Social Care 2012: What Needs To Be Done

For those of you reading this familiar only with the insularity of the housing world, you may be thinking that the new housing minister is the most important change in the Government's recent reshuffle. Perhaps you are right and, as an aside, it's worth noting that Prisk set a welcome change of tone both in public and private at last week's NHF Conference. But allow me to venture that it is actually the new health and social care ministerial team (and their successors) who will have the most profound effect on the world of housing and housing associations - at least if you provide a large scale, generic landlord service meeting the needs of the old and vulnerable.

If you aren't on the same page as me about this yet, perhaps we should wait while you go and have a quick read of this report from the King's Fund. At THT we know that our tenants, in ordinary homes as well as sheltered housing, will get less and less able to cope in their existing accommodation; as they age, their vulnerabilities increase and as cuts to commissioner's budgets result in fewer services delivered in a meaner fashion we are left in whole or in part with the responsibility for their care. We are currently equipped with a set of tools that are woefully inadequate for shouldering this burden. Clearly then we must do something - the question is what? Here's my prescription:

1. We must engage: be the ones to reach out to those health and social care professionals who are now devising the emergent systems, using the language that they speak, to evidence the contribution that housing can make. We can't sit outside the discussions that are now shaping the landscape of care and support bemoaning that "they won't talk to us", but rather articulate the compelling case about the extent of the help we can offer. The language of well-being has much to offer here: our evidence must show how it is that housing organisations can help people in communities to stay connected, be active, take notice, keep learning and give. Of course, as I have covered in previous blogs, having better metrics for assessing the social value of what we do would help here.

2. We must innovate: be prepared to devise a new, people-centred, system of care and support, rejecting the time-constrained, profit driven model of the private sector providers and imitated so often by those non-profits who should know better. There are new models starting to emerge - Southwark Circle combines statutory, voluntary effort with significant self-help within a membership-based organisation devoted to solving life's everyday problems. Models such as this start from a driver of basic humanity - centred on value to the carers and cared for, and not to shareholders.

3. We must invest: be robust with our regulator and our housing minister that value for money is about creating decent lives, and that building new homes, important though it is, isn't the only game in town. If commissioners (currently) are not prepared to meet the full cost of these new innovative models of care and support does that really matter? Most housing associations could choose to cross-subsidise the service from other parts of the business - something most of us have been doing with development for many years.

Do this and we might, just might, have a response to the care and support crisis which will otherwise engulf us and our residents. There is an urgent discussion to be had about social care in 2012; how soon that discussion becomes an argument and at what point that argument becomes an outcry is yet to be seen.

Social Care 2012: The Role Of Housing Associations

My last two blogs (part one and part two) both highlighted examples of what happens for some people in social care when the different organisations delivering their care fail to communicate properly. Whilst visiting one of our sheltered schemes last week I saw and heard first hand the impact of this. One of the recurring themes running through the stories was that the contribution of the housing provider went unheard or ignored.

TrustCall is one way we make a positive contribition to social care

Part of me thinks that this is because all too often we can be seen as "just the landlord" who is only interested in carrying out repairs and ensuring people pay the rent. I suspect it’s this “bricks and mortar” stereotyping that means fellow professionals can miss what we can offer. Consequently, this week I thought I would let you know about some the things that housing associations do that make me believe that we have something tangible to offer in the realm of social care.

We are developing our independent living offer in Trafford. Though a range of services we can help meet a real diversity of needs for our customers. Our sheltered scheme managers are the eyes and ears of the organisation. Several of them have care or nursing backgrounds and the majority have lived and worked in the local community for many years. Through day-to-day long-term contact with older people, and with the benefit of well-developed observational skills they are ideally placed to spot changes in their residents and prompt them to contact health and care professionals when appropriate.

They play an active part in supporting residents when they experience a change in their circumstances and, subsequently, their needs change. They can help people settle into the scheme and local community. Scheme managers can be a conduit to connect residents with the local community and vice versa. The diversity of activities and events provide a range of benefits for those that take part and can help combat isolation, depression as well as building skills in the local community. There is a popular misconception that activities in sheltered schemes are all about cake and bingo, however the reality is somewhat different. With our links to Trafford Leisure Trust we run exercise classes, we promote inter-generational activities though links to schools – for instance, one of our schemes hosts a weekly youth club.

