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By Debbie le Quesne

Archive for September 2012

Is branding the cure-all remedy?

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Social care has a big image problem – if you don’t believe me, read the headlines.

Week in, week out we hear of hidden camera revelations, whistleblowing and abuse.

But there has to be some good news out there. Problem is: How do the 1.8 million people that work in the care sector, cumulatively the country’s biggest employer, get a much more positive response to the work they do?

Why does the sector find it such a struggle to, even if it’s just on the odd occasion, lift its head above the parapet?

We have to find a way of making our voice heard and changing our image.

Writing in the Guardian, Simon Cotterrell, founding partner at Goosebumps brand consultancymakes the following observations.

“Our first observation of the care sector came from looking at the photographs it uses to promote what it does. Whether it’s a prospectus for a care home, a training guide for care workers or a government policy document, there’s one striking consistency that is so expected of the sector that it goes totally unnoticed: wherever a care worker is photographed, they are hunched over in “care pose”. Care workers are always pictured at a lower level to service users.

“Contrast this with how other professions are portrayed. Subtle as this may seem, this diminished status in the way care professionals are portrayed subliminally contributes to the diminished status with which the outside world considers the sector.”

Interesting! But we are not branding experts, neither are we really aware of the psycho babble on marketing. WE ARE WHAT YOU GET.  We are, in the main, caring people with related skill packages. So do we need to wise up? Yes.

Mr Cotterrell adds: “

The second thing we noticed is that, unlike other sectors, the care sector has no one organisation or organising principle that you can point to as an identifiable provider of leadership.

“The care sector is highly fragmented, with tens of thousands of private operators that deliver the service, a myriad of professional organisations that advise them, and a plethora of NGOs that contribute to thought leadership.”

I’m suddenly reminded of an annual care association meting when Digby Jones, now Sir Digby, lamented some 10 years ago that the care sector was fragmented and thus powerless.

Seems little changes.

“Subsequently there are no signature names that the outside world can turn to as the recognised flag bearers for the sector, just as there’s no recognisable hypothesis on what makes good social care,” adds Mr Cotterrell.

Has he been reading my blog of a few days ago?

He is right when he says that the void not only creates a lack of leadership but a sense of enigma that all too quickly leads to suspicion.

“Perhaps, though, the biggest contributor to the poor image of the care sector is the difficulty consumers have in buying the service,” Mr Cotterrell observes.

The delicate matter of placing loved-ones in care id never easy.

The publics’ ability to choose is generally poor. It’s hardly surprising.

Partly because social care is a subject most of us aren’t used to assessing, and partly because there are no consistent criteria to enable a comparative assessment.

At the heart of the sector’s positioning is the National Skills Academy for Social Care, an organisation charged with developing leadership in the care sector.

It’s a thankless task.

‘Care is an occupation where the outcome is more dependent on how you go about the task than the delivery of the task itself,’ Mr Cotterell adds.

If the sector can get behind the notion that it’s the human factor, the ‘how’ care is delivered that’s important to people, it can create a simple stance on which to base a consistent argument: the basis of a better image.

‘Armed with this philosophy, we then set about creating a brand for the academy’s leadership training and advisory offer. The idea we came up with was “Careship” a fairly simplistic term that sees the bunging together of “care” and “leadership”. Ideas like Careship could not only be of benefit to the academy, but add another rung on the ladder that gets the care sector out of its reputation hole,” he concludes.

I really do hope this is the start of something good. My problem is that we’re going to have to shift a mountain of prejudice and I suspect an exercise in clever branding will simply not be enough.

Written by debbielq

September 30, 2012 at 9:21 pm

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Labelling – the way to a less demanding ageing society?

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There’s an interesting bit of psychology being aired by a web group that comments on public policy and finance.

Publicfianace.co.uk proposes that if the government wants to nudge older people to do the right thing – to keep warm or stay active – it should consider labelling any cash payments or allowances to encourage spending in those particular areas.

 

With the population ageing, we often hear often statements about the need to reshape the welfare state or transform health and social care.

In fact, the government seems to be putting an awful lot of energy into doing just that: quite whether it is succeeding is a matter for debate.

But, how society performs at adapting to population ageing will really come down to the behaviour of individual older people and the daily choices they make about how they lead their lives, says the Strategic Society Sector.

