By Debbie le Quesne

Archive for October 2012

A call for change – and can we have it now, please

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Call me old fashioned, but I still love the BBC. They carry an informative and socially enlightening viewpoints page on the health section of their website.

And sometimes there’s pure gold to be found in the comments. I have been unable to extract myself from the Dilnot issues of yesterday and the fact that care minister Norman Lamb appears to be trying to break the inertia of previous months.

Richard Humphries of the King’s Fund think tank writes on the Beeb site: Social care is possibly the only vital public service where people can face a potentially limitless financial liability.

“One in 10 of us will need at least £100,000 worth of care in our retirement. Placing a cap on these costs as Dilnot recommended is a logical extension of the freedom from fear we already enjoy, thanks to the NHS, in relation to healthcare costs.”

Dilnot described our means testing as the worst in the world, leaving people with very modest assets facing the prospect of huge bills.

Worryingly, he says the £35,000 limit proposed by Dilnot “looks too low” and a figure of £50,000 to £70,000 more realistic.

Jane Ashcroft, of not-for-profit care provider Anchor, posts thatDilnot is right – capping individual liability for care costs makes sense. It will help end the appalling unfairness that sees some older people facing catastrophic care costs.”

She adds: “Hunt needs to be bold. Resolving the current mess and finding an affordable solution for the future will not be easy and Dilnot is only the start.

“But our ageing population and the future generations of older people will remember the person that takes a stand and resolves this issue.

“While local authority and health budgets remain separate there is little financial incentive to prioritise services that prevent the need for more expensive NHS treatment.”

Michelle Mitchell, of Age UK: writes:Age UK was delighted to hear Jeremy Hunt talk of creating a social care system fit for an ageing population. There is much to do to meet this aim.

Older people already dealing with the emotional impact of moving into a care home then face the often heartbreaking and unavoidable prospect of selling the family home to pay for their care.

“The recommendations of the Dilnot Commission would, if implemented, help lift that worry from the last years of life by setting a limit on how much an individual would have to pay towards their care.

“A lifetime cap at the level recommended by Dilnot of £35,000 would help people plan – whether that is by putting aside money or buying an insurance product. Age UK wants to see the government announce as soon as possible the funding necessary to make the recommendations a reality – the longer it delays, the higher the initial costs will be.”

The chorus of a need for change – and change soon – grows daily. I’d like to be proved wrong, but my fear is that it will take forever to get real momentum in Parliament.

I agree with Ms Ashcroft that we “must reform the farce that is our current system for funding long-term care.”

However we reform, the reformation needs to be quick and fair. Care home and nursing home owners are having to reduce fees to fill beds at businesses where successive council austerity measures have already cut margins to the bone.

And then there are the countless care businesses which have been closed because they are no longer viable.

What is the future for elder care and for those who are long-term sick or disabled?

Personally, I don’t believe there would be any losers in the Dilnot map for the future and neither does Sarah Pickup, of the Association of Directors of Adult Social Services, also writes on the BBC site.

She says: “In my view the social care system is up against the wire, budgets are tight and reducing and inevitably something has to give whether it is time, quality, numbers supported or reducing spend on prevention.”

She perceptively points out there are two problems that block a speedy Dilnot uptake.

The first is a cost to implementation “and it is this that has prevented the government from going any further than supporting the proposals in principle.”

The second is that the “Dilnot reforms would bring no new funding into the care system and the biggest challenge the sector faces is resourcing care and support for rising numbers of older and disabled people, as well as delivering on the vision for care and support set out in the recent White Paper.”

Written by debbielq

October 31, 2012 at 11:02 am

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Lamb’s attempt to break the Dilnot inertia

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Care minister Norman Lamb appears to have grasped the nettle and is talking of having to “do Dilnot”.

He has promised, in a report on the Local Government Chronicle website this morning, a “significant breakthrough” in the government’s plan to introduce a cap on social care.

