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Home care of older people: the revolution has started!

Brendan Martin, 25 November 2013

What a difference a week makes! The future of social care in Britain looks very different today than it did just last Monday, because of three big steps in the right direction.

1. Allied Healthcare, one of the biggest social care employers, announced it would do away with zero-hours contracts and give 15,000 staff the right to contracted hours from next April.

2. Then the London borough of Southwark became the first local authority to sign up to the Unison Ethical Care Charter, which commits it to “improving working terms and conditions for hundreds of local care workers”.

3. Now, the Guardian reports, Her Majesty’s Revenue and Customs has investigated 183 home care providers and found half of them are paying less than the minimum wage.

Does all this add up to the beginning of the end of one of our country’s biggest scandals – that of forcing some of the most valuable workers in Britain to be also among the most badly treated?

Let's hope so, but just because social norms are changing in that respect doesn’t mean that local authorities, service providers and personal commissioners of social care suddenly have more money.

Undoubtedly social care must have more resources, but demographic and other trends mean that it is not just government austerity policies that are piling on pressure to do more and better social care without a proportionate increase in resources.

So a second stage of a revolution in social care will be needed to ensure the first stage is completed, because without big increases in productivity we risk replacing low paid home care with less home care, through more rationing.

It means we need not only to change how home care workers are employed but also to innovate in how they work.

The problem is that the current model has a rigid structure of time-limited slots of care, as though the needs of an older person in her home don’t change from day to day.

So the carer is told to spend 15 minutes here or half an hour there, and to get that one out of bed and showered and the other one fed and watered.

Wouldn’t it be better if home care workers were organized in local teams able to adapt to changing needs day to day, or even hour to hour, through intelligent and self-managed co-ordination?

And wouldn’t that also mean that their clients could shape the services they receive more directly, and get to know more than one of the team, so that the frequent complaint of unknown replacement carers turning up could be reduced?

As part of the Public Service Launchpad initiative, Public World is working to develop such an approach in Britain. We call it Fairly Flexible.

We are starting by looking at international experience, such as the Buurtzorg model in the Netherlands and the work of our Swedish partner, Alamanco, in Jönköping. Next year we aim to pilot our new approach in Britain.

The aim is to improve jobs and services in a way that will be affordable because of higher productivity. The current model, as well as encouraging low quality services and jobs, is also highly inefficient.

If you are interested in working with us on this, do please get in touch by writing to me at I look forward to hearing from you.

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