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These days it takes a lot for a news story to make me cross, but the revelation today that over 75% of care visits carried out by some councils in England are only 15 minutes in length has properly bugged me. Moreover, the number is rising; 15% in the last 5 years and it’s even worse in Wales and Northern Ireland.
Consider the morning routine you go through every day; get up, toilet, shower, dry, dress, eat breakfast or at the least knock back a coffee. Even the most organised late sleeper would struggle to be out the door in less than half an hour. It takes two minutes to boil the kettle, two to brush your teeth. Throw in the inconvenience of shaving or drying your hair….. Well, you see my point.
So why is it OK to spend only 15 minutes supporting someone else with these tasks, or with using the loo or managing medicines?
It’s actually worse than that (I told you I was annoyed….) as the 15 minutes often includes checking the records of the previous carer, signing in, signing out and writing notes. Add to this the cumbersome business of removing your coat and putting it on again and it’s a wonder you bother going at all.
Now I am not so naive as to think this applies to every episode of care delivered in the community to elderly, frail and disabled people, nor am I such an idealist not to see the need for managers and commissioners of social care to make the most effective use of expensive resources. I was one of those commissioners and the requirement to deliver five star services from reduced budgets is one I am all too aware of.
It’s just that I have no idea how I would demonstrate quality care in 15 minutes, or indeed ask one of my staff to do the same.
I spend a lot of my time these days monitoring and assuring the delivery of care against pretty rigorous standards, designed to make sure that the service user is absolutely central to everything we do. We assess strengths and needs and plan care to accommodate the latter whilst encouraging the former. Supporting independence means often lengthy sessions of hand on hand or verbal prompting and heaps of patience.
It once took me eight months to get a guy to use a walking frame instead of bottom-shuffling.
Independence for many people with learning disabilities has been hard won, and when supported living means being out there in your flat, going about the neighbourhood and fetching your groceries, cooking your tea and washing up after, the daily call from your support worker is the boost that helps keep you there. Even if they just come in to check you are OK or help you with your bills they are a vital and welcome visitor in your home. If your visitor is only allocated a quarter of an hour, there is no time to chat, no time to share and no time for them to observe how well you are doing. Or not. Or how less well you are doing than yesterday or the day before…..
As a community nurse back in the 1980’s I regularly spent around 40 minutes with one lady with a learning disability who lived alone. Once a month I administered her depot injection but the other visits were an opportunity to chat to her about her life, make sure she had food in (I would bring a bottle of milk and pop it into the fridge for her, to check the contents) and keep an eye on the general cleanliness of her place. Aside from the social aspect of having me round to tea, this lady used the visits to ask me to read her post to her, make sure the clock was wound and check her answering machine messages. Funny thing though, the most pertinent and vital information she shared almost always happened as I was about to leave, when she would remember something important as I went out the door. This was true of others I saw; the time needed to warm up, cover the small talk and gather the necessary strength to ask the tricky questions.
Today’s news, from a report by Leonard Cheshire Disability, echoes these views that short visits compromise quality care. Anyone can pop in, but it takes a skilled person to make a difference. And the skill is around observing, listening and being alert to changes or signals. Trust takes time to build and time is therefore the most valuable asset. You can teach staff the basics of personal care, how to move and handle, how to assist with eating or administer a nebuliser, but the skill of being intuitive, being vigilant and being empathic takes so much more to learn.
Small wonder then, that it is said that carers are indifferent or that people are treated like ‘robots to be serviced’ (to quote the CEO of Leonard Cheshire in the report) when we are asking them to deliver care in such preposterous time frames.
I wish I had an answer to the perennial problem of too much need and not enough money. I doubt it lies in making sure your teams are of the highest ethical and moral standards, because even paragons of quality care would struggle to deliver it in the time it takes to cook al dente pasta.
Hurrah then for the government who have allayed my fears with the following quote from today’s Guardian:
‘Norman Lamb (the care and support minister,) said, "It's unrealistic to think that 15 minutes is enough time to help people who are older or who have a disability to do everyday things like wash, dress and get out of bed. It's not fair on those who need support and it's not fair on care workers."
He said there would be an, "amendment to the care bill [ensuring] local authorities would have to consider a person's wellbeing when arranging their care.”
My word – I never thought to consider a person’s wellbeing when arranging their care – I shall ensure I take sufficient time to do so in future.