One service we provide that really makes a tangible difference to people's lives is TrustCall. We are the main provider of telecare in Trafford. Staff at TrustCall are often the first person someone contacts in an emergency. We answer over 11,000 calls and send out an emergency response to 100 people each month. Very often telecare is used to facilitate a discharge from hospital and the monitoring and responses we provide help maintain the independence of people with dementia, stroke victims, diabetes and a range of other disabilities. Every day my staff are out in our neighbourhoods responding to a variety of needs of older and vulnerable people.

What else do we do that brings us into the world of health and social care? Well, we also employ a qualified occupational therapist. Not only can she assess what adaptations our residents might need she is a great help when we are looking to develop new or existing buildings and can ensure that we address the needs of people with disabilities. The assessments she carries out are used by our asset team to install adaptations that help to keep people independent. Put this together with our contract to fit minor adaptations such a grab rails, lever taps and you get the picture of an organisation at the front line delivering low-level preventative and responsive services for vulnerable people that help keep them independent. And this is before I've even talked about some of the health promotion work of our youth team or the work supported though community panels.

Despite protesting that we're not just about bricks and mortar, it’s not surprising that as a landlord our contribution is also about the buildings that people call home. The positive impact on someone’s wellbeing of a warm, accessible, secure and well-maintained home cannot be overstated. However our buildings have the scope to offer more. With a range of communal facilities including lounges, kitchens, offices and laundries there is scope for us to work more closely to develop real community-based services such as mini GP surgeries, a base for community matrons, a meeting point for local carers, treatment rooms for chiropody, physiotherapy, hairdressing and beauty treatments. All of our schemes provide access to the internet to help combat digital exclusion amongst older people.

This isn't supposed to read like a list of achievements - although I am proud of the work that we do - it's more to show that these are just some of the examples from a housing association that qualifies us to be an equal partner in conversations about health and social care in our neighbourhoods. Our services are not immune to the current crisis affecting social care funding, however the opportunity to create a hub for neighbourhood-based care for a range of partners is still there. I'd love to hear about other ways that housing associations are getting involved in social care and in my next blog I will offer some thoughts on how we might jointly respond to the challenges we are all facing.

Social Care 2012: Why It Matters

Two weeks ago I launched a series of blogs on social care, explaining I wanted to look at this issue from a political, professional and personal perspective - today's post sees the recent personal glimpses I've had of the impact of social care. There is a real interface between someone’s health and social care needs. As a local housing provider working closely with our customers in their homes and neighbourhoods we often have a real understanding of their needs. This week I want to use a couple of examples to highlight that perhaps not that much has changed since I told you about Freda’s story in an earlier blog. The two people that I am going to tell you about highlight what happens on the ground and are real life case studies where if the voice of the housing professional had been heard and responded to, then a different outcome could have been achieved.

Let me start with James who lived in one of our sheltered schemes. James was suffering from terminal leukaemia and was taken to hospital on Sunday because he had not eaten. His clear preference was to be able to come home as soon as possible as he was worried about catching infections in hospital so he was discharged that day with the promise of a care package on Monday that would involve his GP, district nurse, Macmillan nurses and a rapid response team. James’s family contacted our scheme manager on the Monday morning concerned that nobody had yet turned up.

What followed was a maze of bureaucracy as the scheme manager contacted various organisations in an increasingly desperate attempt to resolve the situation. James needed his medication and the support of a nursing and care team and whilst he would have received this in hospital his wish was to receive this in his own home so he could be in familiar surroundings with people he knew. His GP did not have any information about the case, the District Nurse did not appear to have a record of the case and agreed to visit the following day, the MacMillan nurses needed a referral from the District nurse before they could respond and the social work assessment team had the wrong address and could not confirm what they planned to do next.

Unfortunately, the scheme manager could not get anyone else to visit that day. Nobody seemed to accept the urgency of the situation or accept the opinion of a fellow professional concerned for the health of one of her residents. James was left with one of his friends overnight. The morning James was taken to hospital in an ambulance where he later died. James’s family and friends felt very stressed and let down by the situation and felt that if only what had been promised had been delivered James would have been able to die with care and dignity in his own home. If some other professionals had listened and reacted to the voice from housing perhaps this could have happened.

