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Raising the profile: Why the home care sector needs greater recognition

Has the home care sector been the forgotten front line during the pandemic? Raina Summerson, Group CEO of Agincare, shares her insights and calls for greater recognition of the sector.

Whilst the profile of social care has been highlighted through the COVID-19 pandemic, there are also deep feelings amongst many parts of the sector that this increased awareness has been limited and that the level of understanding around home care has remained poor.

Government guidance and media coverage has most often placed the emphasis on those living in care homes. The ongoing stories relating to risk, support and rights in care homes have left other parts of the sector, both providers and people using other care and support, feeling left behind. For home care, it is not only the challenges faced by providers and those using services that have not been given the same attention, but that the multitude of positive stories across the home care sector about resilience, innovation, commitment and care have been largely ignored.

Ongoing battle

With a career spanning different areas of social care since 1989, I am used to viewing the sector from different angles. Agincare is relatively unusual in having such a wide range of services and gives me an interesting oversight of differences in approach and understanding. Whilst the NHS and  Community Care Act 1990 may have started to shift focus from ‘institutional care settings’ into a more varied range of community-based services, including home care, here now in 2021 it still seems to remain a relatively unknown and unclear provision despite its scale. Care homes remain easier for the Government, for investors, for the public and for communities to understand; care delivered in buildings one sees in the locality, bed-placed care provision, solid assets for funding and investment purposes.

There have been years of lobbying from many people and organisations across social care, including numerous papers on the subject and research showing how people want to remain in their own homes for as long as possible. According to the United Kingdom Homecare Association (UKHCA) around nine in ten people would prefer to be cared for in their own homes if the need arose, with around just 8% expressing a preference for residential care.

There is also evidence about workforce issues, funding issues and the volume of people both in receipt of care and support and large workforce numbers – still the battle for recognition goes on. Associations such as UKHCA work hard to raise the profile, with much success and in strong partnership with large providers across the country, but still wider recognition is scarce.

The challenges

It has been well documented that, when the pandemic started, the focus was on the NHS. Slogans such as ‘Protect the NHS’ and the ‘Clap for Carers’ started for NHS workers, before being widened to include other key workers, including social care workers. But even during this time, our frontline home care teams were receiving (at best) a lack of the same attention, direction and care for the work they undertook; at worst, they were receiving abuse from members of the public who simply failed to understand their roles and saw their movement out and about in the community as a risk of wider transmission of COVID-19. In giving evidence to the Health and Select Committee in 2020, alongside Mel Cairnduff, part of our brilliant home care team in Dorset, I recall the MPs being shocked in hearing that home care workers felt ‘under-valued’ and ‘at risk’ in their daily work during a time that they were giving so much for others.

Recognition of social care came late but, for home care, it always seemed a step behind care homes. Forgotten and misunderstood. Guidance was often much later than Government announcements, causing concern and confusion, PPE came late causing high levels of stress for providers and the social care workforce, and recognition of home care workers came too late. Other social care agencies retreated to the periphery and families and usual social networks diminished with each lockdown. Home care workers faced new challenges, often being the only support network for people in need of care and support, increasingly lonely and scared by the events taking place across society. Vaccine rollout for home care workers proved more problematic, especially in services such as live-in care.

Gabby Duval, who works for an Agincare home care team in Bristol, said, ‘A lot of the people we support are vulnerable and they weren’t allowed outside contact, certainly at the start of the pandemic. Their families didn’t want to put them at risk and asked us to report back about how they were doing, as we were not only their only point of contact but also company to talk to.’

Care providers found ways to manage, often with whole teams focused on securing and distributing PPE, whilst managing the expectations, anxieties and queries of our teams and people using our services. However, it often felt like a battle to get our teams recognised alongside NHS colleagues and other keyworkers. Even areas such as protected time for shopping in supermarkets and discounted offers were problematic. The emotional impact on the workforce and managers was immense and this remains an area we must not forget as things become seemingly more stable.

Lessons learned

Despite these challenges, home care has shown its true worth through the pandemic. Structurally, organisations have learned that streamlining processes, focusing on essentials and minimising red tape procedures can make ‘the system’ flow so much better and enhance the experience for all of those in it.

Home care responded quickly, offered flexible, innovative services, showed great resilience and great solutions. Providers, largely independently owned and managed, stepped up and have shown that they really are an essential part of the UK’s health infrastructure. Our care teams excelled amidst all the unknowns and despite all the fears and teamwork has been brilliant. Their care and commitment to making a difference to people’s lives has never been stronger.

New ways of working have been developed and many of these will stay with home care organisations and make them stronger: improved digital communications, workforce recruitment, training and development, family and team communication and interaction, partnership projects with NHS and Local Authority teams and, indeed for us, better working across Agincare’s own diverse range of services.

Home care future

For many home care providers across the country, whilst times have been tough and social care reform is urgently needed, there is also a confidence in the future. This is due to the commitment to home-based care, initiatives such as ‘Home First’ taking shape, closer working with NHS colleagues and an increased awareness of the scope of home care potential. Live-in care is one area that has flourished and become more widely used as a solution for independent living. However, for others, the uncertainty around funding and commissioning strategy continues, the increasing cost of delivery, workforce challenges and the sheer emotional legacy of the past year is leading to an exit from the sector.

There are increasing areas of the country where home care is difficult to source and multiple reports from a huge range of professionals and organisations, with Age UK, National Audit Office NHS Confederation and Local Government Association to name but a few, all highlighting issues around strategy, funding, capacity, unmet need and wider societal impact. The Care and Support Alliance recently said that a lack of social care ’undermines’ people’s health, heaps pressure on the NHS and makes it ’difficult or impossible’ for people and their carers to live fulfilling lives.

Social care reform

So, what can we hope will change now? We had hoped that the calls for social care reform – real, proper system change – wouldn’t fade away as they have so many times in the past. But several missed opportunities from Government to give the sector what it so wanted to hear has made us doubt again.

Government must now offer social care some meaningful reform, something that goes beyond financial protection of homes that people don’t want to sell to pay for their care. Funding and how we pay for it is key but there is so much more needed. We must stop social care being seen as – and used as – a support prop for the NHS; we must recognise and reward the valuable contribution, skills and professionalism of its workforce, and we must involve and engage working with – and for – local communities and with those in need of care and support as partners in it all.

The future need is there for home care to thrive, but we need the strategy, funding and workforce to make sure it can.

Raina Summerson is Group CEO of Agincare. Email: Twitter: @Agincare

Do you agree with Raina’s comments that the homecare sector needs more recognition? Share your comments on the article in the comments section below.



About Raina Summerson

Raina Summerson is Chief Executive of Agincare. Raina is a qualified social worker, with a Masters in Mental Health Services. She has worked in social care since 1989, both privately and in the Local Authority/NHS environment.

Prior to joining Agincare in 2004, Raina was a (formerly CSCI) Regulatory Inspector with five years’ experience of registering and inspecting care homes and domiciliary care agencies. Raina is closely involved with UKHCA and other national bodies in respect of lobbying for the social care sector.

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