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15-minute care visits: an indignity that should be banned or a ‘fully justified’ commissioning practice?

Home care picture Photofusion Rex Features 1

Adults’ services directors have today issued a stout defence of at least some 15-minute home care visits ahead of a vote on banning them on the grounds of indignity.

As charity Leonard Cheshire Disability stepped up its campaign for a ban and with peers set to discuss putting such a prohibition into law, the Association of Directors of Adult Social Services said some 15-minute visits were “fully justified”.

It released figures – from a survey of directors last year – which showed that while 51% of councils commissioned care in 15-minute visits they represent 16% of all visits commissioned by councils. In addition, just 8% of the councils who commissioned home care in 15-minute visits used them for bathing and washing; by contrast 88% used them for administering medication and 80% for checking up on individuals.

Adass released its figures in response to a report out today from Leonard Cheshire Disability showing that the proportion of councils delivering 15-minute visits is now up at 60%, based on a survey answered by 137 of the 152 English councils. The charity – a provider of home care itself – wants the practice banned on the grounds that it results in the rushed and undignified delivery of personal care to people, be it help with washing, dressing, toileting or getting up.

As it happens, the Care Bill returns to the House of Lords this week for its report stage, and one amendment that will be considered would normally prevent  councils from commissioning visits of less than 30 minutes for personal care. Leonard Cheshire wants peers to back this amendment “to end the indignity of rushed care”.

However, in a strongly worded response, Adass president Sandie Keene said: “It is totally wrong to believe that all tasks need more than 15 minutes to carry out; and frankly naïve to believe that simply by abolishing 15-minute slots a magic wand will have been waved, and improvements automatically achieved in our care services.”

But Adass’s position has itself received short shrift from the United Kingdom Homecare Association, which represents providers.

While Adass has said that just 4% (or so) of councils commission 15-minute visits for bathing and washing, the UKHCA has said this leaves out a number of other personal care tasks that  are being “squeezed into unreasonably short periods of time”.

UKHCA chair Mike Padgham also pointed out that “the sensitive administration of the complex medication so often required by older people should also be a cause for concern when shoe-horned into a 15-minute visit”.

The government is unlikely to support the proposed amendment to the Care Bill – which comes from ex-social worker Baroness Meacher. Its social care White Paper last year proposed an end to the “crude contracting” of home care by the minute, but through the spread of good practice on outcomes-based commissioning, not through the law.

This leaves us with quite a few questions:

  • If 15-minute visits are appropriate what are they appropriate for and are they ever appropriate for what we call personal care?
  • Is law the most effective instrument for preventing inappropriate care visits (of 15 minutes or otherwise)?
  • If the law is not the most appropriate instrument what is?
  • And can we get rid of inappropriate care visits in the current funding climate?

The last point is one that could potentially unite UKHCA, Leonard Cheshire and Adass, who would probably agree that today’s funding climate makes inappropriately commissioned care visits more, not less, likely.  However, that better-funded care system looks as far away as ever, which means that other methods besides an injection of resource must be found to end undignified home care. The question is what.

Picture credit: Burger/Phanie/Rex Features

Mithran Samuel

About Mithran Samuel

Mithran Samuel is adults' editor at Community Care.

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