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By Debbie le Quesne

Archive for November 2013

Apprenticeships and the need to upgrade the work of carers

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There are vacancies aplenty for carers in the UK, but employers in the sector are struggling to fill them.

The national issue is highlighted in a Guardian piece. A new report by The Work Foundation suggests that social care apprenticeships “have great potential” but  the concept is not without problems – not least educational content and wages.

The article speaks of a need to “strengthen the pipeline for future talent.” But while the social care sector employs relatively large numbers of young people, most recent new apprentices have been aged over 24, research says.

The piece adds that “given the sector’s older age profile, this suggests that apprenticeships are not functioning well as a pathway into social care for young people.”

Personally, I think apprenticeships are great idea – the perfect bridge from school to work. We have a pool of youngsters needing work, but it must be matched by employers willing to offer apprenticeship schemes. Presently, the article informs “while social care employers recognise skills shortages (almost a quarter report skills gaps in their workforce), the low number offering apprenticeships suggests that many do not see them as the solution.”

However, the sector does provide good initiatives to promote apprenticeships to employers – including I Care … Ambassadors, an Employer Champions network, and good practice is shared through the Sector Skills Council.

The Work Foundation suggests “this activity should be expanded.”

Encouraging the young to work with the old and chronically sick is never going to be a glamorous business, but I can’t help thinking that the status of the sector has a huge impact on job perceptions.

I know I keep beating this drum, but the value of care and the work care providers offer desperately needs upgrading.

And we can’t deny that low pay rates, couple with high responsibilities, are a factor in pushing the young away from the sector.

The Work Foundation suggests: “ Along with developing better entry and progression opportunities, tackling low pay should be a key priority.”

Hmm . . . low pay. Isn’t that something that is affecting the providers as well as their employees?

Katy Jones is a researcher at the Work Foundation and the author of The Road Less Travelled? Improving the apprenticeship pathway for young people, points out: “Given endemic skills shortages and increasing demand for quality care services, there is an urgent need to address these problems in social care.”

Quite how in these times of financial restraint, I’m not sure as rewards for work are indeed a primary motivation.

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Response to the ‘scandal of secret mark-ups’

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The Telegraph calls it the scandal of the secret mark-ups – the difference between care fees paid by local authorities to care homes and those paid by self-funders.

Figures are published show “on average those people who fund their own care – because they do not qualify for assistance from their local authority – pay on average 13pc above the ‘real cost’ of providing their care, in England.”

Richard Dyson, author of the report writes: “The ‘real cost’ figure, which is generated from in-depth research into the constituent costs of providing food, accommodation and basic help, also includes a reasonable profit margin for the care home operator.”

And he adds: “The price paid by a local authority on behalf of someone who does qualify for State help is lower than this ‘real cost’.”

More weight is added to the article from charity Independent Age, which this week published a report saying that middle-class residents with modest property or other assets, who are thus forced to pay for their own care, are subsidising those paid for out of a public purse.

I’m sure you can image the feedback on this report is robust and no venom is spared.

And yes, I’m equally convinced as the newspaper says “the figures will make uncomfortable reading for about 210,000 individuals, and their families, who are in the position of paying all or most of their care home fees,” especially when data is presented in this way.

Dyson writes: “Under current rules, individuals in England must ‘self-fund’ or pay their care home fees in full, with no help from the council, if their assets, including their homes, are worth more than £23,250.”

One has to ask: Who made the rules? Care providers? No.

The article says cost discrepancy “creates resentment and anger.” True, but so does the fact that care providers are not offered a proper rate to pay for caring, turn a profit and be future proof, pay for business maintenance and investment.

The figures differ by region, the piece says and they certainly do. On average, in England, the cost of providing residential care, including the care home operator’s slice of profit, is worked out at £563 per week, according to Valuing Care, the marketing analysis consultancy which provided the Telegraph information.

I quote: “Based on the English average, that would mean the fees paid by a local authority on behalf of someone qualifying for help would be as little as £507 per week – compared with the self-funder’s £636.

