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29th November 2013

Us versus Them – Attitudes to Homecare


The Guardian Professional and the Department of Health have recently published their research into Attitudes to Homecare in England. Over 60,000 people received the survey and 1443 completed and submitted between July and August 2013. I myself responded to the survey and the findings are not a shock to those of us who have worked in the Industry for a number of years, and if anything the findings strengthen and support Homecare providers in their argument over commissioning strategies and lack of partnership working.

Contrasting views 

Of no surprise in the survey is the disconnect between views of the respondents who work in a council and those that work for a Homecare provider.  For instance, one question asked ‘Do Councils work well with others to arrange good quality homecare?’... 44% of council employees either agreed or strongly agreed. 57% of Homecare providers either disagreed or strongly disagreed.

Another question asked ‘Do Councils positively influence the quality of Homecare received?’ 64% of Council workers agreed or strongly agreed. 49% of Homecare providers disagreed or strongly disagreed.

How interesting that there is such hugely contrasting views from both sides of the sector. The survey results evidence a lack of dialogue or understanding between Councils employees and Homecare providers.

Surely our aim is a shared goal of delivering top quality services whilst achieving great outcomes.

So how have we come to this point?  We have stopped talking.

Delivering front line services to the most vulnerable in our societies is a huge responsibility. There should be a shared initiative and corroborative working between Councils and Providers, but this is what the industry is lacking.

I believe this demonstrates the feelings of most Homecare providers - that there is a ‘Them’ and ‘Us’ scenario. Many providers feel let down by their commissioned councils and not fully supported as they should be. Bridget Warr, Chief Executive of United Kingdom Homecare Association Limited sums these feelings up:

"There does need to be a re-think on the relationship between councils and their local providers. Just at the moment, the financial climate is creating a 'them and us' relationship, which prevents innovation and joint working. However, without careful consideration of the price paid for homecare services, this is going to continue."

A question in the survey asked ‘What do you see as the Key challenges facing Organisations that currently provide Homecare?’ respondents were asked to pick their top three out of a list of 8 possible answers. 58% of respondents choose Council commissioning as a challenge.

I have offered in the past for key people within commissioning units to come and work for two or three days with the team I work alongside. Only once has the offer been taken up and that individual said it gained her an extraordinary experience and understanding of how the business ran and some of the difficulties of providing care in the community.  I have written before about being unable to source packages of care for people being discharged from hospital only to be told “it’s in your contract specification”. Those responses are not helpful and in some cases when packages are accepted quickly, Providers have complained they can wait days for a Care Plan to be sent through from a social worker.

How can “Good quality Homecare” be arranged when Providers have no idea of the tasks and outcomes required for an individual?  Are we supposed to guess?

Sometimes a social workers lack of understanding of the inner workings of a social care provider can be shocking. Many providers are struggling to meet the demand for the service and pressure to provide a service (sometimes within 24 hours) can only result in one outcome - substandard and poor quality care.

When trying to quickly offer cases, sometimes packages are accepted without a regular team of carers implemented, which can take time to coordinate and properly plan. If different care staff are arriving at different times for the initial few days imagine the introduction these people are having to a Homecare service. And whilst Providers work to try to settle the case with a regular team of carers, already the next caseload is waiting for care to be sourced. Providers and Hospital discharge teams should be having conversations as early as possible when people are due to be discharged with a care package. We are frequently finding that we receive a referral and then are told “It’s a section 5” and the pressure is on to offer the case immediately to avoid the Hospital being fined for bed blocking. If we were made aware earlier that potentially someone is due to be discharged then we can look at the sourcing packages quicker.  This is just one suggestion whereby better communication could result in a better service being delivered to the individual.

It’s not just Homecare providers that want to talk...

One of the positives of the survey was many respondents had added their own comments - nearly 8,400 comments in total which I believe demonstrates the willingness of people to engage and become involved in shaping the future of Homecare.

I work with so many passionate people in this sector regardless of whether they work in a Council or for contracted services. I know lots of people who work around the clock to ensure people are cared for in a respectful and dignified way in their own home.  Most providers I know are willing to engage with Councils and commissioners. Providers are a step closer to Service Users and frontline services. We have a unique perspective and I would say - a good insight - into what our Service Users actually want from their Homecare service and not what we think they want.  We want these debates, which can surely only improve the services we deliver by tackling the problems that stand in the way of delivering top quality services. Yes those discussions may be difficult, but we need them to agree a positive way forward and in partnership with each other. So let’s talk. Let’s have the conversations that really matter and get to the heart of Homecare.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Rosie Robinson

Domiciliary Care Specialist

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