Health and Social Care Committee

Inquiry into residential care for older people

 

RC66 – Wales Progressive Co-operators

 

 

National Assembly for Wales

Health and Social Care Committee

 Residential Care Inquiry

 into the residential care needs of older people

 

Evidence from Wales Progressive Co-operators

 

‘The importance of Social Innovation:

What can older people in Wales learn from Quebec?’

 

Summary

 

• Long term residential care for older people cannot be viewed in isolation from its context, a context in which most care is provided by unpaid carers, often themselves elderly, and in which therefore home care and other sources of community support (and their absence) are fundamental factors in determining and preventing demand 

 

• Existing prevalent models for the delivering of care for older people are difficult to sustain financially or to assure in terms of quality

 

• Existing models of care typically disempower the service user and weaken family and community capacity to care and to safeguard

 

• We need to find a more sustainable relationship between state, local authority and citizens, and for this, social innovation will be essential.

 

• There is strong evidence from other countries that the co-operative model of care service has enormous potential to address the deep problems we face, and merits earnest support for grassroots development in Wales

 

 

Introduction

 

Some older people will undoubtedly continue to need long-term residential care and the quality of that care, and access to it for those to whom it is appropriate, should be improved.
 
In the present situation, and for the foreseeable future, the traditional concept of residential care needs to be replaced by a vision based on new thinking, and on developments that are affordable, intrinsically empowering of the citizen-user, and receive public support.

This is a major issue in the advanced world. Markets have left a shambles and the State has real problems with growing elder care. Services are under pressure, mainly with target driven responses, not proving adequate to what is required. In Wales, we need knowledge of social innovation to break through and rethink models of care.

 

Long term residential care facilities represent a most costly type of intervention. Home care services, extra support housing clusters can delay or actually obviate the institutionalisation of individuals and help keep people at home. To discover how such services can operate effectively we should look to other countries, where co-operative provision is well established.

 

At the recent International Co-operative Alliance General Assembly in Cancun, Mexico, Ed Mayo, Secretary General of Co-operatives UK, commented that the UK has far more to learn from Co-operatives overseas than we have to teach. This is especially true of elder care co-operatives in Canada and social co-operatives in Italy.

 

This paper seeks to encourage international learning. See also the opportunity arising from a visit from a Quebec researcher in February 2011 (Appendix 4).

 

Background

There are important and basic matters to consider about elder care, and they become more urgent because of a rapidly ageing population and a limited amount of finance. Add to this the fact that many old people have limited capacity and may have no family available to advise them at a vulnerable time of their life.

 

Provision of residential care and home-based care is not as it should be in terms of either quality or quantity. Underfunding of some services still persists today. In Wales, despite increasing demand, the overall budget for these services has not increased much over the past few years. A new foundation is required to build future community care services that will replace in some measure the reliance upon residential provision, which is becoming more expensive for local authority and private provision, with the latter providing a financial return to the shareholder.

 

Loss of UK Care homes

The loss of the number of UK Care homes has doubled with 73 care companies going into administration in the year to the end of September 2011, compared with 35 in the previous 12 months. The number of smaller companies exiting the market is quite marked and included: - Southern Care Group, North Wales; Winnie Care Group, Cheshire; Argus Care Group, Scotland (500 residents) and Grosvenor Care, Stockport. Southern Cross is an example of how quickly the whole structure can disintegrate.

 

Extensive media investigations and from speaking directly with older people, all indicate an inadequacy in the quality and range of existing care provision, including residential care. We provide a recent case study of Registered Social Landlord provision at Appendix 1.

 

A recent Equality and Human Rights Commission home care report in England, captures market dysfunction, which is unlikely to differ in other UK countries.

 

Home care services

For several years home care services have been receiving less attention from government. For example, the number of hour care hours has reduced from its peak of 12.8m in 2003/2004 to 11.2m in 2010/2011, with the proportion of local authority staff reducing from 62% to 32% from 2001/2002 to 2010/2011.  Domiciliary service provision by local authority for those age 18 and over   ranged from 10% in Cardiff to 78% in the Isle of Anglesey. http://statswales.wales.gov.uk

Crucial role of unpaid carers 

To put these statistics in perspective, we observe the crucially important role that unpaid carers play in Wales, upon which much of the current system is hugely dependent. In the ‘Care at Home’ report for the Care Council, Welsh Institute for Health and Social Care did some simple analysis about the proportions of care that are provided. Although it is not directly relevant to residential care, it is very important in the broader strategic context.

The 2001 Census collected information regarding the numbers of UK carers and the amount of caring they do for the first time. Based on returns, Carers UK recorded that there are nearly 6 million UK carers, with 340,745 in Wales – equivalent to 11% of the Welsh population. It is possible to analyse these figures and make an evidence-based judgement about the proportion of care in Wales that is paid for, and the amount that is provided by unpaid carers. Subject to a number of caveats, but based on these data, and using the most conservative estimates (i.e. the minimum values in the range) the analysis shows that at least 288.5 million hours of care were provided by unpaid carers in Wales in 2001. When compared with the most recent data of 11.7 million annual hours provided by local authorities (including services commissioned and delivered by others), this demonstrates that unpaid carers provide at least a hugely significant 96% of annual care hours in Wales, with the remaining 4% provided by local authorities and independent providers. This is an even greater proportion than reported in ‘Fulfilled Lives, Supportive Communities’ which states that ‘at least seventy per cent of the care for vulnerable people is provided by family, friends and neighbours’ (see p.19 in Llewellyn M, Longley M, Fisk M, Boutall T, Wallace C and Roberts M (2010) Care at Home: challenges, possibilities and implications for the workforce in Wales Care Council for Wales: Cardiff – ISBN: 978-1-906528-29-4).

Examining alternative methods

On current projections, public resources will be insufficient to meet demand at a time when people rightly value their independence and wish to have a say in how and what services are available. Therefore, we need to widen our approach to examining alternative methods and have an open mind to changes, which must involve older people within a process of ‘co-production’, and impact upstream on the development of policies and programmes that determine the conditions of production and the delivery of services (a process in Quebec called ‘co-construction’).

 

It is essential that we consider