Striking drop in home care hours in Carmarthenshire despite rising demand

Richard Youle – Local Democracy Reporter

The number of hours of home care commissioned by Carmarthenshire Council has halved over the last decade, despite rising demand from an ageing population.

Jake Morgan, director of social services, said in a report that this “striking” trend was the result of measures such as helping people who might need support at an earlier stage, more help for people who have left hospital but who need care before they can go home, and more instances of one home carer – where appropriate – visiting a client when previously two had.

At the end of April this year, the council commissioned 8,601 hours of home care for people who need help with things like washing and dressing. A decade ago it was around double that.

Mr Morgan’s annual report said the council was managing home care demand, although there are more than 100 people waiting for the service. It added: “However, had we not made these radical reforms over the last 10 years then we would have a waiting list of 500 people and spend of an additional £20 million annually.”

His report, covering key trends in adult services and children’s services, was discussed by the council’s health and social services committee on October 4.

Speaking at the meeting, Mr Morgan said Carmarthenshire was the only area in Wales where home carer pay was on a par with NHS peers, and that this had helped with recruitment and retention. “But it has not solved fundamental shortages in the workforce,” he said.

Positive

In Carmarthenshire, as across Wales and the UK, many elderly people in hospital are medically fit for discharge but remain in a ward due a lack of onward support. Mr Morgan said a fortnightly meeting took place reviewing all long hospital waits, and that this had had a positive impact.

He said: “Seventy five per cent of our beds in hospital, sometimes upward of 80%, have frail and elderly people within those beds – hospitals that are designed for mending broken legs and dealing with cancer and all those kinds of functions are now largely overwhelmed by people who have multiple chronic complex illnesses.”

He said the average length of stay in Glangwili and Prince Philip hospitals, in Carmarthen and Llanelli, was more than double the equivalent of comparable hospitals. The more time frail and elderly people remained in a hospital bed with minimal movement, he said, the more they deteriorated and the harder it became to discharge them.

Mr Morgan said the health board had a very good relationship with Hywel Dda University Health Board, but he was concerned that significant health board budget deficits in Wales could mean funding being cut for initiatives to reduce hospital stays.

Training

Moving on to social workers, Mr Morgan said the council was focusing on sponsoring and training its own, while still recruiting externally where possible.

“I think we had 22 (social workers) join last year who we had some role in sponsoring or supporting in doing their professional qualification,” he said.

His report, though, pointed out that the council had been unable to fill social worker posts that were created via a “significant” investment” in mental health services by the authority last year.

Meanwhile, referrals to the child and family services department have increased by around 70% from a decade ago. Mr Morgan said outcomes for children helped by the council were the best in Wales compared to other authorities. “We still have low numbers of looked-after children, and we are good at keeping families together,” he said.

Caerphilly Council, he said, spent £20-25 million more per year on children’s services than Carmarthenshire did. However, Mr Morgan said numbers of young people on the child protection register had risen in Carmarthenshire.

He added that the authority had plans to ramp up its provision of residential care for looked-after children to avoid them having to go outside of the county. “The looked-after children market, particularly in terms of residential care, is not serving children well,” he said.

Councillors asked questions about the fortnightly hospital stay meetings, a rise in suicide in the region, and home care agency funding, among other things, and accepted the report.