Elderly people living alone who aren't able to bathe, dress, go to the toilet, get in and out of bed, shop or cook their own meals get help from their local councils seven days a week. All well and good you might think.
Unfortunately, because there are millions of them needing this level of assistance, and the shortage of organisations and staff to provide the services, people don't get to choose when they do these things. Many elderly people are helped to get ready for bed as early as 6.30pm. If the home help has ten clients, someone has to be first, and they must accept the times that are available.
But worse still, low pay and long anti-social hours mean that those providing this intimate personal care frequently change, so even tenuous relationships are lost as a result. How many of us would like to be bathed and dressed by a complete stranger - who has let themselves into our home with their own set of keys, without any introduction, and whose English language skills may be limited?
Direct payments were introduced to allow people the flexibility to do things differently, money was allocated to people so that they had the flexibility to arrange and buy their own care. But, in reality, the amount of money and the lack of options restrict choice. So why couldn't they take their business elsewhere if they were unhappy?
Well, because there is no elsewhere. Most often, there are one or two agencies operating in an area, paying the same wages, struggling to recruit and retain staff.
The process of commissioning is to be used to change this. At the National Commissioning conference in Birmingham in July, Ivan Lewis, the care services minister, stated: "Councils will need to adopt a much more strategic approach. They will need to gather improved intelligence about purchasing decisions that individuals choose to make to inform their role in commissioning strategically. They will need to work closely with providers, including those in the third sector, to shape and develop the market so that it can better deliver people's needs as well as their choices and aspirations."
All they need to do now is work out how.
Image: Flickr, K2D2vaca
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