New 'super carer' role needed to spearhead reform of home care for old people

A key recommendation is that budgets are pooled so the role of home carers becomes a better-paid professional career that delivers both health and social care services.

The new analysis is published ahead of the report of the Dilnot Commission. Dilnot was set up by the government because of a crisis in funding brought about by a growing elderly population. By 2013/14 the funding gap could reach £1.2 billion. It has been estimated that more than 150,000 older people in London alone are already not getting the care they need - with many ending up in hospital as a result. This problem will get worse as the number of people over 80 increases two-fold in the next 20 years. To tackle this issue, people who can afford it will have to pay more towards their care in old age and more public investment will be needed also.

But the report concludes that extra cash on its own will not be enough. Given the scale of the challenge, the social care sector also needs radical reform across a number of areas.

Reforming the workforce

With the elderly population growing, social care will require up to 1.5 million additional recruits by 2025. But low wages, stressful working conditions and few opportunities for promotion have led to high staff turnover and a high number of job vacancies. At present social care is heavily reliant on migrants - but current immigration policy threatens this key source of recruits.

• Recommendations: Health and social care budgets should be pooled so that they are sufficient to fund 'super carers' with skills in both areas of care. This would raise the status of these jobs, increase pay and prospects, improve professional development, and help with recruitment and retention.

The creation of a single professional body for health and social carers would also help to drive up standards.

Improving coordination

The detailed research focused on London, which faces particularly acute challenges to meet the home care needs of its growing older population. London provides a good example of an area where there is a patchwork of different care providers, leaving users confused as to what services are available. There is also a lack of coordination and integration between health and care providers.

It is widely accepted that it is better to look after elderly people in their own homes, rather than relying on more expensive care homes or hospital beds. But the report identifies a large variation between London boroughs in their use of home-based care. In Waltham Forest only 6 per cent of older people receive care in their home, compared with 17 per cent in Westminster.

• Recommendations: In London the Mayor should be given strategic oversight of the health and social care market. Health and social care should be purchased through joint commissioning arrangements.

Empowering service users

Too often older people are being provided with poor levels of care that does not meet their needs or accommodate their preferences. Giving older people personal care budgets could help - but to make this work, they need better information and support to use their budgets and a range of quality providers to choose from. At their best personal budgets offer choice and independence, but at present only 45 per cent of care users know about them.

• Recommendations: Help older people to use their personal budgets with confidence by setting up peer networks which spread information. Integrate the Attendance Allowance, health services and social care services to give greater flexibility and choice of services.

Jonathan Clifton, Research Fellow at IPPR, said:

"The challenges of providing good quality care for older people in their homes can be met and afforded, if creative approaches are taken. A combination of better targeted public funding and increased personal contributions through social insurance schemes could fill the funding gap. But more investment without real reform of the sector will achieve little.

"If health and social care services were much better integrated, then there could be transformation in the social care workforce. We need 'super carers' - high calibre people, paid at decent levels, with good career prospects, who are valued by society and equipped to provide personalised services for elderly people. If we had a high quality care workforce, older people would be able to make use of personal health and care budgets to 'shop around' with greater confidence."

Clare Thomas, Chief Grants Officer of the City of London's City Bridge Trust, said:

"Reforming home-based care means older people won't be forced into hospital before it is absolutely necessary. It will also reduce pressure on public services and free up much needed beds for other patients.

"With the number of older people set to rise dramatically, we must act now to prevent a wholesale crisis in home-based care. The funding shortfall should be addressed by a combination of increased investment, greater professional support for the home carer, and giving older people greater control over their own budgets."

Notes to editors

The variation between London boroughs in provision of home care is set out in the table below.

The City Bridge Trust, stewarded by the City of London Corporation, builds bridges across diverse communities through charitable grant-making. With the City at our heart, we promote social cohesion and address disadvantage throughout Greater London. With a strong track record in bringing overlooked problems to a wider audience, we ensure long-standing practical change. The City Bridge Trust is the grant-making arm of Bridge House Estates which maintains Blackfriars, Southwark, London, Tower and Millennium Bridge at no cost to the tax payer. Surplus funds from the upkeep of the bridges are awarded in charitable grants to benefit Londoners. The sole trustee is the City of London Corporation. Since 1995 a total of £240million has been awarded to charitable causes.

Contact:

Tim Finch, Director of Communications, IPPR: 0207 470 6110 / 07595 920 899 / t.finch@ippr.org

Nick Colwill: 020 7550 5629 / 07717 897 701 / nick.colwill@champollion.co.uk