Making time to care by making social care fair In the context of the new Care and Support Bill currently going through parliament, Professor Alan Glasper discusses the campaign launched by the charity Leonard Cheshire Disability to make social care fair for those who need it, especially the elderly and 100 000 working-age disabled people who may be denied vital care and support because of the ever-increasing use of flying 15-minute care visits.
Background Every day, over one million disabled and older people in the UK receive personal social care.
1256
With an ever-increasing elderly population, growing old and supporting those in need of care and support, is becoming the business of all citizens predicated on the basis that most of us will, at some point in our lives, need care and support, or know someone in need of care, or provide care for someone in need. The new bill going through parliament (UK Parliament, 2013) is designed to reform the law relating to care and support for adults and that relating to support for carers, and to make provision to safeguard adults from abuse or neglect. Disappointingly, the bill does not address the huge issue of funding care. Although the world of health care has been preoccupied with the failings of care at the Mid Staffordshire NHS Foundation Trust, and the subsequent publication of the public inquiry led by Robert Francis (The Mid Staffordshire NHS Foundation Trust, 2013) little is known about other failings in care provision elsewhere, but not least in the social care sector. Such is the disquiet about social care that a consortium of charities, namely Leonard Cheshire Disability, Mencap, The National Autistic Society, Sense and Scope have worked together to expose the scale of the crisis faced by over 100 000 disabled people. They refer to this as ‘the other care crisis’ The other care crisis: Making social care funding work for disabled adults in England was published earlier in 2013 (Brawn et al, 2013). Data were collected over the summer of 2012, from more than 600 disabled adults aged between 18 and 64. The findings cited within ‘the other care crisis’ highlight a number of crucial problems with the current system of social care provision: ■■ One third of people who use social care are working-age disabled people ■■ In many cases, disabled people’s basic needs are not being met ■■ 40% of disabled respondents have indicated that social care services fail to meet basic
needs like washing, dressing or getting out of the house ■■ 47% of respondents believe that the services they have received do not enable them to take part in community life, such as seeing friends or volunteering ■■ 62% have confirmed that they have expended their own money to help them eat, dress, wash or get out of the house.
The scale of the problem Social care is a critical part of daily life for tens of thousands of disabled people, and it can simply mean helping people get out of bed in the morning, make a home-cooked meal, or enabling them to communicate with friends and family. Social care also provides the support disabled people need to live actively and independently, be it working, studying, or keeping fit. However, the charitable sector believes that social care for working-age disabled adults is under-funded by at least £1.2 billion, but the current debate on social care funding has been almost exclusively focused on how the system should respond to the demands of an ageing population. It is important to stress that the data from ‘The other care crisis’ show that one in three people who use social care services are disabled people of working-age whose needs may not always be the same as those of older people. As decisions about social care begin to be made, with the passage of the Care and Support Bill through parliament, it is essential that society understands what is distinctive about the needs of working-age disabled people. Furthermore, the historic under-funding of care is being exacerbated by cuts to local authority funding, and leading councils to remove care and support from all but a minority of those with the seemingly most complex needs. ‘The other care crisis’ shows that since 2008, over 90 000 disabled people have lost care and support and there are fears that the new Care and Support Bill will make this trend government policy.
© 2013 MA Healthcare Ltd
O
n 7 October 2013, the charity Leonard Cheshire Disability published its latest research findings (Leonard Cheshire Disability, 2013). Leonard Cheshire Disability is one of the UK’s largest voluntary sector providers of services for disabled people. Their wide range of services provide support, respite and care for people with disabilities and their carers. The charity campaigns for people with disabilities to influence government policies and to change people’s attitudes toward disability. Through their campaigns, they ensure that the issues that concern people with disabilities and their carers are fully articulated and heard by those that matter. They used a ComRes market research poll of 2025 British adults, conducted between 6–8 September 2013, to determine the public’s views on the controversial 15-minute care slots. In addition, they used Freedom of Information requests to find out how local authorities are currently using these 15-minute care visits. This research entitled ‘Ending 15-minute Care’ (Leonard Cheshire Disability, 2013), which was undertaken by Leonard Cheshire Disability because of an increase in the purchase of flying 15-minute visits for people who need fundamental care by councils in England, reveals that the public are opposed to their use for the elderly or disabled. Moreover, the findings indicate that the allocated 15 minutes is an insufficient amount of time to deliver good quality care. The charity argues that if non-disabled people take up to 40 minutes to get up, get dressed, eat and go the toilet, how can 15 minute care packages be appropriate for those who are less able? Nurses working in hospitals with the elderly and those with disabilities will resonate with this paradox.
