Royal College calls for an end to de-humanising social care system
RCOT sets out plethora of improvements that can be made by occupational therapists to improve lives and use public money effectively in social care
Published on 14th July 2017
The current social care system is having a ‘dehumanising and isolating effect’ on older and vulnerable people, the Royal College of Occupational Therapists has warned.
While frequently reports refer to the unprecedented pressure the social care system is facing and how the system is broken, those reports fail to stress how the pressure has created a ‘high volume, low margin’ approach to caring that has a ‘dehumanising and isolating effect’ on the oldest and most vulnerable members of our society, the Royal College adds.
This is, however, despite the very best efforts of those involved in the provision of social care. Yet many older people talk of simply existing, not truly living, which is a sad indictment of how we treat the oldest and most vulnerable members of our society, says the College.
“Too often, councils tell people what social care service they will get, based on what it is most efficient to provide, instead of asking what they really need. This gap between the service people get and the services they really want leads to costs arising elsewhere; for example, a costly hospital admission as a result of a fall by a gentleman who wanted to get up at 8am when the council could only arrange a carer visit at 10am,” said Julia Scott, CEO of the Royal College.
“For too long, we have collectively wrung our hands and exclaimed that something has to be done to ‘fix’ the social care system. Clearly some big-ticket items need to be fixed, including long-term funding arrangements, but within this report we are seeking to provide some concrete solutions. What we set out are evidence-based, positive recommendations to make things better for the people who need our care,” she added.
Autonomy, choice and control
The report highlights that there is an estimated £1.9 billion funding gap in 2017 between the demand for care and funding available.
Sustainability and Transformation Plans (STPs) have been introduced to ensure a pooling of resources within a ‘footprint’ and they are designed to strengthen partnerships in order to provide timely and person-centred care.
National initiatives, such as pioneer and vanguard sites, are exploring different models of partnership working in order to deliver efficient ways of meeting local need. But the Royal College of Occupational Therapists argues that, as experts in occupation, occupational therapists can act as an enabling mechanism for the quality of life and wellbeing of the local population.
“Too often the most vulnerable members of our society are provided with social care packages based on what is organisationally expedient for the provider rather than an understanding of the recipient’s real needs,” says the report. “Occupational therapists identify what each person needs and wants to be able to do and helps them find ways of doing it. They see the whole person and, in doing so, return the autonomy, choice and control.”
Better quality of life
The report states that finding ways to enable older people to continue to participate in daily life through problem solving, learning or relearning skills and making adaptations not only improves peoples’ lives but also makes more effective use of public money.
When people’s needs are not met they come to rely on other services and too much social care reverts to long-term support, reducing older peoples’ autonomy over how they live their lives day-to-day. This has a dehumanising and disabling effect, which leads to dependence and strips older people of their vitality and self-esteem, the report argues.
The RCOT argues that the system needs to refocus on creating services that help older people to do as much as they can for themselves, for as long as they can; seeing a person’s overall wellbeing rather than simply a set of support needs. Short-term, intensive reablement can result in a better quality of life and outcomes for older people, and reduce costs for providers.
Punching above their weight
The Royal College highlights that occupational therapists have traditionally punched above their weight, dealing with between 35–45% of adult social care referrals and yet only making up 2% of the workforce.
It is calling for occupational therapy to be incorporated within all 44 Sustainability and Transformation Plans at the next point of review and recommends that:
- Occupational therapists are incorporated into multidisciplinary teams within new models of care, as outlined in the GP Forward View.
- Occupational therapists are deployed to develop person and community-centred approaches to ensure older people live independently for as long as possible in their communities.
- Partnership agreements are formally developed across local housing, health and social care sectors to ensure all older people irrespective of social, economic or housing circumstance, have access to occupational therapy.
Preventing or delaying the need for care and support
The GP workforce is under immense pressure. An estimated 4 million older people in the UK have a life-limiting longstanding illness; this equates to 40% of all people over 65 years of age.
New models of general practice must support GPs to coordinate care for the local population, by providing them with closer working relationships with integrated community care teams. In order to support people to remain in their homes and communities, occupational therapy workforce numbers should increase to reflect the growing health and social care needs of the local population, both rural and urban.
The inclusion of occupational therapists within integrated teams will allow them to address health and social care needs within people’s homes, the report says.
The design of services must include structures and processes to enable occupational therapists to work closely with GPs and primary care colleagues.
- Occupational therapists need to be based within GP practices or community hubs and primary care home sites
- Primary care teams should have direct access to occupational therapy
- The skills mix of integrated teams should reflect the actual needs of the local population through the co-design of services with service users.
“By utilising their specialist skills and approaches, occupational therapists can make cost savings for services while improving wellbeing outcomes for people,” says the report.
Helping older people to remain in their communities
The RCOT recommends that occupational therapists are deployed to develop person and community-centred approaches to ensure older people live independently for as long as possible in their communities.
Older people want to remain in their own homes and existing legislation has been designed to support this, through personalised care planning, shared decision making and involvement of the wider community.