But in the Midlands there is a very different set of figures. Local authority rates include: Birmingham – £405.00, Dudley – £390.00, Sandwell – 378.00, Shropshire – £381.20, Staffordshire – £400.00, Walsall – £365.10. Warwickshire – £365.10, Wolverhampton – £379.53, and Worcestershire – £410.00.

A snapshot average here works out at £384.99, a figure well short of the £486 per week average published in the Telegraph.

I quote: “In general, according to Valuing Care, local authorities use their bulk-buying power to push down care home rates to between 5-10pc below the ‘real cost’ figure.

“Based on the English average, that would mean the fees paid by a local authority on behalf of someone qualifying for help would be as little as £486 per week – compared with the self-funder’s £636.”

Members of the West Midlands Care Association would indeed be very happy with an average residential fee of £486 paid to them by local authorities. I am struggling to see how it now appears that the West Midlands is not at all representative of the national picture, given the Telegraph ‘facts’.

You can image I am now chasing national data as an extra £100 to my members could represent huge improvements in staffing, re-investment and, dare I say it, profit.

Historically the private sector has provided the care pool which local authorities have not and today the demand is increasing. Government is strident in its approach to use the private providers to roll out its care reforms and our MPs support a free market economy too.

Local authority community care is systematically been hived off to the private sectors all over the country and homes are closing still.

I don’t doubt there are ‘victims’ in this system, but I have to ask: In real-world terms how is it going to change? The moral debate can go on at infinitum, but if there’s a niche for say, top-end care provided in luxurious ‘hotel style accommodation’, who are we to condemn?

As for cross subsidising between self-funders and social services paid candidates, yes it does go on – and in many cases it must to make up the hefty shortfall on fees paid by local authorities. The pain of reality is hurtful, but that’s the world most of us inhabit.

Ray Hart of Valuing Care is quoted in the Telegraph as saying: “There is no clear explanation of the difference in fees between self-funders and those who are looked after at the state’s expense. Are the self-funders effectively subsidising those paid for by the local authority, because the local authority is not paying enough? Or are care homes simply using self-funders as a means of generating profit? Either way it does not seem right.”

No answer is simplistic.

Fact: Self-funders are often the difference between keeping a home open or it closing as a non-viable business model.

Fact: Without them many homes in the UK would close and an already over-stretched care provision made more acute.

Fact: Self-funders do help keep residential care services, which the government wants to use, in business.

Fact: The ‘system’ the rules and ‘the way it is’ have not been established by care providers, but rather by successive governments, so please don’t levy all the blame at those who are providers.

Fact: The moral debate can find answers only in Utopia, ironically meaning in the original Greek ‘no place’ before in common use coming to represent ‘good place’.

Fact: I know many of my West Midland Care Association members personally. They are not money-grabbing millionaires who view their residents as a commodity. They are good people doing the very best they can in sometimes-impossible financial situations. They are passionate about good care and desire above all things to deliver it. And does the government help them? Frankly – no, but it’s very happy to use them, decanting its direct responsibility for caring into a third party provider.

Care and remaining ‘optimistic about the perfect storm’

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Love it or hate it, The Guardian probably offers some of the best coverage on social care issues.

My only frustration is that is seen as a “leftie” publication, and while true in some instances, many of its reports focusing on care are much less political than myself forever beating the drum of ‘better fees for care providers, please.’

Today, online, there’s a realistic snapshot of community care issues. It tables a way ahead, the frustrations of the present and offers some frank comments on how social care needs to change.

Under Chatham House rules, where comments are allowed to be reported but without attribution, the paper in collaboration with CapacityGRID – a platform enabling councils to share resources and knowledge – brought together a group of senior social care figures to debate the thorny issue of developing care in an economic hole with little or no light at the end.

The Association of Directors of Adult Social Services reports that in the three years to March 2014, £2.68bn – or about a fifth of the total funding budget – will have been cut from adult social care.

The debate touches on the eligibility criteria, dementia, complex needs, preventative actions, strivers or scroungers, the shadow of the Poor Law, relationships with the NHS and much more.

One thing that really caught my attention was: “The hospitality industry is far better [than us] at motivating low-paid staff.”

Maybe that is true, but motivation in my circle is not lacking.

