CENTRAL LONDON, U.K. -- Before I went to medical school way back in 1996, I worked at my local hospital as a care assistant. It was a bracing experience for an 18 year old, but it taught me a lot about how demanding and often thankless this work was. I always made sure I was respectful and humble when I was working with carers and nurses on the wards and care homes later on in my career.
Fast forward twenty years and we have a crisis in care. Unlike healthcare in the UK right now, many people will be paying for care in the future – predictions from the Department of Health are that 75% of us will need care and that the costs may average up to £75k over our lifetimes. So, increasingly families will be paying for care out of their own pockets and they will be demanding transparency, real-time information and the best for their relatives.
Yet, there is an industrial resistance to making care more transparent across the care sector from domiciliary care to care homes. After all, who are these organisations ultimately accountable to? – an overstretched regulator and local authority commissioners who do not have the bandwidth to oversee every care interaction taking place. The families and people receiving care are relatively powerless to effect change.
It is seductive to think that improved regulation will improve care provision but until a light is shone into the darkest corners by real people detailing their real experiences we won’t see an improvement in quality. It is depressing that families feel they have to fight for the right to film their loved ones being abused as if somehow they are not permitted to know what is going on. It smacks of the worst forms of paternalism and defensive behaviour.
So should we expect a consumer-driven revolution in the mould of TripAdvisor (http://www.tripadvisor.co.uk/) – a theme loved by policy makers and politicians? Sites like Good Care Guide (http://www.goodcareguide.co.uk/) have made a start with this process, but how reliable are reviews on their own? Are you sure care home owners are not gaming the system? How do you verify the information?
But the problem runs much deeper than this. The tick box culture in care is now so extreme, you have to question whether the patient and notion of person-centred care really holds centre stage. Ask a care provider about their needs and it is likely to be regulatory compliance that lights their fire, rather than delivering outstanding care.
Last year, we received an award in care transparency from the government’s innovation agency and we were due to partner with a care home provider. The care provider pulled out; they were apparently worried about the reputational risk of making their care more transparent. After all, who wants to be scrutinised?
These kinds of behaviours raise questions about the sustainability of the care sector in its current form. Many care homes and care agencies have been run as family businesses, but now the sector is under pressure from funding cuts and the carers are getting an even harder deal. Carers have practically no professional recognition and undergo limited training. Their pay is terrible, turnover of staff is high and there is little career progression. It is hardly surprising that the sector struggles to attract good people and that unsavoury characters desperate for work in some instances behave in the way they do.
That offers no reassurance to families, but it begs the question: what is the weakest link in care? What if there was a parallel reimagined version of care where we did not have to rely on agencies or physical homes of questionable quality? It may be a glib comparison, but barely anyone uses a travel agency and many of us now avoid hotels by staying in other people’s homes through Airbnb (https://www.airbnb.co.uk/). Could the care sector one day face a similar revolution where families contract carers directly through their smartphones and share granny annexes with like-minded families?
Dr. Jamie Wilson is a former NHS dementia physician and founder/CEO of HomeTouch.
HomeTouch (http://myhometouch.com/) is a tablet-based service that helps families and carers look after older loved ones. It’s elderly care you can count on.
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Kartik Krishnan
