The Flexibility of Domiciliary Care Services

elderly veteran gentleman receiving domiciliary care at home

I noticed once again that domiciliary care services are very adaptable to the needs of those in the community. In a recent article a new ‘respite at home’ service for elderly veterans, partners and carers was launched by the Royal Air Force Benevolent Fund.

It’s great to see that our former service men and woman are given the support they need in their later years and that companies are looking to provide care for specific groups of people and cater to their specific needs.

The service in the article is based in West Sussex and also provides companionship for ex-servicemen and their families. Friendly visits usually take in activities, light snacks and help with personal needs for up to five hours per week.

Read more here.

Domiciliary Care – support for lone workers

An effective lone working policy will give domiciliary care workers guidance and support, and identify their responsibilities when on duty. The policy should be designed to minimize risks and provide a risk management framework. The policy should be a clear, easily read document that is available to all domiciliary care staff.

lone domiciliary care worker-v2

The HSE (Health and Safety Executive) suggest that establishing a healthy and safe working environment for lone workers can be different from organising the health and safety of other employees, but lone workers should not be put at more risk than other people who work for an Agency.

It will often be safe to work alone. However, the law requires employers to think about and deal with any health and safety risks before people are allowed to do so.

Things the employer should consider that help ensure domiciliary care workers are not put at risk include:
•    assessing areas of risk including violence, manual handling, the medical suitability of the individual to work alone and whether the workplace itself presents a risk to them
•    requirements for training, levels of experience and how best to monitor and supervise them
•    making sure that the line manager knows what is happening, including having systems in place to keep in touch with them
•    Employers have a duty to assess risks to lone workers and take steps to avoid or control risks where necessary.    

This must include:
•    involving workers when considering potential risks and measures to control them;
•    taking steps to ensure risks are removed where possible, or putting in place control measures, eg carefully selecting work equipment to ensure the worker is able to perform the required tasks in safety;
•    instruction, training and supervision;
•    reviewing risk assessments periodically or when there has been a significant change in working practice. This may include:
•    being aware that some tasks may be too difficult or dangerous to be carried out by an unaccompanied worker;
•    when a risk assessment shows it is not possible for the work to be conducted safely by a lone worker, addressing that risk by making arrangements to provide help or back-up. Risk assessment should help employers decide on the right level of supervision. There are some high-risk activities where at least one other person may need to be present. Examples include:
•    working in a confined space, where a supervisor may need to be present, along with someone dedicated to the rescue role.
Domiciliary care workers unlike residential care workers are unable to ask more experienced colleagues for help on the job, they have to rely on the guidance provided by their line manager off the job. They therefore need to be sufficiently experienced and fully understand the risks and precautions involved in their work and the location that they work in.

Training is particularly important in enabling people to cope in unexpected circumstances and where there may be exposure to violence and aggression.

The extent of supervision required depends on the risks involved and the ability of the lone worker to identify and handle health and safety issues. The level of supervision needed is a management decision, which should be based on the findings of a risk assessment, i.e. the higher the risk, the greater the level of supervision required.  Consideration should be given to new domiciliary care workers who are undergoing training being accompanied by a more senior member of staff as part of their induction.

Monitoring Procedures must be put in place to monitor lone workers as effective means of communication are essential.

These may include:
•    supervisors periodically visiting and observing people working alone;
•    pre-agreed intervals of regular contact between the lone worker and supervisor, using phones, radios or email, bearing in mind the worker’s understanding of English;
•    manually operated or automatic warning devices which trigger if specific signals are not received periodically from the lone worker, e.g. staff security systems;
•    implementing robust system to ensure a lone worker has returned to their base or home once their task is completed.

Emergency procedures
Risk assessments should identify foreseeable events. Emergency procedures should be established and employees trained in them. Information regarding emergency procedures should be given to domiciliary care workers.

It is essential that the domiciliary care worker has a clear policy that provides sufficient information to enable the worker to feel confident when carrying out their job. Key to the policy is the assessment of risk along with effective training to reach competency, supported by supervision and monitoring and what to in an emergency. The policy should be seen as a worthwhile investment by providers and in the long run may help to retain domiciliary care workers within the Agency.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

A Betrayal of the vulnerable in our society


I read in the media today with some dismay about the plight of care homes and domiciliary care services. The Care Quality Commission are raising the stakes giving warning that the sector as a whole is at risk as providers of care for elderly and disabled people pull out over rising costs and cuts to council budgets.

