Care home bosses back calls for urgent reforms
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NHS will cease to function without fundamental changes to system
Care home bosses in Wales have backed a call for urgent reforms of the way services are commissioned and paid for.
Care Forum Wales (CFW), an organisation which represents 500 independent care providers, said a review into the quality of life and care of older people in care homes in Wales conducted by the Older People’s Commissioner had revealed worrying flaws in procedures for commissioning social care.
According to Sarah Rochira’s report, A Place to Call Home?, the way care is procured is often more about “contractual frameworks and service specifications” rather than the quality of life of older people. CFW chair Mario Kreft said the report had also highlighted the fact that it was less viable to run care homes in Wales than it was in England. As a result, an increasing number of homes were closing because they were not viable at a time when the need for them was growing because of the increase in the number of older people in Wales.
Care Forum Wales, he said, supported Sara Rochira’s demand for a new approach which would see services being commissioned for quality rather than reinforcing a “culture of compliance to the bare minimum”.
“The report is an important piece of work but it does not fully recognise what is being achieved despite the system and does not give enough credit to the good quality care being provided by many good people across Wales,” said Mr Kreft.
“Yes, the standard of care can be inconsistent in places and where there is bad practice it should be rooted out, but the majority of providers are doing a remarkable job in the circumstances.
“Most care homes and nursing homes provide a very good standard of care while there are many examples of excellent, life-enhancing quality care taking place, often under difficult circumstances and with extremely limited resources because of the chronic underfunding of social care in Wales.
“Many of the report’s findings and recommendations, however, chime with what Care Forum Wales has been working hard to achieve, particularly in relation to importance of treating vulnerable people with dignity and respect and designing services to improve quality of life.”
Mr Kreft said that, among the report’s important recommendations was the call to reform the deeply flawed commissioning process which he said encouraged a tick box mentality rather than fostering a person-centred, outcome-based attitude which is about ensuring the best possible quality of life.
“Unfortunately, the social care sector in Wales is blighted by many years of chronic underfunding which causes a whole raft of problems, not least the fact that it suppresses pay levels for staff,” he said.
“The commissioning process should be about quality and securing value for money and not about paying the lowest possible price.
“The report has underlined that it is less viable in Wales than it is in England to provide these vital, community based services – and that surely cannot be right when we owe so much to the people for whom we are providing care. It is essential that residential care homes and nursing homes are viable businesses otherwise the whole network will collapse.
“The fundamental problem is that in Wales we don’t commission for quality, it’s more about price and we then work backwards from the fee that we’re given by local authorities and local health boards. The commissioner rightly calls for consistency but unfortunately we are working in a system that has 29 different commissioning bodies and this militates against consistency.
“On top of that, we don’t regulate against the service that is being commissioned so we are regulating for a service that in many ways would be an ideal service with unlimited resources.”
Mr Kreft said 11,500 nursing care beds in Wales were underpinning the ability of the NHS to function.
“The report makes no distinction between the private, public and third sectors but the fact remains there are simply not enough new homes being built in any sector to replace the ones that are being lost and this will affect communities across Wales,” he said.
“If we don’t sort this quickly the closures are going to accelerate much more quickly than new investment is coming in – all at a time of soaring demand in an ageing society and when the NHS is also bursting at the seams.”