By Debbie le Quesne

Archive for November 2012

Mr Cameron’s bid to make our judicial reviews impossible

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David Cameron has announced his plans to make judicial reviews more difficult to process.

His justification to reform “the massive growth industry” of judicial reviews is that it will reduce vexatious delays and help to speed up the delivery of new developments (as reported in The Times).

Mr Cameron will change the time limit for when cases can be “so that people think twice about time-wasting”. And the cost will go up too.

I am not sure what this move is aimed at, but I suspect the catalogue of care industry successes would feature alongside such issues as the new airport proposal in the south east of England.

Whatever the driver, this move will make the accessibility to justice on fees paid by local authorities to care providers much more difficult and it’s wrong.

The ministry of justice will carry out a public consultation exercise on the plans shortly with the next steps set out in the new year, so let’s make sure we are heard when this happens.

Mr Cameron sees this a freeing businesses from the constraints of seeking redress for perceived wrongs.

In a speech to the Confederation of British Industry, he said that such a move would bolster the economy, which all right-thinking people will regard is needed.

I think I’m right-thinking and I’m furious over this chipping away of our legal system. Where will this all end? It’s a dangerous track to be running down when we can’t redress official decisions.

The plan is to nod at justice by reducing the actionable period from the present short three months, to a staggeringly shorter six weeks.

Court fees are to be increased too. This is, in Mr Cameron’s words, is to “make people think twice about time-wasting”.

Reported in The Guardian, the Law Society, which represents solicitors in England and Wales, said: “There are already considerable hurdles imposed by the courts before a judicial review can be brought. There may be scope for reform but the basic characteristics of judicial review, of holding the executive to account in the exercise of wide powers, should not be lost.”

Before anyone accuses me of being political, let me say I’m not: I will happily work with any party to further the wellbeing of those in need of care, but will equally fiercely attempt to stop any move which could compromise those services.

Interesting isn’t it, without a judicial review the whole fiasco the West Coast rail franchise would never have been raised and Sir Richard Branson would have lost the deal.

There’s an issue of transparency here too. The Brunswick’s Healthcare review editorial notes that “without an ever-present fear that their decisions will be open to scrutiny by judges via JR, many local authorities would, in my view, give a two-fingered, Harvey Smith salute, to care providers who work hard to be taken seriously by their main customer, the local authorities, in relation to fee-setting.

“We have seen how many JRs providers have had to ‘win’ before councils went about properly undertaking a fee-setting exercise.”

Oh dear, Mr Cameron . . . You could change your mind, but then, in political arenas, humility is a lonely word.

NHS care services into homes: Being frank about the problem

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Yesterday, Denis Campbell of The Guardian newspaper asked a searching question: What can be done to ensure care home residents get quality healthcare?

His article is long but worthy and a good piece of journalism. I do fear, however, the critical nature of its content will be lost because at 1,600 words-plus, it’s not a quick read.

“How we care for our increasingly elderly population at home, in hospital or in residential care is throwing up a great number of questions,” the article says.

Without question the NHS, social care providers and local authorities face a huge challenge to come up with a sustainable answer.

“The task of delivering high-quality GP services to all the 421,000 residents of UK care homes, who are usually old and often have acute medical needs such as dementia, is a key challenge,” the article continues.

What is fascinating is the way this particular article was assembled. With key health providers and industry service representatives, the Guardian held a roundtable under the Chatham House rule, which allows comments to be reported without attribution.

Clearly, this encourages a frank exchange of views.

Inadequacies in provision of GP services in care homes were first exposed in a report in July 2011 by the British Geriatrics Society (BGS) called Quest For Quality. It said that “no model of co-ordinated healthcare has been developed to meet the needs of care home residents”.

And in March this year he Care Quality Commission (CQC said that care home residents need a wide range of medical services such as physiotherapy, mental health support and help with falls. – but these were offered to residents in just 43 per cent of NHS primary care trusts and, when they were, with waiting times of up to 18 weeks. Just 38 per cent of homes received regular visits from a GP.

One debate contributor acknowledged there was “a disconnect between a service literally everyone is entitled to but, on the other hand, the system struggles to deliver”.

