Adult social care: independent review

The Residential Forum makes some specific comments regarding what is said, or sometimes not said, in the Review about care homes in Scotland.

Overall there is a lot in the Review that the Residential Forum welcomes, particularly the Human Rights approach. Of concern is that care homes continue to be portrayed as a service of “last resort” rather than being an option which can be a “positive choice” for many people. Among the reasons some people choose to move their place of residence includes isolation and uncertainty.

Most people have no real experience of care homes so their perceptions are shaped by media coverage or what they think is best for people rather than accepting that they may want and need something different.

The Forum stresses the positives of good residential care including:

  • safety (including feeling safe 24 hours a day if help is needed)
  • security
  • relationships (making new friends – companionship)

These points are actually what has been said by residents of care homes who have been quoted in the Review. As an example see the comments by Helen Morrison a care home Resident – on page 77 of the Review. In particular what she has said about “Living in a good care home is so much better than sitting at home alone and struggling. ………..It really is my home and I love it.”

Providing support and care within a care home isn’t about the building but about the quality of care and the relationships which are developed. It is of concern that some of the Review references seem to dismiss the possibility that a care home should be seen as part of a wider community. An emphasis on enabling people to remain where they currently live is only reasonable if that is the best for them. A house is not necessarily a home and sometimes this reality can be overlooked.

“National Improvement Programme”
Recommendation 27 states: “The safety and quality of care provided in care homes must be improved to guarantee consistent appropriate standards of care.” Nothing wrong with this if it recognises that, despite the lack of appropriate finance available, this has been what has been happening. What is needed is a recognition that regulation must support improvement and finance needs to be provided to continue the journey that providers are taking in this respect. Commissioning should be about driving and supporting improvements and not tied into driving down the cost of care with no recognition that often that will prevent a service improving the quality of care it will be able to provide.

“Reducing the use of institutional/residential care”
The statement on page 64/65 of the Review should not be a target. The target should be about making sure that we are providing the most appropriate form of care for people according to their needs and wishes. In some cases that will be residential care of some form or other.

“Models of Care”
Recommendation 31 states “Investment in alternative social care support models should prioritise approaches that enable people to stay in their own homes and communities, to maintain and develop rich social connections and to exercise as much autonomy as possible in decisions about their lives. Investment in, or continuance of, models of social care support that do not meet all of these criteria should be a prompt for very careful reflection both by a National Care Service and local agencies.” The Forum points out that these criteria can be met in residential care if properly funded and if regulation has a human rights approach as well.

“Commissioning for public good” On page 75 their is a specific sub-section on care homes. In it there is talk of the ‘safety huddle tool’ which “has meant for the first time ever a standard data set is available in real time about each and every care home in Scotland. This data is available to local systems and at a national level, and is helping to ensure support is provided at as early a stage as possible to care homes to ameliorate and better manage risks for residents, staff or the whole care home, identified through use of the tool.“ It is suggested this is opening up “the possibility of a more partnership-based approach to improvement in care homes, which is not reliant on the Care Inspectorate using its regulatory powers but instead focuses on local ownership of improvement work being nurtured and supported.”

The Forum observes that when the management of risks is talked about it is commonly usually from the perception of the professional or politicians. Very little is done to enable people who are residents in care homes to consider and make their own decisions about how risks that effect them are managed by or with them.

There is a reference to the extent that some privately-run care homes yield profits for their shareholders as an issue of concern. The review shares “the unease expressed by many about whether it is right – in a country committed to health-care free at the point of need to all its citizens, regardless of age or any other characteristic – that an important part of our care system is largely run on a profit-making basis”. This must not dismiss the good quality care being provided within much of the independent sector. The Forum takes the stance that it is not ownership or even profit that should be measured but the quality of the service – support and care. If profit becomes equated with bad care then much of social care would be disregarded and the sector decimated.

Recommendation 36 states: “The care home sector must become an actively managed market with a revised and reformed National Care Home Contract in place, and with the Care Inspectorate taking on a market oversight role. ………………A ‘new deal’ must form the basis for commissioning and procuring residential care, characterised by transparency, fair work, public good, the and the re-investment of public money in the Scottish economy.”
This is a good statement and the Residential Forum is ready to assist fill in the details. Turning intention into practice will depend on whether it is seen as a positive way of developing good quality residential care as a meaningful option for people rather than as a way of reducing the range of services available.

Fair Work” In this section there are a number of recommendations about delivery of Fair Work in social care and support. “To improve terms and conditions for the social care workforce, and to properly reflect the value social care brings to Scotland’s economy and wellbeing of its people…” These are very important to Forum members.

Source: Adult social care: independent review –

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