Guest blog for the Community of Practice for Social Care Analytics by John Bryant, Head of Integration and Development, Torbay Council. John is one of the award holders for the Strengthening Social Care Analytics programme run by the Health Foundation.
The NHS Ageing Well programme, as a core element of the NHS Long Term Plan, aims to promote integrated multi-disciplinary team approaches, give people more say about the care they receive, offer more support for carers, and develop more rapid community response teams.
The White Paper: Integration and innovation: working together to improve health and social care states: Integrating care has meant more people are seeing the benefits of joined-up care between GPs, home care and care homes, community health services, hospitals and mental health services. For staff, it has enabled them to work outside of organisational silos, deliver more user-centred and personalised approaches to care, and tackle bureaucracy standing in the way of providing the best care for people.
Behind this, we also know that to achieve the care capacity required a huge workforce shortage needs to be addressed. Facing the Facts Shaping the Future (Health Education England) established that 190,000 additional clinical staff would be required by 2027 while Skills for Care projected 520,000 more social care staff would be needed by 2035 .
With such huge capacity challenges it is essential we ensure that the system is as efficient as possible, optimising the opportunities for integrated working and ensuring the roles within it are as fulfilling as they can be for those delivering care. To retain the staff we have we need to enable and facilitate them to deliver the care and support that they wish to provide, and in doing so producing even better outcomes for those that they care for. This is the challenge that is there to be addressed.
Packages of care for people at home (domiciliary care) in many areas are ‘brokered’ by the Local Authority. Someone is assessed as having a need and a package of care (poc) is created for them. This is then highlighted to a range of domiciliary care providers so that they can review their rotas and staffing capacity and see if they are able to ‘pick this up’. This means that on any given day, one agency may be able to take a poc and care for a client just down the road, even next door, to a client that a different agency picked up the week before. And so it goes on year after year.
The area comprising Torbay has a perimeter measuring 75 miles. For all its relatively compact, non-rural make up Torbay’s 16 Living Well@Home domiciliary care providers are travelling over 350,000 miles per annum to deliver care. At a generously estimated 20mph that equates to over 472 weeks of care, face-to-face interaction of support and enablement, lost every year. This is not the fault of the care workers; it is a challenge for the system – making the right thing to do the easy thing to do.
The Careforce – Releasing Time to Care project will increase face-to-face care time and capacity for caring in ‘at-home’ settings. This will be achieved by reducing travel times within care rounds, enabling care workers to spend more time caring and working in an enabling way with the additional time produced. The opportunity is created to achieve increased wellbeing and independence.
However, this will require changes to clients’ existing care workers – different people being part of a new neighbourhood team through a rationalisation of travel and change in care rounds for individual staff members. Person-centred care at its heart is one that recognises both the care recipient and caregiver. A change such as the one proposed has significant implications for both.
A key feature of the project will be seeking to develop the ‘why’ of it for stakeholders. ‘Why is this disruption and change being proposed?’, ‘why are my care relationships being changed in this way?’, ‘what benefit is this to me and to others?’.
The aim is to achieve change through a developed understanding by all involved, and the part that everyone can play in this move to a better way of working. A key part of this will be using social care data and turning this into information in different ways for different audiences; data through to hearts and minds.
Care is a people business and that means there are human emotions at the heart of the work that we do. No matter the good intentions or beneficial future outcomes, any change will have its curve and recognition of cycles such as Kubler-Ross are important to recognise. To make the downswings as shallow as possible, this project will encourage involvement through evidenced-based communications and by transforming data into information in ways that support engagement and understanding.
The project will offer insight into the challenges of system change with clients/patients and peripatetic staff, how some of those challenges may be supported and the endeavours framed. Efficiency in systems is key to create the space for quality outcomes to be achieved. A legacy of this project will be a set of resources describing the approach taken with stakeholders in sharing information and improving the data that informs care. These resources will support changes towards more and better care; and will describe how people were engaged within this project, what information was shared with them, what tools were used to capture and convey the information and what changed as a result of this work.
Efficiency in Releasing Time To Care will produce effectiveness in creating the capacity for those caring to support increased enablement; for example, strengths-based working and the development of Circles of Support connecting people to their communities, social prescribing opportunities, and voluntary organisations as well as the development of hybrid roles. It is a further step in creating the virtuous cycle that person-centred care offers.