British Journal of Nursing, 2013, Vol 22, No 21
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
healthcare policy This is already having a major impact on the lives of disabled people and their families. Four in ten are failing to have their basic needs met, and under-funding is turning back the clock on disabled people’s independence: nearly half the number of disabled adults report that services are not supporting them to get out into the community. Leonard Cheshire Disability and the other charities involved believe that the government must immediately act to ensure that disabled people continue to receive the care and support they need. For an estimated 0.2% of public expenditure, the charities believe that support for all disabled people can be delivered to allow them to live independent lives of their own choosing, work and take part in the lives of their communities, and be supported before reaching crisis point. The government is taking an opportunity to get people the support they need and the Care and Support Bill currently going through parliament is the biggest change to social care in 50 years.
© 2013 MA Healthcare Ltd
Why should 15-minute care visits be curtailed? As the Care and Support Bill stands, it will do nothing to end the perceived scandal of the flying 15-minute visits (Ramesh, 2013). Subsequent to the collaborative The other care crisis report, Leonard Cheshire Disability also conducted research into the use of the flying 15-minute time slots for social care delivery and identified a number of concerns: ■■ Leonard Cheshire Disability believes that too many disabled people are being failed by a social care system that does not meet their needs. They estimate that over 100 000 working-age disabled people are going to miss out on vital care and support once the bill is passed. Many will only receive very short care visits, thus denying them their right to good quality care and support. It is the short 15-minute time slots allocated to their care that the charity is concerned about, as this prevents the disabled person from carrying out the everyday tasks the non-disabled take for granted, such as getting washed, dressed or making a meal ■■ Disabled people are being denied their dignity, and carers are unable to do their job with empathy. Leonard Cheshire Disability believes that 15 minutes simply does not allow enough time to deliver good quality care and support. They state that if a carer does not even have time to take off their coat, how can they possibly have time to support a disabled person with any kind of dignity through their morning routine of washing, dressing, preparing breakfast
British Journal of Nursing, 2013, Vol 22, No 21
and getting ready to face the day ahead? Regretfully, there is little data about how the carer feels about these flying visits, where they may have to rush through their tasks as quickly as possible, without even having time to stop and engage the client in human conversation ■■ Leonard Cheshire Disability reports that 60% of local authorities now commission 15-minute visits, with some delivering more than three quarters of their care visits in 15 minutes ■■ Similarly, 15% of councils deliver more than a quarter of all their care visits to disabled and older people in 15 minutes or less.
