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By Debbie le Quesne

Archive for February 2014

Three pc rise move on minimum wage

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The Low Pay Commission has recommended a three per cent rise in the National Minimum Wage.

I caught the news on the BBC and although I support every principle of proper pay for the job, my heart sank.

If accepted by Government, and I strongly suspect it will, it will place further strain on an already-creaking social care industry.

Central Government really must face the facts that the fees they pay to private sector providers are shockingly out of touch with reality. I can only hope that such a hike in pay structures for the care sector will be recognised by Cabinet and more funding decanted to local authorities to meet the need.

I read on the Care Industry News website that In February, the BBC used the Freedom of Information Act to discover that only four out of 101 councils in England paid at or above UKHCA’s minimum price for homecare of £15.19 per hour.

The three percent uplift will see the National Minimum Wage go from £6.31 to £6.50 per hour – and with our care and nursing homes and ‘domcare’ services, I have to ask: Where will the money be found?

In turn, this rise would effectively increase United Kingdom Homecare Association’s recommended minimum price to £15.74, a figure far in excess of that offered by most local authorities.

UKHCA Chair Mike Padgham was reported as saying: “We all want to see the homecare workers properly rewarded for the demanding and essential work they do.  However, local authorities have persistently failed to recognise these cost pressures.

“It is imperative that a Government which acts on the Low Pay Commission’s recommendation to increase the Minimum Wage also heeds the Commission’s urge for a requirement for councils to take account of the full costs of care in the statutory guidance it is currently preparing on commissioning of social care.”

Well said!

The commission said it had to balance increased costs for businesses against doing more to help the lowest paid, adding that  the economic recovery justified the move.

But the commission and Government seem to be deaf to the fact that the private care sector is a Cinderella industry – over worked and under valued by those who, indeed, should know better.

Since the economic downturn the minimum wage has risen faster than other wages, the Beeb reported.

I am between a rock and hard place here: Do I wish for carers to be properly paid? Indeed yes; but I know this news will be crippling for so many of the providers I represent. There must be a moral obligation on the Alliance to respond in generous fiscal terms to this news.

You see, Mr Cameron, we have run out of smart thinking, of making economies, and no longer can shelve reinvestment.

Perhaps, when social care fails and there’s a national scandal akin to the Stafford Hospital horror, your Cabinet will realise that caring really does cost money and frankly, we need it now.

* Those aged 16-17 would see an increase of just under two per cent, to £3.79 an hour.

Changes needed to avoid extra 13,500 hospital beds

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I recently read in one of our heavyweight newspapers that if the care system does not change for our growing and ageing population we will need an additional 13,500 hospital beds to meet demand.

Like never before the pressure’s on everyone involved in the care loop to create a fix that offers quality years for the elderly.

Attempts to move care closer to home is not but major change is needed to achieve it, so says Nigel Edwards, a senior fellow at The King’s Fund.

Management of chronic illness in the community is key and heading off sickness is also a priority. Anything to keep our elderly out of hospital has to be considered.

Writing in The Guardian online, Edwards adds: “A great deal rests on community services: they could transform chronic disease management, support reductions in the number of people admitted to hospital and how long they stay there, and help primary care meet a growing demand.”

He outlines that previous initiatives have fallen pretty well at the first hurdle, but there’s a new approach.

Yes, I think we know that: Models to simplify, steam line, join up and end duplication. Oh yes, and we’ll do it all in the community.

Edwards adds: “We also need to wrap services around primary care practices and natural local communities. A common problem is the lack of contact between community staff and GP practices. They will both work more effectively if this is reversed. In some areas social services have changed their team structures to match this.

“Another key step is to create services that offer an alternative to hospital stay, and that can respond more quickly than many currently do. At least 20 per cent of admissions and half of days in hospital can be cared for in other settings, including the home. Where new models are developing, community care teams are intervening quickly to prevent admissions, diverting patients away from A&E or working with hospital wards to speed up patient discharge.”

But there’s a flaw in this plan which is supported by just about every care professional I know.

Edwards notes: “To be successful, however, there will need to be significant investment in developing the workforce and dealing with the impending shortage of community nurses.”

