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Better choices, better care - Independent Age

Independent Age

6 min read Partner content

The postcode lottery in social care is an 'age-old problem' that is badly in need of new solutions, says Independent Age.

Social care is rarely ever out of the headlines. Small comfort for the people the Institute for Fiscal Studies (IFS) revealed last week who no longer receive local authority-organized care and simply now go without. Older people who need help to remain independent and complete the most fundamental day-to-day tasks. Older people, who without local authority support, can find themselves at greater risk of needing more expensive medical help.

What was striking about the IFS report was where it highlighted largely unexplained variation in spending levels across councils with similar profiles and levels of social care need. The typical factors one might expect to account for differences in social care spending per adult – so for example the proportion of older people living in an area and deprivation levels – in fact now only account for around 25% of the variation in social care expenditure across different councils.

Today, we offer our own insights on an age-old problem badly in need of new solutions: the postcode lottery in care quality.

Our own focus is on the stark variation in the proportion of residential care and nursing homes rated ‘Inadequate’ or ‘Requires Improvement’ by English region and local authority.

In some parts of the country, such as the North West, there are far higher than average numbers of poor and sub-standard care homes with a third of homes on offer not – at least not yet - up to scratch. And the variation within just this single region is perhaps starker still. In Stockport and Salford for example, around 3 in 5 residential and nursing homes have been rated by the Care Quality Commission as ‘Inadequate’ or ‘Requires Improvement’. Just a number of miles away, in Bury, local residents are far better served with around 1 in 8 homes falling into this category. We have produced maps for every region of England where MPs and policy-makers can check care home performance in their area.

Like the IFS, we cannot explain all the variation but the reasons for some of the differences may in the end owe something to different levels of funding and staffing. Whatever the reasons, the area older people live in to a very large extent now determines what quality residential care they can get.  

At Independent Age, we know overall levels of public knowledge or understanding of care homes are often lacking. In our Shining a light on care’ report, we showed that nearly double (29%) the number of British adults would first search Google or another search engine to look for information on care homes before they would consider looking to their local council (16%) or even the Care Quality Commission (another 16%).

A further fifth (22%) of all British adults said they simply wouldn’t know where to look for information on a care home, with a similar proportion (19%) of over-65s agreeing they just wouldn’t know what information to seek out on care home quality.

This in turn shapes wider public perceptions of the overall quality on offer in care homes, with more British adults (45%) believing the quality is bad, than those who believe overall the quality on offer is good (39%). We need to do better than this in a market valued at nearly £16 billion.

With so many British adults either feeling negative about the quality on offer or simply unaware what quality to expect, they are already likely to feel very constrained by the range of options before they even start to think through which care home is the right one for them or a loved one.

That is why we produce resources to help people starting to prepare for a care home move. It also why we are so pleased we have partnered up with a local Healthwatch – Healthwatch Camden – which gives out information to local people on care and health providers and can help influence the way they deliver their services.

In recent months, we have worked with Healthwatch Camden to test our new series of care home quality indicators to help enhance the information available to local people so they can compare care providers where they are already starting to think about a care home.

And we are delighted with the results.

Following a small pilot including volunteer visits to all seven care homes for older people in the London Borough of Camden, there are helpful new reports available to local residents which focus on the aspects of care older people had told us mattered to them most when choosing a care home.

Among other things, the reports help Camden residents get a clearer, richer picture of the homes in their area that offer the most visible management. They detail which homes have staff with the time, as well as the skills, to do their jobs. But perhaps most important of all, they provide easy-to-digest information on whether the homes - above and beyond providing caring and safe environments - are enjoyable places to live. For example, there’s information on the range of activities on offer and the quality, choice and flexibility around mealtimes.

Our ‘care home quality indicators can now help any local Healthwatch interested in completing visits of their own to assess how care providers are delivering and then report back to their own local residents.

We want to encourage other local Healthwatch to get involved and will be engaging with MPs in the coming months to secure better care for all those who need it.

If all that results in older people and their relatives feeling they have improved information and choices over their care– all the better.

But ultimately we are clear the Government now has a responsibility to look at these big variations in quality in their forthcoming Green Paper on social care. One of the key tests will be to ensure people don’t experience unacceptable constraints on their care home choices so everyone can access a good care home.

They must use their promised Green Paper to try and understand what drives variation, but crucially, why differences in quality across neighbouring areas can be such a problem across England. Anything less and the review of adult social care will be a missed opportunity.

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