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By Debbie le Quesne

Archive for January 2013

Care caterers are Guinness record champions

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I’ve always championed initiatives that raise the profile of care work no matter what that work is.

So I was thrilled when I stumbled on a story about The National Association of Care Catering (NACC) which has made history by successfully setting the first ever Guinness World Record for most community meals delivered in three hours.

It made me laugh out loud, but the record makers highlight the vital work Community Meals Service in the UK and the numbers who rely on this kind of service.

The official figures from Guinness World Records, released in January, state that the NACC delivered 526 community meals in three hours in 16 locations across England. The figure is 226 more than required to secure the title.

Community Meals providers across the UK successfully served the specifically-developed two-course menu of roast beef, potatoes and seasonal vegetables, rounded off with the Great British favourite pudding of apple crumble and custard to users of the service.

Confirmation of the NACC’s success came from Guinness some three months after the actual World Record attempt, which took place between 11am and 1pm on Monday 1 October 2012 – International Older Persons’ Day and the first day of NACC Community Meals Week, Care Industry News reported.

What is remarkable is that more than 20,000 elderly, housebound, or disabled people in the UK actually used the Community Meal lifeline between 11am and 1pm on Monday 1 October 2012.

This huge gap between official and unofficial figures is due to the very specific and detailed rules created by Guinness in order for the NACC to achieve the record.

The community mantra is heard much more frequently these days and it’s heartening that so many more people can keep their independence longer with care packages at home.

But in these austere times it’s essential that services like Community Meals continue.

As well as providing nutritious hot meals I would confidently assume that it also provides the sole source of regular human contact for an alarming number.

The old Meals on Wheels has had its day, but the need for such a service has not changed.

In sensible economics supply is usually generated by demand.

In care sector economics supply appears to be governed by auditors. I do hope this invaluable lifeline remains viable.

Welfare reform: Are the cuts really worse than what we thought?

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It becomes increasingly difficult to write about social care issues without appearing to make a political point.

I must point out that the West Midlands Care Association is not interested in scoring party points, but we will stand up and be counted if we believe care is being compromised by Government policy.

Simon Duffy, director of the Centre for Welfare Reform makes some interesting points in his Guardian online Professional People report.

One of the extraordinary features of the cuts programme, he observes, has been the fate of social care.

He writes: “At the same time as announcing the deepest cuts in public expenditure since the creation of the welfare state, there have been several pronouncements about extra funding for social care and how any failure to safeguard services for disabled children, adults or older people would be because of failings in local government.”

He cites the 2010 comprehensive spending review that declared that there would be “£2bn a year of additional funding by 2014-15 to support social care”.

But adds: “However, a closer examination of these figures shows it was merely a statistical manipulation, achieved by closing one small funding stream, restarting it and then publishing the cumulative figure for a five-year period. The truth is very different.

 

“In fact, over the past two-and-a-half years, social care has already experienced a devastating cut of over £4bn per year, about 16 per cent.

“By 2015, it will have been cut by more than £8bn per year (about 33 per cent). And there is a very simple and powerful reason for this. By 2015, local government in England needs to make an annual real term cut of £16bn (40 per cent of its central funding) and social care makes up 60 per cent of real local government spending.”

Interestingly, he points out that “most of the funding we associate with local government, such as education, is ring-fenced from the worst of the cuts. It is social care which must bear the biggest share of local cuts.”

I believe the movers and shakers of Social Services departments across the country all know they are stuck fast in this head-in-the-sand purge for savings.

There’s a whole load of spin and PR too that seems to suggest that local authorities ‘are to blame’ for the pain of cuts. Indeed, they are, but they are in reality dancing to the tune of a Whitehall piper.

Mr Duffy suggests “There are so many different cuts hidden within the so called ‘welfare reforms’ that it is a constant effort to keep up with the next attack. “

He points to The Centre for Welfare Reform’s latest report A Fair Society? How the Cuts Target Disabled People. The reading is shocking.

Mr Duffy writes: “People needing social care are hit by a double whammy of benefit cuts and social care cuts. Our analysis shows that, while most of us face cuts in services or income equivalent to £467, people in poverty face cuts totalling £2,195 per person, and disabled people face cuts totalling £4,410 per person.

“Disabled people (including children and older people) with the most severe disabilities, those entitled to social care, will face the biggest cut of all – an average cut of £8,832. This cut is 19 times greater than the cut falling on most other citizens.”

