By Debbie le Quesne

Archive for March 2014

Has Japan got funding for care right?

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Caring for the elderly in Japan was once the sole responsibility of family – but that’s changing as more buy in to long-term care insurance.

The costs of care in the UK for those who have resources are huge. Andrew Dilnot found that one in 10 will need to pay more than £100,000 from their own pockets.

Any alternative options are frankly unrealistic.

As the elderly population increases, so does the demand on an ever-shrinking pot of care money.

Sadly, what is emerging is a reduced number of people getting the social care they need as the bar for qualifying is set higher and higher.

The care bill, currently passing through Parliament, is the government’s response to the problems we all face. But what will it mean?

Holly Holder is a fellow in health policy at the Nuffield Trust wrote an interesting piece which was published in the Guardian online. In it she explores the Japanese model of modern care and how it could be funded.

She observes: ”Until 2000, publicly-funded social care was nonexistent in Japan; caring for the elderly was a family responsibility. There were two main consequences of this approach.

“First, there were many reports of neglect and abuse towards older people being looked after by family members. In a survey conducted by the Japanese government, a third of carers reported feeling ‘hatred’ towards the person they looked after. Caring also restricted the employment options of a growing number of Japanese women.”

A second issue was the development of a phenomenon known as “social hospitalisation”. Older people were being admitted to hospital for long periods – not for any medical reason, but simply because they could not be looked after anywhere else

A radical approach was needed and the Japanese government introduced long-term care insurance. It offers social care to those aged 65-plus on the basis of needs alone. The system is part-funded by compulsory premiums for all those over the age of 40, and part-funded by national and local taxation, says Holder.

I find it remarkable that the scheme is reported as being “popular”. Uptake of the services has far outstripped expectations.

In a nutshell, Japansese residents get access to a wide range of social care services  “with few of the barriers to access which exist in England.”

This all sounds great, doesn’t it?

Holder points out that one of the aspirations of the care bill is that setting a lifetime cap on care needs will allow for the creation of insurance products to cover against social care costs.

Holder adds: “The care bill is an attempt by government to redefine where the responsibility for caring lies; between the state, the family and the individual.

“Japan reminds us that while the balance between these three groups needs to be carefully struck, it is possible to introduce radical reform with public support. But Japan’s recent experiences should also remind us that we can expect the number of older people needing care to continue to grow. “

Birmingham: Children’s services gets independent commissioner

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Birmingham’s children’s services are getting an independent commissioner to oversee its work.

The move follows a government-ordered review after a catalogue of incidents made national headlines.

The review held back on taking responsibility for children’s services away from the local authority, but appointed former Labour health minister Lord Norman Warner to become the new commissioner.

Leaders of the Labour, Tory and Lib Dem groups on the council issued a joint statement in which they accepted ”that inspection and intervention have not yet had the desired impact on improvement” and a “unified, systematic and sustained approach across the city council, the Department for Education and Ofsted is the only way forward in making sustainable improvements.”

It’s a good move and for now all parties seem to desperately want to improve.

In the past we have seen the case of Keanu Williams, who suffered months of cruelty before dying, aged two; then there was the Ofsted inspection where Sir Michael Wilshaw, branded Birmingham a “national disgrace”.

One of the most demanding jobs in the care sector is looking after children and those private providers of this kind of caring can always be assured of our support at West Midlands Care Association.

I am heartened that the feedback from Birmingham regarding Lord Warner’s appointment is positive. He faces a huge challenge to re-establish trust with service users and to get morale back where it should be.

My hope is that Sir Michael will prove an inspired leader in his task and goodness knows, the whole care sector is crying out for one at the moment.

Walsall dismissal: Why all the secrecy?

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The former executive director for social care and inclusion at Walsall, has been dismissed.

In our local newspaper I read the sacking followed an investigation after what’s described as “issues” were raised in the department.

Paul Davies had been suspended from his duties for more than a year.

In a time when transparency in the care business is needed more than ever, it worries me that I read in the newspapers “bosses have remained tight-lipped over the details.” Even my dear old Beeb was unable to break the silence.

Law firm Bevan Brittan was called in to carry out the investigation and Mike Bird, the Council Leader, issued a Press statement, which was reported in the Express & Star last week.

According to the newspaper, Mr Bird said – and I quote the piece: “Mr Davies had breached the rules set for a chief officer, but would not reveal the full details of the case.”

