‘To fix the NHS, you have to fix social care’

For the launch of Complex Care, editor, Jo Makosinski, spoke to Peter Kinsey, chairman of Iris Care Group, about the challenges facing operators and service users and what he would do if he could wave a magic wand

Q: How did you become involved in delivering complex care services?

A: I’ve been working in complex care services for 40 years, though we tend to refer to them as specialist services.

I began my career in 1985 and in 1988 I was a home manager resettling people with autism who presented significant challenges from long-stay hospital.

We were very motivated to give people a better life, but didn’t really understand challenging behaviour and didn’t have proper care plans and risk assessments. It was all rather amateurish, but I’ve learned a lot since then.

For the last 18 years, I’ve been a chief executive of various specialist care organisations and I now chair Iris Care Group and a charity called Guild Care.

Iris Care Group was the result of a merger between two organisations, Ludlow Street Healthcare and Holmleigh Care.

We are unusual because we offer the whole care pathway, so we have specialist hospitals, we have a nursing home, we have care homes for very complex people, and we have supported living.

We have some fantastic clinicians, which means we have the expertise to support some of the most-complex people in Britain.

Q: What are the key challenges complex care operators face?

A: There is always the financial challenge of trying to get enough money from local authorities to fund your services.

Recent changes by the Government are also making the environment more challenging for providers. This includes the recent increase in national insurance and the forthcoming Employment Rights Bill. While I fully support giving workers more rights, the new legislation will undoubtedly increase costs for providers and it is very unlikely that we will receive additional funding to cover those costs.

I’m also not sure how well thought through the new rules are on the use of temporary workers, which could cause some real issues for providers that rely on agency staff.

There is also the longer-term issue of workforce.

Demand for social care staff continues to grow and we have an ageing workforce, many of whom will be retiring in the next few years.

I think the recent change to rules for sponsorship staff was shortsighted and a knee-jerk reaction by the Government to the recent success of Reform in the local elections.

It will make it even more difficult to get the staff that we need.

The reality is that a lot of British people don’t want to work in care and that won’t change until we improve the status, and crucially the pay, of our staff. That’s something that the Government must address.

Q: If you could wave a magic wand and fix complex care, what would you do?

 A: I would first change and improve the current arrangement where you’ve got regulators, commissioners, and providers who don’t always understand each other and where it can be unnecessarily confrontational.

Fundamentally, we are all trying to do the same thing, which is provide really good services for people that empower them and enable them to have the best-possible quality of life.

But the way the system works is just too clunky, complicated, and confrontational and we need to find a better way of doing it.

That’s number one. Number two, I would pay our staff properly and have them genuinely considered to be professionals who are highly skilled. I would give the job more status and pay people a decent wage to do what is a complex job.

And, thirdly, I would really make sure that we’ve got leadership development, not just for providers, but across the sector so we’re getting the very-best people and are equipping them with the knowledge and skills to lead organisations in a challenging environment.

Fundamentally, we are all trying to do the same thing, which is provide really good services for people that empower them and enable them to have the best-possible quality of life

Q: How do you think the Casey Review of social care services will impact the sector?

 A: Older people’s services are really important and I chair an older people’s charity, but they’re not all of care and too much attention gets paid to them sometimes, and not enough to what we do.

I want to make sure that she and her team are really thinking about specialist services because in older people’s care a really important issue is who pays for it and whether people have to sell their houses to pay for their care.

It’s not an issue in specialist services, because we’re fully funded by the state, but we need our issues to be considered just as much as older people’s services.

Q: What do you think of the Government’s recently-released 10-Year Health Plan. This didn’t really go into great detail on the social care sector, did it?

 A: To fix the problems with the NHS, you have to fix social care, of course.

Let me give you a very-specific example of how the current system doesn’t work.

I chair a great charity that runs several outstanding nursing homes.
They are fantastic with lovely staff, a great atmosphere, really nice environments, and their fees are typically about £1,400 a week.

In the local hospital near the care homes, 30% of the beds are filled with older people who don’t need to be there, but there is nowhere for them to go.

Those people will deteriorate in hospital and we’ve got people waiting on trolleys because so many beds are blocked.

It costs the NHS £4,000 a week to have people in hospital and we could take some of those people and put them in a much-better environment for £1,400 a week.

We could free up beds that cost £4,000 a week and get people off the off trolleys and into wards, but here’s the problem.

The £1,400 a week is paid for by social services and the £4,000 a week is paid for by the NHS.

As a taxpayer, I’m paying for both. It’s ridiculous that you’ve got two sets of public money and because of the way things are set up, people are suffering unnecessarily when there is a very-sensible solution.

It’s ridiculous that you’ve got two sets of public money and because of the way things are set up, people are suffering unnecessarily when there is a very-sensible solution

Q: With such an overview of the challenges, and an idea of how to begin to address them, have you been able to lobby ministers and the Government to bring about change? 

A: It has been very difficult to get in front of ministers.

It’s hard to get facetime with them and, to be honest with you, I haven’t met any for a while.

Iris Care Group is a member of Care England and it does a fantastic job lobbying on behalf of the sector. But, sometimes, it feels like what they are saying falls on deaf ears.

A frustration for me, which I’m sure my chief executive colleagues share, is that we are a can-do sector, but we work in a bureaucratic environment where it takes a long time to get things done and there can be a lack of a ‘can-do’ attitude in the public sector.

For example, a few years ago, I was talking to a commissioner and she was very concerned about a group of autistic people living in a unit on a hospital site that had been rated inadequate by the CQC and which was costing them a huge amount of money.

At that time, the organisation I was running was in the process of moving people on from one of our care homes to live more independently, so there was a care home which was going to be vacant in a couple of months time in the same local authority area.

I said to this commissioner: “I can free up a house and offer a better place for those people to live with skilled staff to support them.

It will cost two thirds of what you’re paying now and they’ll have a much better quality of life.”

She seemed interested, but never came back to me.

I’ve had similar experiences to that on a number of occasions.

What commissioners need to understand is that providers, particularly in the private sector, can access the resources to provide the capacity that they need

Q: If all these issues were addressed, is there the capacity within the complex care sector to accommodate all those who need support?

A: Not straight away, but there are opportunities that could be grasped.

A major problem is that commissioners often don’t understand the provider world and providers often don’t understand the commissioning world.

I’ve done both roles and they are very different.

What commissioners need to understand is that providers, particularly in the private sector, can access the resources to provide the capacity that they need.

We have access to capital and we can develop properties a lot more quickly than the public sector, where it can take years to obtain grant funding.

As long as a provider has a guarantee that the commissioner will fund the service when it’s open, they can borrow the necessary funds to develop it.

I think sometimes public sector procurement rules get in the way of making things happen.