The reading is so stark, so bleak, I have to assume it really can’t be that bad. Or is it and we are being swept along, unable to grasp the full reality of the cuts we are trying to survive?

Community caring: A new voice in the chorus of change

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Domiciliary care agencies have been saying it for years, and now the NHS Confederation is adding to the chorus.

GP and community services should receive a higher proportion of NHS spend to enable more care to be carried outside hospital, says the Confederation chief.

Mike Farrar said in his New Year message that he would like to see ‘more investment in primary, community, mental health and social care services as a proportion of the total spend’.

And wouldn’t we all?

An article in PULSE online reported him as saying: ‘For instance, untreated mental illness costs the NHS over £10billion in physical healthcare costs every year. And delayed transfers in care – often a result of the right support not being in place – currently cost the NHS £545,000 per day (approximately £200 million per year).

I never realized so much money was being wasted this way.

He adds: ‘Increasing money in these areas will help keep people out of hospital and leading independent lives, accessing care in their own homes, or closer to home.’

And no doubt that some of that cash could be spent by social services commissioning on private sector community care. Like those running care home businesses, rates for the job are currently diabolically poor.

Mr Farrar also called on clinicians to ‘provide a better explanation of “safe and effective cases for change” that will improve the quality of local services’ and support ‘courageous politicians who put their population’s health above their own electoral health’.

Nicely put Mr Farrer!

He added: ‘If we want to ensure that our health service is improving in the long-term, not just running to stand still, then fundamental change is necessary. We should all be concerned about the future of the NHS and we should all be active in finding the best solutions.’

Yes, like having grown-up dialogue between all care agencies; like putting an end to an autocratic approach to ‘solutions’; like more money to furnish creative care that can be achieved and delivered; like giving us some direction; and perhaps, most of all, listening to the people who actually try to deliver care.Image

Changing the perception of a care home

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We all know that the face of care is changing radically, but residential homes with private members’ clubs – now that really is setting the bar at a new height.

And I think I’m really warming to the concept unveiled by Carebase Ltd which will, in their own words, make the new build into a “social destination”.

The movers and shakers of top-market provider have to welcome in the local community from the outset and so membership of its private members’ club, The Riverly Club, will be open to a number of older people from Abingdon where the luxury care home is situated.

This innovative approach is one that has been championed by Baroness Greengross as she believes it is essential for care homes to become a hub for the local community and that integration is vital for overturning the negative perception that many people have about care homes.

I agree. It’s a fabulous, though brave, concept.

She said in an interview with carehome.co.uk “We have to change the image of care homes and see them as providing something positive to the community instead of as a last resort.

“If you get care homes right, care homes can be a spearhead for outreach action in the local community.”

She added: “People from the local community should be able to visit the care home and do activities there such as have their hair done or watch a film so it becomes a local hub.

“The care home should be providing services for the local community. Some care homes and a few retirement villages are already going some way towards doing this but not on the scale I mean. Years ago I wrote a book on this. It is something we need to encourage. I want the care home to be the initiator.”

All residents of Bridge House will automatically become members of The Riverly Club and will be able to access all of its facilities, including a spa, wellness centre, cinema, café, bar and library.

This, by definition, is care for the well-heeled. Bridge House will be seriously 5-star.

Set near to the river and Abbey Gardens it will provide a unique draw – for those with money to spend.

In the modernization of care treatments we now have dental practices which are uniquely boutique in design and now the trend is spreading to the care sector.

I am both heartened and saddened by this project. Heartened because it pushes the boundaries of pre-conception but saddened because I can think of no investors who would be brace enough to commit to such a build in the Midlands.

The home will house up to 71 older people when it opens in March this year.

Common sense on complex care amidst more economic gloom

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The weekend’s almost here and it’s starting to snow. Great! And just to top it all, I learn tonight on the news headlines we are in a triple-dip recession.

Quite how this latest bad news will drill down to the private sector, I’m not sure. But one thing is certain – the effect will not be good.

Earlier today I read a piece in Brunswicks Healthcare Review highlighting the need for our private sector to work hand-in-glove with the NHS,

Care homes and NHS healthcare services must work more closely together, according to a new study led by researchers at the University of Hertfordshire.  The research was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme.

Most long term care for older people is provided by independent care homes, the report said.

Many of these people have complex needs and are the oldest and frailest of the population. Yet their access to NHS services is inconsistent and determined by local custom and practice rather than the particular needs of the care home residents, the report adds.