In other words, central to public policy on population ageing is that old chestnut: Behaviour change. Why?

This is because demand for things like health and care are so closely bound up with whether or not individuals remain warm, well and active as they age, and how well they adapt to living independently with low-level functional impairments. Public expenditure on older people is directly determined by these daily private choices.

“Any good policy student nowadays can reel off lists of exciting ways of changing behaviour, but one of the most interesting – and pertinent to the issue of ageing – is ‘labelling’,” says the website.

What does this mean? If you’re going to give people money and you hope they will spend it in a particular way, give it a label.

The effectiveness of labelling is incredibly difficult to measure. However, last year the Institute for Fiscal Studies found that found around 44 per cent of the value of Winter Fuel Payments is indeed spent on fuel.

Although the payment is given as cash, and economic theory predicts it should make no difference to the way in which individuals allocate their household budgets, the research found evidence that labelling cash transfers from the state as ‘Winter Fuel Payments’ does indeed result in it being spent on fuel.

This is why older people’s campaigners remain so keen on Winter Fuel Payments.

An interesting aside is that 25,000 elderly are estimated to die because of cold each year.

The labeling issue I find interesting.

For example, imagine taking £10 per week from the State Pension and, instead, giving people a £10 per week Keeping Active Allowance.

Would this work? I don’t honestly know ­ it sounds patronizing ­– but even a marginal change in behaviour among the older population could save hundreds of millions of pounds in health and care expenditure.

I’m also concerned that for the estimated 3.9million older people living in the UK it will have little effect as they perpetually ‘rob Peter to pay Paul’.

 

 

Written by debbielq

September 29, 2012 at 9:05 am

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Moves to freshen up the Dilnot proposal

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Have you heard that care services minister Norman Lamb plans to bring in an independent arbiter to combat the Treasury’s resistance to providing greater funding for social care?

In that exalted publication, The Financial Times, the repot said Mr Lamb believes the move would help ensure the implementation of Andrew Dilnot’s proposals to cap individual costs of care at around £35,000.

This sounds better by every word.

But let’s recap: Dilnot’s social care reform was accepted by Government in July but ministers said funds to implement the plan had not yet been found. What’s more. No-one seemed to have a clue how these funds would be raised. End result ­ more delays.

Prime minister David Cameron backed the principle of a cap over the summer but expressed concern over the £1.7bn cost.

Lamb replaced fellow LibDem MP Paul Burstow. But he didn’t go gracefully, saying he blamed the Treasury for the lack of funding, adding it had “no sense of urgency” and may abandon reforms.

The FT reported Burstow as saying: “The Treasury’s view is simple, kick the can down the road despite our rising elderly population. There is no sense of urgency. No recognition that left unreformed there is no incentive for families to plan and prepare.

“In the view of mandarins there is no need for change, and certainly not yet”

Well, perhaps these high-ranking Government bureaucrats would like to meet our members and explain to them why there’s no urgency.

Liberal Democrat leader Nick Clegg sees the social care reforms as high priority and has looked to Mr Lamb to reach a solution.

 

Meanwhile, analysis by Age UK reveals the economy suffered a loss of £5.3bn over the past 12 months – equivalent to 0.31 per cent of gross domestic product – as a consequence of 300,000 people leaving work to take on unpaid caring responsibilities for older or disabled loved ones.

According to the study, the number of carers leaving work has cost the Exchequer almost £1bn in lost taxes. A further £300m was paid in carer’s allowance over the past 12 months.

Clearly, holding off reform will serve only to further compromise our struggling social care sector.

Written by debbielq

September 27, 2012 at 10:53 am

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The Greek disaster and parallels in our care system

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Who would ever have thought that Greece would spiral downwards into a country where riots, frustration, poverty and chaos appear to touch its people’s live daily?

Like me, I guess the world is watching as national strikes there add to the misery of unforeseen global consequences.

The austerity is pushing this place, favoured by millions as a holiday destination, to breaking point.

The strikes, affecting even the law courts, stand as a memorial to the breakdown of a political system

As I understand it, the political parties still cannot not find the courage to work together in the face of a dire national crisis after inconclusive elections.

They could not even agree on the terms of a televised debate. Put simply – no common ground could be found for a decision to be made.

The social security system is collapsing, hospitals are suffering dire shortages and one in four workers are unemployed.