Conclusion The Leonard Cheshire Disability survey reveals that 96% of respondents agree that disabled or older people should have the right to receive social care visits that allow enough time for care workers to give the appropriate support to clients to allow them to fulfil their daily activities. Furthermore, of those who expressed an opinion, 78% agreed that 15-minute care visits may deprive disabled and older people of their dignity. Hence, the survey confirms that people do not view 15-minute care visits as an effective way of providing high-quality social care to many disabled or older people, a view expressed by 67% of the the respondents. Clearly some patients may only need 15 minutes of social care, but the fear of the charities is that this will become the norm, not the exception. This survey has served to highlight a potential problem with the forthcoming Care and Support Bill and a ratification of the 15-minute care visit. A report in The Independent (2013)
states that Minister Norman Lamb, the Liberal Democrat politician and Minister of State for Care and Support, has indicated that in the light of the publication by Leonard Cheshire Disability, the use of such short visits is unfair, both on the disabled and carers. The minister is proposing an amendment to the Care and Support Bill, which will clarify and make it clear that local authorities will have to consider a person’s total wellbeing when arranging their care. The bill is currently progressing through the parliamentary process and the second sitting took place on 16 October 2013 in the House of Lords. The bill will now progress through the House of Commons and reaches the committee stage in January 2014, before progressing toward receiving the final Royal Assent. During this interregnum, Leonard Cheshire Disability will be working with supporters and will be lobbying ministers to urge them to end the proliferation of flying care visits. Many nurses will certainly be empathetic to this stance. BJN
Brawn E, Bush M, Hawkins C, Trotter R (2013) The other care crisis: Making social care funding work for disabled adults in England. http://tinyurl.com/bhygflq (accessed 14 November 2013) Leonard Cheshire Disability (2013) Ending 15-Minute Care. http://tinyurl.com/qajetpt (accessed 14 November 2013) Ramesh R (2013) Care minister orders review over 15-minute home visits. The Guardian http://tinyurl.com/ p8w9p9o (accessed 21 November 2013) The Independent (2013) Have a drink or visit the toilet? ‘Flying’ 15-minute care visits are a disgrace, says charity. http://tinyurl.com/ludmtjz (accessed 14 November 2013) The Mid Staffordshire NHS Foundation Trust (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. http://tinyurl.com/ bkgyem7 (accessed 14 November 2013) UK Parliament (2013) Care Bill [HL] 2013-14. http:// tinyurl.com/br4kvbn (accessed 21 November 2013)
Key points n The Leonard Cheshire Disability charity believes the elderly, and up to 100 000 working-age disabled people, may be denied vital care and support because of the ever-increasing use of flying 15-minute care visits by local councils n Leonard Cheshire Disability has conducted research showing that the allocated 15 minutes is an insufficient amount of time to deliver good quality care n Every day, over one million disabled and older people in the UK receive personal social care n Leonard Cheshire Disability reports that 60% of local authorities now commission 15-minute visits, with some delivering more than three quarters of their care visits in 15 minutes n Decisions about social care in the future are being debated through the passage of the Care and Support Bill through Parliament n Fifteen-minute time slots allocated to the care of disabled and elderly people may prevent them from achieving the everyday tasks the non-disabled take for granted, such as getting washed, dressed or making a meal
1257
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
Background Every day, over one million disabled and older people in the UK receive personal social care.
1256
With an ever-increasing elderly population, growing old and supporting those in need of care and support, is becoming the business of all citizens predicated on the basis that most of us will, at some point in our lives, need care and support, or know someone in need of care, or provide care for someone in need. The new bill going through parliament (UK Parliament, 2013) is designed to reform the law relating to care and support for adults and that relating to support for carers, and to make provision to safeguard adults from abuse or neglect. Disappointingly, the bill does not address the huge issue of funding care. Although the world of health care has been preoccupied with the failings of care at the Mid Staffordshire NHS Foundation Trust, and the subsequent publication of the public inquiry led by Robert Francis (The Mid Staffordshire NHS Foundation Trust, 2013) little is known about other failings in care provision elsewhere, but not least in the social care sector. Such is the disquiet about social care that a consortium of charities, namely Leonard Cheshire Disability, Mencap, The National Autistic Society, Sense and Scope have worked together to expose the scale of the crisis faced by over 100 000 disabled people. They refer to this as ‘the other care crisis’ The other care crisis: Making social care funding work for disabled adults in England was published earlier in 2013 (Brawn et al, 2013). Data were collected over the summer of 2012, from more than 600 disabled adults aged between 18 and 64. The findings cited within ‘the other care crisis’ highlight a number of crucial problems with the current system of social care provision: ■■ One third of people who use social care are working-age disabled people ■■ In many cases, disabled people’s basic needs are not being met ■■ 40% of disabled respondents have indicated that social care services fail to meet basic
needs like washing, dressing or getting out of the house ■■ 47% of respondents believe that the services they have received do not enable them to take part in community life, such as seeing friends or volunteering ■■ 62% have confirmed that they have expended their own money to help them eat, dress, wash or get out of the house.