Professor Claire Goodman, at the University of Hertfordshire’s Centre for Research in Primary and Community Care, said: “It is very clear that closer working and better integration of NHS services can promote more effective healthcare of older people living in care homes, and there are many good examples of where individual practitioners or services have tried to achieve this.  

“However, our research found that there was not a particular model of working that ensured older people received consistent care, and few systems in place to evaluate what is being achieved. “

It’s when I read material like this I have to endorse radical changes in the care for our elderly. But they need to be ‘real-world’ achievable changes.

As the economy sinks further, less and less resources are being decanted into the care for the elderly.

Just about everyone who is anyone in the care sector are driving impossible budget savings and  feel professionally compromised by unyielding cuts.

Many different NHS services visit older people in care homes, and they are very aware of the need to improve the way they work with the care homes to deliver their service. This has led to the development of a range of initiatives that range from the funding of NHS beds in care homes to the creation of specialist roles designed to promote better working between primary care and the care homes.

However, the study showed that tensions exist between the ways that the NHS services and the care homes provide care to older people. NHS services focus on diagnosis, treatment and support at specific times, whereas care homes prioritise on-going support and relationships that nurture a continuous review of the older person’s care.

Sadly the study also found that access to NHS services and identification of older peoples’ health care needs hardly ever involved joint review or discussion with care home staff, and even more rarely did it include the older person or one of their family.

Quite rightly, the study suggests that NHS services need to see care homes as partners in care and not just the solution to the problem of where to place older people who can no longer live at home. 

Time for tea to help fund better dementia care

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Dementia UK is calling for us to get the kettle on and make tea (I think I need a cup now).

The organization is looking to drum up support for  their Time for a Cuppa campaign; an annual, mass participation fundraising event, which this year runs from March 1 – 8.

Time for a Cuppa is dedicated to raising money to provide more Admiral Nurses – highly trained mental health nurses provided exclusively by Dementia UK to families and individuals who are affected by dementia.

These specialist nurses to an invaluable job.

Unfortunately there are not nearly enough in the UK and it is now, like so many other services,  a ‘postcode lottery’ dictates who will receive this vital help.

This year’s  campaign was officially launched in November by Phyllis Logan (Downton Abbey’s Mrs Hughes), who joined Dementia UK’s Admiral Nurses at Kensington Palace to show her support for a cause close to her heart.

Phyllis’ own family has been affected by dementia, and she has called for action to be taken to address the problems faced by family careres. I can only imagine the challenges facing these famililies.

During the week-long event, people across the country are encouraged to get together to hold a tea party.

Joanna Westley, Head of Fundraising and Communications at Dementia UK explains: “Time for a Cuppa is a great social activity for staff and residents at care homes, and our campaign fundraising pack and website contain some fantastic resources for anyone looking for inspiration, including games and recipe ideas.

“It is all of our responsibility to make life better for families affected by dementia and we call on the care industry to do its part by hosting a Time for a Cuppa party. Registration levels are currently down in comparison to this time last year so we need the industry to support what is a vital funding source for Dementia UK’s provision of Admiral Nurses.”

Come on, we need to support this great initiative.

Rosie Holman, Activities Co-ordinator at Brambles Care Home in Leigh-on-Sea, Essex (last years’ Time for a Cuppacompetition winner) describes their experience of the hosting an event: “We supported Dementia UK’s Time for a Cuppa campaign by hosting a Mad Hatter tea party, which commenced with a tea themed quiz, downloaded from the Time for a Cuppa website, as well as a tea themed session of Bingo. The latter was also adapted from the Time for a Cuppa website, and included pictures as well as words to ensure that residents with severe dementia could join in too. The event was a resounding success and we were thrilled to raise £320 for this important cause.”

Want to get involved? For information on how to host an event, or to download a fundraising pack, visit www.timeforacuppa.org.

Capping: Fears over £75,000 limit and the saga goes on and on

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At the backend of last year there were rumblings that pensioners will pay up to £75,000 but no more for their long-term care in old age.

Now, according to The Telegraph newspaper, the reforms agreed by David Cameron and Nick Clegg, may well be officially tabled before Parliament next week. Under the plan elderly and disabled adults will be given state protection against unlimited care home fees for the first time.

That all sounds good; but is it?

Shadow Social Care Minister, Liz Kendall, says ministers must implement a “carefully balanced package” drawn up by an independent commission and she’s alarmed that the original Dilnot proposals are being shelved.