One Greek reported said: “One would think this is the time for political consensus and a national programme for the country’s recovery. Instead, the absence of a viable new political force means that people have to look either to old parties with all their baggage or be drawn to formerly marginal extremists.”

As I watched, I observed scary parallels between their crisis and that facing the care sector. The lack of political will to lead, the coalition, the arrogance of decision-making without compassion to the most vulnerable, the political fall-outs and the sense of loss.

Uncertainty in our care system is ever present these days. It’s the root of what is happening in Greece.

We hear through the media how the Greek people feel frustrated and powerless. And that is exactly where we are in the care business too.

We see too that none of the Greek political parties seems fit to deal with the challenges they face. That sentiment has been said of our parties too.

The Greeks are split and disorientated and the playing field is ripe for trouble.

Do we learn form history? It doesn’t appear so. Rampant inflation in Germany prior to the Second World War help bring the Nazis to power and unrelenting austerity in Greece is also fostering favour for the extreme right.

Perhaps it’s time for the holders of our care purse strings to watch, listen and learn as this sad drama unfolds on an international stage.

Written by debbielq

September 26, 2012 at 9:36 am

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Another report highlighting the same old problem – no cash

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NHS leaders have warned the Government not to leave the health service with the costs of a long-term funding gap of £2 billion a year for social care.

In another new report, this one by the NHS Confederation, it says that while use of NHS funds to plug the shortfall now is a “necessary sticking plaster”, continued dipping into healthcare coffers would have a severe impact on patients.

It increasingly appears to be the case that funding really is the new ‘F’ word.

I read that Jo Webber, the confederation’s deputy director of policy, said: “We support the short-term transfer of NHS funds to support local social care shortfalls in funding. But the health service cannot keep on picking up the pieces of a broken social care system.

“If it continues to do so it will buckle under the pressure. A policy of robbing Peter to pay Paul would be very short sighted. We need to address this issue now and transform models of care, or risk paying the price further down the line.”

Yes we do need to transform the models of care; yes, not to do so is shortsighted; and yes, borrowing funds from the NHS will add to problems further down the line.

The confederation, which represents all organisations that commission and provide NHS services, urged the Treasury to find funds for the “practical and credible” proposals of the Dilnot Commission, which outlined a blueprint for reform last year.

Under the commission’s proposals, the amount individuals would have to pay for social care before the state stepped in would be capped at £35,000. However, the recommendations would cost up to £2 billion a year to implement.

But there’s an underlying problem which impacts on t he NHS and social care . . . the small matter that the Government want to save from the already stretched health service, £5bn a year.

The confederation’s report has received the backing of the Association of Directors of Adult Social Services (ADASS), which agreed that an “already serious situation is bound to deteriorate over the coming years”.

But ADASS also said some transfer of NHS funds to social care could be justified if there was a “clear payback” for the health service.

A Department of Health spokeswoman said: “We are already providing £7.2 billion over four years so that local authorities have sufficient funds to protect people’s access to care and support.”

What world does the Department of Health live in? Far from protecting people’s access to care and support, it’s my Association’s experience that a good number are being denied it.

The spokesman added: “But this is not just about money, earlier this year we announced the most comprehensive reform of social care in over 60 years.

“These reforms are about transforming care and support to make the best use of the resources we have – by focusing on maintaining people’s independence and wellbeing, and by driving up quality through more choice, control and information.”

I can’t help believing it’s all about money – principally, the lack of it. Here’s another report lamenting the shortage of finance. Are our Government leaders deaf?

 

Written by debbielq

September 25, 2012 at 8:21 am

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Sir Terry Pratchet and our need for a high profile campaigner

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Image

Earlier this month The Telegraph carried a wonderful interview with Sir Terry Pratchett – fantasy fiction author and famed for having and campaigning in the fight against Alzheimer’s disease.

The interview was encouraging, noting that in five years his condition appears not to have deteriorated too much and that he is still busy writing and promoting his books worldwide.

His creative powers in tact and with a firm handshake, says the report, Sir Terry is a delightful affront to medical science.

Since the diagnosis, he has made two television documentaries and become an industrious ambassador for assisted dying.

Sir Terry has posterior cortical atrophy (PCA), a rare form of early onset Alzheimer’s, which affects the back part of the brain responsible for recognising visual symbols.

