poor health outcomes and to see their physical and mental condition decline, pushing them into social care. Creating a more social environment for these people would therefore have a big preventative effect, potentially reducing the burden on the health and social care system.
What can the sector and the government do about this? At the moment, the social care sector has no incentive to tackle loneliness. Its funding is based on those it helps, not on those it keeps out. The government is likely to support volunteer projects led by groups such as Age UK with grant funding and possibly facility access. Either way, expect more pressure from the third sector on the issue.
Reablement is becoming an increasingly hot topic in the health and social care sector. As budgets continue to come under pressure, reablement offers a way to reduce costs for councils whilst maintaining peoples’ independence.
In 2018, we released an ebook that covered the basics of reablement. We have now produced this in a blog format so that you can easily find out the information you need on this topic. You can still download our PDF ebook for free, though, if you prefer.
What is reablement?
Sometimes, when people experience a sudden deterioration in their health or physical condition, they need help to adapt so that they are able to maintain independence and live full lives. This help, usually short and intensive, is called reablement.
Reablement is becoming increasingly important for people and for society overall. As health and social care costs increase, the focus for services is to encourage people to live independently in their own homes for as long as possible. Technically speaking, reablement is a form of ‘intermediate care’, which is a type of short-term support from health and social care services. Intermediate care as a whole is designed to encourage independence and prevent unnecessary hospital or care services admissions.
The remaining three types of intermediate care are:
Crisis response – By definition, an assessment and short-term care that typically lasts 48 hours or less, and is designed to prevent a trip to hospital or a care facility.
Home-based intermediate care – Services provided in a person’s own home or in their care home.
Bed-based intermediate care – Services delivered in a hospital or care home.
Who can receive reablement?
Reablement is designed for people who have had a sudden change in their physical condition. They may have become disabled, suddenly frail from an illness, or they may be recovering from an accident. Reablement helps them perform normal, daily activities that we may take for granted, such as getting around the house, washing themselves or cooking. This may mean helping them adapt to their new physical condition and state of health, or relearning skills.Who exactly is eligible for reablement depends on the local authority.
Since one of the aims of reablement is to reduce costs to local services, resources tend to be targeted at people who are most likely to benefit physically from reablement. This means that individuals with severe mental illnesses, degenerative diseases, or who are receiving end of life care, are less likely to receive support. GPs or other health services can also refer people for reablement services.
Benefits of reablement
Many people benefit from reablement: the people using the service, their families, and their wider community.
The Social Care Institute for Excellence (SCIE) claims that reablement is typically welcomed by people receiving support, and they experience greater health and social care outcomes compared with those using home care. Their quality of life tends to be better, and their physical condition is more likely to improve.
Although we tend to talk of independence in terms of its benefit to local services, there is also the underestimated impact on the individual. Many people don’t like asking for help, and transitioning from being independent adults to being at least partly dependent on carers or family can be incredibly difficult.
Reablement allows these people to retain their pride and dignity. This means that their personal relationships are likely to be stronger. Although many families help members who are struggling physically, it can sometimes place strain on their relationships. Maintaining a person’s independence helps them, in turn, maintain strong relationship with their family, their friends and their local community. This prevents social isolation and loneliness.
The reablement process
Assessment: Reablement starts with an assessment, usually by a healthcare professional, of whether a person may benefit from it. The assessment will take into account factors such as the person’s mobility, what skills they still have, their physical strength, and their ability to perform basic tasks such as cooking and washing.
Frequent, longer visits: The purpose of reablement is to help a person very quickly become independent once again. This means that reablement workers may make frequent visits, but it also means they are less likely to intervene in the performance of tasks than a traditional care worker. They are more likely to observe and encourage, only taking over or helping directly when necessary. These visits are therefore likely to be longer than normal care visits. Workers may be specifically trained in reablement, but they may also be physiotherapists or occupational therapists.
More assessments: Reablement workers aim to help a person regain their independence as quickly as possible. They will assess often to determine when the person no longer needs support.
Adjustments or Equipment: The reablement workers, or an occupational therapist, may recommend that adjustments be made to a person’s home or that assistive aids be introduced to help them remain independent. Such aids may include a stairlift or support bars in the bathroom.
Forward Planning: If done properly, the planning for what happens after reablement ends should begin at the very start of the process. This planning will involve healthcare professionals, the reablement workers, the individual receiving support, and any family or friends who may be involved in any ongoing care and treatment.
