Social care needs to solve its own crisis
Few would dispute that adult social care in the UK has reached, and probably passed, crisis point. As the population ages, funding shortages bite, and the industry struggles with impossibly high staff turnover, it has become increasingly clear that the status-quo is skating on the thinnest of thin ice.
Yet when it comes to what can be done in response, the focus tends to narrow on two issues: the role of state intervention, and how much money is needed to plug the long-acknowledged funding gap. Recent experience shows that there are no easy answers on either front, while the Government’s response so far has been more presentational than progress-oriented. Social care might have been added to the Department of Health’s nameplate, but the reality is that the green paper on social care, first promised last November, will now be delayed until the coming autumn.
And, having committed to an overall funding interest for the NHS, none of the annual £20bn increase will be used to support social care. Moreover, the appetite for bold political measures may have been curbed by the ‘dementia tax’ debacle, which showed the obstacles to building public permission for raising more funds for care in later life.
If those working in, and dependent on, social care expect the Government to ride to the rescue, they will be waiting a long time, for policy and public funding that threatens to be deeply insufficient to meet the need.
Instead the industry needs to look to itself. Because even if the Treasury could rustle up the money to fill the funding gap (£2.5bn a year by 2020, according to the King’s Fund), that would not solve the problem. Even worse than the system being underfunded is the reality that it is flawed by design: a model of care provision that is sparking a recruitment and retention crisis, and which fails to take advantage of technology to improve patient outcomes and cut costs in parallel.
More money may be needed, but alone it will not heal all ills. That can only happen by fundamentally reforming how care is provided, and a new approach that helps us make more of the funding that does exist. The social care crisis is not just one of funding, but recruitment, patient and carer experiences, and health outcomes. Only when the industry embraces the need for change that encompasses all of these challenges, can we hope for meaningful reform and progress. That will require focus on two issues beyond funding: the organisation and administration of social care, and how frontline care is delivered in practice.
Changing how care is organised
No-one takes a job as a social carer without good intentions to help people and make a difference. But carers are working in a system that makes it almost impossible to be a trusted and personal support system that patients can rely on. As the Guardian reported in 2016, a typical day for a carer might include over 20 house calls in 12 hours, including 20 miles of driving, as part of a rota that allows just two days off every fortnight. Many caring jobs are on zero-hour contracts, while the average salary for a frontline, full-time carer is £14,800.
Too many carers are being treated more like contract cleaners than the care professionals they are, with the wellbeing of hundreds of thousands of people in their hands. And the negative impact on care-givers and patients is alike is clear to see.
For carers it has contributed to a crisis in recruitment and staff turnover. An average of 928 carers leave the profession every single day, which added up to 27.3% of the entire workforce over the 2015/6 financial year. In parallel, a report by the Communities and Local Government select committee has found that 48% of new caregivers leave within a year of starting. This is clearly unsustainable in a sector where over 84,000 jobs are already vacant. But it is hardly surprising given the low pay, demanding schedule and near impossibility of delivering meaningful care through tightly packed
Nor can anyone be shocked that patient satisfaction in social care is cratering: just 23% were ‘very’ or ‘quite’ satisfied with social care in 2017, down sharply from its 2007 level of 43%, and well below the 57% for the NHS as a whole. That surely reflects the demise of a strong bond between patient and carer, where the average experience can amount to four different visits a day from four different carers, lasting just 15 minutes apiece.
In other words, the system is one that serves neither carers nor patients, and has diluted the essential bond between them. The only way to reverse the damage is to go back to first principles: restoring the direct relationships between care-givers and those they support. At HomeTouch, this is something we are doing through our online platform, which matches families with carers.
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Another model we admire is the Dutch Buurtzorg (neighbourhood care) model, where carers team up to look after groups of patients in a local area, organising independently and with only light-touch administration.
That principle, allied to the power of digital platforms to connect caring expertise with patient needs, can give power back to families and carers alike, breaking out of the bureaucratic and impersonal system that many currently experience. And only then can we start to think about reversing the crisis in recruitment and retention that is threatening to bring social care to its knees.
Changing how care is delivered
It is not just the administration of care that is undermining its efficiency and effectiveness. Equally, if not more, important is what the sector currently considers to be meaningful care giving.
The ‘time and task’ model imposed on many carers, where they are required to cram a list of tasks into a short home-visit, leaves little space for responsive and empathetic care giving, as well as demoralising carers with an unsustainable workload. In turn, the emphasis on developing new treatments draws attention and capital away from what can be done right now to help patients. The pharma industry has spent tens of billions on a putative cure for Alzheimer’s disease, while insufficient attention is given to what can be done to prevent and slow the progress for patients who cannot wait around for the miracle drug to arrive (not for another decade at least).
Instead, prevention should become the guiding principle around which social care is re-organised. When it comes to neurological conditions and diseases, for instance, rather than everyone shooting for the moon in search of a wonder pill, we should be focusing much more on what can be done to improve brain health right now. When up to a third of dementia cases could be prevented by simple lifestyle measures, from a more Mediterranean diet, to stable sleep patterns, exercise and ensuring your brain is challenged with new experiences, it is essential that we do more to help people help themselves.
According to the Alzheimer’s Society, just 2% of the population know what they can do to help prevent the onset of the disease. Under the Buurtzorg model, carers are required to provide this education and guidance as well as meeting immediate caring needs. A shift from the emphasis on immediate fire-fighting to long-term health coaching will allow patients to play a greater role in their own care, potentially reduce the number of care hours required, and acknowledge the severe limits of what can be achieved in a 15-30 minute home visit, which will remain the case regardless of how much new funding is found.
Alongside a greater focus on prevention must come increased and improved use of technology. From monitoring tools for those living alone, to care robots that can replace some functions of a human carer and help combat loneliness, and assistive technology that can support in areas from maintaining a regular sleep pattern to automating elements of cleaning, gardening and cooking, there is huge scope for technology to make care more efficient and support people to live an independent lifestyle for longer.
There will be reasonable fears that automation will make care less human; but really we should be looking for a balance, where technology releases carers from tasks that currently fill their time, allowing them to focus on areas where the human touch can make the most difference. In reality, technology can and should be good for patients and carers alike: providing an always-on support system for those who need it, while uplifting the role of caregivers to the point where the job regains the meaning and purpose that should be its core attraction in the first place.
Fix before you fund
The depth of the challenge facing the UK’s social care system means that we need to move past old assumptions and solutions, and look towards fundamental renewal of a broken model. There is much that can be fixed and improved without tapping a reluctant public purse for more funding. For some it will always be a heresy to suggest anything other than more money as the solution to our problems. But while the simplistic, headline-grabbing view will always warn that less expenditure means a lower quality service, in fact the opposite is possible.
Through re-organising how care is organised and delivered, focusing on stronger relationships, preventative care and patient empowerment, all allied to technological enhancements, we can create a social care system that performs better, costs less and achieves much more.
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.