How can we improve access to and quality of social care? Catherine Needham, co-author of Micro-enterprise and personalisation, discusses how micro-enterprises and micro providers could improve care services.
At a time when the Red Cross is warning of a ‘Humanitarian Crisis’ in the NHS, there is a growing recognition that pressure on NHS services will not be alleviated unless we get social care right.
Social care services support frail older people and people with disabilities. They are run by local government and have borne the brunt of the local authority cuts in recent years, with around 26 per cent fewer people now getting help than did in the past.
Many care providers have gone bust due to downward pressures on fees and in many parts of the country it is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.
“It is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.”
Together these pressures contribute to older people being stuck in hospitals, unable to be discharged into the community because the support is not available to them.
Fixing social care
Getting social care right is not a quick fix. Access to good quality, affordable care for people with disabilities and older people is a challenging issue.
Demographic changes are increasing the numbers of people who need care at the same time as government cuts are biting hard. Stories of care which is rushed and poor quality are common. Policy-makers struggle with the conundrum of how to ensure that the standard of care gets better without overly burdening the public purse.
“The ‘Goldilocks’ question: What size of social care provider is ‘just right’?”
At the University of Birmingham, we led a research project looking into the potential for very small care providers run by local people to contribute to the delivery of high quality and financially sustainable model of care.
Funded by the Economic and Social Research Council, we started with the ‘Goldilocks’ question (what size of social care provider is ‘just right’?). We compared micro-providers of care and support (employing 5 members of staff or fewer) with small, medium and large care providers in three areas of England.
Twenty-seven care organisations in England took part in the study, covering a range of sizes and functions, including day activities and care in the home.
Interviews were done by academic researchers working alongside people with experience of local care services on a co-research model. Among the 143 people interviewed were owners, managers, members of staff, carers, and those receiving care services, including older and disabled people.
We found that micro and small care providers offer more personalised support than larger care services, and contribute to better outcomes. These benefits seem to be based on smaller providers having greater continuity of staff, greater staff autonomy and greater accessibility of managers compared to larger organisations.
The research also found that micro providers offer good value for money: their hourly rates were on average lower than the comparator organisations, helped by low overheads. Micro-enterprises are also innovative in the ways in which they deliver care. As a micro-enterprise coordinator in one of the localities put it:
“We have got a lot of traditional services, people who do home help, personal care, shopping, meal preparation. But it’s their approach to it that’s different. One of the micros I work with they will do meal preparation but they will sit down and have a meal with that person, interact with that person.”
A lot of micro-enterprises are set up by people who are disillusioned with working for large organisations, or have experienced poor quality care for a member of their family.
The research found that to get started and keep going they need dedicated business support which can help them understand care sector regulation and funding as well as more general small business advice.
They also need help to market their services to potential users as they aren’t likely to have a formal contract with the local authority in the way a large care company will have.
Social workers, GPs and other care professionals need to be informed about micro-enterprises operating close-by so that they can match up people with support in their local communities.
Dr Catherine Needham is a Reader in Public Policy and Public Management at the Health Services Management Centre, University of Birmingham, @DrCNeedham. Images are by Laura Brodrick, Think Big Picture.
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