In social care, the most important cogs in the machine are frontline professional carers. Not nurses, not doctors but carers. Why carers? Because it is carers who spend the most time with people needing care and support. It is carers who cover every county and village in Ireland. It is carers who interact with people in their own surroundings and it is carers who are the first line of defence when it comes to prevention and anticipating sickness.
Other health care professionals generally only play their role when someone has already fallen sick. They are reactionary, while carers have the potential to be preventative.
The tragedy for our health sector, is that to date, we haven’t gotten the most out of this fantastic resource and the results are manifest in rising waiting lists, overburdened acute settings and budgets at breaking point.
As I see it, there are multiple reasons we aren’t getting the most out of our professional carers;
Carers are invisible and have little or no voice at the tables where decisions about our health sector are made
Caring isn’t an attractive career and as such, carers themselves are demotivated and passive
We underestimate what carers are capable of and the role they could potentially play, especially given adequate training and the increased use of technology
We under hugely value the importance and healing power of social interaction and basic human contact
If we are to get the most out of the army of great carers across the country, we need to put carers front and centre of our health care initiatives including Slaintecare, HSE yearly plans and indeed the commissioning system for social care.
What are some of the actions that could be undertaken to ensure we maximise the potential of carers throughout the country?
Listen to Carers
The first thing we need to do is listen to carers and their views. What this does is, firstly provide us with expert frontline knowledge on the issues facing our health sector but secondly, it sends an important message to carers themselves, that their view counts and they are important.
What is striking, is that professional carers have no official voice that allows them to interact with other stakeholders. Carers need a national association that enables them feed into the national conversation on where our health sector is going but also into the decision making forums active across the sector.
Caring in the community by its nature leads to a dispersed isolated workforce which is all the more reason why they need an association that supports and advocates for them.
Make Caring a Respected and Attractive Career
Who in their right mind would become a carer? Pay rates barely above the minimum wage, payment only for contact time, no payment for travel, no guarantee of work, no career pathway and little or no respect.
The reason for our dwindling pool of carers is blindingly obvious. If we are to address the current carer shortage and indeed attract new people into caring, caring has to be turned into an attractive career. The best way to do this is by rebalancing the axis of power between employers and carers.
Presently the majority of funding for home care comes from the HSE who in turn pass out these funds through a limited number of approved corporate providers both for profit and not for profit. This puts huge power into these employers’ hands and allows them dictate terms and conditions for carers to their advantage.
The single best way to shift power to carers is to give families in receipt of HSE funds the option to use them directly with local qualified carers if appropriate. By giving this option and removing the monopoly that corporate providers have, those providers will be encouraged to work only where they are genuinely adding value. They will also have to offer attractive employment conditions or risk carers and families cutting them out where appropriate.
Better Utilisation of Carers
Carers are a huge underutilised resource spread over the whole country. Carers visit people needing care and support on a daily basis and sometimes up to 4 times a day! Carers are the proverbial canary in the coal mine and need to be trained up so that the regular contact they have with people is used to its maximum.
Imagine if this army of carers were equipped and trained to provide a fuller canopy of services some presently provided by public health nurses and also collect and distribute vital clinical data to relevant stakeholders? This way people would only enter acute settings when absolutely necessary.
I have also seen first hand what happy, well rewarded and motivated carers are capable of, on our Home Care Direct platform and how they respond positively to increased responsibility.
Once you have a well-funded and widespread professional non clinical home care service in place nationwide, it is much easier then to begin to transition that workforce and indeed supplement that workforce, into providing more clinical type care at home where the real savings can be made in our health budgets.
Increased Adoption of Technology
Even with making caring a more attractive profession so that we retain the existing cohort of carers and attract new entrants, it is unlikely that the full demand for social care will be able to be meet without the adoption and more widespread use of technology.
We will need to embed AI, big data, wearable devices and in-home technology into our social care offering, in order to make better use of our scarce resources. Technology will also have to be more user friendly for older and disabled people in order for its up take to increase. Advances in the area of voice technology will help hugely here.
By harnessing technology, we will equip carers to do even more and move them up the acuity scale, opening up more professional development and career opportunities.
The single biggest lever to affect change in how carers are treated and utilised, is our commissioning system. It is through the commissioning system that the HSE can affect how carers are treated, how carers are rewarded and viewed and hence how effective our care workforce is. Their actions are complicated by the fact that the HSE are commissioners, funders and providers at the same time.
Despite this, the fact remains much can be changed through the tendering process. How about implementing the TYCO ruling from the European courts whereby carers are considered working once they leave their house? How about introducing personal budgets whereby families can actually use state funding to contract directly with local qualified carers rather than have to go through approved corporate providers. How about insisting that providers pay carers the living wage if state funds are involved.
Our commissioning system sets the tone for how carers are valued and contribute, and unless the HSE accept this reality and utilises this power in a positive sense for carers, very little will change.
In summary, if we are to fully utilise the fantastic resource we have of a nationwide network of professional carers and indeed grow that resource, they need to be supported, nourished and valued. Elevating caring to a career worth doing and that can be fully harnessed, could be the single biggest initiative to making our health service fit for purpose.