By Debbie le Quesne

Archive for October 2013

CQC: Deadline looms for our comments

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Remember, remember the . . . 25th of November. Okay, I know it’s not quite right, but I hope the adapted Bonfire Night rhyme will help you mark a very important date.

 It’s a date which could have huge influence on the future of Care Quality Commission (CQC) inspection in our business.

The Commission has published a consultative document outlining the fees that it proposes to charge providers in 2014/15 – and it wants our feedback on the plans. The consultation closes on Monday, 25 November, so the deadline is scarily close.

Please . . . we have to make the time to be involved in this. We are the only real barometer of opinion the CQC will measure and to do that we must respond to their invitation. It will give no platform to grumble at the changes if we have not had our say.

Under the proposal, fees for all health and social care providers, will increase by 2.5 per cent. Not good on the heels of massive hikes in the prices of electricity and gas.

The fees will help continue to fund the commission’s essential regulatory work, we are informed, and yes I do know I have blogged about it before.

Reported in a number of publications, David Prior, chair of the CQC said: “We do not underestimate the impact on providers of paying fees, especially in the current economic climate, and we will continue to look carefully at our costs relating to regulation.

“As an organisation, we have a responsibility to cover our costs by charging fees, but we are also accountable for demonstrating that we are fair, efficient, effective and proportionate.”

Changes to the fees structure involve altering the bandings for residential care home providers to reduce what is known as the ‘cliff edge’ effect, that occurs when providers are pushed into a higher fee band through a small increase in the size of their service.

My biggest concern is that the cliff edge is perilously close to too many providers already and the tipping point is not being driven by CQC, but rather the spiralling costs of overheads.

Don’t forget you have until November 25. The online questionnaire is found at at:


‘Marketisation’ driver for low pay and poor deals on care fees

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I read yesterday in an article by a couple of professors that “the minimum wage is becoming the benchmark figure for those working in the frontline of caring.”

Sadly, that’s true, but also know another truth: That the majority of care providers would be happy to pay a whole lot more if they had the funds to do so.

We have just seen the headlines everywhere that cuts in social are funding have resulted in some care firms breaking the minimum wage law.

I can’t defend this action, but I understand how it’s occurred.

Undoubtedly the cuts play a part, but so does a culture of hiving off what were traditionally social care services.

Mark my words the next headlines will be all about the ‘living age’.

Professor Ian Cunningham (University of Strathclyde) and Professor Phil James (Oxford Brookes University) state: “Since the 1980s, governments – Conservative, Labour and coalition – have pursued policies intended to increase competition in social care provision.

“One upshot of this is that the majority of care is outsourced to often non-unionised charities and, increasingly, private companies. Another is that the resulting price-based competition has acted to increase workloads while driving down pay levels and a host of other staff conditions, such as pensions, sick pay entitlements, overtime payments, and allowances for callouts and night work.”

It’s an interesting socio-economic theory that seems to hold water and a rational approach to why the minimum wage appears to be the norm.

But they also point out – and here’s the rub – that “recent revelations that providers have struggled to provide services at the price local authorities have been prepared to pay, or that they are refusing to bid for unsustainable contracts, come as no surprise to those of us who have been researching the impact of social care marketisation.”

They add, in the Guardian online comment, “that action is clearly needed to counter the adverse consequences of these developments for both staff and the clients they serve. The introduction of a requirement on contractors to pay a living wage would be a clear step in the right direction.“

Suddenly care meeting have a new phrase . . . the ‘living wage’. It’s the new buzzword with local authorities and care campaigners.

It’s a noble goal, but one I suspect is a long, long, long way off.

The “working wages’ of which many local authorities are now speaking convert in real terms to an extra £25 per bed and £1.50 per hour for domiciliary services.

So what is the difference between the living wage and the national minimum wage?

The living wage is an informal benchmark, not a legally enforceable minimum level of pay, like the national minimum wage. It is currently calculated by the Centre for Research in Social Policy at Loughborough University.

The basic idea is that these are the minimum pay rates needed to let workers lead a decent life. Will this ever catch on? In my dreams.

Safeguarding high on the agenda as associations meet

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The misuse of safeguarding procedures was again high on the agenda when representatives from 24 local associations met in London.

The meeting at the Skills for Care offices seized the opportunity to establish a monitoring ‘tool’ to assess what is happening with safeguarding in various regions and what, if any, the shortcomings are.

It’s a positive approach to a problem that is not going away. Too often, safeguarding is being used as a mechanism to overcome inertia on decision-making and as a complaints procedure.

Eight safeguarding boards will be scrutinised and if specific areas are deemed critical, a national approach will be made to address them.

The national lead for safeguarding has been contacted and made aware of our on-going investigations.

Nursing homes and the RGN crisis

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Nursing homes across the UK are struggling to attract RGNs as the regulatory pressure mounts on the profession.

At a recent meeting in London of representatives from care associations from all over the country, delegates reported that replacing and keeping nursing staff was a growing problem.

I’m not in the least surprised.

Among the issues facing some nursing home RGNs are poor support mechanisms on critical, clinical decision-making, the unyielding demand for hands-on nursing care, not having immediate access to doctors, increased awareness of a blame culture, the clinical exposure of not having five or six other nurses on shift at the same time to help in crisis, and the noticeable increased dependency levels of admissions.

The problem of recruitment has been made more acute since the clampdown of foreign nursing staff and poor bed prices mean providers cannot match NHS contracts on salaries, sick and maternity pay, career opportunities and pensions.

One nurse, defending her decision to jump ship to the private sector, said the opportunity to build meaningful relationships with residents and their families helped offset the negatives of not having the might of the NHS supporting her.

