Alex Fox on the viability of care rooms and the need to look at other patient-centric models that already exist in the NHS
It has become a cliché that you shouldn’t waste a good crisis, as an opportunity for radical ideas. Delayed transfers of care certainly represent an NHS crisis (if one of many at present) and Care Rooms was certainly a radical idea.
Dubbed “CareBnb”, the suggestion was that ordinary people, suitably vetted, would rent out their spare rooms for into which a local hospital would place “bed blockers”, with the host providing no personal care, but conversation and three microwaved meals a day.
Person-centred support
A crisis, however, is also when people find it increasingly hard to focus beyond the immediate future. Care Rooms felt to some like a quick fix which did not seem to embody the kind of person-centred support and relationships we would hope for within our future public services. Why would people recover more quickly as a lodger in a stranger’s room?
The adult moves in with their chosen Shared Lives carer, receiving the personal care they need as part of a supportive household, or visits that household regularly for short breaks or day support they might otherwise receive in a day centre or care home
This was also an example of something we do too often: reaching for “new” ideas, rather than making good use of the ones we already have. Shared Lives is used by 14,000 people via the local services which are now in almost every UK area, and consistently rated by the Care Quality Commission as the best performing regulated care sector.
Shared Lives carers are put through a rigorous, three to six month approval process, before being carefully matched with an adult who needs support.
The adult then moves in with their chosen Shared Lives carer, receiving the personal care they need as part of a supportive household, or visits that household regularly for short breaks or day support they might otherwise receive in a day centre or care home.
Some Shared Lives carers are registered nurses and it is already used as home from hospital care, with, for instance, stroke survivors appearing to recover more quickly and fully than expected.
Social focus
This is partly about the quality of care, but just as much about the model’s social focus: people share mealtimes and other social occasions, rather than microwaving ready meals.
It is important to develop and utilise models which understand that community is not a place, it is our relationships to others
The Department of Health and NHS England are both investing in developing the health applications of what has previously been a social care model, along with seven clinical commissioning groups, as part of the Integrated Personalised Commissioning approach.
The model is radical, but has a 40 year history and national infrastructure behind it. It is not a quick fix for all people, but if all areas just caught up with the areas using it the most, at least another 20,000 people would use it, saving well over £100 million a year through lower costs.
It could be developed today in most areas, but its success would hinge on a long term commitment, not just to moving existing approaches into “the community”, but developing and utilising models which understand that community is not a place, it is our relationships to others.
Those relationships are often as crucial to our long term health and wellbeing as the quality of healthcare we receive.
Alex Fox is the chief executive of Shared Lives Plus, the UK network for small community services, and author of a new guide to personal health budgets aimed at charities and other not for profit.
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