tjagain – Member
Sorry Rusty. training for home care staff is inadequate. That is simply true.

Not in all cases.

As you seem unable to acknowledge that your generalisations are unhelpful and incorrect, I’ll not respond to you further.

Good luck gt, I hope everything goes well for you and your family.

Rusty –

I want good standards of care by properly trained staff. I know of no care provider that provides anything like adequate training. care to enlighten me as to what you think is the adequate training provided by a care provider? for me svq / nvq level 2 is the minimum standard that should be used. Even that is barely adequate

Edit – I think the difference is that what you consider adequate and what I consider adequate is too very different things

geetee1972 – Member

Well I guess it makes a change me not being the one to cause the rabid arguing and cat calling

You are though really, you started this 😉

Seriously though, hope you get something sorted for your dad.

3500 covers all specialties (and I rounded), but here’s more details:

According to ISD there were 3444 in 2016 : Hospital Beds. There’s a spreadsheet on there where you can get the stats for WGH on its own. 350 delays there would be half the beds.

Similarly, delayed discharge stats are reported here: ISD again

I wonder if the differences relate to the duration of delay (and the point of census). Very few are delayed over 12 weeks, but that doesn’t mean they aren’t important.

EDIT – while a matter of interest, this doesn’t help Father – let us know how that goes?

I think the difference is that what you consider adequate and what I consider adequate is too very different things

Fab, but as already discussed what you consider adequate is irele-phant. Become the Head of the CQC and then you can set the Fundamental Standards of Care

the 350 delays were WGH and RIE combined and its the information we were given by the delayed discharge coordinator. You are probably right tho about the numbers being counted in different ways for different purposes

Ta for the info tho. All knowledge is useful unfortunately I don’t have a recent enough excell to open the spreadsheet but I was very surprised by the number of beds you stated

EDIT – while a matter of interest, this doesn’t help Father – let us know how that goes?

I quite agree. I am sorry I have done it again haven’t I – taken a thread off in an unhelpful direction. *ducks head in shame*

Nickc – that document is full off woolly phrases but no laid down standards that I can see

as you can tell this is a subject that I care passionately about and I want to see a fully professional, well paid and highly skilled home care service not what we have at the moment which is a “cheapest tender” basis leading to a race to the bottom.

enough – I have derailed this subject too much and I apologise for that.

yeah, that’s the public face of it, the actual inspection is pretty thorough (having done a few) the HR Qualis and documentation checks are pretty robust, from basic stuff like infection control, and safeguarding, all the way through nursing qualis for critical care. It’s not perfect by any means, but any organisation that’s managed to get through an inspection has it’s ducks in the right rows IME.

That’s not to say that pay couldn’t be better, but that’s a whole different conversation TBH.

Arrgghhh – I want to argue further given my knowledge of the gulf between what they put on paper and what they actually do!! quick nurse – the restraints and gags
*muffled shouting and thumping from the corner*

😆

start a thread..?

Arrgghhh – I want to argue further given my knowledge of the gulf between what they put on paper and what they actually do!! quick nurse – the restraints and gags
*muffled shouting and thumping from the corner*

It’s my thread and I say you should debate and argue TJ!

I have the information I need now so thankyou. The wider issue is important and I think it should be discussed.

Fill your boots.

I’m also interested in what tj and the others have to say. Parents (incidentally located in Scotland) are likely to be in similar/related situations in the future. Currently they are together at home and managing 100% by themselves but both 80 so that won’t last indefinitely. Been thinking about some temporary relief for my mother but no action as yet…

Probably worth reiterating that the Scottish system has fundamental differences from that in England (and elsewhere). However the general principles of assessment of need and obligations to provide care thereafter are similar.

From something I did earlier – this relates mainly to care in the persons own home:

Personal care is free of charge to those in Scotland aged 65 and over who need it, whether at home, in hospital or in a care home. Free nursing care is available for people of any age who need it. People can also purchase services as a private customer.

These (assessed) personal care services are commissioned (or delivered) by a local authority. To get them, an assessment by social work services is required. The details of care provided will vary according to the assessed needs, and the eligibility criteria set by the local authority (see appendix).

Personal care is of a personal nature. Essentially if it involves touching you, then it is personal care. This may include: bathing, nail care, toileting, help with eating, dressing, help getting in and out of bed, using hoists, or with prostheses, mechanical and manual aids.

