Max Parmentier, CEO of Birdie, believes that the social care ‘reform’ of scaling the current system ‘from the 80s’ is not enough and will only exacerbate its faults
COVID-19 has highlighted the numerous challenges facing the social care system in the UK, from lack of PPE supplies to often difficult communication between care providers and hospitals. However, social care is multifaceted, far from one homogeneous sector, and no single approach will be able to solve every issue. We must start by considering which aspects of social care need the most attention.
With a proportional increase in deaths of 208% in care homes during the pandemic, it has been well documented that this area is in need of reform. However, another key part of social care – domiciliary care – has seen an even greater increase in deaths (225%). This is an area that is regularly overlooked. Both before and during the pandemic, the Government has focused on patient issues once they engage with the NHS stage, despite the fact that improving home care can help reduce the number of elderly and vulnerable individuals needing to go into care homes or access the NHS in the first place, helping reduce the pressure on these already stressed systems.
Care needs to enter the 21st century
Pressures on care homes are immense; they face a funding and staffing crisis on a scale that very few other industries have had to deal with. However, while a lot of attention has been placed on care homes, many policymakers have largely ignored the benefit that improving at-home care can bring to this industry.
Enabling elderly and vulnerable people to receive the care they need at home helps reduce the demand for beds in care homes, and can keep those individuals out of hospitals, which is crucial when it comes to reducing the pressure on healthcare. While this is incredibly important at the moment, it will also provide longer-term benefits to society and the healthcare industry – notably through the benefits to people’s wellbeing of being able to stay autonomous and independent, close to friends and family, and part of their local community, for longer.
The role of technology in keeping people at home is massive, and while introducing it could be relatively inexpensive, the impact for caregivers as well as patients would be significant.
People that suffer from the early stages of dementia, for example, might forget whether they have taken their medication or not on a given day. Caregivers may not always be up to date with the latest medication to be administered or whether someone who visited earlier already gave it to them. Technology can be used to track medication intake and highlight potential issues promptly so that caregivers can implement alternative long-term solutions. Meanwhile, the digitisation of documents so that they are readily accessible by all stakeholders can help ease the administrative burden on caregivers, improve collaboration, and help prevent patients falling through gaps in the system.
Internet of Things-enabled smart devices and sensors in the home can also help ensure both that elderly and vulnerable people do not feel abandoned and that they are safe in their home when their care worker isn’t present. For example, these monitors can detect if someone has fallen over and alert the authorities immediately, rather than potentially waiting hours or even days, which can cause greater physical and mental harm to the individual. They can also flag an individual’s pattern and detect any issue early on.
Care starts at home
There has been some debate recently about the possibility of social care being brought under NHS control. While this could have some positive outcomes – for example encouraging greater collaboration between agencies, and allowing better integration of currently fragmented budgets – there are also risks. Care is best managed at a local level, meaning decisions can be taken that accurately reflect the conditions on the ground. Fully integrating with the NHS risks taking those decisions into a central office, diminishing the beneficial impact of local knowledge. However, taking a local integrations approach, such as the pilots with the Primary Care Networks and the Integrated Care Systems, is very promising.
Keeping integrated care a regional issue will also help control costs, a problem that many councils might struggle with as budgets are stretched further than usual as economic and health crises continue. Digitising care can allow these local officials greater insight into the health needs of their communities. Continuous assessments of health and wellbeing – and increased insight from remote technology such as sensors in the home – will allow officials to optimise care as needed. Moving away from the model of booking hours of care without knowing whether they will actually be needed or what outcomes result, and towards commissioning the right care only when it is needed, will improve efficiency and patient outcomes.
At-home care can sometimes seem to be afforded lower priority than the NHS and care homes in central government policymaking. This can be seen for instance in the latest visa reforms that have excluded caregivers from overseas from obtaining a visa to work in the UK, compounding a staffing issue that was already a problem before COVID-19. This is very concerning, as the demand for at-home care is set to increase, with 34% of families planning on keeping their elderly relatives at home. What is very encouraging however is the recent budget allocated to hospital discharge programs (Discharge Home to Assess) in order to accelerate the hospital discharge towards home care. This will greatly benefit the patients and save costs to the NHS. Again, technology will dramatically help – with digital tools, clinicians will be able to review care providers’ information
It is vital that the UK Government begins to put greater emphasis on at-home care as a means of improving elderly and vulnerable care. COVID-19 has, at great cost, exposed the weaknesses in the care system that many of us outside the system were previously unaware of. Social care is a system that has not embraced a lot of innovation since the 1980s, and we need it fit for purpose for the present day and beyond. Through technology we can achieve greater insight, allowing councils to more efficiently allocate resources, care workers to spend more time with patients, and clinicians to spot early symptoms of disease, allowing preventative care to be carried out in the home, and away from hospitals. It can also ensure no one falls through the cracks of the system, keeping the elderly self-reliant for longer.
