By Debbie le Quesne

Archive for July 2014

Good homes awareness is key rather than ‘minimum standards’

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A well-respected former Dudley care commissioner has added his comments to the debate on the new measures to improve failing care homes.

Mike Marshall RGN, RMN, MIHM, Dip.HSM, who paved the way for the West Midlands borough to up its care standards, says the Care Quality Commission proposals mirrors a former National Minimum Standards of Care ratings initiative.

But this system “failed to work, so few home reached satisfactory standards of care,” says Mr Marshall.

“As a Local Authority Social Care Commissioner of many years standing I

regularly identified care homes of poor standards.  These were often

recognised by CQC in something called the Local Area Market Analyser (LAMA).

“Nothing was done to address poor standards by CQC apart from issuing

‘threatening notices’ that would have to be adjudged by ‘CQC’ legal teams

rather than those directly involved.

“One such home I was monitoring singularly met none of the standards of care and CQC were wary of taking action pending ‘legal team’ involvement.  

“My solution to this was to involve two other local authority councils with social care responsibility to revoke the contracts for placement.  This involved the safe movement of many residents to enter other care homes.

“Despite concerns for resident health and safety there were no untoward issues associated with the moves.

“There are indeed good and excellent care homes that the public should be

aware of, rather than the ‘meeting of minimum standards – or not.”

Brave stand, Mike, but very true!

System to improve failing homes sparks concerns

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The system used to improve failing is to be extended to care homes, the BBC announced last week.

The Care Quality Commission (CQC) introduced the process a year ago at 11 failing trusts.

And the good news – most have made progress, though just five have been or are being taken out of special measures.

Health Secretary Jeremy Hunt said the scheme would be introduced for care homes and home-care agencies next year. It will mean 25,000 services are covered and could lead to the closure of those that fail to improve.

The Beeb explained that In the hospital sector, special measures has involved: Closer scrutiny by regulators; management changes; “buddying” schemes with successful trusts; and an improvement director being parachuted in to oversee any necessary changes.

Details of the regime for care homes are still being worked out, but is likely to “rely on shorter deadlines” to shock the providers into action.

“The first services will be placed in special measures from April, as the underlying ratings regime will be rolled out in the social-care system from the autumn’” the BBC says.

The scoring gives health and care services a rating of outstanding, good, requires improvement or inadequate.

CQC social care chief inspector Andrea Sutcliffe said extending the failure regime to social care would drive up standards, the Beeb reported.

The National Care Association said that anything that safeguarded vulnerable people “has got to be good”.

Nadra Ahmed, chairman of the National Care Association, was reported as saying that she said she have concerns about how the new measures would be implemented and the financial pressures.

Former Dudlley commissioner Mike Marshall RGN, RMN, MIHM, Dip.HSM had this to say: “As a Social Care Commissioner of many years the proposed new inspection scheme will be useless unless time is spent with the people who use the care home services.  

“Relatives are also a good proxy measure of satisfaction for people with a dementia. 

“Too much CQC time is spent office bound within care homes.  Many who ‘inspect’ are not appropriately trained or qualified – not only my view but those of care home proprietors, particularly in the West Midlands.

“Social Services, who place the majority of residents in care homes, also carry a responsibility for driving up standards.  Often their monitoring staff is insufficient or indeed lacking in experience to undertake the role adequately.  I have witnessed, whilst working in the North West, monitoring staff seeking to emulate the role of CQC instead of contractual issues and higher standards of actual care.”

Mike was the highly respected commissioner who worked in the Dudley borough for many years. His work significantly contributed the higher standards of caring that we have today.

The time to take part in funding consultation is NOW

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Unless a high-speed railway is about to be directed through your garden, why would a member of the public take the time to respond to a government consultation?

Take, for instance, the consultation from the Department of Health on the rules affecting who qualifies for care and support, which was published in June.

Much too long and boring?

Not so!

Independent Age points out that it’s one of the most important consultations for years but is concerned too little is being done to publicise it.

There is a real danger the only people who are responding will already be known to government. Local government will respond no doubt – and rightly so. And charities will be doing their best to present a powerful case for more funding so adults with significant care needs can receive state-funded care well into the future.

Which, according to Independent Age, begs a burning question” Whose consultation is this anyway?