The article, see www.theguardian.com/social-care-network/2013/nov/27/role-families-social-care concludes . . .”But despite the tough times ahead in implementing deep spending cuts, the panel was energised by the prospect of building a care system focused on enabling people to live fulfilling, independent lives.

“The difficulties and risks are immense, but so are the possibilities. As one panelist put it: ‘I’m optimistic about the perfect storm’.”

If you get five minutes, read this piece. It’s not conclusive or academic, but some of the quotes in this are enlightening, or perhaps frightening. You decide.

Care providers ‘flouting law on minimum pay’

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Up to half of care providers are not paying the minimum wage, a shocking investigation by tax inspectors has revealed.

I’ve read the news in The Guardian online, but it’s everywhere and the source is no less than Her Majesty’s Revenue and Customs (HMRC).

The investigation found that of the completed 183 investigations, 48 per cent of employers had paid workers below the national minimum wage, set at £6.31 for adults.

The HMRC said it was “the highest level of non-compliance identified in this sector in the last five years.”

I quote: “The main reasons offered by care sector employers for not paying the minimum wage included making illegal deductions such as uniform costs; not paying for time spent training or travelling between care jobs; charges for living accommodation; incorrect hourly pay rates; and incorrect use of apprentice rates.”

Tuesday . . . just getting into my week and I feel depressed by this news.

Interestingly the newspaper reports on a comment by David Norgrove, head of the Low Pay Commission. A month ago he “told the Guardian that cuts in council funding had left rising numbers of care firms with little option but to break the law by paying below the minimum wage.”

Among employers targeted by HMRC, more than half of the law breaking was found among residential care service providers while a third of transgressions took place among homecare providers.

Mike Padgham, the UK Healthcare Association chair, is quoted in the article saying: “It is a disgrace that social care is so poorly funded that employers struggle to keep ahead of the minimum wage.”

With more than 80 employers still under investigation, where are we all heading?

Do I understand why the pay law is broken? Yes. Do I condone it? No.

But life is seldom in primary colours and pledges of punishment do little to correct the underlying problem. No doubt the wrongdoing will see a raft of businesses close, creating more issues for those they care for.

Seems unfair that the service users will get punished too. What a mess.

I am wholly persuaded that until fees paid to providers represent real costs of caring the problem will no really improve. Yes, there are great initiatives on smart thinking and yes, business models have been revised to find savings.

But there is a limit to what my members can do. Perhaps with the latest news acting as a barometer on the industry, we have now reached that point.

Double-shot latte please . . .

The workforce capacity gap and the care cost quality equation

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The biggest component cost of delivering care is staffing. It’s fact that some local authorities do now recognise and agree with providers that quality staff often equates to quality care.

Retaining, training and recruiting the right people are also critical to good care standards.

Recently in my role with West Midlands Care Association I have been working with Birmingham and Worcester local authorities to establish the correlation between fees paid to providers and the number of safeguarding issues reported.

Currently we have no conclusive data but in due course we should have some conclusion, albeit on a very small national sample of local authorities.

The ongoing issue of staffing levels in care have never seemed to leave the headlines since the Francis Report highlighted not only the news-grabbing issues of ‘culture’ and ‘candour’ but also levels of staffing.

Clearly, shortfalls in staffing levels need to made apparent and making them easily accessible to service users in the residential and domiciliary markets could be a viable option, though for some, far from a popular course of action.

It would, however, certainly foster a more open debate around staffing levels and meeting patient need.

Social Care Partnerships, much like the one between Lancashire Care Association and its local county council, have gone public with recognising the links between cost, resident need and staffing and pledges have been made to debate the matter further. All good.

Care homes and home care providers are all facing the same key issues: Meeting ever-higher levels of need and disability in the context of a workforce capacity gap, and then we have commissioners who often have little understanding of provider costs, or are so dominated by budgetary targets they are not motivated to take them into account.

Damning report by CQC: ‘Lessons still not learned’

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The Care Quality Commission has issued a damning report that says more than half a million elderly people are being admitted to hospital with conditions which could have been avoided if they had not been neglected by GPs, care homes and social services.

This pulls no punches and as you’d expect the headlines are everywhere.