The report adds that the allegations against Mr Davies were ”over a period of just short of three weeks” . . . he had “suspended for just over a year” . . . and “the circumstances were due to procedures, rules and issues surrounding the chief officer’s code of conduct.”

While I do not support what has become known as red-top journalism, secrecy adds nothing in helping the cause for social care. Currently, as cuts bite deeper and with more gloomy forecasts on funding emerging, the industry is awash with rumours and this approach adds more.

If care fails, the issues are very public – no provider or carer is spared the details of any misdemeanor.

I’m left asking why, as the head of this kind of care delivery, such a dignified approach has been taken?  I’m sure lawyers aplenty have guided this outcome and indeed the shutdown of information, but indeed it smacks of double standards.

Written by debbielq

March 31, 2014 at 10:52 am

Care quality alert as screw tightens on the NHS

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Social care and the long-suffering providers who serve its needs are not alone when it comes to underfunding.

In a week of harrowing newsbreaks, I see that NHS acute services are to face more cuts when 2015/16 changes to funding arrangements will see £2 billion transferred to community health and social care provision.

The warning comes in a parliamentary report.

The impact for the NHS is already causing waves, while social care operators in the private sector suspect the cash injection will be far too small to plug the holes.

The House of Commons Health Committee highlighted a warning from the chief executive of health regulator Monitor, David Bennett, that the cash transfer, resulting from the introduction of the Better Care Fund from April next year, will present a “huge challenge” to NHS medical and surgical treatment mostly provided in hospitals.

The committee warned that the current model of care is “not changing quickly enough” to cope with demand and funding pressures.

As a result it appears there is a threat to both the quality of care received by patients and the financial stability of individual providers.

Now the committee has called on both the regulator and NHS trusts to “address the need to develop different structures to meet changing needs”.

“At a time when NHS providers face an unprecedented need to change the care model, Monitor must be a facilitator of change, not an obstacle,” says the report.

The committee stated (published in the Guardian: “The model of care provided by the health and care system is not changing quickly enough, with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided;

“These pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015.”

And sadly, the committee adds that as the financial screw tightens the challenge for Monitor in supporting trusts in financial difficulty is likely to increase.

Social care has always been the poor relation in the care loop and the transfer of this funding from the NHS I fear will do littler other than to deepen the divide between the two essential disciplines.

Care sector zero hours contracts: The price of an economic uplift?

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Listen to the TV headlines, catch the soundbites and film clips of a smiling Chancellor and we’re telling the world and its wife we are in economic recovery.

True, the figures are encouraging – but at what cost? While the mega-rich seem to be getting richer, those who are are lesser mortals are not yet really enjoying the same mirth as Mr Osborne.

You would like to think – though to do so would be naive – that economic recovery would be reflected some in the care sector. But data from the Office for National Statistics suggests something different.

Some 583,000 people are employed on a zero-hours contract, with the largest numbers in health and social care, hospitality and administration.

The growth of zero hour contracts for me spells out a very clear message that our economic stability is a best fragile. Few want to invest in more moral contracts that dictate holiday entitlement and set hours.

I can understand it too. Do you know that more people are employed on zero-hours contracts in the public and third sectors than in the private sector?

Economic restraint, the cuts and uncertain futures drive this kind of employer purchase.

According to the figures more than 300,000 workers in the care sector are employed on zero-hours contracts, including a whopping 60 per cent of domiciliary care workers.

My biggest concern is that if our employees are given inadequate terms and conditions, how will that impact on the care we give?

We have seen scandals aplenty and the 15-minute call debate still rumbles on.

So many carers and care managers feel their contributions to reforming social care are undervalued. Personally, I don’t believe there is a single politician who really knows the true worth of when out industry achieves.

I know too, that many of our West Midland Care Association members desperately want to up the pay and conditions of their staff, but their hands are tied because the one-trick pony cut, cut, cut policy plays out its worst scenarios in the care sector.

Dignity, choice, excellence in care and personalised packages are great goals.

While you celebrate, Mr Osborne, the economic uplift, please spare a thought for those who are helping you achieve it. We spend much out our time in the care business doing risk assessments on care packages that benefit the clients. Perhaps it would be worth considering doing a similar exercise on those private sector providers which are paramount to delivering the government’s Care Bill reforms.

We really are worth it!