Nursing care needs involve the knowledge and skills of a qualified nurse. A general guide might be that anything that breaks the skin is included e.g. administering injections or managing pressure sores. Some simple treatments, creams or ointments fall under personal care.

Assessments of care needs are requested from the local authority (which now act on behalf of the Health and Care Partnership). They have a duty to assess needs and determine whether the local authority’s eligibility criteria are met. Once needs have been identified via the assessment, the authority has a responsibility to meet them. Traditionally this was done via direct provision or commissioning of care services.

Self-Directed Support is intended to provide those with assessed needs greater control over how these needs are met.

The Scottish Government says
“Self-directed Support allows people, their carers and their families to make informed choices on what their support looks like and how it is delivered, making it possible to meet agreed personal outcomes.”
Self-directed Support includes four options to support choice and control:

1. Direct Payment (i.e. actual money), the use of which will be audited;
2. Funding allocated to a provider of your choice (the council holds the budget, but the person oversees how it is spent);
3. Services arranged directly by the council (like the traditional method); or
4. People can choose a mixture of these options.

In options 1 and 2, the person receiving service may choose (within reason) how their support is provided and by whom. Social Work departments operate an audit process to ensure that Direct Payments are used appropriately and in line with meeting the outcomes defined in the care plan. Generally, a separate account, details of receipts, etc are needed to evidence appropriate management of funds.

OK – geetee kindly helped me out of my restraints 😉

There are two issues here
1) how to get the best out of the current system
2) how to improve the current system

1) as shown I do not know all the details of the current system especially in England.

Some form of direct payment / self directed care type agreement as outlined above is the best way to get adequate care but you must be realistic as to what this would involve. It can be a lot of work to arrange and IMO works best for young disabled not frail elderly but if the older person has someone who can take over the management then this might well be the best route. Be realistic about what it would entail and how much of your time you are prepared to put in. Everyone has their limits for what input they can give into care of their relatives and these limits vary. If you end up going beyond the amount of input you are happy to give then you end up resenting it and family relationships can be affected adversely. Caring for relatives can be very hard indeed and I have seen people take on too much ending up with resentment and stress and the breakdown of the care arrangements

If you cannot do the direct payment / self directed care route then you are reliant on the social services to organise the care.

Be prepared to question the assessment and to ask for explanations of why decisions are reached. Do not put up with care that does not suit because thats all thats offered. One key issue that comes up time and time again is early bedtimes. Most care providers will not do visits into the late evening so the “tuck up” visit to put them to bed cannot be arranged at a time to suit the person receiving care. Now the statements of how the care will be offered will include things like ” holistic and person centred” If the person receiving care was a night owl that never went to bed before midnight then a 7pm tuck in is not “person centred or holistic” so you can challenge that on grounds that its not meeting the minimum standards set out. It will be a very difficult to get it altered but study the documentation and use that against them. “holistic and person centred” does not mean ” you will go to bed when the carers are available” It means the care must be arranged to suit the person not the service

If you want to get good service the recipient of the service needs either to be able to stand up for themselves or to have a strong advocate to speak for them. Monitor the service being provided carefully and I would have covert cameras if the recipient is not able to speak up for themselves – not just for the ( fortunately rare) serious abuse but to pick up on the inadequate care, the shortened visits, the late visits and the low level poor care, the carers drinking the person tea and spending part of their visit time taking a break. The sort of thing that is commonplace IME is a half hour visit only actually being 15 mins as the carer has to make too many visits in the day and travelling time is not paid or accounted for properly. Traffic jam on the way to a visit = shortened visit. That sort of thing. My friends care visits supposedly for half an hour actually varied from 10 – 25 mins. Do not rely on the documentation the carers fill in and leave. Get objective measures of the time they spend in the house and what time the arrive and leave.

Be prepared to complain if the care falls below the standards set but you MUST have good evidence to back up the claims other wise it will be dismissed. Insist of being present at the case confernce that decides the care needed and be prepared ( and I mean do your preparation ) to question and to argue for the care the person needs. Personally check the documentation the care provider has for the training etc of the career and then subtly check with the carer that what is put on paper is actually what is done.

2) how to improve the current system.