The scale of the problem Social care is a critical part of daily life for tens of thousands of disabled people, and it can simply mean helping people get out of bed in the morning, make a home-cooked meal, or enabling them to communicate with friends and family. Social care also provides the support disabled people need to live actively and independently, be it working, studying, or keeping fit. However, the charitable sector believes that social care for working-age disabled adults is under-funded by at least £1.2 billion, but the current debate on social care funding has been almost exclusively focused on how the system should respond to the demands of an ageing population. It is important to stress that the data from ‘The other care crisis’ show that one in three people who use social care services are disabled people of working-age whose needs may not always be the same as those of older people. As decisions about social care begin to be made, with the passage of the Care and Support Bill through parliament, it is essential that society understands what is distinctive about the needs of working-age disabled people. Furthermore, the historic under-funding of care is being exacerbated by cuts to local authority funding, and leading councils to remove care and support from all but a minority of those with the seemingly most complex needs. ‘The other care crisis’ shows that since 2008, over 90 000 disabled people have lost care and support and there are fears that the new Care and Support Bill will make this trend government policy.
© 2013 MA Healthcare Ltd
O
n 7 October 2013, the charity Leonard Cheshire Disability published its latest research findings (Leonard Cheshire Disability, 2013). Leonard Cheshire Disability is one of the UK’s largest voluntary sector providers of services for disabled people. Their wide range of services provide support, respite and care for people with disabilities and their carers. The charity campaigns for people with disabilities to influence government policies and to change people’s attitudes toward disability. Through their campaigns, they ensure that the issues that concern people with disabilities and their carers are fully articulated and heard by those that matter. They used a ComRes market research poll of 2025 British adults, conducted between 6–8 September 2013, to determine the public’s views on the controversial 15-minute care slots. In addition, they used Freedom of Information requests to find out how local authorities are currently using these 15-minute care visits. This research entitled ‘Ending 15-minute Care’ (Leonard Cheshire Disability, 2013), which was undertaken by Leonard Cheshire Disability because of an increase in the purchase of flying 15-minute visits for people who need fundamental care by councils in England, reveals that the public are opposed to their use for the elderly or disabled. Moreover, the findings indicate that the allocated 15 minutes is an insufficient amount of time to deliver good quality care. The charity argues that if non-disabled people take up to 40 minutes to get up, get dressed, eat and go the toilet, how can 15 minute care packages be appropriate for those who are less able? Nurses working in hospitals with the elderly and those with disabilities will resonate with this paradox.
British Journal of Nursing, 2013, Vol 22, No 21
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
healthcare policy This is already having a major impact on the lives of disabled people and their families. Four in ten are failing to have their basic needs met, and under-funding is turning back the clock on disabled people’s independence: nearly half the number of disabled adults report that services are not supporting them to get out into the community. Leonard Cheshire Disability and the other charities involved believe that the government must immediately act to ensure that disabled people continue to receive the care and support they need. For an estimated 0.2% of public expenditure, the charities believe that support for all disabled people can be delivered to allow them to live independent lives of their own choosing, work and take part in the lives of their communities, and be supported before reaching crisis point. The government is taking an opportunity to get people the support they need and the Care and Support Bill currently going through parliament is the biggest change to social care in 50 years.
© 2013 MA Healthcare Ltd
Why should 15-minute care visits be curtailed? As the Care and Support Bill stands, it will do nothing to end the perceived scandal of the flying 15-minute visits (Ramesh, 2013). Subsequent to the collaborative The other care crisis report, Leonard Cheshire Disability also conducted research into the use of the flying 15-minute time slots for social care delivery and identified a number of concerns: ■■ Leonard Cheshire Disability believes that too many disabled people are being failed by a social care system that does not meet their needs. They estimate that over 100 000 working-age disabled people are going to miss out on vital care and support once the bill is passed. Many will only receive very short care visits, thus denying them their right to good quality care and support. It is the short 15-minute time slots allocated to their care that the charity is concerned about, as this prevents the disabled person from carrying out the everyday tasks the non-disabled take for granted, such as getting washed, dressed or making a meal ■■ Disabled people are being denied their dignity, and carers are unable to do their job with empathy. Leonard Cheshire Disability believes that 15 minutes simply does not allow enough time to deliver good quality care and support. They state that if a carer does not even have time to take off their coat, how can they possibly have time to support a disabled person with any kind of dignity through their morning routine of washing, dressing, preparing breakfast
British Journal of Nursing, 2013, Vol 22, No 21
and getting ready to face the day ahead? Regretfully, there is little data about how the carer feels about these flying visits, where they may have to rush through their tasks as quickly as possible, without even having time to stop and engage the client in human conversation ■■ Leonard Cheshire Disability reports that 60% of local authorities now commission 15-minute visits, with some delivering more than three quarters of their care visits in 15 minutes ■■ Similarly, 15% of councils deliver more than a quarter of all their care visits to disabled and older people in 15 minutes or less.
