A question of balance

Posted on January 4th, by geoff in CT blog. 1 Comment

Des Kelly gave a talk following the Caring Times Christmas lunch on December 10 – although spoken without notes this is the gist of the presentation.

Reflecting on the journey travelled I chose ‘A Question of Balance’ – taken from the Moody Blues album – as the title of my personal reflections because it seems to me to best capture the idea that across a 30 years or so horizon, residential care might be described as being in a permanent state of ‘crisis’.

In the 1980s there were concerns about the quality of care that led to the 1984 Registered Homes Act and the formation of the Wagner Committee the following year. This led to the publication of Residential Care: A Positive Choice in March 1988. As a member of the Committee which was established by Norman Fowler, as Secretary of State for Health, and the only care home manager on the group I am hugely proud of the report and the recommendations made all those years ago. Most of the recommendations made in the report have either been implemented or overtaken by subsequent events and it is easy to miss its importance in setting a professional standard for residential care.

Physical standards have improved through a combination of regulation and market forces, sweeping away multiple-occupied or shared rooms and introducing en-suite toilets. Such physical standards perhaps symbolise changes in the ways in which we now relate to people living in care settings. The notion of care and support personalised to the individual with rights and respect, voice, choice and control, privacy becoming accepted principles underpinning best practice. A valuable contribution has also been made by initiatives such as My Home Life.

A changing ‘market’

Market developments have been the response to a changing group of people now receiving care across this time period with more specialised and diverse services being delivered by an increasingly segmented sector. Such developments have happened by default rather than design and as a consequence there is a risk of practice being out of step with policy. On top of this there has been the ever-growing reliance on stimulating a ‘market’ of people able to fund the full costs of their own care to off-set the chronic under-funding from local authorities. It sometimes seems like the only strategy of almost all care providers.

The experience of inspection

Currently it is the actions of inspectors and their interpretations of regulation to produce a quality rating which appears to be the biggest concern of providers. Issues of consistency and proportionality are still causing difficulties. The delay between an inspection and receiving a report is also problematic. Providers typically express the view that there seems to be little appreciation by CQC of the reputational damage that can follow the publication of a report – even in draft form. The power balance is not yet right.

Future funding and the management of change

As the dust begins to settle on the Spending Review settlement and we assess the likely impact for social care we can expect that public sector spending will remain challenging for the next few years. As a consequence the market is the most uncertain and fragile that it has been for many years. Sadly, successive governments appear to have placed funding for social care in the ‘too difficult to do’ pile.

The introduction of the new National Living Wage (and especially maintaining differentials) will undoubtedly add to the difficulties of the care sector. It remains to be seen if the dire warnings of a mass exodus from the sector will materialise although it seems likely that capacity will be reduced as providers reconfigure or change their offer.

The future then, rests in the management of change and, in particular, the vital role of the registered manager. We have always known this but the evidence is growing stronger. The relationship between best practice and good frontline managers can be seen in the ratings of CQC. Good employers cherish their frontline managers and remember that it’s all a ‘question of balance’.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

One response to “A question of balance”

  1. Tony Stein says:

    Des makes some good points. I’ve spent much of the festive season mulling over the issue of funding for care, the problem Des correctly suggests politicians have shelved as being ‘too difficult’ to deal with.

    Care has to be seen in the wider context of the economy.
    We live in a world of increasing inequality. Imagine a pyramid with the wealth increasingly migrating towards the point at the top. The growing number of less well off at the bottom are living longer and need more care. Previous generations (and to some extent the current generation) have the benefit of some equity in their properties to fund their care however, rather like the fossil fuels, this is rapidly vanishing. Operators are concentrating on those with some ‘family silver’ left to pay for their care and the publicly funded are largely ignored – they are the government’s problem.
    In the longer term we need to ensure that people have the opportunity to buy their own homes as this is one of the principle ways that people will be able to generate equity to pay for their care in their old age. The increasing number of people forced, through high house prices, to rent may make the rich richer in the short term but in the long term the issue of how we fund care is only going to get worse as a result.
    The problem of rising house prices was exacerbated by the banking sector allowing increasing multiples of earnings to fund mortgages. This allowed house prices to rocket at at a time of under-supply and we’ve never managed to pull the situation back. Rent controls, government grants for the building of affordable housing and limits on lending for property purchasing are probably the long term answer. Sadly, I suspect that political expediency will prevail over economic necessity and as ever, tough decisions will come second to concerns over re-election.

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