Providers are in trouble because their costs have increased by up to 30% in the past year while their profit margins have fallen by more than 40%, it warned. It pinpoints the national living wage (NLW) and the inability of cash-strapped local councils to pay higher fees for these services as the main causes of a growing problem.

It is alarming to learn that the number of care homes overall in England has fallen from 18,068 in September 2010 to 16,614 in July this year, at a time of growing need linked to the ageing population, according to figures released by the CQC.

The total number of beds available in care homes also fell between 2010 and 2016 from 255,289 to 235,799 this summer – a fall of 19,490. While the number of nursing homes increased slightly, from 4,387 to 4,623 in that time, more than one in 10 residential homes – for elderly, often frail, people – have closed. The total of those available has fallen from 13,681 to 11,991 – a drop of 1,690.

CQC are also worried that the same pressures could push providers of domiciliary care to the wall. “Provider exit and large-scale contract handbacks demonstrate the fragility of this market. At what point can the replacement providers only make the returns work by compromising on the quality of care?” the briefing paper asks. 

To many people who rely on care homes and domiciliary care for help in their own homes with washing, dressing and eating, the effect of contraction to services could become greater if more and more of the private companies that dominate the market go out of business, the CQC fears.

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, was responding to the leak to the BBC of a recent internal briefing document that spells out how rises in providers’ costs and the squeeze on local councils’ budgets are leaving care services in an unsustainable position.

“We know that the adult social care sector faces many financial pressures which, worryingly, could undermine the quality and safety of care that people receive and rely upon every day,” said Sutcliffe.

She confirmed that information from care providers detailed in the CQC document “does highlight a concern that the long-term sustainability of high-quality care within this sector could be at risk. Given the impact this would have on people’s lives; it is important that we continue to monitor these trends closely.”

To those who work in the care sector, myself included, this is a degradation of duty on behalf of government and local councils. If the end product of buck passing between the 2 parties where on the one hand insufficient funding has been made available to provide quality care. On the other there has been no requirement on local authorities to ring-fence funding specifically designated for use in the social care sector.

This situation as we all know is exasperated by NHS bed blocking where packages of care designed to accommodate people’s needs in the community, would not only be the choice of patients but save money for a cash strapped National Health Service.

Barbara Keeley, Labour’s shadow minister for social care, said: “These figures are an alarming reminder of the desperate state of care services in this country. Despite all the spin from ministers, the Tories have left social care on the brink of collapse, with thousands of people’s care at risk as a result. It’s not enough to turn a blind eye to this crisis. We need ministers to step up and guarantee that they will properly fund care services. Anything less will be a betrayal to the most vulnerable in our society.” I would add that labour when in power could not agree a funding strategy for care with the Tories and Liberals.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Impact of Brexit on Domiciliary Care Services

Brexit effect on domiciliary care

As we all know a big decision was taken by the UK on the 23rd of June 2016 to leave the European Union. There have been numerous articles and hours of TV coverage discussing what the impact of Brexit will be on the UK economy and the workforce across many sectors. At the moment no one knows exactly what that impact will be. This uncertainty will no doubt cause much anxiety for domiciliary care workers who have chosen to come here from the European Union.

Latest available figures suggest there are around 6.6 per cent or approximately 80,000 people who are employed in social care are from the European Union.

Domiciliary care workers along with others employed in the social care sector will be extremely concerned about their future working in the UK, and the impact that new immigration laws will have on their residential status. Workers looking to settle in the UK will have no idea of what new legislation may be introduced that may well have a huge influence on whether or not they choose to continue to work here.

The domiciliary care sector in particular continues to experience difficulties in recruitment and severe staff shortages. This is partly accounted for because many people born in the UK do not find working in the care sector attractive or rewarding. It is hardly surprising then that many employers are very concerned about what is going to happen in the future.

Central government needs reminding of the critical importance of this group of workers to domiciliary care and the wider social care sector and the impact this would have on the ability of providers to provide a service. Even if funding became available. Any policy change on immigration needs to account of these factors. Failure to do so could have a critical impact on the present structure of social care as we know it.

It may well be in the end that the changes that follow on from Brexit will acknowledge the valuable contribution made to social care by workers from the Europeans Union. 

Stuart Cook
General Manager
Bettal Quality Consultancy