Conclusion The Leonard Cheshire Disability survey reveals that 96% of respondents agree that disabled or older people should have the right to receive social care visits that allow enough time for care workers to give the appropriate support to clients to allow them to fulfil their daily activities. Furthermore, of those who expressed an opinion, 78% agreed that 15-minute care visits may deprive disabled and older people of their dignity. Hence, the survey confirms that people do not view 15-minute care visits as an effective way of providing high-quality social care to many disabled or older people, a view expressed by 67% of the the respondents. Clearly some patients may only need 15 minutes of social care, but the fear of the charities is that this will become the norm, not the exception. This survey has served to highlight a potential problem with the forthcoming Care and Support Bill and a ratification of the 15-minute care visit. A report in The Independent (2013)
states that Minister Norman Lamb, the Liberal Democrat politician and Minister of State for Care and Support, has indicated that in the light of the publication by Leonard Cheshire Disability, the use of such short visits is unfair, both on the disabled and carers. The minister is proposing an amendment to the Care and Support Bill, which will clarify and make it clear that local authorities will have to consider a person’s total wellbeing when arranging their care. The bill is currently progressing through the parliamentary process and the second sitting took place on 16 October 2013 in the House of Lords. The bill will now progress through the House of Commons and reaches the committee stage in January 2014, before progressing toward receiving the final Royal Assent. During this interregnum, Leonard Cheshire Disability will be working with supporters and will be lobbying ministers to urge them to end the proliferation of flying care visits. Many nurses will certainly be empathetic to this stance. BJN
Brawn E, Bush M, Hawkins C, Trotter R (2013) The other care crisis: Making social care funding work for disabled adults in England. http://tinyurl.com/bhygflq (accessed 14 November 2013) Leonard Cheshire Disability (2013) Ending 15-Minute Care. http://tinyurl.com/qajetpt (accessed 14 November 2013) Ramesh R (2013) Care minister orders review over 15-minute home visits. The Guardian http://tinyurl.com/ p8w9p9o (accessed 21 November 2013) The Independent (2013) Have a drink or visit the toilet? ‘Flying’ 15-minute care visits are a disgrace, says charity. http://tinyurl.com/ludmtjz (accessed 14 November 2013) The Mid Staffordshire NHS Foundation Trust (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. http://tinyurl.com/ bkgyem7 (accessed 14 November 2013) UK Parliament (2013) Care Bill [HL] 2013-14. http:// tinyurl.com/br4kvbn (accessed 21 November 2013)
Key points n The Leonard Cheshire Disability charity believes the elderly, and up to 100 000 working-age disabled people, may be denied vital care and support because of the ever-increasing use of flying 15-minute care visits by local councils n Leonard Cheshire Disability has conducted research showing that the allocated 15 minutes is an insufficient amount of time to deliver good quality care n Every day, over one million disabled and older people in the UK receive personal social care n Leonard Cheshire Disability reports that 60% of local authorities now commission 15-minute visits, with some delivering more than three quarters of their care visits in 15 minutes n Decisions about social care in the future are being debated through the passage of the Care and Support Bill through Parliament n Fifteen-minute time slots allocated to the care of disabled and elderly people may prevent them from achieving the everyday tasks the non-disabled take for granted, such as getting washed, dressed or making a meal
1257
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 18, 2015. For personal use only. No other uses without permission. . All rights reserved.
