Defining and delivering quality care in a post-austerity era is a challenge, but users’ experiences can shape policy and practice
Tue 23 Jul 2019 10.41 BST
Last modified on Tue 23 Jul 2019 11.19 BST
“Funding matters, of course it does, but the thing people really care about is the quality of the care that they receive,” Matt Hancock, the health and social care secretary, told the recent Local Government Association annual conference.
What is quality? How do you define it, how do you measure it and, most importantly, how do you provide it?
Clenton Farquharson, who has recently taken over as chair of the Quality Matters initiative, which aims to inspire high-quality adult social care across England, admits that the concept can be intangible. In the end, he thinks it comes down to how the individual receiving care and support is made to feel.
“An example from my own experience was a time when I was in hospital for an eye condition, unable to see and worried that I was going blind,” says Farquharson, who lives with multiple long-term conditions and is a wheelchair user. “The doctors did a brilliant job on the eye, and I couldn’t fault them for that, but they missed the personal touch.
“It took a healthcare assistant who could see I was terrified to demonstrate the kindness and compassion that is the real hallmark of quality. She just put her hand over mine and told me she was there for me if I needed her.”
Quality Matters, a government programme set up in 2017 and led by partners from across the social care sector, aspires to achieve high-quality care “even when no one is looking”. Farquharson’s ambition for his six-month stint as chair is to ensure that quality is “fundamentally grounded in the experience of citizens” so their experience directly informs practice and policy.
“In other words, the sector recognises co-production as a prerequisite to embedding quality,” Farquharson says.
Co-production, which is built on the principle that people who use a service are best placed to help design it, was central to debate at the annual conference of the European Social Network (ESN) in June, when delegates from 35 countries met in Milan to discuss how to raise the quality of care and support in a post-austerity era.
The ESN, which is funded by the European Commission but also draws members from outside the EU, shares knowledge and best practice in social services. It wants the commission to draw up a new framework for quality to guide EU states and others as policy moves on from a primary focus on ensuring continued provision of services in the face of the financial constraints of the past decade.
Katarina Ivanković-Knežević, the commission’s director for social affairs, told the conference that quality was “as important as the availability of social services” and a golden thread running through the 20 principles of the European pillar of social rights proclaimed in 2017.
It was work from Scotland, in the form of health and social care standards introduced last year, that helped shape much of the discussion in Milan. These are intended for all services, not just those regulated by statute, and are based on underlying principles of dignity and respect, compassion, inclusion, responsiveness of care and support and wellbeing.
Peter Macleod, chief executive of the Care Inspectorate in Scotland, said the principles were rooted firmly in a human-rights approach to care and support, and that the goal should be for the individual to be able to say: “I am receiving high-quality care that is right for me.”
What does this look like? Eva Liz Moen, a disabled woman from Norway, told the conference how she was enabled to employ two personal assistants – “my liberation tools” – to support her lifestyle and her work for Norwegian independent living charity Uloba. “What’s important is that I decide who, what, where and when,” she said.
Eloy Van Hal, founder of the celebrated Hogeweyk dementia care village in the Netherlands, said quality meant “living as usual” for residents of the village, however advanced their condition. And John Healy, deputy director of the Genio project in Ireland, which is enabling people to leave institutional care settings, reflected that “the voice that has been ignored for decades is often the most influential in the room”.
But can a quality-led agenda be compatible with a continued imperative to maximise value for money in public services? John Bolton, visiting professor at the Oxford-based Institute of Public Care, was in no doubt that the two could go hand in hand.
Shorter, more focused interventions to “re-able” older people and help them regain independence and control over their lives after discharge from hospital could achieve a 10% reduction in overall care and support costs, Bolton told the conference. As few as three in 10 needed continuing services. “Not everybody can progress, but many more people can than the current system allows.”
Source: https://www.theguardian.com/society/2019/jul/23/how-to-provide-quality-social-care