The impact of reablement
Reablement has been an active policy since 2010. SCIE have reviewed the impact of reablement across numerous independent and official studies and have found that it has had an overall positive effect. They concluded:
Reablement is becoming a ‘default’ service whenever needs are identified, rather than just being available to those leaving hospital.
63% of reablement users no longer need the service after 6-12 weeks.
People and families appear to have welcomed reablement. People in the study seemed to have been particularly pleased with the speed of the service.
Reablement is proving likely to be cost-effective by reducing long-term care costs. Although the upfront costs are higher (on average £2000 for reablement compared to £1,392 for 6 weeks of home care), 26% of users had a reduced need for home care hours after going through the process. The overall need for care services is reduced by 60%.
Nevertheless, some issues were noted. Some people felt that they were not given enough assistance with performing domestic tasks at the start of the reablement process. There was also a concern that some of the reablement ‘ethos’ was lost in handovers between service providers.
SCIE have also noted that the skills required for reablement are very different from those required for traditional care work. For example, reablement staff are required to observe and watch rather than directly intervene, a skill that can be difficult for someone used to helping others. There is also a need for “active reassessment” at every session to track progress and identify need. Reablement workers also require more flexible working practices than is typical, since it’s important that the reablement worker(s) visiting the individual remains consistent. Managers and supervisors need to ensure any staff participating in reablement work have the appropriate training.
Perhaps the most interesting point from SCIE’s research summary, though, is that individuals receiving support need to change their expectations and attitudes if reablement is to work properly: “reablement was considered to be more successful if service users were motivated – ‘people have got to want to do it.” The reablement worker could be crucial here as a motivator, and managers and supervisors may wish to ensure reablement workers have positive outlooks themselves.
The remaining questions
Reablement is a relatively new concept in social care and there are still some questions that require more research. The National Institute for Health and Care Excellence (NICE) released a paper in 2017 outlining some of these questions:
How effective is reablement for people with dementia? Although local authorities are currently less likely to provide reablement services to people with dementia, there is still little evidence or research as to whether those with early stage dementia – or their families or carers – may benefit.
How effective and cost effective are repeated periods of reablement, and reablement that lasts longer than 6 weeks? Although this document has assumed a single period of reablement, there is no technical limit to how often reablement services may be provided to a person. In practice, reablement is only funded for 6 weeks, even if sometimes it is offered for longer and more frequently. Therefore, there are no studies as to whether these extended periods of support are cost effective or deliver better outcomes for the individual.
The Government published its long-term plan for the NHS this week. We’ve looked at what it means for mandatory, clinical and specialist training for the next decade:
Focus on mental health
There has been a huge emphasis on mental health in the media and in politics in recent times, and this has carried over into the NHS. Mental health training features on a number of occasions. There is a recognition in the plan that certain groups of young people are particularly vulnerable to mental health issues, and it says that teams will receive “information and training to help
them support young people more likely to face mental health issues – such as Lesbian, Gay, Bisexual, Transgender (LGBT+) individuals or children in care”. The plan recognises that “preventative support” is important to help address problems before they have serious repercussions.
The plan also says that ambulance staff will receive training to help deal with people with mental health issues who are “in a crisis”. Some trusts are already doing this, but growing awareness of the scale of mental health problems in the UK and the impact it has on 999 calls means that all ambulance staff will soon be able to help with issues.
Training to improve end of life care
One of the aims of the plan is to “personalise” and “improve” end of life care. This, it says, will mainly be accomplished by training to help staff identify patients’ needs as they head into the final stages of their life. The plan hopes that this will reduce emergency admissions, but the majority of people will see this as a necessary part of a caring modern society.
There is little new about a wish to improve end of life training. Former guidance has included breaking down training into “bite-sized” sessions to build knowledge quickly, as well as role modelling good practice at every opportunity. It will be interesting to see how this new commitment bears out in practice, and whether it will mean mandatory, classroom-based courses for practitioners.
Learning disabilities and autism awareness
The plan states an intent to roll out training in awareness of learning disabilities and/or autism to NHS teams. The plan alludes to a consultation published in 2018, which says that the aim of the training is ultimately to help staff “support people with a learning disability, their families and carers; to ensure that perceptions of learning disability do not prevent a robust assessment of physical health, and that staff can make personalised, reasonable adjustments to care”. The skills and competencies required for this awareness have already been outlined in the Learning Disabilities Core Skills Education and Training Framework.