Pensions and the care costs perils of cashing in

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George Osborne has given all of us more freedom to handle pensions. The up side is that we can cash in our pension pots and for those who have been fortunate with investments, it opens a plethora of financial and/or self indulgence opportunity.

The down side, people could lose their right to free social care ­– something that has only just emerged from the Budget fallout.

At the weekend both the Joseph Rowntree Foundation (JRF), which works to combat poverty, and Age UK,  Britain’s largest charity for the elderly, said people without large assets who cashed in pension savings could become trapped into paying care costs which they would have avoided if the money had remained invested in a pension.

Excuse me if I seem a little cynical here, but does anyone else think that there many have been a hidden agenda in Mr Osborne’s generosity about investments.

It all comes down to what the pensions experts say as assets. I’m all for reining in the Nanny State and letting the elderly take responsibility for their own actions. But for some a word of caution would be wise.

A piece in the Guardian said: “Under plans for the future funding of social care, to be introduced in 2016, money held in pension schemes is not counted as an asset when calculations are made about how much an individual has to contribute to their own care.

“But if the money is taken out of a pension and held as savings or put in another investment it would be counted.”

The JRF warned . . .

“Should pensioners buy property or put pensions into their savings, that will be taken into account as part of their asset base, which could mean they have to pay for care costs in later life.”

And Age UK, said people would need to bear in mind that drawing down on their pension could make them ineligible for free social care.

I wonder why this wasn’t said during the Budget speech?

The fatal flaw that will cause the Care Bill to fail

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Writing in the Guardian Rachael Byrne, executive director of care and support at Home Group says: “The defeat of former care minister Paul Burstow’s proposed amendment to the Coalition’s care bill left those of us in the business of delivering social care frustrated, but also questioning if MPs fully understand the gravity of what is at stake for society as a whole?”

And she adds: “The abstention of Labour MPs reflect the findings of a Home Group commissioned survey, which revealed that almost all MPs questioned had no experience of receiving or delivering care.

“A majority also had a dim view of the current state of social care and future plans. Even the National Audit Office is now getting in on the act with its recent warnings about the dangers in the way we intend to provide care.”

She goes on to say that social care is being rationed under the current sytem and while much of the Care Bill is to be applauded, few MPs have a real clue about what’s needed.

I quote: “So while we welcome much of what it is doing we also have to recognise that we’re only half way there. We need to get the implementation right – eligibility has to be set at a level that means people that need support to do the basics get it.” True!

I agree we need to see preventive care, care support with out domiciliary providers and a shift in thinking that out elderly are not on the fringes of society.

In short, although the Care Bill has some excellent content, we are a long way off from where the care industry wants it to be.

We have a golden opportunity to get it right. Let’s not miss it.

As Byrne says: “The government needs to make sure that everyone who needs care is captured in the system. We think the bar should be set to allow people to live independent lives, not just exist. We are concerned that if they set the bar too high, people who need support will be shut out of the system.”

And rooted in basics of this legislation is the the fatal flaw: Under-funding.

Councils need to be investing more just to keep up with demand. But instead they’ve been forced to reduce their budgets,” says Bryne.

Will I ever stop banging thos drum? No! We need future-proof investment and Bryne estimates it to be a £2.8bn black hole.

Reform clearly has a cost. For me, it’s a wise investment and a moral one too. Election fever wil soon be with us . . .let’s see who will pledge to pay the piper.

Landmark care laws for Wales and . . . the Budget

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A landmark Bill which aims to revolutionise how social services are delivered in Wales passed its final Assembly hurdle this week.

It represents a huge shake-up of care and for those who know me well, I have high regard for the Welsh – they know a thing or two.

The law aims to equalise standards of care across the country, will create a single, national adoption service and see the introduction of safeguarding for vulnerable adults for the first time.

It has been described by Ministers as the biggest and most complex piece of legislation to have ever been put before the Assembly since it was granted law-making powers in 2011.

I will be watching its development as the changes roll our carefully. Interestingly, at the final hurdle,  a Plaid bid to outlaw zero-hours contracts in the care sector was voted down by Labour and the Conservatives, with the Deputy Minister for Social Services, Gwenda Thomas, questioning whether it would be within the Assembly’s powers.

Assembly Members voted by 53-5 to pass the law, with the Liberal Democrats voting against, I read.

The face of caring is changing across the UK. Our own Care Bill has the potential to improve social and NHS care for all of us, but there’s a big “but . . .” that hangs above all the rhetoric and fine thinking. Yes, the frame is now almost in place to build upon, but – and here it is – funding to finance transition must be released to us.