May’s story is equally sad. Twelve months ago May was a confident outgoing person, always socialising, and ready to pass on a bit of gossip. Today she is unrecognisable from that lady: staying in bed, unwilling to get up, frightened to go out and totally dependant on her daughter. She has had a series of hospital admissions, some quite prolonged and some of the care she has received when coming out of hospital has sometimes failed to address the most basic of needs. Her first set of carers kept preparing her solid food when she was unable to eat solid food following her treatment. She is suffering from incontinence, yet her bed was unmade and soiled bedding was left on the floor. With time slots for care being strictly adhered too the carers are unable to get her out of bed. Again with the scheme manager on site each day able to observe the effectiveness of care being delivered there is scope to involve a housing partner in this process to try and find a solution that better meets May’s needs.

I think the key to both May and James' stories is that care is often seen as a dichotomy between the carers and the cared for, but that overlooks a simple truth - namely that the carers are different people and don't present themselves to the cared for as a united team - often this is because they're not.

Bemoaning the fact that multi-agency work often means that people fall through the gaps is certainly nothing novel, but it seems to me that we have reached a crisis point. In an earlier blog I spoke about the fact that there was a real appetite for improving the way different groups try and work together. However, we can be as eager as we like, but without real investment and support from a Governmental level, the gaps we try to fill will simply prove impossibly wide.

Social Care 2012: Where We Are

Over the next four posts I want to take a deeper look at the issue of social care. I'm hoping to include thoughts and views from others on Twitter, comments and email, so please feel free to add your own opinions, regardless of whether you agree or disagree with my views. I've been inspired to write in-depth on the topic because I believe that it is time to make social care personal.

You might think that personal experience is no basis on which to make (or even suggest) public policy. Policy absolutely must be based on research and evidence, on rigour and analysis. Debate about desired outcomes must be couched in what's best for society as a whole - mustn't it? Well, it's an argument that I understand, but when it comes to issues around social care, I can't help but feel that the focus on research and analysis is just serving to dehumanise what is at root a very human issue.

For me there are three main factors - professional, political and personal - that are driving the rising importance of social care. Firstly, at a professional level, the absence of housing organisations from the centre ground of social care debate continues to flummux me. From housing ministers (from all parts of the political spectrum), through the support organisations of the CIH and NHF, to (most) individual housing associations, the issue of the supply of new homes has way greater prominence than the issue of care and support for people living in existing ones. Yet, by any statistical analysis, the reverse should be true - while we argue about whether 150,000 or 250,000 new homes are needed each year to solve the supply crisis, there are in excess of 500,000 households receiving home-based social care each year.

Another factor that exists at a professional level, too, is that it saddens me that we continue not to learn the lessons of what makes a difference. Experience tells us that prevention is better for the person and cheaper for the provider than crisis intervention can ever be. History has revealed how "just in time" social care remains a pernicious bean-counter's myth. We need new voices in these debates and new partnerships need to be forged to make change happen.

Even then, there's no guarantee the new approach will stick: last year, I shared "Freda's story" which brought together police, social care and housing people in response to just such a crisis, we were united in our outrage that "the system" had failed Freda. Now, the chief superintendent and the main social work contact who were involved in that case have both moved on and so the energy and ability to create change inevitably dissipates.

Politically, I watch, hopeful but not expectant that some consensus will emerge about how the demographic forecasts and the financial ones can be reconciled to create a better social care system. But the facts are stark and there is no easy answer. More old people will rely on the taxes from fewer working people to fund their needs in old age; more old people will have less by way of family support - 20% of women born in 1964 are childless compared with half that number from a generation before; and medical advances mean that more old people will live to be very old, with a consequential impact on care levels and budgets.

Finally, at the personal level I have had three direct, and quite different, experiences of social care in the last 12 months. I've seen quality residential care, so I know it can be made to work. I've also witnessed the effect of the benign neglect of institutional incarceration; and I've seen the not-so-benign neglect of a profit-driven domiciliary care provider and the consequential hospital readmission of a sick and vulnerable old woman.

Over the next four posts, with your input, I'd like to address social care from these different angles, share what I've learned and experienced on the topic and suggest some ways forward, because the one thing that we all agree on when it comes to social care is that we can't go on like we are - can we?

Share your thoughts in the comments, on Twitter or to me directly by email.