Investment – now that’s a challenge. The care industry is creaking Mr Cameron and some of the emerging business models, I suspect will not pass CQC’s sustainability scrutiny. Why? Because in responding to need – more and more clients are being decanted into the private sector from council-run social care services – and the only way to turn a profit in serving them is by keeping things lean.

Lean is certainly not smart. I’d like to think this is not the creative working the Cabinet envisaged.

The private sector is a central pillar to rolling out government policy on care. It’s time the rates local authorities are paying for it represent its true worth and the funding assigned to social care packages enough for clients to buy in a sustainable, quality service.

Ageing Britain: Why getting oldere I not a picnic

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Elderly people gather in an idyllic woodland and settle down for a bite to eat, but the caption beneath this picture in The Guardian online tells us “Life is no picnic for many older people.”

And we are reminded too in an article outlining the fears of our ageing population that David Cameron once said: “We’re an old country – with our best years ahead of us.” Hmmm . . . well, that’s how he sees it.

Research, however, is not so optimistic with growing concern about pensions, rising costs, health and social care.

The survey for The Guardian shows that just 29 per cent felt the standard of living of older people in the UK was currently at a good level, compared with 46 per cent who disagreed.

The article adds: “And the long-term outlook is even gloomier: just over 11 per cent expect older people’s standard of living to improve over the next 20 years, against 79 per cent who disagree. Over 70 per cent do not believe older people’s overall quality of life will rise in the next two decades, compared with under 16 per cent who do.”

More than 1,600 took part in this study.

What emerged was a perception of a rich-poor divide – those who are financially secure as they retire and those who are struggling in their old age.

“One respondent is quoted: “Pensions are worth nothing, care is being cut back, people are living longer, jobs are going digital. All this, to me, adds up to a hideous time ahead, potentially, for older people.”

More than three-quarters (77 per cent) do not believe public services are working in a co-ordinated way to meet the challenges ahead.

Clearly, there are huge challenges ahead and the spin doctors’ work is not fining a resonance with the elderly. Good!

But what I find most sad is the fact that elderly people have a growing unease about their future.

In the report, Claire Turner, head of ageing society at the Joseph Rowntree Foundation, says: “There are some huge challenges ahead . . .”

Indeed there are and successive governments’ delay at not properly addressing the issues of an ageing Britain has not helped. As they say in the Black Country, the pigeons are now coming home to roost.

We need more joined-up thinking on the delivery of care, smart systems to make social care sustainable and most of all, some realistic funding.

The uncertainties of future as we desperately try to prepare for the unknown are not only found in those who will need care intervention, but those who delivery too.

I read that housing group Anchor has been spearheading a campaign called Grey Pride, calling on the government to appoint a dedicated minister for older people who could pull together policy on everything from pensions and social care to transport and discrimination.

In the survey nearly 60 per cent said that government should take the lead – something that in my opinion has been lacking and I don’t suppose this latest research will change a single jot.

On the subject of dementia . . .

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A Channel 5 News and YouGov poll has found that one in five of us fear developing dementia more than cancer.

Some two thirds of those polled also fear they may also be diagnosed with the memory-loss condition in the future.

In a statement the Alzheimer’s Society said: ‘With dementia treatments a generation behind those for cancer, it is not surprising that people are more fearful of dementia. With dementia now in the spotlight, we urgently need to turns words into action and see tangible improvements in the care and support provided to people with dementia and their carers.”

Some 800,000 people live with dementia in the UK.

And just to add to the urgency of finding a treatment or cure, I read that foods high in compounds called advanced glycation endproducts (AGEs) could contribute to the build up of beta-amyloid, a major hallmark of Alzheimer’s disease.

The findings are published in the Proceedings of the National Academy of Science journal.

AGEs are found in cooked foods and have previously been linked to health conditions including diabetes and dementia. I don’t understand any of the medical stuff here , but simply,  according to the authors, AGEs suppress SIRT1 – a protein in the body thought to protect against neurodegeneration.