Sometimes he cannot see the cup that is in front of him. Clumsiness is another of the symptoms. So far, the cognitive parts of his mind seem untouched.

He does lament, however, that he can no longer touch type.

Sir Terry has written 50 books, sold 80 million and his novels have been translated into 38 languages.

Here is a man worshipped for his stories and now especially for his ability to keep them coming. His two-hour BBC documentary Living with Alzheimer’s won two Baftas and made him the public face of the disease.

Indeed, he has championed research for the conditions and much more. He has given it a public face.

As I scanned the interview, I so desperately wanted someone to champion the cause of the care sector. I wanted someone bright, someone engaging, passionate about the good delivery of care, someone who would help make us the right kind of headlines and tell the Government we just needed more money to carry on doing what we do.

Money means that Sit Terry will not have to worry about his wife after he is gone. It means he can afford the Alzheimer’s drug Aricept, which he is too young to receive free under the NHS.

And he hopes that when the time comes he will be able to buy the right kind of care to die well. These are great privileges not available to the majority and the great author knows it.

So who will be the care sector’s champion? Reality dawning on a wet, grey Monday morning, I know the answer is not the one I want to hear.

Our profession is bursting with heroes and heroines. Every day they add to the quality of someone’s life. The champions are already out there . . . oh that the movers and shakers would only recognise them.

Written by debbielq

September 24, 2012 at 9:31 am

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Time to adopt Dilnot reforms

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The Daily Telegraph is a heavyweight daily newspaper not well known for siding with those left of centre in their political persuasion.

You can imagine my surprise then at yesterday’s piece about Paul Burstow, the former care services minister who lost his job in the recent cabinet reshuffle, questioning the coalition’s determination to push through funding changes deemed by charities and campaigners to be urgently needed.

In the article he blamed George Osborne’s department for delaying a decision on the financing of reforms, which could result in the government putting the issue “back in the ‘too difficult to do’ drawer”.

Writing in The Telegraph, the Liberal Democrat MP suggested his party leader, Nick Clegg, and David Cameron may also lack the “political will” to help elderly people who are too frail to look after themselves.

The longer the Coalition “kicks the can down the road”, the more elderly and disabled adults and their families will lose their homes and savings, the former care services minister warns.

I can fully sympathise that the elderly feel betrayed – for that matter, so does the private care sector.

Mr Burstow says the Chancellor has not yet “smothered” the Dilnot plan but he challenged Mr Cameron and Mr Clegg to “take on the Treasury” and give families “peace of mind”.

And that’s what we all need. Clear direction, leadership, call it what you will, but the dalliance of this Government has been culpable.

His intervention offers a glimpse into the deliberations inside the Coalition over how to pay for supporting Britain’s ageing population, one of the most critical long-term policy decisions facing the government.

Figures show that in the next 25 years the number of people aged over 85 in England is projected to double to 2.4 million.

Growing numbers will require 24-hour support in care homes but currently there is no state funding to pay for services except for adults with assets worth less than £23,000.

An estimated 40,000 people a year are forced to sell their homes to meet the cost of care, which typically reaches £26,000 a year.

Just weeks into their term the coalition appointed economist Andrew Dilnot to draw up recommendations for reforming the funding of social care.

Despite widespread backing for his plans ministers took a year to respond, before declaring that they supported the “principle” but could not promise the £1.7 billion a year to fund the reform.

I cannot help believing that something must break soon on the funding matter and with the Treasury burying its head in the sands, the sooner the better.

You’re dead right Mr Burstow: There’s no sense of urgency. A voluntary scheme is no solution . . . Please, will the cabinet show some resolve, compassion and not least, vision, and engage the Dilnot reforms.

 

Written by debbielq

September 21, 2012 at 2:24 pm

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Changing the mindset on care for the elderly

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Recently, a report by the Royal College of Physicians demonstrated the strain elderly patients are putting on acute care within the NHS.

Another report from the British Geriatric Society (BGS) at about the same time concluded that intermediate care for the elderly was key to the way ahead.

The finding of both these investigations prompted a response from Lawrence Tomlinson, Chair of Ideal Care Homes, a relatively new name to the industry but clearly an influential player,

Writing a guest column in The Guardian, Mr Tomlinson said elderly patients were too often viewed as a burden on the NHS, social services and Government spending. He has called for a more positive approach to ensuring health and social care services can respond to growing demand effectively and in the interests of patients.

