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Quality care services are not just about more money

I recently read an article in the Times that reaffirmed my view that quality care services are not just about money. The article referred to a woman who had spent weeks looking at places for her father, who has had dementia for 12 years and now needs specialised nursing. In her search she came across the average, the diabolical and the inspirational, all within a few miles of his town.

Surprisingly, money didn’t seem to have the greatest effect on quality. The most expensive felt like a prison with the dementia inmates locked in, staff vacancies, grey sloppy food, a regimented timetable and dark, echoing corridors.

Elements of a good care home

The most impressive was the cheapest not-for-profit charity home where even the handyman stopped for a chat while putting up a curtain, there were packets of digestives on tables, the vicar popped by, the Brownies sang a song, and there were signs on each door with instructions such as: “Mrs. Jones likes her tea lukewarm, her hand shaken not squeezed and a cuddle at night”. The staff were motivated, kind and chatty. Everyone wandered freely, couples were welcomed, their bedrooms were covered in cards and photos, the garden was full of benches and bird feeders and when they demanded liver and bacon it was provided instead of pizza. But it has a long waiting list.

Difficulties facing social care services

We all know that financially it’s tough to run a care home. At least 148 businesses became insolvent in 2017, up 83 per cent on the previous year; 2,492 residents were evicted with nowhere to go because their homes closed, up 39 per cent on the previous year. This is particularly harsh for those with dementia who need familiarity. They are also often the ones being charged the highest rates. According to a report this week by the Alzheimer’s Society, providers can add as much as 40 per cent to the bill for dementia patients. About 850,000 people have dementia in Britain and pay an average of £100,000 for their end of life care. Increasingly, families cannot find anywhere that will take them, so they end up on hospital wards.

There are also not enough staff for care homes, with vacancy rates running at 11.4 per cent and 90,000 places unfilled. That’s before Brexit curbs the number of EU migrants. Caring is viewed as “unskilled labour” but the British need to see it as a vocation and a worthwhile career.

The elderly staying at home often aren’t faring any better. According to Age UK, 1.4 million older people are now not getting the necessary help to carry out essential tasks such as washing and dressing, a 20 per cent increase in only two years. There are already 7.6 million people caring for elderly relatives but even with their help the Local Government Association is warning of a £3.5 billion funding deficit by 2025.

When a care home place is not available the NHS fill the gaps. Simon Stevens, chief executive of NHS England, said recently that the equivalent of 36 hospitals were out of action because of a lack of social care.

Funding in the future

This week Matt Hancock, the new health and social care secretary, announced £240 million for the elderly, which could provide 71,000 more domestic care packages to help pensioners stay at home. This will alleviate some pressure on wards but it’s not going to address the long-term issues. Mr Hancock hasn’t been allowed to announce anything more radical, although he has been pushing quietly for a new social care fund where payments could be deducted by employers for future care costs. By the end of this parliament there will be a million more people in Britain over 75 than there were at the start of it.


We bang-on about the lack of funding for social care services, which it badly needs. But, as this lady found a cheapest not-for-profit charity home in her opinion provided the best service. Reading between the lines what she found was a home, who knew the service users and their preferences. Staff who were motivated and chatty and made everyone feel welcome. These things are not about money, they stem from the leadership of the manager, supported by staff who are committed to a culture based on the values of a quality service.

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

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