Mr Lamb outlined a two-year timescale for introducing the key Dilnot proposal at a private meeting with councillors at the National Children’s and Adults’ Services Conference in Eastbourne last week.

This is the first time a minister has indicated publicly a deadline for the introduction of the social care cap, recommended by economist Andrew Dilnot.

Is this the first sign of government leadership we have seen in the Dilnot Debate? I think so.

He is quoted as saying: “My personal view is that we just have to get on and do Dilnot. We could achieve quite a significant breakthrough in the next two years.”

Mr Lamb also said he thought the government should “legislate for the principle of doing it” soon, before the details, such as the level of the cap, had been decided. Hmm, this is where it’s getting sticky, I fear.

Mr Lamb’s comments already seem to have sparked action with Conservative-controlled Kent County Council launching a drive to get Dilnot’s recommendations implemented by 2015.

“The Health Secretary, Jeremy Hunt, needs to put the wheels in motion on this report,” Paul Carter, the leader of the council said on a blog.

 “With every day, week and month that goes by, the pressure is building on our social care system, which is no longer sustainable,” the blog adds.

Already Mr Lamb has hinted that the Dilnot cap, including its level, could differ from the original proposal. Oh dear . . . is it all unraveling now?

 “We’ve got to get to a version of Dilnot and we need to make a decision soon to proceed,” the Chronicle website reported.

While the news that there seems to be an attempt to break the ministerial inertia the Dilnot proposals have caused, I’m still puzzled. It appears we are now moving (good). But the direction is still unclear (oh dear).

There’ll be plenty of talking on pension-related funding of social care, I’m sure as well as other Dilnot proposals before the plans become reality.

In the meantime I have to console myself with the knowledge there is a growing “culture of cooperation” across the health and social care regimes – the latest buzz phrase to paper over the very obvious cracks in any long-term strategy.

The cooperation push is being driven by Secretary of State for Health Jeremy Hunt, though I think he may well be distracted at present as he has ordered an independent review into how 5,000 patients were sectioned in the last decade without proper approval.

Mr Hunt said he would have to put through “emergency retrospective legislation” after it was found that in four areas of NHS – Yorkshire and Humberside, north east, East Midlands and West Midlands – “2,000 doctors were not properly approved, and that they have participated in the detention of between 4,000 and 5,000 current patients”, according to today’s Guardian.

Written by debbielq

October 30, 2012 at 10:05 am

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Personal budgets: The target moves

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Creeping under the radar on Friday last week, I discover the government has dropped the target that required councils in England to give all users of social services a personal budget to buy their own care and support.

Well, that’s a turn up for the books, but I think a good one!

Reported by The Guardian online, Councils had been expected to issue the budgets to 1.4 million people by next April. But critics of the target said it was unrealistic to think that all users of services, especially frail and older people, could understand and manage a budget.

According to the report, figures show that 43 per cent of eligible people have a budget, although only a minority takes the allocation in the form of a direct payment of cash.

“For most, the council manages the money on their behalf,” the newspaper says.

Norman Lamb, the care services minister mad the announcement on Friday, agreeing with council social services directors to drop the April target to a “realistic” 70 per cent.

Quite how ‘realistic’ the 70 per cent is remains to be seen.

“I want to be clear that 70 per cent must be seen as a foundation, not a ceiling,” Mr Lamb was quoted as saying.

 Call me a cynic, but I always get worried when these announcement are followed with the immortal words . . . the government remained committed to personalisation of services.

New is that the test bed of trials for personal budgets will yield results next month and the verdict, according to Mr Lamb is looking positive (but he would say that, wouldn’t he?).

“If it is, the next step will be to introduce personal health budgets more formally,” Mr Lamb told the National Children and Adult Services conference in Eastbourne, The Guardian adds.

Under the personal budget system, people are allocated a sum of money to help meet their assessed needs. As well as buying conventional care services, users have joined gyms, bought bicycles and taken respite breaks in hotels rather than care homes. Some of this is good, but I still have issues with those less scrupulous families which see is as a gravy train for self-indulgence.