Complaints such as malnutrition and bedsores are the source of some admissions, so says the Daily Telegraph.

But what I find most troubling is that the CQC report says the NHS has not still not learned from the Mid-Staffs scandal.

The newspaper online report says: “The CQC said hospitals have made “no improvement” in monitoring the quality of care, nor in ensuring that patients are kept safe or treated with dignity and respect.

“Inspectors were ‘alarmed’ to see the way patients were treated.”

The study found the number of older people being admitted to hospital in an emergency, with conditions which could have been avoided – such as pneumonia, malnutrition and pressure sores – is far outstripping the growth in the older population.

Clearly we need more primary intervention and if the government is serious about fostering a community-based approach to care, we clearly need fiscal policy to make it happen.

Quoted in the article, David Behan, chief executive of the CQC, says: “Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital.

“GPs, care homes, home care agencies, community health services and hospitals, with local commissioners, must plan effectively to make sure our older and more vulnerable people are cared for in the way they deserve.”

Domiciliary care providers generally do an excellent job of flagging up potential problems with clients. But the access points to this kind of care are often far too complex for the elderly to navigate and there is still a pervading fear that “involving social services will put you in a home.”

I agree with Norman Lamb, the care services minister, that “there are no excuses for services failing to keep people safe and free from neglect.”

Truth is, we still have a problem. Our care providers are often creative – they have to be to juggle the poor financial rewards of social services funded care.

I know of one care home developer who is looking to engage the local elderly in flu-jab clinics, and create a hub for other health services at his new home.

And there are domiciliary providers who desperately want to deliver more care, but time contracts and tight financial margins dictate disciplined schedules.

I can think of very few carers who don’t want to offer more.

The CQC report serves as a reminder we still have a long way to go on the road of care reform.

Unified funding approach to homecare: A call to back changes

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The care bill – there’s no need to shudder, yet – is being brought into sharp focus next Tuesday at the United Kingdom Homecare Association’s England conference.

The association represents more than 2,000 members across the United Kingdom, in England, Wales, Scotland and Northern Ireland whose care is dispensed into homes.

It’s serious body of members and their chief executive Bridget Warr is keen to rally them to help make change happen.

Truth is, it will happen with or without their blessing and the same applies to WMCA. Like it, ot lump it care is changing – forever.

There is a strong emphasis in the care bill on improving people’s overall wellbeing, which shifts the emphasis from a remedial, “deficit” based system, to one which seeks to take pre-emptive, preventive and supportive measures.

A noble charter, that according to Ms Warr, writing in The Guardian, marks a “recognition that this will necessitate a move towards a more integrated approach to the design and delivery of social and health care services.”

I agree. She adds: “But we can’t just wish the changes needed into place – we need to make change happen. And, understanding that there are finite resources, it’s not just about making more money available, but it certainly is about spending the money that is already in the health and social care budgets smarter.”

She argues well the point that people over 65 accounted for 7 million (46%), of the 15 million adult hospital admissions in England last year. “It doesn’t take a great stretch of the imagination to work out the potentially significant cost savings that could be made in the health budget, if even a small proportion of these admissions, which often become unnecessarily extended periods in hospital, could be avoided, or discharges brought forward, by the use of appropriately deployed, community-based social care.”

This is to many in the care industry commonsense. But as I have intimated before there are huge financial and political hurdles to overcome.

The current separate health and social care budgets, with fragmented responsibilities for planning, commissioning and funding services are systemic barriers to the design and delivery of integrated services, writes Ms Warr.

Quite how noble sentiment is translated into delivery is going to be interesting, but I dearly hope the Cabinet don’t think that this initiative will self-fund from day one, though it has huge potential for hospital savings if at a domiciliary level more resources can be deployed.

Ms Warr points out that “this kind of approach will require the players in the supply chain for previously separate elements of people’s care solutions to come together at an earlier stage and collaborate in new ways, in order to enable them to support improvements in people’s overall wellbeing more effectively. “

Speakers at her conference include movers and shakers from  central government, local government, workforce development, the NHS, and the care regulator.

Oh to be a fly on the wall as the debates begin. I’ll be keeping an eye out for the Press releases.