Firstly once again it comes down to money. care is provided on a lowest tender baisis. this encourages corner cutting and poor standards. It needs to be taken out of the private sector completely. This was done purely as a cost cutting exercise because direct council employees get council terms and conditions of employment which are far superior to those offered by private care providers.

Minimum standards of training must be increased hugely. These are lone workers going into vulnerable adults homes. The care should be done by professionals not minimally trained people. No one should be allowed to either go into a vulnerable adults home or supervise trainees without significant training. Currently the carers are completely inadequately trained. SVQ level 2 ( NVQ in england???) should be the very minimum standard before someone is allowed into a vulnerable adults home unsupervised and even this is barely adequate.

Care should be provided in a person centred way ie the care shuld be what the patient wants not what fits in with the system.

I would prefer that actually councils went back to only doing “home help” type care and that all nursing are which includes what is defined as personal care as above in the post becomes the responsibility of the NHS with care needs being assessed by district nurses and delivered by a mix of district nurses and NHS care assistants.

far more supervision of home care is needed

Pie in the sky due to costs you might say. I say we are rich country and we can easily afford it but its a political choice to underfund the service to keep taxes down

Finally I strongly believe that those with assets should be using them to pay for care. why should the state pay for care so that middle class children can inherit. Protecting peoples assets means that the general taxpayer subsidises middle class peoples inheritances

I tend to agree that the challenge with SDS is the degree of responsibility that comes with it. It seems to me that the position of many with care needs would make the management of carers activities (or indeed staff management if they choose to employ a carer) very difficult. Even for younger adults who retain full capacity, this is difficult. Putting it crudely, how do you go about a disciplinary issue with the person you’ve employed to wipe your bum?

On the other hand, I’m aware of examples where it has worked extremely well, supporting a person with considerable physical disability to run a successful business. You are quite right about the simple questions of ‘bedtime’.

I have some different thoughts on your views of ‘the system’. The quality of commissioning and procurement varies hugely between authorities – as of course does the standards of in house care they are able to provide. That said, it isn’t correct to say all care is private sector – many of the Scottish authorities retain a large home care workforce, and operate residential care services too. Alas, this is no particular guarantee of quality.

While it is possible to deliver private sector services at lower cost, this is a factor of overheads, pay rates and of course pensions, sick pay and holidays. Typically procurement of care will address both quality and cost (not simply a lowest cost exercise), the authorities that are good at this tend to operate a mixed market model which includes public, private and third sector organisations. The good ones are making inroads into outcomes based commissioning, which shifts the focus away from the tasks and towards the wellbeing of the individual receiving care and support. That’s not easy!

I’m not quite sure I follow you on training standards – my reading of the SSSC registration requirement is that home care staff need to hold SVQ2 as a minimum (for historic qualification, SNQF6 in new money I think) – this would need to be in place for a registered service, so effectively this is the minimum standard already.

Clear and separate roles is another discussion probably, but is at odds with the policy of integration. In my mind one key advantage of integrated services is that fewer callers get to know the person receiving care better. rather than a load of strange faces visiting.

Is that svq for staff working in care homes or in the community? certainly around here home care ( not care home) staff do not have svq – they may be ” worjking towards” but certainly do not have it. It takes a year or more to obtain via the usual pathway.

From my understanding the usual training is minimal before they are allowed out on their own.

Home care – SSSC. Have a look at the ‘past practice qualifications’ section.
Actually, having checked, it is similar for Residential Care. Working towards is reasonable in my mind (we all need to learn), but maybe some time constraints would be smart.

‘should’ and ‘do’ aren’t always the same…

Interesting – its obviously being tightened up

Please note: Workers new into their role after 2 October 2017 should achieve registration within six months of taking up employment in this role.

In other words they are closing the loophole of “working towards”

I would not allow them out on their own until they had the qualification. turnover of staff is so great that I bet many do not ever get the SVQ.

an FOI on this might be interesting to see what % of the care workers actually have the SVQ

Yes, maybe just to you and me though…

I’ve seen a worker’s employment discontinued for not meeting those requirements (in a LA), but don’t know the numbers for private agencies.
Careful wording of the FOI might be needed for that. I’d be interested to see what you get back (but you may well have realised I’m not in a position to raise the request).

I think turnover, and the need to get folk on the routes probably means they do get sent out earlier than might be ideal. Sorting conditions of employment and reducing turnover is what’s needed to solve that one.