Mind the Care Gap: The frontline of health and care

Our Mind the Care Gap campaign encourages an honest conversation about the challenges we face as our population continues to age. Much of the debate about adult social care has been dominated by funding and what the state can do to tackle key long-term pressures. It is right to explore these issues, but our campaign will draw upon the views of frontline health and care professionals, as well as learning from the experiences of older people providing or in need of care, and explore key facets of the care deficit.

This week we are launching our campaign to make sure a focus is maintained on tackling some of the key issues faced across adult social care provision. Over the next four weeks we will look at different themes and discuss how the government and society as a whole can approach care in the future.

We have spoken to a number of people from across the country, including frontline health and care professionals, individual service users and unpaid carers looking after loved ones, to get their perspective on health and care provision.

Week one, 10th – 14th Jan 2018: Tackling social isolation and long-term conditions

A growing number of older people are living at home alone and this is impacting both their mental and physical health. We need to look at new ways to tackle loneliness in the face of demographic change. On home visits, a GP told us the medical issues tend not to be the primary problem. Poor mental health and loneliness are contributing factors, which means GPs and adult social care workers need to adopt a joined-up approach to supporting older people.

Dr Joshi, a General Practitioner in Leicester, talked about loneliness:

“Often as GPs when we go into people’s homes, the medical issue tends not to be the primary problem because they are not functioning, they cannot function, there is a breakdown because they cannot manage their daily activities and what you really need then is an integrated care approach to support that patients care. A lot of the time, poor mental health and loneliness plays a big part in how a patient deals with their medical issues.”

An adult social care worker spoke to us about the need to allow professionals more time to deliver face-to-face support for older people living alone:

“A telephone call assessment doesn’t give you that realistic a picture. A patient can say they’re fine, then in a week’s time they’ve ended up in hospital because they were not managing and the home environment is in absolute need of support, advice and guidance.”

Week two, 15th – 21st Jan 2018: The Workforce

Recruitment and retention challenges are a major concern across the sector. The demand for more care professionals means a new ladder of opportunity is needed to grow and develop the formal work force. Health and care staff need more time away from their day job to pursue additional training and educational opportunities. There needs to be better management so that staff can access cover to be able to learn and progress in their chosen profession.

Dr Adam, a General Practitioner in Leicester, discussed the importance of health and care professionals being given more time to learn:

“There also needs to be more work on education to release staff from there day job to help further educate someone, if you do that they are more likely to stay in that job. That’s a good investment, but if you cannot get staff out of the day job to educate them, things like backfill, so covering peoples time so they can go and learn is also needed for care home staff too.“

Week three, 22nd – 28th Jan 2018: Community response to health and care needs

We need to nurture integrated health and care provision at the local level in both formal and informal settings. We want to shine a light on some of the challenges practitioners and service users face as pressure in the system grows, and to highlight opportunities to improve matters.

Carer’s strain is a growing problem. GPs are seeing an increasing number of cases where people in later life are struggling to manage caring for loved ones at home. This strain often surfaces when the health of the primary carer at home begins to deteriorate both mentally and physically as they are unable to cope with manging their own care as well as that of their loved ones.

Rene Baterip, a 79-year-old who lives in an enhanced sheltered housing scheme, spoke to us about the standard of care support by staff and how residents are forced to look after one another:

“It has deteriorated over the years, and I find now that you have got residents looking after residents, because often staff are not here or the staff haven’t got the expertise, or its getting near going home time for the staff and they do not want to get involved.”

Another important issue is end of life care provision in local communities.

Dr Adam, who is also a Clinical Lead for End of Life Care in the East Midlands told us that:

“…the district nurses are the most stretched. If someone is dying at home and they have breathlessness or pain, we have already prescribed everything they need, the link is that the district nurse needs to come out and administer that medication and that can take 2 hours on average, and if you are in pain or looking after someone in pain that is a long time. I think the service gaps are the nursing teams, people on the ground that can go out and administer.”

Week four, 29th Jan – 2nd Feb 2018: Future health and care provision

In the final week of our campaign, we will build on our vision for health and care. Unification of the system is our primary focus. By getting health and care providers working more closely with every generation in our communities there is an opportunity to deliver greater collective wellbeing across society.

There needs to be better coordination between health and care professionals across local communities. Dr Joshi, whom we interviewed, also spoke of his own medical practice and how it approaches integrating health and care:

“…we got a social care worker to work with us. Later we were also able to get a mental health nurse too. So, the key idea was to look at a patient’s health and social care needs, including mental health, a holistic approach.”

So why now?

We need a new settlement supported on a cross-party basis in Parliament. The settlement could be delivered by establishing a Care Covenant – a new agreement between the state and the public – which sets out a clear commitment to support the health and care needs of everyone.

We are nearing a critical tipping point in adult social care. The government’s consultation this summer is an opportunity for us all to demand a step-change in our approach to care and embrace new ways of working to address the challenges that lie ahead.

In our most recent policy paper, Securing the Future, we challenged leaders from the public, private and third sectors to help us explore the potential for future health and care provision. The paper explores a range of topics including intergenerational fairness, technological advancements and the role of the social care workforce, both paid and unpaid. One of the core themes that came out of the paper was a frustration that longevity is often viewed negatively. It is important to look at the positive aspects of living longer and work towards building care provision that is responsive to changing needs. The paper is clear in its conclusion – we need a new National Care Plan, complemented by Future Care Guarantees to support better independent living in old age and adult social care provision that is fit for the long-term.

Conclusion

Our campaign aims to raise awareness of these issues to a wider audience by continuing this debate with leaders from the public, private and charitable sectors. Working together, we want to discuss how we can support a new approach to adult social care in the form of a new National Care Plan. We hope that the Government considers our campaign and the practical recommendations put forward to address the current gaps in care provision across local communities. By supporting a community response to loneliness, embracing new technology to assist independent living, offering support for unpaid carers and a new social care workforce plan, we can establish a care system capable of meeting the demands of our ageing population.