Quite how this matter is addressed, I don’t know, but it certainly won’t go away.

The system undoubtedly can be cheaper than traditional services, arranged by councils, and some people do not spend their full budget allocation.

Critics have argued that the 100 per cent target – set by the coalition government in 2010 – was too ambitious and was discrediting the initiative.

People, especially the elderly, need time to digest new information.

Sarah Pickup, president of the Association of Directors of Adult Social Services, has welcomed the dropping of the target and I do too.

She rightly says that the focus should not be chasing a number but rather getting best outcomes.


Written by debbielq

October 29, 2012 at 8:23 am

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National Care Association Conference highlights

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Health Secretary Jeremy Hunt and care services minister Norman Lamb are to be presented with a White Paper about qualities that are needed to make a good Care Manager in a move to improve his knowledge of first-line care in the industry.

And the West Midlands Care Association has been privileged, along with others within the industry to make a contribution.

The document, being drafted by Sheila Scott the National Association’s Chief Executive and Nadia Ahmend OBE the body’s Chairman, want to inform government ministers exactly what is required in good care managers and why the industry is struggling to find enough of them.

As part of the paper’s process I took part in a brain-storming session while attending the National Care Association Conference – a timely diary date which has given some insight what other regional association are doing and what is on the agenda for the national body.

The Quality Manager/Care Quality Provider session was particularly productive, despite the original speaker unfortunately being taken into hospital. A subject close to my heart, there was chance for discussion and a brain-storming session which will be fed into the White Paper document.

Critically, is was unanimously agreed that quality care come about only through a capable and inspirational manager.

During the discussions we listed on four sheets of flip chart the key elements of care management. Among the listings were the need to be empathic, to have a good leadership skills set, to be assertive and thick-skinned. There was nothing new here, but seeing the extensive catalogue of skills required to run a home or care service reminded me just how big a job the undertaking is.

We did of course have a discussion on the way Local Authorities all around the country are using Safeguarding as a complaints procedure.

We also discussed the fact that there is no incentive for the Safeguarding teams to complete a case – a worrying issue.

I have no problem with investigations of referrals, but we need the focus to be on the particular offending incident and not for cases to be overblown and kept open for two years while trying to get managers to comply with the way investigating teams see fit to run businesses.

These complexities and what is believed the way forward are also heading back to Messrs Hunt and Lamb.

The other speaker, which you will be interested to know about, was Dame Denise Platt CBE.

She has been asked to be the Independent Sector’s Better Regulation Champion and goodness knows we need one.

The former head of CQC has been asked to take on ‘The Red Tape Challenge’ in a kind of   gamekeeper-turned-poacher role. Her own thought is that the task is more a ‘gamekeeper turned hunter’ engagement.

The Government has made it clear that all t Care Regulations need to be scrutinised and should only be kept in place if there is a good reason.

You will have a chance to go on the website and have your say about each regulation. Remember, using this tool your comments can be viewed by others, but a private email system will also be an option.

In similar reviews, we were told, some 50 per cent of regulation changes, were merged or scraped.

Here’s an opportunity to have our say. Let’s take it, or we’ll have no rights to grumble. The Association will ensure you have the link to the web site as soon as it is available and we will discuss the matter more at our meetings.

Also in the spotlight were local contracting arrangements about Continuing Health Care and the thorny issues of Deprivation of Liberty Safeguarding. Again costings were central to discussion, but the general counsel was that “we need to ensure or experience and voice is heard.”

Although the national players will not be looking at other regulators within the sector, ie Health and Safety Fire etc, they will be passing on any worthy comments made about them to ministers.

After engaging the London conference, I now feel I can leave the national agenda to the national people, whom our Association is proud to support, and get back the West Midlands . . . which motorway was it home?

Written by debbielq

October 28, 2012 at 9:15 am

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Exposure? Not really as CQC come under scrutiny

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This week ITV took the lid off residential care and regulation of the sector in Exposure.

