NHS Reset: Looking closer to home for solutions to social care

The NHS Confederation kindly published this blog as part of its NHS Resetcampaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic. Full blog here.

There can be few more daunting challenges than safeguarding an entire population against a deadly virus.

And while the spotlight was initially on the vast and justly celebrated achievements in acute care, the social care sector took weeks to persuade leaders to focus on the tragedy which was quietly unfolding in our care homes, until the numbers became too huge to ignore.

A specialist report estimates that more than half of all deaths in the UK that are directly or indirectly related to COVID-19 will have been among care home residents.

We may never know how many more people who use social care died, isolated at home following visits by untested and poorly equipped social care workers.

There is an argument being made that this discrepancy between relative success in protecting the NHS and the unconscionable number of deaths in social care demonstrates the need to merge social care into the bigger, better-resourced and more loved NHS.

But there’s another way to look at this, and one that offers optimism and hope to set against the UK’s grim death toll, one of the worst in the world.

Only connect

Perhaps the most positive – and unexpected – impact of the crisis has been the number of people who have proven willing to support and connect with each other.

We saw 750,000 would-be NHS volunteers sign up when the call was raised, while countless thousands formed their own mutual aid groups. This has not been evenly distributed but it hints at a different way to approach keeping people well – particularly the isolated older people who are one of the biggest groups using health and social care.

There are existing models that show us what can be achieved when we start to consider more localised, community-based options.

These include two innovative home-based models, Shared Lives Plus and Homeshare UK, which have proved resilient and have indeed flourished while the pandemic has had a devastating impact on some building-based services.

Shared Lives – now used by approaching 15,000 people in the UK – is rated as the best performing social care model by the Care Quality Commission. It matches an approved carer with someone who needs significant support. Uniquely in adult care, the older or disabled person moves in with their chosen carer and lives as part of the household or visits them regularly in place of traditional short breaks or day services.

A powerful example of the service in action is Meg, who now lives independently with a Shared Lives carer after a history of mental illness and self-harming including four and a half years of residential hospital care.

Almost every area in England has a scheme and 79 per cent of them now offer healthcare as well as social care for people with mental ill health, acquired brain injury, stroke or other long-term conditions. With no staff team going in and out of the Shared Lives household, infection and mortality rates have been mercifully low.

For many users of traditional social care, an extended period of isolation is bringing risks to their mental health. Home-sharing not only addresses this, but it also offers a solution to the eternal challenge of releasing acute care beds when patients are ready for discharge but need some support with ongoing health or care needs.

In a post-coronavirus landscape, we will need our hospitals and medical facilities to recover and thrive. More crucially, we need a wider support system that enables people to live safely and well at home.

A kinder, more connected society

Looking back on the pandemic, we were able to ‘protect the NHS and save lives’. But there were times when it felt like we were protecting the NHS from the older people who needed it most.

Going forward, we need a new approach to both health and care which is focused on keeping people safe and well at home. This will reduce pressures on the NHS, but most importantly it will offer people a life during and after lockdown, not just survival.

Shared Lives, Homeshare and other forms of personalised care must be central as we look to create a stronger, kinder and more connected society.

The connections that people are currently making with each other are as crucial to the next phase of COVID-19 planning as the smoothly running hospital was to the first.