Jay and I had an interesting few days recently at the Health Care Expo in London. It’s always good to catch up with customers and to chat with domiciliary care managers about changes and issues in the sector.
Not surprisingly it didn’t take long for the subject to get around to 15 minute care visits. And by a not altogether surprising coincidence, Andrea Sutcliffe, the CQC Chief Inspector for Social Care, was participating in debate on the same issue during the event.
Titled ‘Coping or Caring’ the debate explored whether or not 15 minute care visits could ever represent an acceptable level of care.
The panel comprised: Jane Harris, Policy Director at the charity Leonard Cheshire Disability, Roger Booker, Chief Executive of Sevacare, Mike Webster, Assistant Director at North Yorkshire County Council and Andrea Sutcliffe.
Time and Tasks
In an audience mainly of home care providers, sympathies were always going to be with Jane Harris and her view that: “A service focused on time and task is a coping service, not a caring service.”
People we spoke to on the CareForIt stand echoed this view time and again. Fifteen minutes just about gives you time to perform the most very basic level of care. And yet we know that service users want more than this from the care system.
There seems to be a real conflict between a lot of commissioning practice and the definition of good care from a service user’s perspective defined in the recent SCIE guide Commissioning Care for Older People.[link to recent blog article].
What does CQC think?
The CQC view is an interesting one. Clearly Andrea isn’t a fan of short care visits: “If someone has to choose between a bath and breakfast – it’s not safe, it’s certainly not caring, it’s not effective or responsive to people’s needs and no well-led organisation should let it happen.”
Reading between the lines there’s a clear frustration that the CQC believes that commissioning is largely to blame, yet they have no authority to prevent commissioners from issuing contracts that include 15 minute visits.
But there was also a challenge thrown out to some providers: “It can also be poor organisation of rotas and timetables, cutting corners to reduce costs, inadequate assessments of people’s needs and a lack of flexibility on the part of the provider.”
I’m certain that it’s not common for providers to deliberately curtail care visits, but we have been asked whether our domiciliary care scheduling system would allow appointments to be doubled up, or whether calculated travel times could be overridden. Just for the record, these functions are not, and never will be, available in CareForIt.
The LA view of 15 minute care visits
Not surprisingly, Mike Webster felt compelled to stage a defence for 15 minute visits within a ‘wider package of care’. Maybe he genuinely believes this to be the case and that he would be commissioning 15 minute visits even if his budgets weren’t under so much pressure. Who knows – but he certainly won’t find many domiciliary care providers agreeing with him.
With public finances as they are it’s unlikely that 15 minute visits will go away unless somebody is brave enough to expressly forbid the practice.
For providers the challenge is to ensure that there are straightforward processes in place for assessing and documenting care needs (so you can demonstrate why 15 minutes is insufficient), and having modern systems in place to make sure that 15 minutes doesn’t become 12 or 10 because the scheduling system is flawed.
And of course, with shorter visits, continuity of care becomes even more vital. Service users want a good relationship with their care worker – so a familiar face is essential.
A 15 minute care visit also provides little opportunity for a care worker to familiarise themselves with a service user’s background or personal issues. A scheduling system that struggles to cope with the demands of maximising continuity of care, coupled with 15 minute care visits seem to be as far as you can get from the person-centred care that we know most domiciliary care providers want to deliver.
Director, CareForIT. Cost-effective Domiciliary Care Management Software