Another participant said “the inconsistency and variation in the quality of care and safety in care homes is unacceptable”.

Needy people are being denied support in what is “a form of rationing”, said another.

“We don’t treat any other group like this,” the roundtable heard.

These are harrowing comments about a level of care a tier higher than that delivered by our service providers.

One participant noted that until the 1980s many complex care patients were looked after in hospital but then the NHS hugely reduced its stock of elderly care wards. “That effectively put some very sick and vulnerable people into a system that wasn’t designed for them and still isn’t designed for them.”

The roundtable agreed that the general medical services contracts between the NHS and GPs, which set out what services family doctors have to deliver, is nowhere near enough to ensure good care for residents.

It emerged too that some care home owners (according to CQC 10 per cent) pay GPs for “enhanced services” in order to ensure that a doctor will come when needed.

One participant said: “We are breaking the rules of the NHS – people should have care that is free at the point of delivery.”

Opinion was divided on the need for specialist GPs. Supporters said that the unique set of challenges involved in looking after residents, which can also include end-of-life care, justified creating a new medical specialism.

Issues of drugs knowledge, training and staffing retention were also raised.

As for the solutions? The Welsh government’s policy of agreeing enhanced services contracts with GPs who work in care homes, was tabled as a way ahead.

So was a New Zealand model guaranteeing patients and their families a care review with the GP every six months, and a system in Edinburgh where community psychiatric nurses support care homes.

The Guardian stated: “Most participants also backed the idea of enhanced GP care being routine and all new residents receiving a comprehensive geriatric assessment upon admission to a residential home.”

The issues of this debate throw up some problems I’m sure for the new GP-led clinical commissioning groups, which will replace NHS primary care trusts in England next April.

GPs will be expected to prioritise the commissioning of better services for care homes than many receive at present.

I can only hope there is a joined-up thinking way forward and to repeat one contributor at the Guardian round table – there has never been a better time to resolve such a problem.

Rita, 78, and her take on the Birmingham’s Quality Event

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Rita Cotterill is a spritely 78-year-old who helps out at the West Midlands Care Association occasionally, answering phones and doing other office duties.

Recently. The former insurance worker was my guest at a care conference – Birmingham’s Quality Event – held at the Aston Villa Stadium, I wanted her to understand some of the work the association is involved in, but above everything, I just wanted her to have a good day.

She had a lot to say about the event, and here in her own words, is a selection of her quotes. While some make me smile, others are deeply worrying as we consider the present and future development of care.

 The arrival . . .

“When Debbie asked me to come to the Birmingham Quality event to see what was going on, I was interested, but also a bit concerned. Would I understand what was being said and would I be asked questions I couldn’t answer? However Debbie persuaded me that it would be okay.

“We arrived just in time after a dreadful drive through the floods and the traffic. I had to laugh when I got my badge all nicely printed and a personalised plan for the day. Debbie hadn’t been registered so had a hand written badge and had to borrow my plan.”

Not enough money . . .

“I was fascinated by the two screens showing the pictures during the talks. I wasn’t sure what they were talking about until Debbie explained that commissioning meant buying and procurement also meant buying.

“All the speakers were clear and interesting, I think they said they hadn’t had enough money in the past, they don’t have any money now and I they definitely won’t have any money in the future . . . They still, however, want quality care and green companies which care about the environment.”

Memories . . .

“The Conference was held at Aston Villa, which was much-loved by my late husband, so I was delighted by the chance to see the pitch and directors’ boxes. Debbie took a picture for me on her new-fangled phone.”

 Training . . .

“We had an interesting session about training, where I was surprised about how passionate and concerned the people in the room were about the ‘service users’ (Debbie explained it as the people who the carers come and see) and how they were used to getting the service in a certain way and do not want it to change.

“I understand this as my friends know what they want they like and that is what they already have – what they understand and what they feel comfortable with.”

 Technology . . .

“We also went to the talk about electrical things (Telecare), which I didn’t want to go to as I don’t like aids, but it was easy to understand and I like the idea of being able to speak to someone when you are scared about who is at the door,

“Eunice, my friend, who I go on the bus with and lives in a dark place, would love that!”