AGEs are found in cooked food, particularly high fat proteins such as animal meat. Vegetarian recipes suddenly seem very exciting to me. . .

Launch of dementia app at theatre performance

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There’s no stopping technology and it can help enhance the caring an ever-ageing population needs, bring it on.

Dudley MBC undoubtedly has lit a beacon with its Dementia Gateway initiative and its success has received national acclaim.

The pathway ensures that formal diagnosis is made by a dementia specialist and a lifetime of care and support is offered by a dementia nurse or dementia advisor.

The outcome is that with the right treatment and support many people who have dementia are able to lead active and fulfilling lives.

In a new development, the authority is launching a dementia friendly community app at a special theatre performance about the life of someone living with memory loss.

The new app is designed to give everyone the knowledge and confidence to support someone with dementia. I love it, can’t wait to get and copy and do a review!

It had been produced by the Dudley Council’s dementia gateway service in partnership with community interest company, Equip 4 Change.  People will be able to download the app from the council’s website to their smart phone or other device.

The app will be launched during a special performance of Finding Joy, a funny and moving play performed by award winning mask and mime company, Vamos on Wednesday February 26 from 8pm at the Cornbow Hall in Halesowen.

The play tells the story of Joy and how she, her daughter and grandson are coping with her memory loss.  The performance is suitable for people aged 14 plus.

People with dementia and their families are invited to attend the free performance.  People can request tickets by calling 01384 818723 or by emailing carers.network@dudley.gov.uk

In a Press release, Councillor Dave Branwood, cabinet member for adult, community and housing services, says: “Supporting people with dementia and their families is a key priority for the council but we’re also keen to develop the wider communities’ understanding of the condition.

“As the number of people with dementia is predicted to rise in coming years, our new app can provide information about its effects and the support available locally.  I’m delighted we’re able to launch this app during the performance of Finding Joy and I hope people come along to enjoy it.”

The launch of the app and the Finding Joy performance is part of the council’s work to develop a Dementia Friendly Dudley.

The council, with the Alzheimer’s Society, Equip 4 Change and other key partners have been working with local people and organisations to establish Halesowen as the first dementia friendly town in the borough.

This success will be built upon and rolled out to other areas in the borough as part of Dudley’s commitment to the National Dementia Action Alliance.

To find out more about Vamos go to www.vamostheatre.co.uk

Nutrition and Hydration Week: Going global

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Nutrition and hydration – two essential elements of wellbeing for those who are in the care loop. It’s a simple, but important message that will enhance people’s lives and aid recovery.

In fact, the message is so valued that national Nutrition & Hydration Week 2014 (17-23 March) is expected to go global.

The essential week of action to raise awareness and improve understanding of the vital importance of good nutrition and hydration across social and health care settings is now reaching reaches far beyond UK boundaries.

Activity has been confirmed and registered as far afield as India and Canada.

The three leading organisations of the campaign – Patient Safety First (PSF), Hospital Caterers Association (HCA) and National Association of Care Catering (NACC) – have put out the challenge to everyone involved in nutritional care in health and social care settings to use the week as a platform to demonstrate and share nutrition and hydration best practice, and illustrate how by making changes to eating and drinking habits people can improve their quality of life.

There will be a host of activities during the week, I’m sure, but one worth mentioning is the Worldwide Afternoon Tea on Wednesday 19 March.

I understand tea dances, a wartime themed afternoon tea party and cake events are already planned, with more events in the Midlands being added daily.

The fantastic mix of activities is limited only by imagination.

Neel Radia, Chair, NACC, comments:  “Nutrition & Hydration Week is shaping up to be an incredible week that will focus attention and efforts on the importance of good nutrition and hydration – a message that is relevant across the globe. By coming together in the spirit of education and sharing best practice and ideas we can create a long-term legacy that will ensure those entrusted to our care always receive the correct nutrition and hydration.”

Andy Jones, HCA Chair, is reported as saying: “The international support for the week shows that good nutrition and hydration is a global issue that presents the same challenges for providers in all countries.  One of the key messages in terms of patient feeding is the need to recognise the subtle but critical difference between ‘eating for good health’, rather than ‘healthy eating’.  