His comments are worthy, well thought out and, I believe need more exposure – hence, this piece.

 

Commenting on the reports, Mr Tomlinson says in the newspaper:

All too often it feels like we are fighting fires with elderly care.  As the BGS’s report shows, there are methods out there, such as intermediate care, which has positive effects on both the care for the individual and the strain on resources in the health service. 

“It is therefore disappointing that these services are not better utilised, especially when the RCP are reporting the impact fractured care is having on elderly patients care in hospital.  I was shocked by their findings that elderly patients are so frequently moved between wards and receive ‘fractured’ care due to short shift patterns. 

“Especially heart breaking is the fact that 4 per cent of patients who die in hospital are not in the appropriate care setting- there are more appropriate capabilities available so why aren’t we using them?”

I find it sad that hospitals know elderly patients are not necessarily in the right place but do not have easily accessible pathways to alternative arrangements. 

Many of our member’s homes would be better placed to offer end of life care.

Hospital staff become frustrated and an attitude towards elderly patients as being a burden to the NHS becomes self-perpetuating.

Mr Tomlinson urges a change of mindset, The Guardian reports:

“We need to reverse this idea that demographic change is going to lead hospitals buckling under growing pressure from elderly patients with complex needs.  Let’s get a proactive system in place that takes advantage of all care settings, reducing the load from hospitals, so that those who require medical treatment get it and are not compromised by the strain on the system from those who would be better treated in a different care setting.”

Mr Tomlinson goes on to say that NHS reforms offer a real opportunity to make these problems a thing of the past and I wholeheartedly agree.

I believe the private sector has a key role to play in improving care for the elderly, especially in resolving the care home/hospital dilemma.

Mr Tomlinson adds: “I call on Health and Wellbeing Boards, Commissioning Support Services and Clinical Commissioning Groups alike to engage with your local providers and get an effective and responsive care pathway in place to better distribute the responsibility of care for elderly patients. This will be immeasurably important in changing the attitude towards and improve the quality of care of elderly patients receive, no longer allowing them to be seen as a burden.”

Mr Tomlinson, please keep campaigning . . . perhaps as more of us push for the care our elderly richly deserve someone with Cabinet influence will hear our cries.

Written by debbielq

September 20, 2012 at 10:13 am

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Stepping back in time to help the present

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I’m terrible for TV channel hopping – may be it’s because I get bored too quickly, or perhaps television is not as good as what it used to be.

I caught a snippet of news about a care home where they’d built a 1950s street and then had to search the web to track down the details. Eventually Care Industry News came up trumps.

It’s a lovely story to help the week along when so much tragedy has been in the headlines.

The mock street has been created within the grounds of a care home in Winterbourne, near Bristol to provide a unique place where elderly residents can spend time and spark memories of their youth. 

Memory Lane is now open to residents of Blossom Fields, a luxury care home for the elderly and The Grove, specialist dementia care home next door.

Included in the street is a greengrocers, The Post Office with genuine George VI Post Box in the wall, the White Horse pub, a telephone box and a bus stop with a seat where people can relax.

Wow! This is serious investment into our elderly. The project is a way to help elderly and dementia sufferers remember the past, prompt conversation with visitors and care staff and provide a place where residents can go out safely, browse the shop windows or even go to sit in the pub.

 Christopher Taylor, Senior Manager of Grove Care, was reported as saying: “Rather than just sit in a garden most elderly people want to see something and go somewhere to keep their minds active. Memory Lane is a destination to make a walk around our grounds worthwhile.

 “Some of the people we care for ask staff if they can go out to the shops, the pub or to the bus. This will enable staff to allow them to get their coats on and go down to Memory Lane. It is a safe environment for them.

 “For our other elderly people it is a place they can go with their families. We are filling the street with 1950s memorabilia. So there will be ration books, old newspapers, shop window displays, posters and groceries that will all create interest and prompt conversations and memories.

 “Although care homes have created 1950s rooms in the past for dementia patients we do not know of any other street like this. We have had great fun collecting the items for the street and we are still looking for items to keep the interest of our residents and welcome donations of 1950s ephemera that will fit into the street.”

