Home care in Newcastle – A spotlight
There have been many conversations in recent months about home care services, and the expected impact the rise in the minimum wage will have. We also know that a squeeze on council funding has led to challenging times for care providers. How providers and commissioners will deal with these challenges is still being played out, but there is cause for concern, with a provider withdrawing home care services in Liverpool and the Wirral due to wage pressures being only the most recent example (www.liverpoolecho.co.uk/news/liverpool-news/home-care-provider-pulls-out-11574512).
Concerns have also been raised nationally about poor training, high staff turnover, workers being on zero hours contracts or not being paid for travel time, and the short duration of care visits.
Here at Healthwatch Newcastle we recognised we did not know much about the state of home care provision in Newcastle and what people think of these services.
The opinions of the people who have home care and their families are seldom heard as they tend to be isolated and vulnerable. We were also aware that the service would go out to tender during mid-2016 for a three year contract, with a probable budget reduction of 28%. As a result of this, and feedback from the public and stakeholders, we made this service one of our priorities for 2015—16.
In 2011 Newcastle City Council commissioned five home care providers to deliver services to 1,900 service users across the city, totalling approximately 13,400 hours of home care per week.
We focussed on these five providers and from December 2015 to January 2016 set out to speak to service users, family and carers, providers, commissioners and the voluntary and community sector (VCS) to increase our knowledge base and to develop three questionnaires tailored to service users, family and carers, and to home care workers.
With the assistance of the local authority we were able to send questionnaires to a large, random sample of those who receive publicly-funded home care and to their families and carers. We also worked with two unions to promote the questionnaire to care workers.
In carrying out this work our aims were to:
- Build a detailed evidence base on home care in Newcastle
- Give service users, commissioners, providers and the VCS an opportunity to share their views anonymously with an independent organisation
- Share the findings with service users, commissioners, providers and the VCS
- Support commissioners and providers to implement any changes identified within the work
We received a good response to the survey with 363 respondents, including 199 service users, 124 carers and relatives, and 40 care workers. We were pleased to have gained a large enough sample size, from a seldom heard group of service users, carers and relatives, to enable statistical testing for significance with the results and subsets.
What did we find out?
Users, carers and relatives reported high levels of satisfaction with the overall quality of care provided. Over 91% said they were either ‘very satisfied’ or satisfied’ with the overall quality of care provided.
The percentage of service users, carers and relatives, who said that all allocated tasks were completed, and that they were treated with dignity and respect, was also very high. Eighty-nine per cent of respondents said ‘always’ or ‘mostly’ when asked if their care workers completed all their allocated tasks; over 94% said their home care workers treated them with dignity and respect.
“The regular small group of care workers provide a fantastic service. They are caring and professional with a chat as well. Don’t make me feel I’ve lost my dignity.”
“I feel I can go out during the carer visit. I am in the knowledge that my husband will be well looked after, and this is very reassuring.”
Relative of service user
Areas for improvement
Although overall satisfaction with the quality of care was high, there were seven areas that required improvement:
- Continuity of care worker
- Medicine management
- Communication between service user and the provider (not user and care worker)
- Timeliness/punctuality of care workers
- Management of the provider
- Complaints handling
Respondents were very clear that continuity of care worker was their most important concern and the issue they most wanted to see improved. More than 28% of service users who responded said they ‘partly’ or ‘never’ had a regular carer. This raised problems including:
- Care workers lacking knowledge about their physical and emotional needs, including medicine regime
- Care workers only doing the essential tasks, without tailoring them to the individual
- Anxiety for service users when having many new faces in their home
- Hindering the development of a relationship in order to build trust and rapport
People living with dementia found it particularly difficult to cope with a change of care worker, with several examples given of service users who did not want to get out of bed with strangers present.
Service users, carers and relatives also reported some of the lowest satisfaction scores around how the care provider communicated with them. Just under 77% reported being ‘very satisfied’ or ‘satisfied’ with how the provider communicated with them. This dropped to 67% who responded ‘always’ or ‘mostly’ when asked if they were kept informed about changes in their care.
Ten recommendations were made in the resulting ‘Spotlight on home care’ report, and we are very pleased that six of these – including continuity of care worker and monitoring of visit times/change of care worker – were wholly incorporated into the new home care tender commissioned by Newcastle City Council in summer 2016, which has have been receptive to this research.
“The results of the survey from service users and their carer or relative have been insightful and valuable evidence for us to help evaluate the service and prioritise improvement areas for the coming home care service tender. We support the recommendations from the report. We have also been impressed with the professionalism of the work and the scale of the survey which has given the report credibility and importance in our thinking.”
Ang Jamson, Commissioner at Newcastle City Council
The Newcastle City Council Service Manager also said he could use some of the feedback outlined in the report straight away to assist with his management of home care providers, and help improve the quality of the service.
Key impacts of research
- Prioritised service users’ biggest concerns — the two most important issues for service users (continuity of care worker and management of medicines) have been prioritised for improvement in the new service specification
- Best practice from the latest NICE guidance — the council will also ensure that best practice is incorporated in line with the latest NICE guidance for home care services, related to the areas for improvement voiced by the service users
- Better performance monitoring — the council will incorporate performance indicators into the home care service, with specific performance indicators related to the priority areas where service users want to see improvements
- Knowledge sharing — service users and their carers and relatives have learnt more about the home care service and their rights and choices relating to it. This has happened through the process of interviews and focus groups and via feedback through presentations and discussions post-survey
Read the full report at www.healthwatchnewcastle.org.uk/about-us/documents/ in the ‘reports’ section.
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