Across England there are more than 8,500 home care providers, collectively helping an estimated 673,000 people to continue living independently within their communities.
Over the last year, the number of local Healthwatch citing home care as a priority has doubled. Home care, also known as domiciliary care, can include regular visits from a carer to help with personal care, getting dressed, using the toilet, shopping and preparing meals.
Healthwatch England analysed the experiences of 3,415 home care users, their families and front line staff across 52 local areas between August 2015 and June 2017. These findings came from local Healthwatch events, surveys and site visits to health and care services.
Most people had positive things to say about their home care. These services are invaluable to many people, both for the quality of care provided and the support and company of care workers.
Older people in particular said that one of the most positive things about home care is that it enables them to remain in their own home and to maintain as much independence as possible.
However, Healthwatch also discovered four themes across our research that will be of interest to those who commission, provide and regulate social care services:
• Care planning – People frequently reported that staff were unfamiliar with their clients’ care plans. In cases where it was a staff member’s first visit to a client, insufficient time was often allowed to enable them to read the care plan. A care user speaking with Healthwatch Blackpool said, “Unless they have attended before they do not know what has to be done.”
• Skills and qualifications – Many of those who spoke about their experiences said they valued the dedication and experience of those sent to care for them. However, others lacked experience and basic skills, such as being able to wash someone or make them breakfast. One resident in her 80s told Healthwatch Bradford that one of her carers was unable to boil an egg or make the bed, while another person said care workers needed to be taught “home care common sense.”
• Consistency and continuity – All local Healthwatch found problems with staff coming at different times and even missing appointments. Healthwatch Staffordshire found a number of people reporting that it felt like care packages were designed to meet the needs of the service provider rather than the service user.
• Communication and feedback – Providers need to look to make greater and more regular use of feedback to address problems early and prevent minor issues turning into complaints. Several people who spoke with Healthwatch highlighted the lack of communication they had with the organisations providing their care. Healthwatch Bucks found that all communication with clients of one provider was run through frontline staff. This created problems when staff were on holiday or were off sick.
Healthwatch driving improvements:
One in seven of those who responded to Healthwatch Newcastle’s survey said they had experienced medication being missed due to the home care provider, with one in six stating they felt the provision of medication was either partly safe or never safe. Due to the importance of this issue, Healthwatch Newcastle secured agreement from the City Council to ensure that providers must be compliant with the latest NICE guidance on medicine management in new home care contracts.
The very nature of home care means that it’s not always easy to find out what people think of it, making it probably the area of health and care where commissioners, regulators and policy makers need the most help collecting intelligence.
Although this report highlights a number of concerns in home care, it is encouraging that many local Healthwatch have already had their evidence used by local commissioners to inform the development of new service specifications and contracts.
The Healthwatch network will share the findings of this briefing across the health and social care sector, as part of a wider programme to encourage greater use of user feedback.
Neil Tester, Deputy Director of Healthwatch England, said:
“It’s often incredibly important to people to be able to stay in the familiar surroundings of their own home. One of the most positive aspects of home care is that it enables people to hold on to as much independence as possible.
“We listened to people using home support services and those delivering care and they have given us a clearer picture of how the system works for them. We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards.
“Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard. So if anyone has a story they want to share or an idea they think might help, I urge them to get involved and speak to their local Healthwatch.”
List of local Healthwatch who have contributed to this report:
Barnet, Bedford borough, Bexley, Birmingham, Blackburn with Darwen, Blackpool, Bolton, Bradford, Bromley, Buckinghamshire, Calderdale, Central Bedfordshire, Central West London, Cheshire West and Chester, Cornwall, County Durham, Darlington, Devon, Dorset, East Riding of Yorkshire, Essex, Gateshead, Halton, Hampshire, Hillingdon, Isle of Wight, Islington, Kent, Lambeth, Leeds, Lewisham, Liverpool, Newcastle, North Lincolnshire, North Somerset, North Tyneside, Northamptonshire, Northumberland, Oxfordshire, Redcar and Cleveland, Rochdale, Southend, Staffordshire, Stoke-on-Trent, Sunderland, Thurrock, Torbay, Wakefield, Warrington, West Berkshire, Wiltshire, York.