Our social care services are struggling. There are huge recruitment and retention issues limiting the number of people who can receive services. This also has an important knock-on effect on quality as continuity of care is adversely effected, visits are missed or care isn’t even put in place. In addition, budgets are under pressure, so that in many areas, new entrants only get funding when existing service users pass away.
It is evident that the Status Quo is not serving our older and disabled population needing care, well. The way our systems, governance and commissioning work, seem to have as their aim the maintenance of existing structures at all costs over the prioritisation of people’s needs and improvements. A kind of, let people fit into the system rather the system accommodate people and their needs. There is also a culture of risk avoidance at all costs. Better for example, to leave someone without care under existing structures, rather than try a new solution that could deliver that care.
The fact is technology is advancing at an incredible rate. The world is changing and the fourth revolution is here. Why should social care be immune to these influences? Why should social care not explore the positives technology can bring?
The sector has changed little over the last 30 years and this is to a large part due to how we commission our social care services. We commission to preserve the existing order rather than to take account of changing communities, to foster new approaches or to maximise assets already in place.
Staunch barriers to change have been erected over the years and the main threads running through them are risk aversion, protection of territories, restriction of choice, and lack of trust. Attempts to introduce innovation and change all too often become bogged down in the swamp of governance and bureaucracy.
Of course we need to introduce change in a controlled manner. New initiatives must be brought in on a small scale first and those that show promise should be scaled so as to bring their benefits to a wider audience. Controlled and monitored local pilots are one way of doing this. However, we must not lose sight of the fact that the whole point of a pilot, is not to make small tweaks to existing systems and structures but rather to try things that represent significant change and see if they work.
A good example of an ineffectual pilot is the limited roll out of Consumer Directed Home Care (CDHC) in the latest HSE home care tender. Rather than structuring the testing of CDHC as a true test of putting trust and control in the hands of service users, instead a tepid tweaking of existing practices was put in place with the only real change being allowing families to decide within strict parameters when their home care hours were delivered. Otherwise, prescription was the order of the day. Families still had to use a restricted list of approved providers, still had to use funds for a limited set of tasks and still had little ability to get better value for their budgets.
The social care sector is facing a myriad of problems that existing systems can’t deal with. What about the scourge of difficult to service home care packages that do the rounds of approved providers for months but aren’t taken on because cases are too remote or it doesn’t pay approved providers to do so?
Why doesn’t the HSE step outside the approved provider list and allow the families to work directly with a local qualified carer? It doesn’t happen because it is deemed less risky for the HSE to leave the family without care rather than provide sustainable care directly through a motivated local carer with some accommodations around governance and control.
Maybe by letting go and trusting, the HSE might find that local communities rediscover their self-motivation and ingenuity to help themselves. Our systems prioritise, the propagation of corporate solutions and provision but our world is changing and what those systems need to be promoting and fostering today are strong, self-dependent communities who are prepared to assume risk in the search for a better way of organising and helping themselves.
The problem is that authorities are keenly aware of immediate risk but less aware or concerned of the risk that comes further down the road because of short term risk averse decisions made today.
Other ways to foster innovation and intelligent risk taking in health, is too highlight advances made in other sectors and how they are benefiting from technology. This helps to contextualise and diminish the perceived risk involved.
If real change is to be introduced into social care systems, then staff, service users and administrators must be supported to grow their resourcefulness and digital self-assurance. This way sustainable and significant change can be introduced, deep organisational cultural change effected, with innovation being nurtured and welcomed across the social care sector. This in turn will lead to a social care sector embedded and owned by communities, a social care sector truly fit for purpose.