Crisis in Care – Thoughts on the Panorama Documentary

They are Us and We are Them

When we heard about the 2 part BBC Panorama documentary looking at Crisis in Care, we knew as a technology provider for the care industry, we had to watch it.

Care Services at Full Stretch

The programme left us feeling somewhat deflated. The documentary focussed on numerous people in Somerset who were facing issues with the care they received from Somerset Council. Carers were being stretched beyond their limits as the levels of services were being cut year after year.

It was reported that Somerset Council had overspent on their budget and needed to find £13m in savings. This meant that libraries were closing, children’s services were being cut, the roads were being gritted less in winter and 120 jobs were being lost. Of the £13m that needs to be saved, £4m was to be cut from adult social care.

Funding Conflicts

There is a funding conflict between the service users, the local councils and the NHS. Service users are forced into financing their own care until they have less than £23,250 in savings or assets (that includes the homes that they may own). Social workers fight on behalf of the service users to get the NHS to pay for care if their medical needs are sufficient, but this is under constant review, so it could all change in as little as 3 months. The pressure on everyone involved must be tremendous. The commitment of the staff working in the care organisations was clear but the system is clearly under strain and as the population ages, the amount of funding needed to care for them needs to be going up not down. Something is not working correctly if the number of care places has fallen by ½ million in the last 9 years.

It is difficult to see how Person Centred Care can be achieved in this environment. We find ourselves asking what kind of difference Care Management Software can make in a situation where the gap between the amount of funding and the cost of running the service is so large that even the largest care provider makes losses of hundreds of thousands of pounds every year.

Whether people need care due to illness or old age, it shouldn’t matter who pays for the care. It is frightening to think of how much money is wasted in meetings alone, between social workers and the NHS as they try to decide who pays for an individual’s care. If care is needed it should be there. For an elderly couple to be forced into selling their assets to pay for care after a lifetime of paying taxes does not seem like the right thing to do. Neither should any vulnerable, elderly person be faced with the prospect of living in isolation due to the care she needs being scaled back.

The Panorama documentary made for difficult viewing and one can only hope that when it is screened in Parliament, enough MP’s will feel compelled to do something. One thing is clear to us as a technology provider. We can help and while we may not have the ability to solve all of the issues around how and who funds social care in the UK, we are in a position to change the way care is managed and if that can help free up more resources to provide better care in a more accountable and robust way, then we are doing our bit. We must never forget that at some point, any one of the people in the programme could be us or one of our loved ones. Their stories are our stories.

The Humble Checklist and its Use in Domiciliary Care

Lessons from Disaster

Major Pete Hill was the chief test pilot of the US Army Air Corps and he had the responsibility of testing the plane. As Major Hill took off, he must have realised something was wrong quite quickly. He wasn’t able to level off the plane and it kept on climbing until it quickly stalled and fell back to Earth killing all on board. Boeing carried out a meticulous investigation into the crash and they found that the plane had no mechanical faults but that the pilot had forgotten to unlock the elevator control flaps. This meant that they were locked in place making it impossible to level off the plane after take off. In response to this, Boeing created something that would change the airline industry. It wasn’t more training or more technology that was needed. After all, Major Hill was one of the most experienced and well trained pilots of the day. The problem was that the pilots had become overwhelmed by the complexity of what they were doing. Simply put, humans are fallible and prone to forgetting things. So in order to resolve this Boeing created the ‘Before Flight Checklist’ and it led to such a significant improvement in aircraft safety.

Surgical Checklists

This story was told by Dr. Atul Gawande in his book ‘The Checklist Manifesto’. Dr. Gawande developed a Surgical Safety Checklist in 6 hospitals around the world ranging from the UK, Tanzania, Canada and the Philippines. The results were impressive. Postoperative complications and death rates both rates fell by 36 percent on average. Dr. Gawande realised that the levels of complexity that had developed in medicine meant that there was more specialisation. This meant that there was more team activity for every case than in the 1930’s, when a single Doctor would manage the treatment with the support of a small nursing team.

‘Confirm – Do’ Checklists give Peace of Mind

So with a well written checklist, we can see that significant improvements can be achieved not only in the way individuals work but also in teams. With Fastroi’s Real-Time Care™ we were able to implement checklists into the domiciliary and residential care system – While we call them task lists in RTC, they are essentially checklists for the care workers to ensure that nothing is forgotten. We understand the power that taking the pressure off of care workers and placing it within the tools and processes can have on staff. As with any activity, if we record it, then we can prove that it happened. Having this kind of checklist built into Care Management Software, we are able to provide the care staff the reassurance that everything they need to do during a visit will be presented to them in the form of a task list which can be customised for every visit. As every task is confirmed as ‘done’, it is saved on to the server so that an electronic record of the visit exists which can then be used to evidence what was done during the visit.

Where an electronic task list can be superior to a paper based one is in the level of information and detail that can be incorporated. We can add information about the clients needs, wants and requirements so that it becomes truly person centred. The checklist has changed the lives of millions of people from aircraft passengers to patients in operating rooms and their families. The beauty of the checklist is that it also benefits the airlines and the engineers who prepare the planes and the surgeons, nurses and other OR staff who no longer have to worry about forgetting a critical activity brought about by unmanageable complexity.

By skillfully designing the checklists into the tools that are being used for reporting, recording and planning we can reduce the chances of mistakes being made due to staff being under pressure. Less mistakes means greater quality, greater quality means better care.