 The feature includes:

The White Horse Pub: Etched glass doors and windows into “The Snug” where an old beer pump, bar stools and beer mats bring back the authentic 1950s drinking den (Why can I remember this? I’m not that old!).

Martin McCarthy, father of Grove Care directors Sarah McCarthy Taylor and Fiona Jarman, who had the original idea for memory Lane, is honoured at the pub by being named as “licensee”.

The Post Office: Outside residents can put letters in the genuine George VI Post Box and inside they can see ration books and memories of the 1950s, they can read 1950s newspapers and just along the road there is a phone box they can stand in with handset.

Greengrocers: Complete with its delivery bicycle parked outside the greengrocers features 1950s milk crate, postcards for sale and fruit and veg and a chocolate vending machine on the outside wall.

The Bus Stop: A comfortable seat and bus stop with 1950s poster advertising a cowboy film where residents and relatives can relax and watch the world go by.

Blossom Fields provides nursing, end of life care and support for dementia patients. The Grove is a specialist dementia care home.

This tale has so cheered me. It’s heartening to know that someone sees care for the elderly a worthy investment. I cannot help feel sad though, that many of our elderly have not got the kind of wealth to buy into this kind of excellence.

But I would hope the Government could take a leaf out of this very worthy book.

Written by debbielq

September 19, 2012 at 9:23 am

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Domiciliary care: The Which? Report and why we need more cash

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FAMILY carers who bear the brunt of struggling home care service are at risk of illness and poverty, consumer watchdog Which? announced yesterday.

The report said some pensioners cared for in their own homes are being left all day to cope without food or drink.

The study, published in the Daily Express, also warns that serious failings in the care of the elderly is leaving vulnerable people subject to cruel or incompetent treatment.

Which? asked 40 family carers to keep a diary of their experience and that of their cared-for relative.

One daughter’s diary told of her mother having her face washed with a flannel with faeces on it and being dressed in yesterday’s soiled clothes.

This makes horrible reading and four paragraphs into the story I’m fuming. I’m angry once again because it gives good care providers a bad name and I’m angry too because there’s not enough money to deliver the kind of care the Government want to roll out.

The Express reports that other relatives spoke of untrained staff using lifting equipment, mix-ups with medication and alarm pendants being left out of reach.

The diaries also reveal the toll on family carers, who said that their own health and wellbeing was suffering as a result, leaving them impoverished and stressed.

One said she was “struggling to make ends meet” and another wondered how much longer she could carry on “with this stress of caring”.

This is a sad but true narrative which I have heard many times.

Carers UK chief executive Helena Herklots was reported as saying: “These powerful personal stories highlight how the chronic underfunding of social care services too often leaves families without the vital help they need, or struggling with poor quality or unreliable services.

“Better quality and better funded services that families can have confidence in must be a priority for the Government as it takes forward its reforms to care and support services.”

Yes please!

Her quotes continue: “Families shouldn’t have to keep picking up the pieces of a failing care system.”

On average, for every five hours of paid for home care, a family carer spent one hour sorting things out.

How can this happen? It begs the question did the Which? researchers deliberately choose cases where they knew the care was poor?

Poor quality care also meant that one third of family carers asked agencies not to send a particular worker back as they were not up to the job.

Common complaints throughout the study research included missed visits, inconsistency and duration of care.

Four in 10 reported at least one missed visit in the last six months while 28 per cent were unhappy with the length of care visits and 52 per cent had to repeat information unnecessarily to different people.

Half of family carers surveyed had concerns or complaints about their care provision, but those who complained to care agencies were largely unsatisfied, with just 23 per cent saying efforts had been made to prevent a problem repeating.

Richard Lloyd, executive director at Which?, was quoted: “Our research shows vulnerable people left scared, hungry and sometimes put at risk, and when things go wrong, it is family carers that bear the brunt, giving up their hopes and plans, even sacrificing their own health.

“Family carers shouldn’t have to struggle alone. The Government has promised a high standard of care and support. Those words must now be turned into urgent action for the families affected by a system that is failing them today.”

Councils are struggling to find new savings of £1billion from social care budgets. Personally, I believe it’s an impossible task.

Domiciliary care is crucial in maintaining the Government’s own directives. Please can we have some more money to make it happen and hopefully end the kind of findings in this latest report?

Written by debbielq

September 18, 2012 at 10:25 am

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