Quite apart from the politics of this powder-keg debate, I do have personal issues with the way this whole affair has been handled.

In a government-appointed initiative, Andrew Dilnot was tasked with finding a way forward.

As an economist, he surely would have structured a carefully balanced package of measures. The government now seems to be ignoring the very advice it sought, I’m puzzled – you pay for advice: Then you ignore it!

No doubt our elderly will be encouraged to buy private insurance to cover them up to the new limit. This is all making me feel uncomfortable.

What I want people to know is ably stated by Ms Kendall in a Guardian online report.

She is quoted: “It is vital that people understand the Dilnot ‘cap’ doesn’t cover what the individual actually pays but to what their local council would pay – and the average local authority rate for a single nurse-care room in southern England was £470 a week in 2010-11.

“This means in practice the elderly person wouldn’t reach the cap for over five years. The average length of stay for residents in a Bupa care home – which includes state and self-funders – is around two years, and for homes like those run by Partnership UK which are entirely self-funded – is around four years. In other words, the elderly resident would be dead before they hit the Dilnot ‘cap’.”

Currently, one in 10 adults faces a lifetime bill of more than £100,000 for care.

 

Knowledge – the key to getting what disabled deserve

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Sourcing help for disabled love-ones and friends can sometimes be a bumpy ride – with everything from sentimental mush to the inaccessible clinical out there on bookshelves.

As an association we often take inquiries, so I was thrilled to read of a book that has been penned by the mother of a severely disabled child. It charts her own experiences in a matter-of-fact way, tells of her misery and fury, confesses to suicidal thoughts, a long period of depression and damage to her marriage.

It’s raw, not glossed over with sentiment, does not read like a terrible magazine heartbreak story and it helpful on may platforms.

The work was inspired after Jane Raca gave birth to James at 24 weeks. He was diagnosed with severe disabilities.

In a Guardian online article, Jane says she was moved to start writing by a huge sense of injustice.

Alongside the gripping human account of bringing up a disabled child is a searingly angry portrayal of the state’s failure to support her family properly in the years following his birth.

Disability campaigner Rosa Monckton writes in the book’s forward saying it “should be required reading for every MP, for every person in a local authority who has anything to do with providing services for disabled children, and for any doctor or nurse charged with their care”.

Birmingham City Council comes under fire as she recalls that when she and her husband were trying to come to terms with their son’s diagnosis, they had to begin battling against a system, “which is not only complex but which seems designed to thwart [people] to save money”.

She is campaigning for all parents of disabled children to be immediately allocated a highly trained keyworker, who will be on hand to help and to co-ordinate all the services they need – social care, health and education.

I find it remarkable that this woman is a lawyer and despite her learning, still struggled to get the results she needed.

The article quotes: “We had a particularly bad experience, but I think it’s not that uncommon. Our local authority has a bad reputation, but this is going on all over the country.”

She recounts her prolonged campaign to get respite care (which no one had told her she was entitled to), and later to get funding to send her son to a residential school.

Almost every encounter with a social worker appears to conclude with an agreement that help will be given, but is swiftly followed by the observation that “nothing happened” – a phrase that recurs throughout the book.

There appears to be an unspoken, unwritten edict where cash crisis councils rely on the ignorance to help balance book. If someone needing care, or their carers do not identify need, it cannot be met by a statutory obligation. The book goes into much more detail.

We must, at all costs, remain intellectually sharp and not allow a culture which relies on applicants’ lack of knowledge about their rights to help shore up a financially struggling social system.

Jane is quoted: “If central government has legislated to make life better for disabled children, but you’ve got local authorities without enough money that are bending every rule in the book to try to avoid fulfilling their statutory duties, then that’s not on. Don’t pretend we’re going to support our disabled children if we’re not.”

Standing Up for James is available from the standingupforjames.co.uk website.

MPs’ essays spell out strong message for mental health reform

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My knowledge of mental health issues is scant, but I do know its one of the most significantly deserving, yet often neglected, areas of care in the UK.

Like most, I’m content to think my response to mental illness is enlightened. But the truth is that my attempts to engage this difficult subject are forever punctuated with excuses of why I shouldn’t learn more.

“I’m well versed with elderly care, the core of our association’s work; I understand its complexities, the nature of its delivery . . . and I have understanding too of community care, looking after the learning disabled and how the safeguarding system works,” this is my platform for excuse.