Where are the voices of older and disabled people, those of care and nursing home owners and what more can we do to ensure people with care needs are directly influencing the consultation outcome?

In particular, the outcome will have a huge effect on the level of local authority bed payments being agreed in the future. Dare we miss having our say” No way.

The Care Act 2014 is an interesting piece of legislation which will change the dynamic of the care industry.

Its impact on the South of England where they rely heavily on the public to fund their own Care will be dramatic and will see the cost of care for the Local Authorities go up. There will be less impact here in the West Midlands, but it could mean that homes will need to introduce larger top-ups as localauthorities will cover less. There are other part of the legislation which will affect the industry, but truth be told, it’s what is being consulted on between now and mid-August that really matters, says Independent Age.

We all have an opportunity to a say about how generous the publicly-funded social care system will be and who it should support.


Get the message: We need to promote frontline care

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WMCA Chief Executive Debbie Le Quesne at

the Houses of Parliament

20140710_143747 20140710_125325

Debbie all set to represent the West Midlands in a meeting

with Glen Mason, Department of Health director of People,

Communities and Local Government

“We need to promote the frontline carers” – that’s the message coming from the Department of Health director of People, Communities and Local Government.
Speaking to care association heads in a Houses of Parliament meeting, DoH chief Glen Mason, spoke of the need to recognise how important the role of carers is and how necessary it is to recognise the invaluable work they undertake.
As a representative of West Midlands Care Association, I attended the meeting last Thursday along with other Local Association representatives from around the country and we explained how the Great British Care Awards initiative was an ideal opportunity to honour the often-ungsung heroes and heroines of the sector.
The London trip provided a useful platform to make Glen aware of the issues which affect care providers.
During lunch we also spoke on the mounting pressures on health and social care delivery and discussed positive steps in working together to get the standing of social care to be recognised at least as an equal partner and in some cases as a superior service.
We looked at examples of good practice and discussed ways that the Association may wish to get involved to improve things within the sector.
We also spent time discussing real people and real situations, what care approaches worked and what could be done better.
The group also discussed opportunities to help each other around the country, highlighting things that are working for Associations and things that are not.
Although Glen has a high powered job, he is at heart a Black Country lad, having come from Wolverhampton and been awarded an honorary doctorate from the city’s University in 2012. It was a real privileged to have a nice chat with him about down to earth things.
Since returning I have been busy capitalising on trip, chasing people for contacts and details of those industry ‘tools’ that we can utilise in the West Midlands.

Written by debbielq

July 14, 2014 at 7:35 am

Posted in Uncategorized

Co-operatives: Is this really the way forward?

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Not to be confused with The Co-op, Co-operatives UK is a national body that campaigns for co-operation and works to promote, develop and unite enterprises.

And it’s just possible it might have come up with a trump card in these times of care funding austerity and at the same time help restore public confidence in the sector. We’ll have to see when all the cards are on the table . . .

Published in a national newspaper, Pat Conaty, a research associate at Co-operatives UK, tables this question: “Could the active membership and co-operative ownership of workers, service users, volunteers and family members rebuild public trust in services and put an end to cruelty and neglect through a socially inclusive solution where the system of care is owned by the recipients?”

This week also saw the launch of the UK and Wales co-operatives research report Social Co-operatives, a Democratic Co-Production Agenda for Care Services in the UK.

With austerity measures aplenty, the publication identifies opportunities for co-operative approaches to deliver social care across the UK. It’s a brave agenda, but the logistics of management and accountability worry me.

So many stories of bad caring have dogged the industry and more recently the Winterbourne View scandal and the Southern Cross crisis have served to erode public confidence even further.

But what if there was a democratically accountable ownership model for health and care services, asks Conaty.

In a growing number of countries, from Europe to Canada and Japan, social care co-operative models are being rolled out.

Conaty believes these approaches can develop in the UK and would directly empower the people receiving care. Personally. I’m cautious. I have spent time studying care in Europe and there is a strong embedded culture of wives giving up work to care for elderly parents of in-laws. True, things are changing, but slowly. It’s important that people don’t think the co-operative approach is the default setting in Europe.

She adds: “We have researched social co-operative approaches extensively and the Italian co-operative movement provides a good example. The movement has been at the forefront of innovation in the provision of social and health care services.

