Brexit/COVID-19 impact on job market, particularly around care – inflationary pressures
But is this also an opportunity to revisit the current care model allowed in commercial packages? How has care been delivered in lockdown?
Care is, usually, the single largest head of loss in a high value claim. Seven figure care awards are common and, one suspects, bear little relation to the regime that is ultimately implemented at the conclusion of a case. The contrast between the care regime advocated in personal injury proceedings and the care received by individuals where there is no compensable accident or tortfeasor, is stark. In the real world the cost of care has to be balanced against the finite public purse. But things appear to be changing. Judges are increasingly sceptical about the care regimes recommended by claimant experts and COVID-19, Brexit and the increased use of technology have demonstrated that things can be done differently.
A Mencap online survey in August 2020 found that care packages had, at least, halved during COVID-19 for most people with learning disabilities, as their needs had increased. A Care Quality Commission insight report in May 2020 suggested that staff absences, as a result of COVID-19, were running at 10%. Support services had closed and treatment had been delayed. Care regimes were disrupted and family members had taken on increased responsibility (not always by choice) in the absence of any alternative. Changes in routine and lack of social contact will have had an impact on some vulnerable individuals and disrupted rehabilitation will have resulted, for some, in a missed window of opportunity to maximise a claimant’s recovery. But others have adapted. Therapies and assessments have taken place remotely. There is anecdotal evidence that physiotherapy, speech and language therapy and personal training have worked well remotely, occupational therapy less so. Case managers are no longer travelling long distances for short meetings. There is little evidence that this has changed long term outcomes. On the contrary, in freeing up time, experts, therapists and case managers can focus on areas where they can add real value.
One in every five care workers is born outside the UK (266,000 people). Most are from non-EU countries (191,000) but there are regional variations. So in parts of South East England, according to an article in The Guardian on 7 December 2020, up to 1/3 of care workers come from the EU. But the situation is changing. Net annual EU migration between the Brexit referendum and leaving the EU at the end of 2020 had fallen by about 150,000, although this number had been largely replaced by non-EU migrants.
Work in the care sector is unattractive to UK workers. The hours are uncertain, the pay is low and working conditions are often difficult. A Nuffield Trust Report suggested that “The perilously uncertain future facing the UK at the end of the Brexit transition period could put the UK`s health and care system at risk”. This is confirmed in a report by The Independent Age and International Longevity Centre – UK, which confirmed that in 2020 the shortfall in care workers was 200,000 and by 2040 this would increase to 1,000,000, no doubt compounded by an aging population. We are beginning to see the impact of this impact on care costs. ASHE 6115 (care workers, home carers and senior care workers) confirms a median hourly rate increase for care costs of 5.5% compared to the 2019 data.
The Government has introduced a points-based immigration system and the focus of this is on skilled workers (RQF3 or above – equivalent to A Level standard) and a general salary threshold of £25,600. This will effectively exclude most migrant care workers who invariably earn less than this.
It has been suggested that the care sector faces a “ticking time bomb” of fewer carers and lower quality care because foreign care workers tend to be younger and better qualified than their UK counterparts. The solution to this has to be different ways of working and a greater use of technology.
Technology and different ways of working
Technology is never going to replace a person. What we need to achieve is a balance between the two, so care can be delivered efficiently and cost effectively whilst providing some human interaction. To do this, there has to be a change of mindset on the part of claimant lawyers who, too often, seek to maximise a claim in monetary terms rather than necessarily acting in their client’s best interests.
COVID-19 has demonstrated that healthcare professionals can make technology work. We are increasingly seeing remote assessments and meetings but there is so much more that can be done with Technology Enabled Care (TEC).
Apps and smart appliances can be used to communicate with experts, seek urgent help, reduce social isolation, control the home environment and maintain health and fitness. The support provided does not end when the carer leaves the claimant’s home.
Sensors can be used to monitor a claimant’s vital health signs including blood sugar levels, blood pressure, body temperature, heart rate and breathing. If there are changes that warrant investigation, arrangements can be made for a home visit.
Telecare can go beyond monitoring of vital signs. Personal alarms can protect the claimant from dangers in the home. Sensors can track activity and identify potential risks. So if the claimant normally visits the toilet three times a day but the sensor detects that this has doubled, that might be something that warrants further investigation. The claimant, themselves, might be unaware of the potential significance of this and not mention it to their carer on a face to face visit, so telecare can result in a qualitative improvement in the care provided.
PainChek uses AI, facial recognition and smartphone technology to intelligently automate the pain assessment process at the point of care. The smart phone camera records a short video of the person’s face, then analyses the images using facial recognition analytics to recognise facial muscle movements that indicate levels of pain.
Claimants with brain injuries often seek a “buddy” to provide prompting and enablement when this can be done just as effectively with memory and prompting aids.
Doing things differently does not necessarily involve technology. Care providers are increasingly advocating the benefits of a single carer to roll an individual in bed and hoist them. It is a myth that Manual Handling Regulations mean that two carers are always required. Statutory services are adopting techniques which are less intrusive for the patient and effortless for the carer. It also assists with recruitment as fewer carers are needed. This is an excellent example of reducing cost without compromising quality.
The disparity between the care provided to a victim of a tortious accident and others is difficult to justify.
Claimants are entitled to fair compensation to meet their reasonable needs but awards in recent years have pushed the boundaries of what is reasonable. With pressure on the care sector increasing, it is essential that we look at more efficient and cost effective ways of delivering care without compromising quality. We can achieve that by the use of technology and adopting different ways of working to free up carer time so they can then focus on areas that require personal interaction. We have started to see that already during the COVID-19 crisis and it is to be hoped that this will continue. But most importantly, there has to be a change of mindset amongst claimant solicitors whereby “success” on a claim is not judged solely by the level of damages recovered.