It was once again one of those programmes where I sighed heavily and concluded there was little new the viewer could glean from the journalism.

Lack of inspections, the CQC cash restraints – it was established with less money than it’s predecessor bodies, the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection – and how the regulatory body has failed to maintain regular checks were in the frame.

Sadly, we all know this omission has meant some bad practices have slipped through the net. The programme made the point that even good or excellent homes can quickly deteriorate and the premise of leaving them unchecked if they scored well on inspection was dangerous.

It appears also that the unannounced inspections have been lacking in frequency.

However, this focus has changed and the CQC has stated that regular, unannounced inspections are taking place now.

The big hole in regulation is the fact that the CQC readily ditch reports from their public-access website when homes change hands, as if new automatically presents a better-than-before option.

Why? Because the CQC has met some legal challenges – and have backed down. Perhaps this body is fast becoming a toothless tiger . . . something that the industry can do without.

Critically, the care sector needs inspectors who intimately know the business of running homes and cannot be easily imtimidated by an ever-increasing litigious society.

As is always: More information is better and people do need some kind of easily digested rating system which is both authoritative and independent.

I do have more hope with the new CEO, David Behan and some of the changes that have taken place but the programme showed the need for a strong and authoritative regulator within health and social care.

I read comment recently that commissioning bodies – local authorities/NHS and private funders – need to establish positive working relationships together and the synergy created could pave the way forward.

Clearly the cuts within the care business have had a significant effect on the CQC and I’m left wandering after the programme if the body really has enough money to continue to do its job effectively. What is the point of having this commission if it cannot meet its remit?

I hear the cry of that f-work again: Funding – or more precisely, the lack of it seems to be the root of all our maladies.

Written by debbielq

October 26, 2012 at 8:52 am

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Care sector demand defies logic of the big squeeze

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There are more than 22,000 care providers in England and the social sector is expected to grow, new figures from Skills for Care suggest.

Ironic, isn’t it, that clearly there is a demand for our services at a time when they have never in modern history been so badly financed.

Demand for care and support of the growing numbers of older people is driving growth.

The figures, reported in the Guardian online, suggest that an estimated record 1.63 million people were employed in adult social care in England last year.

They worked in 1.85m “job roles”, a figure up 4.5 per cent on 2010 with the increase attributed largely to a 15 per cent rise in personal assistants recruited by people taking direct payments.

The report goes on to say that the number of organisations providing social care services is put at 22,100, an increase of 1 per cent on 2010.

But not all is rosy in the social care garden, the article adds. Too true.

Growth is itself a source of difficulty in that it is running in line with Skills for Care’s previous forecast that, short of any unexpected game-changers, the sector may need to employ as many as 3.1 million people by 2025 – a staggering number.

Recruiting the right staff is hugely challenging and whether we like it or not, the job suffers from an image problem that deters young and male candidates.

The economic and social difficulties care needs foster are made more complex by a distinct lack of leadership from government sources. Lobbying, I know, is going on but results so far are disappointing.

I was shocked to learn that people in parts of southern England are being quoted as much as £2,000 a week for a bed in a nursing home.

According to market analysts Laing & Buisson, 41per cent of people in care homes are now fully responsible for their own fees, and 55 per cent are paying all or part of the fees as the state’s funding role diminishes.

Written by debbielq

October 24, 2012 at 10:20 am

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Mystified by the care system

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The Social Care Institute for Excellence has released research that reveals many people are mystified by the care system.

The majority of Britons admit they do not know what options are available to them and two thirds have no idea of care costs.

Key findings include:

  • Majority of adults unaware of what care is available (59%) and have no idea how much it costs (66%)
  • More than two thirds of people say that they are not likely to consider care decisions until they become urgent, increasing the risk of not choosing the best provision
  • A quarter of adults who already use care provision say they struggled to find appropriate care and now feel they ended up with the wrong type of support.
  • Is this scary? Most definitely, yes.

Written by debbielq

October 24, 2012 at 10:18 am

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