 A great day . . .

“We also got a chance to talk to some lovely people about Health and the Interweb and Opportunities Fairs, which was a real eye-opener.

“It was a great day, but I was glad to get back and get my slippers on.”

 A big job for the bosses  . . .

“I think that Birmingham bosses have a big job on their hands to sort out this problem of whom to give care to and how to pay for quality, but what I don’t understand is . . . Yesterday we went past that monstrosity of a new library; why didn’t they use that money to pay for care?”

Why indeed?

Tough new standards for social care services to meet

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New tougher standards to measure how local authority social care services shape up are to introduced next year.

Critically, there will be one to test on how well health and social care services link up, a central pillar in delivering health reforms for the nation, the  Local Government Chronicle reports this week.

Health secretary Jeremy Hunt, who published the new measures last Friday, wants service users and members of the public to employ the revamped measures to hold councils to account.  Getting access to full details of the ‘new measures’ at present , however, seems quite difficult.

The new criteria, against which councils will have to report their progress, includes a measure of how services improve “people’s experience of integrated care”.

The standards will also measure the effectiveness of “reablement” services, which aim to help older hospital leavers to readjust to home life.

All this seems good, but it will be interesting to see exactly how these standards will be policed and who will try to enforce them. Without any mechanism for enforcement we will end up with the proverbial toothless tiger.

Other measures cover the quality of services which help dementia patients to live independently, and the extent to which care users report having “as much social contact as they would like”.

Mr Hunt says in a forward to the report: “People who use care and support, carers and the public can use this information to see how well their council is performing, making local authorities genuinely answerable to their communities for the quality of care.

“Councils themselves use the measures to help them drive up standards of care, and give people genuine choice and control over the services they use.”

Mr Hunt said there had been “progress” in many areas of social care, such as the rising number of people using personal budgets.

However, he said: “While it is positive that nearly two thirds of users of care say they are extremely or very satisfied with their care and support, this leaves scope to do more to ensure that everyone has a good experience.”

Written by debbielq

November 26, 2012 at 11:08 pm

Posted in Uncategorized

Carers feeling the strain

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Some things never change. A recent survey shows almost one in three people who care for someone who is sick, elderly and disabled and many find it hard to cope with the strain.

Research from Centre for the Modern Family, a think tank from Scottish Widows, highlights the need for people to plan for the long-term care of a loved one.

Its report shows that 13 per cent of people in the UK today care for someone who shares their home while a further 16 per cent act as a carer to someone who lives elsewhere.

We’re fully aware that this research is just another tool to encourage business with the insurance company, but it serves as a timely reminder the price ‘unofficial’ carers pay.

The study showed that people looking after someone who is sick, elderly or disabled “often end up not looking after themselves as well as someone who isn’t a carer.”

Also disclosed was that 45 per cent of carers worried about ill health, compared to 25 per cent of non-carers, and 15 per cent of carers found they ended up missing meals – almost double the 8 per cent of people without a sick, disabled or elderly dependent.

The research, published online by http://www.payingforcare.org, underlined the importance of planning for care funding by revealing that many carers are worried about their finances.

The report claimed 40 per cent of carers believe they will become poorer over the next 12 months and 39 per cent said they could no longer afford to regularly put some of their money away in a savings account.

The survey also showed that 30 per cent had even sold some of their possessions over the internet to help make ends meet. And more than one in three (38 per cent) said most of the rows in their family concerned money and their financial situation.

Psychologist Professor Cary Cooper, who is a Centre for the Modern Family panel member, said in the article that the negative impact caused by the stress of caring for a loved one was worrying, especially as the cost of care made it more likely that more care would be provided by family members in the future.

He was quoted as saying: “We are urging families to realise the benefits of the multi-generational household, whereby support can be shared across multiple people of different ages. This won’t totally solve the problem, but it will go some way in easing it.”

Prof Cooper’s ideal is a worthy goal, but I fear wholly unrealistic. Many families cannot take on the added responsibilities of full-time caring as both partners work to meet the daily financial demands of living. It’s a huge problem we face and although I have worked in the care sector for many, many years, have no real insight for a solution.

