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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Children’s books with a grown-up message

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I have been in the States on holiday and was surprised to discover that issues relating to the care of the elderly are now being targeted at children as young as four.

In downtown Manhattan you can find a range of books that describe the symptoms of Alzheimer’s disease in language suitable for four to 12-year-olds.

Titles like “What’s Wrong with Grandma?” “The Memory Box” and “What’s Happening to Grandpa?” offer the young readers an explanation of this all-too-common disease.

I later discovered that more than 30 titles are available and they had been published since 1988.

Just like the UK, America has an ever-growing, ageing population and the challenges of Alzheimer’s rise along with the number of its older residents.


I wonder, given that most of those people are in their 70s and 80s, whether storybook readers are likely to be not grandchildren but great-grandchildren.

It’s hardly bedtime reading, but I applaud the attempt to explain in more detail what happens to those who are Alzhiemer’s sufferers.

The books appear to offer a gentle way of explaining a difficult subject, giving children insight while also providing a parental path for discussion.

The books portray well the cognitive aspects – memory problems and poor judgment, but critics say only about a third of publications depicted anger or irritability.

Whatever the critics may say, I am convinced this is a hugely useful tool for a family dealing with this problem.

Perhaps there is a market for children’s books that handle the issues of the normal ageing process. I’m no writer. But I would suspect achieving this without stereotyping would be hard.

Like all educational books, there is a danger of them being well-intentioned but dull. Those with children will know favourite stories can be requested frequently. “Read me the one about  . . . “ can be a bedtime mantra. But “What’s Happening to Grandpa?” somehow doesn’t do it for me.

The key must be conveying information about a terrible disease while simultaneously telling an absorbing story – not an easy fix.

As authors try to improve on the model I wish them every success. My struggle is one of how they would arrive at a happy ending. Perhaps a less direct approach would work with the focus on a single character among many in a narrative being used to convey the critical information.

What I do know is that the books need to have the ‘kid appeal’ of the Harry Potter character but finding the magic wand to make that happen is a mystery only JK Rowling could resolve.

Written by debbielq

October 23, 2012 at 10:31 am

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The Big Society findings its own response to elderly care

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David Cameron calls it the Big Society – I think it’s a society in survival mode as more and more socially aware groups find new

With widespread cuts, the responsibility is falling on inspired organisations to fill the gaps in elderly care.

If this is the Government intention, I’m left speechless.

Adversity has a long track record of being a cursor for change and sometimes for the better.

Communities, neighbourhoods and families have been establishing projects that aim to enable pensioners to feel confident they will be cared for as they age – regardless of their financial situation, according to the BBC in a report posted on its website last week.

“In York, the Joseph Rowntree Foundation charity has established Hartrigg Oaks, a home for pensioners and elderly people. The idea is that residents move in when they are still fit and healthy, for instance in their 60s.

“They pay money into a communal pot – approximately £170 per month for a 60-year-old.

“This guarantees them nursing care free of charge if and when they need it – thus avoiding the potentially crippling care fees many older people pay,” the article says.

Residents John and Jennifer Mitchell, moved into her bungalow there at the age of 61. Her parents had died

Mr Mitchell is quoted as saying: “You’re paying effectively care insurance. You pay the same sum, effectively year on year, with small increases which covers your care, however much you need.

“When you’re fit, okay you pay over the odds, when you need major care you don’t pay a penny more for it.”

Another idea – already popular on the continent – is the homeshare.

An NHS carer moves in permanently and rent free with an old person who needs help. In return they perform 10 hours of help a week.

Iona Anderson, who lives in Wickford, Essex, has been cared for by 45-year-old live-in NHS worker Graham Allen for the past two years.

He helps her with the shopping and does odd jobs around the house.

She said: “He has been absolutely amazing – he’s given me my life.

“My quality of life has risen like that – we laugh, he makes me roar with laughter.”

Mrs Anderson, whose husband died in 2002 and who has rheumatoid arthritis, continues: “I desperately wanted to stay here [at home].

“I love my house – I intend to be carried out in my coffin from here.”

Meanwhile on the Isle of Wight, a social experiment is hoping to help the younger generations become part of the solution to the problems of elderly care.

The scheme, called Care4Care invites volunteers to look after old people.

For every hour’s care they put in, the volunteers build up an hour’s worth of care credit that they can keep in a time bank. They can then use it for their own care later in life.

What a wonderful initiative!

The project was created by Professor Heinz Woolf. He says: “I hope that over the next three years or so we will build it into quite a large national scheme. I hope there might be a million members.”

Nearly a quarter of the UK’s population is expected to be over 65 within 20 years.

Our government has so far not delivered an long-term solution as the austerity measures rack up more and more social care problems.

Elderly should feel confident of knowing they could be cared for should they require it. These initiatives demonstrate a good deal of creative thinking – shame our Cabinet doesn’t seem to have the same ability.

Written by debbielq

October 22, 2012 at 8:53 am

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Insights on care reform from the fringe

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I have watched with eager anticipation all the big three political party conferences, hoping for an insight of what lies ahead for the care sector.

All discussed the rising cost of care. And all failed to commit to a course of action. Great!

Health secretary Jeremy Hunt’s pledge to implement the Dilnot cap on social care costs “as soon as we are able” will have encouraged many, but not me.

Very often, it’s not the main stage where the whole truth emerges, but fringe meetings and it was at such a get-together that it was revealed his pledge “to face up to some hard truths about how we are going to pay for social care” could be some time coming. In fact, it could be years away.

To his credit, the health secretary did recognise the need to transform services to meet the challenge of an ageing population.

He spoke about changing the culture of the health system “to make it the best in the world at looking after older people”. Very Good ­– he’ll need to do something as failure to act in the interest of social care will inevitably see many more older people entering the health system in the months to come.

According to AgeUK, in a Guardian Professional online article, one in four people now considers care for older people among the most important issues that will sway their vote.

The leaders’ party conference speeches indicate Messrs Cameron, Clegg and Miliband may not all be convinced.

I quote The Guardian report; “Older people’s issues didn’t merit a single mention in Cameron’s speech, unless you count a reference to the huge pension bills of ‘countries on the slide’. Miliband spoke briefly of having to ‘tackle the care crisis’ and the fact that people will have to retire later to fund our ageing society. Clegg’s focus, meanwhile, was on balancing the books so the government doesn’t ‘go bust’ and hit ‘the poor, the old, the infirm; those with the least to fall back on’.

As for the Dilnot capping proposal . . . you’re right: Nothing.

Many hope Norman Lamb, social care minister, will get get social care funding plans moving again despite the Treasury objections. I truly would love to believe he will, but here have been too many false dawns.

David Rogers, chairman of the Local Government Association’s community wellbeing board, described the care crisis as the most important issue this country is facing and one that is growing in magnitude.

“The challenge of reforming adult social care is set to fall off a cliff edge, and politicians need to act now or risk severely impacting on the services councils can provide for generations to come,” he was quoted as saying in The Guardian.

The challenges of which he speaks are huge, but please, will someone do something to help us soon?

Having now totally depressed myself, I must cheer myself up. Did someone say the weekend’s almost here?

Written by debbielq

October 18, 2012 at 10:12 pm

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