There are substantial challenges for the care sector at present. One factor is the current shrinking economy of care, whereby funding is increasingly reduced in this time of public austerity. A second trend is the increasing demand for social care, caused by an increasingly older and more dependent population.
These two trends are squeezing care provision, with obvious ill effects: there appears to be increasing difficulties in funding the personalisation of care, and assessment and waiting times to obtain services are a source of frustration for many families.
Care services are surviving by reducing their costs, but this may not always mean shedding staff or reducing the service.
Expensive structures
As a manager of a care home for older people, I was surprised when a student pointed out to us that our service was very hierarchical, with fixed structures and job descriptions. Yet often, we saw the best service was provided outside the structure where staff ‘went the extra mile’.
In a previous blog post, I demonstrated that minimising hierarchies is cheaper, more effective and preventive. One such service is Buurtzorg Nederland, founded in 2006 by Jos de Blok. The service is community-based homecare carried out by nurses, with a minimal management structure.
High levels of autonomy are entrusted to the nurses to carry out the tasks that each individual may need carried out. An independent case study in 2012 found that the service produced ‘a reduction in hours of care, improved quality of care and raised work satisfaction for their employees.’
This model is being considered by the Scottish Government in a current review of services.
A revolution?
Further examples are around, for example the Green House movement from America. The emphasis is on communal living and across-the-board sharing of tasks in an environment designed to promote participation and reduce exclusion.
This model is being implemented by services in this country, including Evermore. The keynote seems to be reducing organisational structure while implementing a physical structure promoting both privacy and participation. Evermore proclaims on its homepage that it is ‘starting a revolution’: perhaps we need to listen and rally to this flag.
I believe we need to adapt to our changing circumstances. While we need to protest at unfair removal of funding, we should look at the opportunities for change which are around. And perhaps implement a more rational and effective model which truly puts the person at the centre of their care.
Tony Clarke – QCS Expert Scottish Care Contributor