Should I learn more about caring for the mentally ill? Well, I guess I ought, but there are myriads of more pressing thing to do . . . and so it goes on.

Mental health issues leave me out of my comfort zone, but I like to believe I’m morally and professionally committed to improving care for the one in four who at sometime in their life will encounter such a problem.

We don’t have to understand the scope of mental illness or its treatments to have a good attitude towards sufferers, but we do need to realise it is a global problem and the incidents are not necessarily dictated by our age or personality.

In an attempt to bring some gravitas to a problem that affects people of all ages, regions, countries and societies, a bunch of Conservative MPs have published a collection of essays.

Some are deeply personal accounts, others are reflections on professional experiences and how memories of these times have shaped responses.

Remarkably, they all appear to agree on one thing: That they earnestly require things to improve.

To this end, the experts met at Westminster last week to mark the publication of these writings.

At the meeting Professor Philip Sugarman, chief executive of the UK’s largest mental health charity, St Andrew’s Healthcare, asked why NHS mental health expenditure has shrunk in the last year, despite the government’s commitment to maintain mental health funding and the unprecedented comments by sitting MPs in the House of Commons last September.

Professor Sugarman said:  “MPs should be praised for their support for mental healthcare. 

“It is certainly true the traditional priorities in mental health may have to be challenged, but resources must be found for innovation and new priorities.

“St Andrew’s and many other national mental health groups are advocating new priorities in childhood prevention, early access to diagnosis and treatment, and greater use of specialist therapies. Our Parliamentary colleagues believe that the new NHS commissioning arrangements will address these challenges – we need to know how this will work in practice.”

Yes we do need to know. Just how will we improve? And how will the current changes afoot – for instance, the new Work Capability Assessment – impact on those who are currently receiving treatment?

There’s some pretty emotive language being used in some influential quarters about “ the assault on people’s dignity.”

Last week’s event was organised by national think-tank, the Centre for Mental Health. The speakers were heavyweights – but, for my money, the real core message is in the essays. They can be downloaded at:

http://www.centreformentalhealth.org.uk/pdfs/Making_Up_Our_Minds.pdf

 

Happy news to ease us through a snowy weekend

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Okay, the big freeze has arrived and snow of mountainous proportions is supposed to be heading our way. But even if the snowfall turns out to be less than expected, we just know it will create chaos.

Already meetings have been cancelled, train timetables changed even before it arrived and panic buying has hit the supermarkets.

So we need something happy to help us through this very seasonal weather . . . a bit of good news – so here goes:

Groundbreaking work to improve the daily lives of people with dementia is being highlighted to in the hope that it can be more widely adopted.

A pilot programme in Shropshire has achieved such a high degree of success that health bosses want to share their care model.

Shropshire LINk, which works to represent the people of Shropshire in improvements to health and social care, is backing the distribution of the results of the trial in the hope that the approach can be used to benefit many more dementia patients.

Staff at Coverage Care Services’ Woodcroft care home, in Market Drayton, made critical but subtle changes to their daily work to make residents feel more at home.

This is heartening news.

Residents have the chance to take part in routines and activities which made them feel more settled and reminded them of how their days may have been spent before dementia.

The results of the trial have been so impressive that Shropshire LINk decided that it wanted to see the information shared with care organisations across the county in the hope that the techniques could be more widely adopted. A new brochure has now been produced which is being distributed to all county care providers.

The changes are based on techniques developed by researcher Dr David Sheard,, director of the Dementia Care Matters organisation, and is known as the Butterfly Approach.

It is a way of putting the patient at the centre of planning for their care and removing some of the traditional elements of a care environment.

Chief executive of not-for-profit Coverage Care Services, David Coull, said: “While many of the actions involved in this approach may seem to be obvious, it is in putting them together and training staff to implement them to full effect that brings the tremendous benefits to those living with dementia for whom we care.

“The results of the trial were very impressive, reducing average falls per month by almost three quarters, leading to lower doses of medication for half of those who needed it, eliminating most behaviour that was problematic to staff and reversing weight loss in all of the residents who were struggling to maintain their nutrition.“

Clearly there is a national move to better the care for dementia patients but to have this happening on our doorstep is a real privilege.

Pondering these extraordinary ‘gains’ in helping dementia sufferers is a fantastic way to head off into the snow for the weekend. Hope you’ve got the shovel in the car, but if that fails there’s always the snow plough (pictured above – it has to be in America).