An industry evolving to meet complex needs

The National Care Association (NCA) was set up in the early 1980s by a handful of care providers who came to a realisation that social care was moving from a cottage industry to a potential business opportunity for the private investors. People from all walks of life were choosing to invest in open care homes for older people with little or no medical experience. The association was founded to support the membership through the transition that lay ahead and for the first time providers had opportunities to share concerns and have a unified voice to represent them with local and government bodies.
This was a very different time when older people made the positive choice to come into residential care. They received an allowance which by and large covered the fee for a room in a community setting where they would no longer need to worry about paying bills, preparing meals or worry about utility bills or laundry services. They had the opportunity to converse with like-minded individuals in the services and so share memories and make new friends in the autumn of their lives.

However, with the political and economic landscape changing it became clear that this model of retirement was going to be unsustainable through the public purse as the post war baby boomers moved into the sphere where their need for social care, the promise of ‘from cradle to grave’ became a reality.

Championing members’ rights
Over the years the association has had many successes on behalf of its membership with a well-respected leader, Sheila Scott OBE at its helm almost since is inception. We continue to work on behalf of our membership through a small voluntary board at both local and national level, and pride ourselves on a very personal service. The membership covers all registered care services, with the exception of children’s homes. The service provided includes national and regional events to inform on development in the sector, business advice through our partnerships with leaders in their fields, access to a DBS service both paper and online and to a 24 hour helplines and funding opportunities and many more. We deal with membership queries daily through the office ranging from the minor to major issues. Additionally, we work on behalf of our membership by responding to local and national consultations from the provider prospective.

A changing sector
The challenges that have faced the social care sector over the past three decades have been wide and varied, changing the infrastructure of a service which was seen as local alms based service to a corporate lead business opportunity. We have seen a gentle but fundamental shift which has created a very complex service with a variety of delivery options. This has created opportunities for people in the sector but also for investors who have studied the market and can see that the demographics favour the market. However, it has to be noted that over 70 per cent of all services are still provided by small to medium sized providers who have personal time and money invested in the business and contrary to popular believe do not command six figure salaries from their businesses.
As challenges have grown in the sector so has the range of service we provide and the representations we make on behalf of our membership and the sector as a whole. Over the past decade a great deal of our time has been spent on supporting our providers to rise to the challenges they now face with the changing client group coming through their door and the commissioning changes laid upon them by the local authorities as they procure services to support vulnerable members of our society.
Additionally, we have seen a marked difference in the needs of individuals entering the social care world as long stay geriatric wards closed and the NHS has moved into its own challenging period. The social care providers have found themselves delivering acute services within the registered framework to people with very complex medical needs as well as social care needs. The mix has made dialogue with the commissioners ever more challenging as they too struggle with the funding issues for long term care and support. Where once relationships between commissioners and providers were generally positive we now find a much more autocratic role by the commissioners: their dominant position as purchasers who do not or cannot recognise the true cost of care make for a fraught relationship.

Raising standards
The difficulty in all this is that we have changed the nature of the offer for care services. Quite rightly, we have raised the expectations of the general public about what should be expected from a care service but what we haven’t done is taken any notice of what that might cost the public purse. A cosy environment in a converted property situated on the edge of the town or village is no longer an acceptable concept. Over the years legislation has moved us into a highly regulated industry with ever increasing bureaucracy which requires strong business management skills in addition to care skills. The emergence of registered managers and the crucial role they now play in delivery of care services is a long way from the care provider of the 70s and 80s. The media focus on failures in poorly commissioned services heightens the tensions.

The sector rises to the challenges put before it and up and down the country we now see some of the most innovative purpose build care services in the world. The shift has allowed true choice to emerge as people are given the ability, but always the choice, to stay at home, enter a sheltered unit, consider supported living, a care village or a residential setting. This has created opportunities for soft furnishing companies to develop options to suit the needs of the users of the services, from beds to crockery and cutlery. Clearly the care industry is a great market place for innovators and inventors alike.

A skilled workforce
The important thing to note is that social care is high on the political agenda, not always for the right reasons but it remains a priority for the forthcoming elections next year. There is no doubt that the delivery of care to vulnerable people must be done by highly skilled staff but with the skills they must have an aptitude for the job as well as compassion.
At times I think we concentrate so much on the technical skills that we forget that assimilation of knowledge can be measured but application must be observed, and so holds a greater priority in our estimation. We have created complex methodologies on measuring skill set as determined by awarding bodies etc but I believe we need to have a greater emphasis on the technical supervision and appraisal of the workforce so we create a competent and confident workforce who take pride in the caring profession.

Challenges of care provision
Much of this will rely on support for registered managers who often operate in silos, trying to keep up with the bureaucracy which surrounds them. We are beginning to see a shift in the thinking of some local authorities who are supporting mangers networks and investing in the sector to understand business planning for the future as they look towards greater innovation in the delivery of care services. What we now need to consider is how we are going to create the tripartite relationship between the local authority, the NHS and the provider. The challenge of the integration agenda is that we do not let gaps appear in services which will have an impact on the services we provide.
As we move forward we see the local authorities and provider organisations sit across the same table and very often voicing the same concerns about the services we provide. The fact of the matter is that we all want to see the very best service for frail and vulnerable individuals and in order to do that we have to agree the parameters of the contracts with local authorities. We have to consider what falls within the health budget and how we create seamless pathways to ensure there is a multi-disciplinary approach which puts individuals at the centre of the service. There is great uncertainty about how we are going to make sure all the pieces of this massive puzzle with its oddly shaped pieces fit especially when the driving force behind it is quality without funding.
Social care providers and commissioner must feel empowered to work in a flexible but confident way: there must be a desire and a method to ensure partners forced are based on trust and respect. For too long the relationship has been fraught as they commissioner hold a dominant position in the relationship and so erodes at the trust between the two. Failure to be equal is not an option we face some of the most challenging times ahead through implementation of the bill. The fact that the transformation board in local authorities has providers around the table is a great step forward but it must also invest in the innovation that evolves from these debates.

The future of care
The future of long term support calls for a strong and vibrant delivery mechanism which will create seamless help and support when it is needed. It needs to be one where the central focus is the offer made to each individual about what they can realistically expect from the state and what lies outside of that sphere. As we raise expectations we must also consider the consequence, failure to do so create a break in the chain. It is right to create better pathways to care and support and to put safeguards in place to tackle failures but what we must never do is create expectations which lead to breaches in trust at a time when individuals most need care and support.

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