If this roll-out follow the recommendations included in the consultation, it means that a further consultation on proposals will begin in March this year, as well as an audit on skills in the NHS workforce. The CQC will monitor the uptake of the training from its full introduction.
Dealing with violence
The long-term plan mentions that a programme has already been launched to train staff in how to handle violence. This may include positive behaviour support, de-escalation training, and breakaway techniques. Its inclusion in the plan emphasises that this is a growing problem and such training is here to stay.
Click here to see what courses Advantage Accreditation can support you to deliver.
The Care Certificate was launched in April 2015. At the time and since, it has been subject to many myths and misconceptions. What is the Care Certificate? What do your staff need to do to be able to complete it?
What is the Care Certificate?
The Care Certificate is a set of 15 standards that care workers should follow in order to do their job successfully and provide a good level of care. It was developed together by Health Education England, Skills for Care and Skills for Health and based on the requirements of the Cavendish Review. It replaced the Common Induction Standards and National Minimum Training Standards, its direct precursors.
The Care Certificate is fairly similar to the Common Induction Standards in a number of ways, but included new standards that recognised the modern challenges in the health and social care sector, such as mental health issues and dementia (Standard 9), safeguarding (Standards 10 and 11) and information privacy and governance (Standard 14).
Who need to do the Care Certificate?
Any new health and social care workers from April 2015 were required to ‘do’ the Care Certificate. If you use agency, bank or temporary staff, it is up to you to determine whether they have training suitable to perform their role.
If you have hired someone who claims they have undertaken training in the standards with a previous employer, then you should still take steps to verify their claims and assess their competence in the workplace.
Is it mandatory?
Technically, the Care Certificate is not mandatory. Although it was widely expected pre-April 2015 that this would be the case, Skills for Care confirmed in 2015 that the Care Certificate had no statutory power behind it.
In their own words, however, “the Care Quality Commission will expect that appropriate staff who are new to services which they regulate will achieve the competences required by the Care Certificate as part of their induction”.
In practice, this means that the Care Certificate is effectively mandatory, or at the very least expected best practice for care providers. The CQC actively look for evidence that:
The Care Certificate forms part of the staff induction process, or if not, a suitable alternative is used;
Staff know the standards and that they have been trained in them and assessment against them;
The provider is actively assessing against the competencies in the Care Certificate.
The CQC use the Care Certificate as a baseline because that is precisely what it was intended to be, to apply to both regulated and non-regulated workforces. Assessing against the Care Certificate help ensure a minimum standard of care for everyone.
Is there a time limit?
Another myth perpetuated at the time of launch was that Certificate had to be completed within 12 weeks of induction. This belief actually originated from Skills for Care’s own pilot project that showed that 12 weeks was the approximate time it would take someone to demonstrate the competencies and knowledge. Again, technically, there is no time-limit. All the CQC need to see is that it forms part of the “induction process”.
What do staff need to do to complete the Care Certificate?
‘Completing’ the Care Certificate is not as easy as sending staff on a training course. That is because it requires a joint-effort on behalf of both the care worker and the employer. Care workers must demonstrate knowledge and understanding of the Care Certificate, but the employer must assess this is their everyday work.
Many providers use a combination of methods to help new staff understand the Care Certificate. Classroom-based training, distance learning or e-learning can help with many of the more theory-based standards, although distance learning or e-learning alone is likely to be insufficient for Standard 12: Basic Life Support. The assessor should then look for examples in their everyday work that they are actively applying the standards, or, if such situations do not present themselves, create scenarios to help them demonstrate their knowledge and skills.
What resources are there to help?
Skills for Care and Skills for Health have produced a number of free resources, including guidance on all standard, a self-assessment tool, and free e-learning.
Advantage have also developed a distance learning package designed to meet the needs of both staff and employers, including assessment sheets and easy-to-follow knowledge guides. Get in touch to find out more.
Readers will be well advised to read a very interesting and provocative article in The Spectator on the need for reform in the social care system, concluding the system needs much more than just fresh cash.
The article, by James Mumford, who led a review of social care for the Centre for Social Justice, argues that funding is not the only answer for social care. Especially since, as implied in the last general election campaign, many seem unwilling to countenance a change in funding in order to fund those in need.