Occupational therapists should be deployed to work with older people to tap into community resources and structures to support them to make choices about how they live their lives, says the report. Occupational therapists can provide advice, support and training to older people on how to undertake daily living activities by teaching techniques and advising on assistive technology, equipment and adaptations.
The commissioning and structuring of services should be changed to enable occupational therapists to take a community-wide approach. This would enable occupational therapists to:
- Take on leadership roles to provide expertise and mentoring to community providers
- Train carers and community workers to encourage a personalised and enabling approach to care and support
- Work with community providers to improve accessibility to existing resources and services for older people with complex needs
- Advise on the provision of equipment and adaptations to improve older peoples’ independence beyond the home
- Contribute to developments that support self-assessment of standard equipment and minor adaptations for people with less complex needs.
“By utilising these specialist skills and approaches, occupational therapists can make cost savings for services while improving wellbeing outcomes for people and reducing unnecessary care packages,” says the RCOT.
Ensuring quality of access to occupational therapy
The RCOT recommends that partnership agreements are formally developed across local housing, health and social care sectors to ensure all older people irrespective of social, economic or housing circumstance, have access to occupational therapy.
The Royal College of Occupational Therapists wants to ensure that older people are able to access the appropriate expertise to address their needs. In order to ensure equality of access to occupational therapy is achieved, the design of services must enable occupational therapists to widen their approach in order to meet the varying needs within their local communities. This means:
- Resourcing occupational therapy services sufficiently so that they can take referrals from all sections of society, including hard to reach groups
- Providing information to the public on ageing well and adapting the home to meet changing needs
- Providing opportunities to establish and maintain partnerships across sectors, for example housing, voluntary organisations, private providers and social enterprises
- Providing access points to occupational therapy advice for community teams such as home care and reablement providers
- Training and mentoring roles, for example to care home staff.
“By utilising their specialist skills and approaches, occupational therapists can make cost savings for services whilst improving wellbeing outcomes for people,” says the College.
‘We need to enable older people to live and not just exist’
As part of enabling the older population to live as independently as possible for as long as possible, the Royal College of Occupational Therapists recommends that within the STP process local occupational therapy workforce and services are specifically considered and included. The report says it is ‘telling’ that many STP plans focus on the numbers of doctors, nurses and midwives that will be required, but neglect to consider Allied Health Professional requirements at any granular level.
“Local health and social care economies should consider the breadth of occupational therapists’ skills and how they could be used more effectively to meet older peoples’ needs. Service design should allow occupational therapists to expand their roles in enablement and rehabilitation, giving them the scope to redesign interventions to meet local needs and expectations and to move towards a more preventive and enabling approach. Barriers need to be removed to ensure all occupational therapy services achieve this,” says the report.
The Royal College of Occupational Therapists concludes by urging that existing best practice is built on to ensure that occupational therapists:
Engage directly with GPs, either by being based within GP practices or within integrated teams that have direct links with local practices.
- Take on leadership roles working with community providers to provide training, coaching and expertise to ensure all carers and staff take a person-centred, enabling approach to working with older people.
- Be innovative in their approach and extend the range of their practice to giving advice, developing resources and working with communities.
- Develop mechanisms to support self-assessment of standard equipment and minor adaptations for people with less complex needs.
“In short, using the occupational therapy workforce more effectively to enhance the prevention agenda will help to put health and care services onto a more sustainable footing and, more important for any civilised society, enable older people to live, rather than just exist,” the report concludes.
British Red Cross chief executive, Mike Adamson, said: “British Red Cross welcomes the report from the Royal College of Occupational Therapists. With an increasing elderly population and decreasing budgets for care, as a society we must seek to do the best we can for everyone who needs care – not just the bare minimum.
“As this research shows, early intervention can help people stay in their own homes, continue with social activities – and save money in the longer term. Surely this is a no-brainer. It’s time to change the mind-set on care to treat the person, not a set of needs,” added Mike Adamson.
Whilst LGA Health Spokesperson Cllr Izzi Seccombe, welcomed the report, she called for a wider debate about the future of social care which brings politicians from all sides together to find long-term sustainable solutions, something that we have also been calling for. She said: “It’s great to see some examples in this report of councils providing a person-centred approach to care, and we support the emphasis on prevention and treating the whole person. Councils recognise the importance of prioritising and investing in prevention. But inadequate funding, coupled with significant demand and cost pressures, means that investment is actually reducing.”
“The government is in the process of drawing up its plans for the promised consultation on proposals for reform in social care. This report is important material for these consultations.
“Councils stand alongside the NHS, charities and care providers in their call for government to work out a long-term funding solution, and we need a series of proposals that works out how best to share the costs of care between the individual and the state, if we are to get serious about social care – in particular, we need to work out whether or not the cost should be met only by those who require care, or whether it should be shared more broadly.
“That’s why it is vital that a national debate on this subject has cross-party backing, and takes place urgently. Without this, any proposals to tackle the funding crisis in social care and deliver lasting reform will simply not work,” she concluded.
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