She added, however, that nursing is harder on those who work in the care industry because of long hours caused by unfilled vacancies.

Somehow this seems wholly unfair. The care sector should be able to compete and not rely on personal ethics to drive nurses into job vacancies.

Sadly those ‘old school’ nurses are getting thin on the ground.

The nurse added: “A few years ago we saw nurses coming off wards to work in the sector when the NHS decided they had too many [nurses] and most of them struggled with all the other work they were expected to do.”

Living Room project clears first grant hurdle

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As the dear old girl used to say who once ran the tea trolley in a previous working life: “It’s been a week.”

So the mix of stress, bad care industry headlines and more bad care industry headlines needs an antidote.

And here it is, as if by magic appearing in my cluttered email basket. Do you recall the Living Room project grant application which the West Midlands Care Association was partnering? Well, under the management of independent community interest company Creative Health, the scheme which aims to dramatically challenge the stereotypes of entertainment and activities delivered in care homes, has overcome the first big hurdle in getting Arts Council funding.

A ten-minute presentation and an hour’s interview will now be the decider. I don’t have a date yet, but there’s some frantic activity to get the best possible pitch we can.

The thrust of the project is to integrate artwork into care where professional artists, performers and residents are all encouraged to interact. Key to the project’s on-going success will be the training of activity coordinators in the homes.

Some 30,000 older people in residential care settings and more than 4,000 care workers would be targeted.

The “Living Room – Turning the Everyday into the Extraordinary” application explains: “We all pass time in our living room: somewhere to chat, undertake activities, rest, welcome visitors or watch television, together.

“Creative Health CIC and partners are proposing to use the idea of the family living room – where we feel at home, comfortable; surrounded by the people we love and also the everyday objects that mean something to us – to inspire a ‘Living Arts Room’ . . . a living, breathing space that stimulates warmth, emotion, sharing between residents. Families, providers, staff [and] artists.”

Living Room also aims to carry out a feasibility study into a Quality Mark for Arts in Care Homes. Together, residents, care staff and artists would benchmark arts activity in care homes.

Everything about the Living Room plan challenges the very heart of the traditional approach to residential setting entertainment and craft. Instead of being an add-on, the idea is to actually integrate art into care.

It’s all about adding to the self-worth of residents and other users, stimulation and building stronger relationships with each other and community. Basically, it’s remapping our thinking on the role of arts in care and I love it.

Forced to break minimum wage law because of care cuts

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Attend a meeting of care providers over the next few days and I guarantee the unofficial agenda will be centred around the latest news on the cuts.

Cuts so deep, it appears, that according to The Daily Mail, The Guardian, The Alzheimer’s Forum, Twitter tweets, The Public Sector Executive and any number of health care bloggers, care homes are forced to break the £6,31 minimum wage due to lack of council finding.

A government body – The Low Pay Commission – has issued the warning. David Norgrave of the Commission is reported in the Mail online that Her Majesty’s Revenue and Customs (HMRC) has identified 120 care providers for investigation.

To cut costs, care companies are allegedly using tactics such as not paying for travel time between care visits, so that they don’t have to pay the minimum wage.

It’s an old chestnut, been in the news before and this issue will not go away.

And I can understand why. Just look at what the United Kingdom Homecare Association estimates: That a homecare company needs to be paid a minimum of £14.95 an hour by a council to fulfill wage law and training responsibilities.

But the UKHA believes that one in five councils were now paying £11 or less, the lowest being £8.98 an hour.

Well, that’s a surprise (NOT).

The Mail adds: “The association said that 90 per cent of councils had slashed its members payments in the past year, leaving them struggling to comply with the minimum wage law – the alternative being they stop trading or go out of business.”

There’s more in the article, this is enough for me to chew on for a day or two.

Other publications are beating the same drum.

What will it take for this Cabinet to sit up and listen? Their arrogance is matched only by their ignorance regarding the issues of the care industry.

And here’s a question I’d like to see answered: If, as now we all know, the care sector is so being deprived of funds to the point of collapse, how will we care for an increasingly aged population? We need proper leadership, a Cabinet that gives priority to the care sector and not least, politicians who will represent us in securing the wellbeing of our frail, elderly, long-term sick and vulnerable.

Elections looming – let’s see if the tune changes.

Good news on National Care Home Open Day

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I’ve just got some figures for this year’s first National Care Home Open Day – the event which offered the public to take a real-life look at what residential care is all about

More than 2,500 care homes across the country collectively opened their doors to the public for the first ever event of its kind on June 21.

Run by a group of leading care providers and associations, the National Care Home Open Day aimed to connect care homes with their local communities, challenge misconceptions about residential care and show local people the excellent services that are at the heart of their community.

It was, and still is, a fantastic tool in re-educating the general public about the good work we all do.

The open day allowed people to see for themselves the level of care available to their loved ones. It also provided a great opportunity to invite members of local communities across the country to consider becoming a volunteer in their local care home.

Dozens of MPs visited care homes across the country, including prominent frontbenchers such as Michael Gove and Douglas Alexander.

The initiative achieved great media coverage for all the right reasons and if you should want a reason for joining in next time around, this single thing should be good enough.

I admit that changing preconceptions is always going to be a slow burn, but at least some 2,500 lit the torch.

Baroness Bakewell, National Care Home Open Day Ambassador, was reported in Caring Times as saying: ”The National Care Home Open Day was an important event to participate in. It was a great opportunity for people to see the range of care services at the heart of their communities.

”Care homes, and most importantly the residents who live there, are an invaluable part of our communities. The National Care Home Open Day helped to connect the residents and staff with their local communities.”

To learn more visit: http://www.nationalcarehomeopenday.org.uk/