“During the fiscal crisis of the late 1970s it pioneered a social solidarity system that enabled workers, volunteers, service users, family members and providers of co-operative capital to become member stakeholders in the governance and ownership of care services.“

Pretty radical, I think, but it’s still functioning. Most Italian social co-operatives have fewer than 30 worker-owners and less than 100 other stakeholder members.

Development in the UK has been slower but some co-operatives in the UK are now delivering home care.

Conaty says that in Wales, co-operative approaches to care delivery are specifically advocated in the Social Services and Well Being (Wales) Act which received royal assent at the beginning of May. Whatever may develop in the UK, be assured I’ll be fighting the corner for the private sector to be fully engaged. I don’t believe co-operatives can be a substitute for what we already have in place, but working alongside them seems a possible way forward. Watch this space. . .


Birmingham’s sticky questions over online procurement glitches

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It was standing room only when West Midlands Care Association hosted a questions and answer meeting over Birmingham members’ problems with the online portal and procurement system they now have to use. Birmingham care services commisioner Jules Gregory and Elizabeth Ross, the city’s Assistant Director for Commissioning, attended the regional association meeting on Thursday (July 9) to address a raft of problems encountered by service providers as they have attempted to place tenders.

The Sproc.net site, that is designed to deliver the end-to-end process of commissioning services, including stimulating supply through to payment, is under fire from association members. The system has been used to mini tender for home care for several years and was “working quite well” the meeting heard, but problems with the more recently introduced Care Home section have emerged.

Members reported there concerned by the number of cancelled tenders being flagged up without any understanding of why, they also reported placements not going through the system which Jules and Elizabeth said would cause problems with payment later in the process. Both Jules and Elizabeth were puzzled by the scale of criticism, but said a new manager had been appointed to ensure that in the future more detail on how to secure contracts will be uploaded onto the site.

They also added that it was still the job of social workers to find the right place for their service user and a working together approach was needed to ensure right procedures were followed so that payments for services could be made quickly.

Developer Matrix SCM has created a new help desk number 0871 474 0332 that providers can use if they need to reset their password to use Sproc-Net, or they have any technical issues using the system. Providers can continue to use the Commissioning Enquiry Desk number 0121 303 3893 if they have any other queries in relation to the Sproc-Net system.

King’s Fund sound alarm over shortfall in care funding

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Budget cuts of 26 percent will threaten the sustainability of social care the Association of Directors of Adult Social Service warned.

As I have previously blogged the organisation said the results of the annual budget survey show that while spending on adult services has reduced by 12 per cent since 2010, the amount of people needing support has increased by 14 per cent.

Put simply, the figures don’t stack up and councils have had to make savings equivalent to £3.53bn. David Pearson, president of ADASS, was quoted in The Guardian as saying: “As resources reduce and need increases, directors are increasingly concerned about the impact on countless vulnerable people who will fail to receive, or not be able to afford, the social care services they need and deserve.”

The warning has drawn comments from Richard Humphries, assistant director of policy at the King’s Fund: Again quoted in the Guardian online, he says: “This survey once again highlights the enormous pressure on social care budgets.

“Despite the best efforts of local authorities, this will result in further cuts to services and fewer people receiving support.

“Worryingly, half the money being transferred from the NHS budget to support better joint working between health and social care is now being spent on protecting social care services from budget cuts, rather than driving integrated care and other service changes needed to better meet the needs of patients and service-users.”

I would dearly like to bring some positive, creative solution to this ongoing debate, but frankly like so many in the care sector, my day of making savings through working smarter is nearly through. Everyone I know has cut, restructured, re-invented and re-thought the way they work to deliver more efficient care. There has to come an end – it’s an inevitable economic principle – when the wheels will finally drop off social care machine.

The King’s Fund embraces some of the finest minds in the country and the government would do well to heed the alarms.

The only real lifeline we have is the new Care Act and the Better Care Fund that focus resources to help manage their own care and hopefully save billions. Critically, however, we need monies to roll out the new working methodology – cash, it appears that is already spent on “protecting social care services from budget cuts.”

