What is happening to city’s social care

Before and since the onset of the coronavirus pandemic, a lot has been made of the varying crises the UK faces. Who is to blame for the state of the economy? What will happen to the NHS?

These matters have a way of filtering down locally over time. One major issue likely to have just as big an impact is the state of social care.

Adult social care includes all forms of personal care and practical assistance provided for people in need, aged 18 and over. This could be because of age, illness, disability, or a range of other circumstances.

Liverpool has more than 150 care homes across the city, ranging from specialist facilities to general nursing homes. Some of these facilities are facing worrying assessments by industry officials, most commonly the Care Quality Commission (CQC).

The CQC is the independent health and adult social care regulator which monitors and inspects health and care services to ensure they meet standards of safety. In the past 12 months alone, at least four care homes in the city were found to be inadequate, while 35 were deemed as requiring improvement.

This has a massive human cost to those living in the homes and relatives of residents. Last month, it was revealed how in one home in Sefton Park, black mould was found and a staircase falling away from the wall. 

That home was then plunged into special measures.

Not too far away, just off Jericho Lane, one provider said they would simply shut their facility down following a negative report because it was “distressing” and officials had “a lot” on their shoulders already. 

In one heartbreaking case, a bereaved father blamed himself for the standard of care his late daughter received in north Liverpool. Melvyn Chazen, 80, said his daughter Linzi Thomas “did not deserve” the care she received in the final years of her life at Alt Park Nursing Home in Gillmoss. On that occasion, the CQC found a blame culture, with residents left shouting for help and at risk of abuse.

In October last year, the CQC released its State of Care report assessing the shape of social care. It found how a factor affecting patient flow through hospitals is their inability to move patients back into the community once they have been assessed as no longer needing to be an inpatient.

The report said that in August, the number of patients waiting in hospitals nationwide who no longer met the criteria to reside was nearly 12,000. This is down from a peak of 14,000 in January 2023.

A Liverpool Council report last year found around 240 beds are unavailable for use throughout the city owing to poor performance in the care sector, while a further 113 have been lost owing to sites closing. A spokesperson said, “When a home is inspected by the CQC and requires improvement, we work with the care home team to offer support as they address the issues. 

“Assisting the sector to drive continuous improvement, forms an integral part of our transformation programme for adult social care.”

A survey by the Association of Directors of Adult Social Services (ADASS) received responses from directors of adult social services in 94% of the 153 councils in England. This found that 99% of respondents agree increased pressures on the NHS will result in additional pressures for adult social care in the next year.

What is the reasoning behind issues in Liverpool for the sector, then? Some providers told the LDRS they have concerns around digitisation of records and adoption of AI in delivery of care. One staff member said, “If it goes down this route, I will leave.”

Staff have also felt overwhelmed by the challenges faced in an ever pressurised sector.

Mikhaela Williams-Brown is the operations director at Liverpool Social Care partnership, an organisation set up to support the sector in the city. She explained the changing state of care here and further afield.

She said, “There’s a massive change in the sector. It’s not just for care homes but across the board.

“Some of it is down to rates of pay, people looking at the hourly rate and everything else has gone up in terms of cost of living, but there are other elements on top of that we’re starting to see in terms of the dynamics and demographics of our workforce. We know we’ve got an aging population and now the older we get, more people are living with long-term conditions.

“What we’re seeing at our recruitment events is around 700 people in the city centre but now we might see 20 in a morning, so there is a massive difference there. I think it’s also people’s perception and understanding of the sector.

“There can be a misunderstanding in terms of the job roles, type of work, because it’s so extensive. People don’t realise you need strategic managers in social care, people who have HR and finance skills, as well as the care and support roles.

“In the past, we haven’t done ourselves any favours in how we sell our product, how we sell ourselves. The care home is only as good as the registered manager and nominated individual. 

“There are individuals who work in this sector who are lazy, not interested, have lost their motivation, but you get this in every sector.”

Mikhaela said the impact of coronavirus on the social care sector has been “absolutely huge” across Liverpool, with some walking away entirely. She also cited having to compete with the NHS to retain workers as well as the impact of Brexit and immigration changes.

She added, “I really don’t think the politicians and the leaders really understand what social care is. It’s a word, it’s a job role but they don’t really understand the different variances in what individual workers do. 

“If you’re a lone worker, there’s a big responsibility there.”

The state of care report said the rising cost of housing in certain areas of England has meant that, even if providers have managed to recruit staff to their vacant posts, new recruits have not taken up the offer of employment as they have been unable to find affordable housing. 

Mikhaela said, “We’ve seen reductions in social care budgets to local authorities year on year and this impacts in terms of how it’s distributed across services. It’s about more individuals having to pay an element of cost towards their social care needs.

“If you’re in an environment that’s 24-hour care, some can’t afford it, plus the fact the homes run at unit cost face losses. If the service users don’t have the money, it restricts their ability.

“Sometimes, it’s the handover of information into a service area. On hospital discharge, sometimes information is not clear, it’s not effective and the same happens when individuals are put through social workers.

“That has an impact on the care an individual is going to receive.”

In the LDRS’ own reporting, areas around medicines management, leadership and quality control have been identified at home throughout the city. Mikhaela, who leads the community interest company, said this was all down to the central issue of recruitment and made an interesting comparison of who managers need to be like.

She said, “In care, some are entering into registered manager roles not really understanding the massive amount of responsibility that’s there. In effect, your registered manager is like Harry Potter, especially in small care homes, they have to be the IT person, the HR person, the leader and understand medications, planning and training.

“They also have to market themselves and work with service users’ families to make sure there’s continuity of understanding and communication. They also have to be mindful of nutrition and hydration needs, safeguarding for service users and staff. 

“It’s a highly skilled role that we’re only now starting to focus on. The demand we put on these individuals is immense, but we are also facing care home owners who are just in it for the bottom line, the bottom buck. 

“The CQC need to pull up something when they see it’s not right but when they come across organisations that are practising irresponsibly, they need to action things. People are taking up hospital beds on wards because the right care packages and providers can’t be found. 

“More often than not, it’s because they don’t have the workforce to cope with the capacity they’re dealing with. More often than not, they’re operating dangerously.”

Image credit: Matthias Zomer

Why not follow birkenhead.news on Facebook, Twitter, and Threads? You can also send story ideas or letters to the editor to news@birkenhead.news