Simon Arnold, CORC (Commission on Residential Care) Commissioner and MD of Tunstall Healthcare looks at one of the key recommendations in NHS England’s new report.
NHS England, recently published its NHS Five Year Forward View, a 40-page plan which, in the words of chief executive Simon Stevens “will make the case for some of the changes we’re going to need” in funding and reforming the service.
It’s a very interesting read, especially because it isn’t just Stevens’ own views on what’s needed: all the major NHS organisations are in agreement about the report’s recommendations, including NHS England, Monitor, NHS Trust Development Authority, the CQC, Public Health England and Health Education England.
It’s probably the most comprehensive health review for a generation and attempts to draw in elements of care and housing as well. One point in particular caught my eye. A section titled ‘New care model – enhanced health in care homes’ points out that one in six people aged 85 or over are living permanently in a care home. Data suggests that had more active health and rehabilitation support been available, some people discharged from hospital to care homes could have avoided permanent admission. At the same time, the Care Quality Commission and the British Geriatrics Society have shown that many people with dementia living in care homes are not getting their health needs regularly assessed and met, with one consequence being admissions to hospital, which could have been avoided.
Both points are symptomatic of the position we have taken regarding people in residential care – somehow they are almost ‘outside’ of the healthcare system and so no one takes responsibility for resolving the issues. The report goes on to say that using the opportunity created by the setting up of the Better Care Fund, local NHS and the care home sector can develop new shared models of support to tackle this problem.
In fact, much of the work in evaluating the role of residential care in a modern system, and developing recommendations for better-integrated care and support has already been done. Over the past year, the Commission on Residential Care (CORC) has brought together experts and practitioners to evaluate the role of residential care in a modern system. With evidence gathered from care providers, current care home residents and staff, DEMOS recently published a report which explores the current issues affecting residential care in the UK.
Housing with care
Care homes should offer a positive experience for older and disabled people. As outlined in the CORC report, residential care isn’t about restricting people’s lives; it’s about putting people first, and helping them to gain (or regain) a measure of independence and avoid unnecessary hospitalisation.
But how do we position residential facilities as ‘housing with care’; emphasising that they are places for people to live with dignity, supported by person-centric care packages? By integrating personalised support packages with technology, it’s possible to transform services to ensure people maintain independence and autonomy as their needs change.
In compiling the CORC report, we looked at several case studies, specifically those in which assistive living technology has been used to enhance service delivery. There are many such examples across the UK, which support the health and care needs of people as they move into a ‘housing with care’ environment.
As an example, a successfully deployed telehealthcare scheme is one step closer to creating a residential care system that is truly fit for purpose. Technology at present is an underutilised tool in the ‘housing with care’ sector and can be used to join up services in a straightforward way. As such, we need to make sure older people are included in the journey, rather than bypassing their access to technology over fears of it being “too complicated” for them. There is significant evidence to show that this is simply not the case and yet it is one area within society where the technology revolution has still to fully take off.
The sector should also make greater use of innovations such as customised tablet computers, pre-loaded with simple, easy-to-navigate tools. With this intuitive technology, users are given access to a wealth of information and the means to connect easily with the ‘outside world’.
With these approaches, the ‘care home’ environment can evolve into an effective shared model of support that can cater for mixed needs, meaning that those with more complex requirements can co-exist in an environment that also accommodates higher levels of independence. This is the essence of ‘housing with care’ and the wide spectrum of technology already available can support it to be a reality.
It’s a change that can happen now – it doesn’t have to wait five years, so what are we waiting for?