How commissioners can play their part in social care

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In its June bulletin The Social Care Institute for Excellence offers a wealth of care information, comprehensively covering everything from commissioning of home care to whistleblowing.

At the risk of an information overload, the document is well worth a scan. With a growing number of people over 65 in the population, the new SCIE guide suggests what commissioners can do to improve how they assess, plan, contract and monitor home care services for older people with complex needs.

President of the Association of Directors of Adult Social Services, David Pearson, says: “This guide will help commissioners be clear that we are responsible for ensuring that a high quality and sustainable care market exists in our council areas. This is a responsibility which we share with our NHS colleagues.”

He publication highlights latest research findings on social care and offers some practice examples of good work in this area. Aimed at health and social care commissioners of home care services for older people with complex needs, the guide lists more than 20 tasks to ensure people get what they need to keep them out of more costly hospital and nursing environments.

So much of it is commonsense, with recommendations falling into the areas of assessment, planning, contracting, monitoring and further research. But is does – and very successfully – underpin what should always be fundamental criteria.

A dignified life, supported in the community, is what everyone wants to aim for. And the cost of doing so must be seen as an investment into the NHS.

My concern is that all investment monies will be viewed as overspend, but the economies of scale here are huge. Initiatives like the Vitality Partnership to assess needs in the community, particularly for the elderly, and head off costly hospital admissions.

We must drive forward flexibility, person-centred packages that marry successfully social care and the NHS, create diversity among providers and monitor outcomes against emerging needs.

The SCIE is just one of many wheels in the cogs of change. It’s heartening to see that funding issues have also been addressed, but that’s worth a blog in its own right.

Clearly apparent is a genuine commitment to partnership, something that West Midlands Care Association has been driving forward for years. I can only hope that every commissioner takes the time to read the SCIE observations, findings and advisories.

‘Make or break’ time looms for social care

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Councils in England face a funding gap of £5.8 billion between March 2014 and the end of 2015/16, new Local Government Association analysis shows.

The figures are scary and according to Care Industry News, the online magazine, local authorities will need to make huge savings equivalent to 12.5 per cent on their total budgets before next April.

Successful integration of health and social care is vital, says the LGA to stop the care system from collapsing.

The £5.8 billion shortfall in council budgets will be caused by a combination of reduced government funding and rising demand on services – particularly from the elderly.

The funding gap in adult social care alone already amounts to £1.9 billion by 2015/16 – based on council adult social care budgets in 2013/14, says the Care Industry News report.

My abiding fear is where new saving will be made. Already we have heard pledges to protect spending on adult social care next year as much as possible, but I can’t help worrying worse is to come.

Next April, will mark a critical point for adult social care in England with the pooling of £5.4 billion from councils and the health service. The Better Care Fund will aim to improve care for older people and reduce financial pressure on councils and the health system through stopping lengthy waits for discharge from hospitals and avoiding unnecessary admissions to care homes.

Initiatives like the Vitality Partnership are already under way to make a difference in the community and funding for such work has been assigned for the year.

But the scale of savings which need to be found next year illustrate the urgent need for the Better Care Fund to “quickly succeed in radically improving the way public money is spent on looking after England’s elderly,” says Care Industry News.

Indeed, 2015 I believe will be make or break for social care and council leaders are saying the same.

Quoted din the online article, LGA Chairman Sir Merrick Cockell says: ”In recent years, local government has worked tirelessly to save billions while protecting services for those who need them most. But the scale of the challenge facing local authorities next year is stark. Council finances are on a knife-edge and the old way of doing things – including the way we care for our elderly population – just won’t work anymore.

“Next year will be a make or break moment for adult social care, for local services provided by councils and for the NHS.”

Central to the rescue mission is the introduction of the Better Care Fund (BCF).

“Neither councils, the NHS or England’s elderly can afford for this not to work,” he adds.

And I have just returned from a meeting about the Better Caring Fund. Interesting – it seems the Government is still “deciding and discussing,” while local authorities and CCG’s are now too far down the line to stop in what seems a perfectly reasonable use of money. Spend the money to help people stay healthy in their own homes or care homes and spend a whole load less on acute hospital admissions.

More cuts to an already financially struggling industry or cutting back on the BCF would be catastrophic.  The challenge ahead is enormous and I for one have everything crossed that all will be well.