“With under-nutrition and dehydration leading to increased hospital stays and readmission rates, our focus must be on embedding the concept of nutrition and hydration as a key part of a patient’s recovery plan. The NHS Trusts’ support for the week is an encouraging sign of attitudes changing and progress being made.”

Hey, this is all good! It’s also another opportunity to do something local with a national platform and get some publicity. Why shouldn’t we be beating our own drum?

Here comes the bride . . . a happy reunion

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Olive and Ron Thelwell on

their wedding day

Residential care settings are an easy target. For mostly the wrong reasons our Press is often poor, so it’s wonderfully heartening to share this nugget of good news.

Olive and Ron Thelwell, husband and wife of over 60 years, have been reunited at a care home after their health needs forced them to live apart.

They were both placed in care setting in Crew and Ron regularly visited his wife. But the heartbreak of separation proved too much and Ron called on the help of The Elms CLS-run home to try and bring them together.

This is so sweet!

All credit to The Elms, they quickly established they could meet Olive’s care needs and “he asked her to move in with him.”

A wedding-themed party – complete with Big Day cake and lots of flowers – was organised by staff to make the occasion extra special.

Reported in the Care Industry News online magazine and the Crew Chronicle, Helen Clark, manager at The Elms, says: “We are delighted to have Ron and Olive living together again, and Olive seems extremely happy in her new home.

“Marriage is a very significant aspect within a person’s life and here at CLS we go to great lengths to try and uphold each resident’s wishes. Everyone has been touched by the happy story, which has sparked countless wedding and marriage reminiscences among the other residents.”

I know this should be a Friday story, but let’s have a bit of light relief a day earlier this week,

And finally . . . A big thank you to the Express & Star for publishing my letter praising the great response to the Dignity Action Day.

Beware explosive material: Drugs rationing for elderly

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Bloggers, campaigners for older people, Tweeters, the aged and young are making their voices heard over the latest drug criteria being tabled for the elderly.

Frankly, I’m not surprised. It’s not often I lose sleep, but I found my mind in overdrive in the small hours of this morning thinking about how the National Institute for Health and Care Excellence (Nice) is due to change the way decides which drugs can be provided.

The consideration criteria: The wider “societal benefits” and, of course, cost.

Simply put: If you’re old and don’t contribute a lot, you’re not going to get the pills.

Comments on the interenet this morning range from the “Department of Death (not Health)”, “genocide”, “sentenced to die” and “minimal treatment” to referenced to Hitler.

Emotive language, indeed. We all know that drugs have been rationed by stealth for a long time and consultants’ budgets can rule over life or death. But they are decisions taken professionally and there’s no formal framework of reference – or at least I’m not aware of one.

What makes me so cross it that now we are formalising this decision-making process. This is oh so dangerous and I’m amazed it has made its way through the mechanics of Whitehall without someone saying: Stop!

Melissa Kite, writing for the Mail online sums it up admirably. “It is not just that the elderly have worked all their lives, paid their taxes and should expect, in any civilised society, to be cared for once they are no longer ‘productive’.

It is simply, to me, morally unacceptable to quantify a sick person’s suitability for treatment based on their possible use to society.”

True.

If we hold to any Christian belief, the sanctity of life is paramount. And if we are agnostic or atheist, the same should be the case.

There’s a new phrase – “heath tourism” – where people from other countries arrived in the UK with the express purpose of falling ill and getting treatment. Maybe we should be addressing issues like this before we start writing off our older people.

This debate is going to run and run . . . and if I could set the clock on my own life, I’d choose to live to ripe old age just to spite these policy makers.

Elderly drugs ban: A moral debate

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There are those who may be brave enough to say drugs have always been denied the elderly if it’s deemed these ageing souls are of no benefit to society.

But mow there’s an official NHS line. The National Institute for Health and Care Excellence (Nice) is due to change how it decides which drugs can be provided.

The consideration criteria: The wider “societal benefits” and, of course, cost.

This story is everywhere this morning and the heavyweights have done a pretty good job with it.