As Mumford points out, though, as we have consistently said on this blog, that lack of funding is not the only issue with our care system: “It is not a funding issue when a resident isn’t given a glass of water. It is not a funding issue when people in charge fail to deliver. And it is also not a funding issue that we, so often, look the other way or quite simply stay away.”
Mumford points out that when people are moved into a care environment, they are typically cut off from their possessions and their social connections, and are seldom given the opportunities to develop new ones. As a result, their mental well-being deteriorates along with their physical health. Mumford references a recent social experiment broadcast on television where children entered a care home and caused an increase in the physical health of residents, evoking a similar scheme in the US.
Mumford also echoes Advantage’s calls for us to think bigger and in a more imaginative way, citing the proposal from a New York doctor for smaller but more homely facilities for the elderly. Above all, he stresses the need to end the “marginalisation” of the elderly. There are no shortage of ideas to help with this. One idea mentioned in our Future of Care report called for housing schemes to be designed around the young and the elderly.
Increasingly, the mood seems to be that funding is not the only answer for care. Instead, we need radical and progressive thinking that recognises the need for a change of culture and mindset.
The results of an Advantage survey for a new report on the Future of Care show that many in the care sector are pessimistic about the future of the sector and the quality of care.
The survey asked respondents to rate their optimism about the future of the sector out of 10, with 10 being very optimistic, and 0 being very pessimistic. The average rating was just 3. Of those that delivered very low ratings, the main reason stated was a fear of demand outstripping supply and funding. Only 13% of respondents gave a rating of 6 or above.
A majority also felt the quality of care would suffer in the foreseeable future. Of those that answered ‘Other’, the general feeling was of stagnation.
Why did our survey respondents feel so negatively? What can we do to help our social care system prosper? Download our new report on the Future of Care to find out.
The head of NHS England has signalled that there is no intention of ending plans to more closely link the British health and social care systems.
A report from the National Audit Office earlier this year suggested that health and social care integration was not being carried out effectively enough to deliver the desired results, although where it was done well there were undoubtedly benefits.
Addressing the NHS Confederation in Liverpool, Simon Stevens reiterated that the course had not changed, and said that his priority was to end the “fractured” health and social care system, with nine areas covering 7 million people to be targeted as priority areas for integration.
The integration at a local level will be driven by ‘accountable care systems’ (ACSs), which will bring together local NHS organisations with voluntary groups and care organisations. The intention is to build on those local areas where successes have been made, which has had a particular impact on hospital admissions.
Although many will, without debt, criticise some integration efforts, but the evidence from the NAO’s report does suggest that there are benefits when it is done well. Experimenting across different localities may not always be pretty, but we can all acknowledge that our care system needs a shake-up, and we should welcome any moves that improve welfare whilst alleviating burdens on overstretched public services.
A new start-up is seeking to let more people with dementia live in their own home by using technology.
Adam and Daniel Pike started SuperCarers in response to their own family’s experience with dementia. Their grandmother suffered with the disease, but preferred to stay in her own home. Lacking the finances to pay for private carers, the family relied on local authority carers until eventually Adam and Daniel’s mother took over. As the condition worsened, however, the family had to turn to residential care. The Pikes’ grandmother, they say, resented the decision, and made their mother feel guilty about it until the day she died. The impact is still with their mother even ten years later.
Recognising that 90% of over-50s who need care would rather stay in their own home, SuperCarers is attempting to reduce the costs by linking carers and families online directly, eliminating the need for agencies and their associated costs and overheads. SuperCarers acts as an introducer, and as such is not regulated by the CQC.
The Pikes argue that this gives more families more cost effective care over which they can exercise more control. Further, since SuperCarers is an introducer and not an agency, carers are self-employed and can set their own rates, meaning they will typically earn more than if they were part of an agency.
This new model has led to calls from some, including the UK Homecare Association, for the government to introduce new regulations to take account of changes in the health and social care market. This does not seem to be on the horizon, though. Further, SuperCarers seems to be taking its role seriously, with its team of advisers including luminaries from the CQC, the National Dignity Council, and even an ex-minister. It’s next step, according to the founders, is to build relationships with the NHS to help speed-up discharges and reduce the 445,000 days a year elderly people to spend in hospital while waiting for in-home care.