It is very welcome that NICE issued guidelines for support of older people in their own homes in September. A headline was the statement that people should generally receive at least 30-minute visits from carers.
It is the first time the health and care watchdog has set national standards for care in England. Social care is every bit as important as health care, and we need to ensure that disabled and older people are enabled to live in their own homes with safety and dignity for as long as they possibly can.
However, many people are reporting that they have received visits of 15 minutes, which are highly unlikely to deliver that.
The impact of social care cuts
In the current climate of austerity and social care cuts, the situation of nearly 2m people using social care is becoming more precarious.
For the past five years, funding restrictions to council-funded adult social care have meant that net budgets have been reduced by 31%. At the same time, the number of people with multiple long-term conditions is expected to increase by 50% in the decade 2008-18.
Austerity has a number of impacts. Fewer people are getting support: 90% of councils are only able to respond to people with ‘critical or substantial needs’.
This translates into 400,000 fewer disabled and older people being helped. Personalisation, which was meant to give people choice and control, has reverted to social workers care-managing people to receive a limited number of options.
Because provider fees are being frozen, care homes and care agencies are having financial difficulties and leaving the market.
All of this impacts on the NHS, because if guaranteed safe and effective support for people to live in their own homes is lacking, then those individuals will remain for longer on hospital wards, taking up resources which should be spent on acute needs.
It won’t help to increase health budgets by 5% if social care funding simultaneously declines by 10% in cash terms.
NICE recommendations on social care
In this context, it’s not clear what difference NICE recommendation on social care will make, given that they are aspirational rather than mandatory.
For example, on that well-publicised commitment to 30 minute visits, shorter visits are allowed if the home care worker is known to the person; the visit is part of a wider package of support; and the visit is to conduct specific tasks, or to check to see if the person is safe and well. But those exceptions cover most of the situations in which a person receives home care.
Just as with the fine words in the Care Act 2014 about wellbeing, we can design the most beautiful laws and policies in the world, but they are unlikely to make much difference to people in need, unless they translate into well-funded services out in the communities.
The key to getting homecare right is not these NICE guidelines, welcome though they are, but appropriate levels of funding to meet the growing need, so that local authorities can invest in the support which older people and disabled people require to lead independent lives.
We have had the two institutional scandals at Winterbourne View and Mid Staffs in recent years. The homecare crisis is dissipated across 2m homes, and rarely makes the headlines, but is just as serious.
- Tom Shakespeare is senior lecturer in medical sociology at Norwich Medical School, University of East Anglia, and researches in social care and independent living