The moral issue of some families being made bankrupt by the demands of caring, losing homes, inherited wealth, savings and the freedom to live spontaneously, is a big debate and the initiative for any solution n has to be with Government.

Yes, stressed carers are feeling the strain. Sadly, the current austerity measures are adding to it.

Quality of care is suffering, says CQC

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The BBC has announced today that the quality of services provided to people across the health and care sectors in England is beginning to suffer.

The Care Quality Commission’s (CQC) warning comes after it examined reports from more than 13,000 inspections.

“The regulator said staff pressures and the rise in complex cases seen in the ageing population meant everyone from hospitals to care homes was struggling,” the Beeb says, adding overall, one in four services failed at least one of the 16 key standards.

Failure to meet the criteria of dignity and respect, nutrition, care and welfare and the workforce, which covers both numbers and skills of staff, were too common, it appears.

But then there are a couple key paragraphs, which perhaps should have been worthy of more journalistic digging. They say: “The regulator said the pressures on the system meant staff were increasingly unable to focus on the individual needs of people for whom they were caring.

Instead, they were essentially running through to-do lists in the way they approached their responsibilities.”

In the words of the CQC the stresses of the industry hadcreated a culture in places that were struggling where the “unacceptable becomes the norm”.

Clearly they will take enforcement action in places where the most serious failings had been identified and I agree performance should always be good.

But I find myself at odds with the comments from CQC chief executive David Behan, who says despite the pressures there was no excuse for poor performance and “health and care services need to rise to the challenge,”

Please, Mr Beham, come and walk in the shoes of our carers.

I don’t know a single WMCA member who does not want to give excellent care; I don’t know any who wouldn’t want to give better care; but (and it’s a huge but} there’s not the money to do it.”

How loud do we need to be shouting to be heard? Everyone is doing their best in these days of austerity.

The CQY appraisal is the most comprehensive overview view yet of care. It covers every corner of the health and social care sectors with the exception of GP practices.

The 13,000 inspections cover a third of the health and care sectors.

Data has been assembled from NHS services, such as hospitals and mental health services, care homes, nursing homes, home help, dentistry and the independent sector, which includes private hospitals and charity-run services.

The BBC report adds: “Broken down by sectors, the report showed 22 per cent of the NHS had failed on at least one standard, 19 per cent of the independent healthcare, 28 per cent of social care and 12 per cent of dentistry.

It is the first year the CQC has had such comprehensive data and so a comparison with 2010-11 is not possible. But CQC said the picture emerging was one where providers of care were finding it more difficult. Too true!

The report is right on the heels of the Patients Association warning about standards of care, highlighting 13 cases of what it says is “appalling” care.

Katherine Murphy, of the Patients Association, said the findings were “scandalous”, adding patients were receiving substandard care across the country every day.

And Peter Carter, general secretary of the Royal College of Nursing, said the CQC warning echoed what the union’s members had been saying for a long time.

“We hope that this report acts as a warning that cutting staff at a time when the country’s health care needs are becoming more complex is a recipe for disaster.”

Health Secretary Jeremy Hunt certainly seems to have his work cut out, doesn’t he?

He wants to do much more to raise standards and he says there is no hiding place “for those providing poor care or sub-standard practice.”

There are great statements, which everyone would expect a Health Secretary to say. But the reality remains: There is an inextricable link between care excellence and funding.

On a happier note, the weekend is almost here. Have a good one!

New culture of training needed to stop abuse

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I read recently it is estimated that nearly £200m was spent on social care training in local authorities last year.

A huge sum, but worryingly according to latest research, only a tiny fraction of this was ever assessed to see if it made a difference, according to Professor Keith Brown, director of the National Centre for Post Qualifying Social Work in the School of Health and Social Care at Bournemouth University.

His comments appear in The Guardian online and he is calling for greater impact evaluation to measure the effectiveness of training in the social/health care sector.

And he makes an interesting point that in cases like Baby P, the Winterbourne scandal and, not least, Jimmy Savile, how did these things go undetected for so long?