George Osborne placed savers at the heart of economic recovery in his Budget with new deals on pension funds. For a few moments I though “yes, this could help free up funds and inspire better investment”.

And then I watched the analytics unfold on TV. Despite economic growth, which is good for the care sector, austerity is still on the horizon with no real plan to ease the pain the care sector and its clients are feeling for years to come.

What has been defined as the “wriggle room” of where Mr Osborne can find additional savings is a scary prospect. There seems to be a one-trick pony in this race and it involves slashing local authority budgets. The cuts are then decanted into the community, and not least, the care industry.

If the Chancellor believes that by introducing a new Pensioner Bond to help out the over 65s, I believe he’s missing the mark by a country mile. True, the interest rates are tempting, but few of the pensioners our care providers look after have disposable savings income to take advantage of the initiative.

If Mr Osborne really wants to help the elderly, he should be thinking of releasing his stranglehold on funding for their good care!

Arts group takes on day care with a difference

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With day care decimated in the Midlands region, I’m hugely encouraged to read that an arts centre in south-east London is being proactive to help isolated and lonely senior people.

Meet Me at the Albany is a creative day club for the over 60s led by artists based at the Albany.

And a wide range of stimulating stuff is going on with circus workshops, performances of Neo Soul music, and poetic word projection to accompany cups of tea.

“The bold new approach to day care for the isolated old is spearheaded by the Albany and Entelechy Arts, and is a response to a public health agenda focussed on supporting the continued independence and healthy aging of older people’” so says Jackie Brook of Care Industry News, the online magazine.

For me, this is a great initiative. I’m all too aware of the breaking effects of isolation and loneliness and it’s a lovely way to embrace our elderly.

Meet Me at the Albany provides a regular meeting place where participants can become involved in creative workshops, experience performances from leading artists or simply sit back and enjoy the atmosphere, as well as enjoying a home cooked hot meal and beverages for just £6 a day.

Please, can we have something going on like this in the West Midlands?

‘Guilty secret’ to be exposed by care reforms

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Social care has always been the poor relation in its inextricable partnership with the NHS. It’s been a fact of life for carers and care providers for as long as I can remember.

But I read with growing interest that reforms in the Care Bill could finally truly expose the extent of the fiscal restraint which the care industry endures.

Underfunding, according to the Guardian newspaper, is about to go public in big way.

I quote: “The reforms, including a cap on what people will have to pay for care and a deferred payment scheme so that people will not have to sell their home, will cost local and central government a great deal of money while failing to meet the expectations generated by this complicated and widely misunderstood legislation.”

The statement is backed by a County Councils Network survey that reveals “overwhelming concern that the changes are going to increase pressures on social care budgets.”

This week the Local Government Association and social care leaders warned there is a £135m shortfall in the new money for councils to implement the Bill.

The wrangling over figures has become very political as you’d expect with the Guardian reporting that the Department of Health recently accused the LGA of publishing misleading figures. Oh dear.

The National Audit Office findings say councils spending on adult social care in 2012-13 was £19bn – an eight per cent real terms cut in two years. And it adds that around 85 per cent of adults over 65 live in local authorities where the eligibility threshold only meets substantial or critical needs. Informal carers and the NHS pick up much of the rest.

Emotive as it may be, the Guardian goes on to add that social care cuts are local government’s guilty secret. While local media reports millions being taken out of budgets and councillors highlight service closures when railing against plummeting government funding, the complexity of the care system means few people have a clear picture of what is being lost and what remains.

This observation is so true. Within the sector and with the help of analysts and industry thinkers, it’s almost impossible to work out just how great the losses are. The public and amazingly, our MPs, remain silent – something that has always puzzled me.

The true chaos of the cuts will be fully revealed as under-funded machinery – the Las and private service providers – will be made known when the reforms of the Care Bill are rolled out.

I quote the article again: “The NAO spells out that central and local government simply do not know whether the care and health systems can continue to absorb the growing pressures, and if so for how long. The unknowns include how many care providers will be driven out of business, and how quickly.”

Indeed, closures of businesses are already happening, and suspect that these are but the birth pains of something much more devastating.

Sadly those at the sharp end of the cuts to social care do not have a voice and equally distressing is the fact that they are generally the only ones who truly understand the extent of them.