Whether we like it or not cost generated with treatment needs to be balanced against results . . . and those results, according to a quote from Health Secretary Jeremy Hunt, would not discriminate against the elderly.

However, reported in The Express, Katherine Murphy, chief executive of the Patients’ Association, called the plans “disturbing and discriminatory”, adding: “Human life cannot be assessed in terms of cost and benefit.”

I think I’m with her on this one. You could argue this is a kind of drug rationing, but quite whether it’s morally correct is up for a big debate.

It seems to me that the older and most vulnerable of society are currently getting a bad deal. Their social care has ben slashed, the threshold of getting benefits increased and now it appears their economic worth is under scrutiny.

You take this line of thought to its ultimate conclusion and the results are very scary.

Quoted in The Express, Paul Green of Saga, says: “When you look at things from a pounds, shillings and pence perspective, you get some very curious results. Society should be driven by things that are morally right not just those which are financially correct.

“I think everyone accepts that there are limited budgets but to say that the distribution of drugs should solely be based on what your future economic contribution is going to be has lots of very uncomfortable undertones to it.”

He added: “The implications are that treatment is going to be denied to people based on their age.

“Quite naturally, somebody in their 60s, say, will potentially make a shorter economic contribution than somebody in their 20s.”

Where do we draw the margins on this? Are those who are prematurely denied work because of sickness or injury less valuable? Would they be in the same category as the elderly?

I understand care budgets and the fact that this is a deeply complex issue, but this carried moral overtones – or is that just with me?

I know plenty of elderly people – some in care settings – but they do contribute to society. They enrich lives, they receive and give love, they have compassion and passion, they laugh and they cry, just like the rest of us. Their social contribution is clearly not economic, but for me hugely valued.

I wonder what will be the moral epitaph written over the coalition? I have long lost confidence in any government to be a moral guardian and in the light of today’s news my stand is well justified.

You see, I just don’t get it. Life expectancy is longer, we are working longer and maybe drugs are being rationed. One comment to close heard in a conversation about the NICE development. “Government minister are high earners with gold-plated pensions. They view the elderly as a burden on resources, knowing that if they reach old age their security is copper bottomed. Us mere mortals, however, do not enjoy the same privileges.

Do the Danes have the solution to cut care costs?

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I know very little about the care models of Denmark – but I do understand it has one of the most socially progressive cultures of the world and that alone should be reason enough to check out what they’re doing.

Browsing the news last week while on holiday, I found that the country is undergoing a care revolution in a true Tomorrow’s World kind of way.

We are aware of technology monitoring care, but the Danes seem to be taking things a step further.

Copenhagen is a lovely city and it’s clean and perhaps I now know why.

Making their presence felt in its residential care homes is an army of robots that take some of the jobs of cleaners and carers.

There’s a robot that does all the cleaning – well, most of it. Fewer cleaners means more personnel available for residents.

I quote a piece in The Guardian online: “Over the last six years Denmark has cut the amount it spends on care for each person over 65 by nearly a fifth, according to figures from Statistics Denmark – an average cut of 10,851 Danish kroner (£1,200) per elderly person every year.

“The robots are a key part of the ‘welfare modernisation strategy’, Denmark announced last September. The aim is to use technology to cut 12bn kroner (£1.3bn) from the government’s welfare budget by 2020.”

This, I hope, is a refreshing change from the UK approach of compromising frontline services. I read some 84 per cent of managers in care settings employ one of these cleaning robot.

And it doesn’t stop there. For those who are mobile, there are drink machines with special adaptations to help those with shaky hands. I can’t imagine how that must work . . .

Finally, there’s a general change in emphasis in the delivery of care: More able-bodied and alert residents are encouraged to help those less able. Everyday rehabilitation is training focused – most, with the elderly. It’s not so much about what they can’t, but what they can do.

According to Jens Hoejgaard at DaneAge, government spending on practical help for the aged at their homes has been cut by a third since 2008, while personal care has been cut by only 12 per cent.

The policy is not without its critics, with some arguing it is the beginning of the end for the Danish universal welfare state. Hey, this has a familiar ring, doesn’t it?