We know that abuses go on every day that they are not reported. Prof Brown wants “the student nurse, the social worker, the shift manager, and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to” if they suspect abuse.

Just as critically, directors of care organisations must be given the leadership skills to create transparent cultures, he adds.

Such training would have to be tailored to the specific areas of care, with the professor saying  “generic leadership courses are not good enough.”

It now seems – and this is a terrible indictment on society – that delivering good care and being able to balance books is just not enough.

“New cultures” is the latest trigger phrase, but it does seem we need one where people are not afraid to speak out. It is simply not good being appalled. Those of us in the care business need to make significant changes.

I applaud the message from Prof Brown, but as ever, the training issues come down to money – and money the care sector just doesn’t have.

On his point of impact assessment, again I agree. Any internal evaluation would be good, but may be this is a role CQC could embrace.

All I do know is that we have a moral and social obligation to make a difference and to champion those for whom we care.

Prof Brown concludes his piece: “It is time to stop the sensational coverage of one tragedy after another and realise we have the power to stop abuse. It requires a radical rethink so that the professions, the public and all citizens can have confidence that vulnerable people in care will be protected appropriately – and better.”

Written by debbielq

November 22, 2012 at 8:12 am

Hard work, hard times and the vacancies nightmare

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This month The Caring Times published an article highlighting that many care workers feel they are doing the work of one-and-a-half people.

I understand – there are days I feel like that too.

According to a study by Social Care, Allied Health and medical recruiter Randstad Care, the problem appears to be rooted in recruitment.

And yes, it is difficult to appoint the right candidates for care jobs. Regularly there are vacancies and regularly there are managers’ desks awash with applications. Few, however, are suitable candidates.

It is a well-trodden path that the care sector has been known for not paying the best wages.

This undoubtedly has a bearing on the problem – another crucial symptom of the funding restrains foisted onto the sector by government.

The survey which included 142 workers found “that, on average, health and social care professionals felt they currently had to perform the job of 1.5 people, meaning they were covering 50 per cent more work than one person should be; the equivalent of fitting an additional two-and-a-half days’ worth of work into the ordinary working week.”

Randstad Care operations director Vicky Short warned of the dangers of leaving vacancies open for too long. Quoted in TCT, she says: “Recruiting for a care post is like trying to sell your house.

“Leave it on the market too long and, for whatever reason, people start to think there is something wrong with it. That leads to fewer applications and increased pressures on the rest of the staff left trying to cover the empty position.

“We know social care professionals already feel they are performing the job of one-and-a-half people. If they’re cramming an extra two-and-a-half days’ worth of work into a working week, they are going to find it extremely difficult to cover for vacant job posts, too. Leaving a hole in the workforce too long will inevitably undermine service provision.”

Ms Short is spot on with her analysis. We’ve all seen recurring vacancies and wondered why the advertised job appears to be such a poison chalice. 

Ms Short observes: “The best applicant is often the one who turns up early in the process“ and . . .

“The trick is not to turn that person down in order to keep benchmarking against other people who may or may not be in the market. If employers see the right person on the first day of interviews, they need to have the courage of their convictions and hire the candidate straight away.“

It’s my experience that good employers tend to keep staff. I know of one nursing home where promising carers have positively been encouraged to better themselves and become nurses. The manager’s success in this initiative has been as remarkable as the business’s care reputation.

But the survey finding, I fear, are a little too simplistic and fail to address the underlying struggling economies of the care sector. Maternity cover, holiday entitlement, long-term sickness, the slowing of referrals from social services, and the government drive for more care being delivered at home, all need to be in the final analytical mix.

Written by debbielq

November 21, 2012 at 7:37 am

Digital advances – the future for sourcing care?

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The recent White Paper on reforming care has seen precious little action to date. There’s been plenty of rhetoric; a lot of debate, but no real advances . . . well, not that we’ve seen.

There has been, however, some interesting developments emerging in less likely quarters. For instance, there is a big push toward online information portals for social care, and the development of e-marketplaces in which individuals and families can identify and buy services.

The government wants all local authorities to radically improve their online information and support services. And Downing Street is so committed to the initiative is has pledged £32.5m to make it happen.

I know my way around a computer, but I’m far from a technical wizard. I do know, however, that any credible online presence will need on-going search engine maintenance, updates and resources to make it happen. The e-marketplaces for care services will clearly need web traffic as new ways of commissioning and paying for services come on line.

Exactly how this drills down to those using the service – the elderly, disabled, frail, long-term sick and mentally ill – I cannot imagine.

According to the Guardian online, the Department of Health‘s own figures suggest local authorities fund home care for 532,000 older people and 350,000 working age adults. If half of these individuals and their families were to be successfully nudged by councils into becoming regular users of online care portals, this will still be less than half a million people.

Add in a similar level of take-up among the 325,000 older people who pay for home care themselves, we are still looking at relatively low numbers.

The figures are small when set against the backdrop of disability and impairment across the population, and the millions of others who would benefit either from receiving formal care, or from other interventions such as home adaptations or Telecare, the Guardian observes.

We will never hold back digital advancement but educating a care sector client base to use online portals to access care is, in my opinion, flawed. The task of directing people to them would be immense, but there is hope.

To identify these opportunities, the Strategic Society Centre is currently working with Independent Age to explore more about who receives attendance allowance and the effect it has on their lives.

The aim is to use the attendance allowance system to direct people to information portals and e-marketplaces for care services.

Writing in The Guardian, James Lloyd, director of the Strategic Society Centre, says: “If the government wants local authorities to move beyond their focus on those receiving means tested support and direct their attention to the whole population, making better use of the attendance allowance has to be one of the key levers for doing this. I can see huge advantages for health and social care professionals with these developments.”

Interesting, isn’t it, that there is money for this supportive care initiative, while no funds seems forthcoming for delivering it at its point of need.


Written by debbielq

November 20, 2012 at 11:18 am

Posted in Uncategorized

Savile legacy: Out of bad things come good . . .

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I grew up with Jimmy Savile on the TV in our living room. I could never have imagined then what legacy of grief and suffering that man’s selfish actions would leave.

For me as a teenager, he was the face of Top Of The Pops and Jim’ll Fix It! But there was something very dark happening behind the celebrity cigar smiles. And now we all know his shame.

Not often do good things emerge from tragic circumstances, especially were children are involved. Children deserve the right to trust adults.

We’ve just seen the annual Children in Need appeal raise a record £26.7m from donations pledged during this year’s live show of celebrity performances.

The charity’s chairwoman, Stevie Spring, said she was “absolutely thrilled” by the amount raised during the show on Friday night – around £1.4m more than last year.

Television and music personalities taking part included One Direction, Girls Aloud, Leona Lewis and Kylie Minogue. They had a common aim: to get as much cash for needy children as possible.

Sir Terry Wogan, who launched the event at BBC Television Centre in London, addressed the crisis over the shelved BBC2 Newsnight report on child sex abuse allegations against Jimmy Savile in a video segment he introduced.

I can’t help feeling that the outpouring of generosity was a direct response to the appalling Savile legacy.

I was shocked at the statistics that more than one in three sexually abused children do not tell anyone about it.

David Ramsden, chief executive of BBC Children in Need, said the total raised was phenomenal.


Indeed, it is. And it just shows that as a nation we can still dig deep even in terrible economic times.


Most of my blogs centre on life’s end, rather than beginning, but the appeal response has lessons for us as we address the issues of care for the elderly, frail and mentally ill.

The whole nation responded positively. It was prepared to step up and make a stand for something it believed in.

How we need to galvanise the care sector to stand together! We need a roadmap for the future from the Government. We need realistic responses to fees. We need to be heard with one voice in the corridors of Westminster and Whitehall. And we need a positive, creative response to all that it negative around us.

I dare believe that we can do it. The private care sector is central to Government plans to reform care. It cannot do it without us, but we forget so easily.

Let’s try to remember our worth. We’re not just carers, we are guardians of a national treasure – our elderly, we are the voice of those too ill to speak, we are the champions of the marginalised. We are indisputably valuable!

Written by debbielq

November 18, 2012 at 11:07 pm

Posted in Uncategorized