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By Debbie le Quesne

Archive for February 2015

Conditional living wage contract adrift from reality

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Islington council appears to be the only local authority that has gone as far as offering a conditional contract based on living wages being paid to staff.

I hear a whisper too that Birmingham is considering following the same path.

As Birmingham providers do not have the extra £30 per week per resident to cover this cost, it would mean residents and their families would have to find deeper pockets.

 

In the Guardian online Social Care Network, Janet Burgess, deputy leader of Islington council, is quoted as saying: “I am really pleased we have got one care home to pay the London living wage. It is frustrating other care homes do not see the great value there is in paying a decent wage for what is a very demanding job – the benefits affect not only the care workers themselves but also the organisation.”

She concedes that local authorities should recognise that they have to contribute some of the extra costs of the living wage. That’s big of her.

Sadly for me, some of the comments that follow in this piece are adrift of reality.

Charlotte Fischer from Citizens UK, which founded the Living Wage Foundation, would like to see non-payment of the living wage in the care sector tackled “to restore dignity for both the care recipient and the care worker.”

I’m obliged to ask: How Charlotte would propose to fund this extra outgoing.

Heather Wakefield, head of local government for Unison, wants the owners of care homes to “stop looking to provide care on the cheap, Care home employees often work long hours and their jobs can be challenging – any employer who recognises this by paying their lowest paid staff no less than the living wage will certainly reap the benefits,” she says.

Hmm . . . For many, Charlotte, especially in small business environments, the economic outcomes would be certain closure. How then would care providers care providers reap ‘benefits’?

I have campaigned a lifetime for quality, sustainable care and my comments here are drawn from a wealth of experience. I applaud the ethic of a living wage, but reality tells me that although Government nods approvingly at such initiatives, there is no release of purse strings that could make it happen. Ultimately, local authorities can spend only what monies they are given or raise at a regional level and for many of them the pot is empty.

If LA’s raise the fees, ages will go up – it’s as simple as that. However, in care nothing is black and white. Many carers work part-time and their incomes are supported with tax credits. It appears by paying the living wage, tax credits could be compromised and some would actually be worse off.

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The living wage: Concept of fairness – at a price

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Found an interesting piece online with the Guardian Social Care Network all about the thorny subject of pay – the living wage to be precise.

The article notes “care work has become synonymous with poor pay, zero-hours contracts and long hours. “

But it adds there is a split in the sector in its response to pay.

Let me quote: “This surprising split within the care sector has seen 20 homecare providers out of about 5,000 become accredited living wage employers, paying the living wage of £7.85 an hour or the London living wage of £9.15 an hour, whereas there are only four care home providers out of over 8,000 in the UK similarly accredited.”

The article informs that an estimated 1,200 homecare workers are paid the living wage, while the number of care home staff receiving it is thought to be around 700.

The article rightly observes that “part of the reason some homecare providers are more willing to pay the living wage seems to be pressure from local authorities, such as Islington and Southwark, that are committed to being living wage employers.”

It’s an enlightened approach, but one that by economic definition is going to be regional. The South has more than here in the West Midlands. More wealth, more private clients, more better paid jobs . . . generally more of all the wealth generators.

According to the article, Michael Vaughan, owner and manager of Red Rocks care home on Wirral, which pays the living wage, believes councils are too scared to pressure care home providers as then they will have to pay a higher fee to those homes.

Indeed!

He claims to have seen pressure placed on homecare providers by councils to pay the living wage, but not on care home providers.

He is quoted as saying: “I think the local authorities have a major part to play in this. The large majority of care homes up and down the country rely on socially-funded clients and the wages of the staff take up half of the fee for each resident. I know care homes that receive social services funding and they would love to be able to pay the living wage.”

That’s very true. Many of the West Midlands Care Association providers have a genuine desire to reward better their staff, but the local authority fees will not sustain such a privilege.

He also thinks homecare agencies have been more forthcoming in paying the living wage because they have fewer overheads than care home providers.

Mr Vaughan has been paying the living wage to his staff for well over a decade and admits he can only do this because the large majority of residents in Red Rocks are privately funded.

As I’ve mentioned in a recent blog, charging the right fee is crucial, but the pain of reality is readily captured in comments from Ian Smith, chairman of Four Seasons, the largest care home provider in the UK.

According to the Guardian he believes it is just not financially viable for most care homes to pay care workers the living wage, and thinks it would result in closures.

I agree.

He says: “The living wage is a concept of fairness that few would argue with, but it has to be affordable and right now for many employers that just isn’t the case. Due to financial constraints in the aftermath of the international financial crisis, the fees local authorities pay for care home places have reduced by 5 per cent in real terms over three years while non-discretionary costs of wages, energy, food have risen.”

With payrolls the biggest single cost item for operators, minimum wage increases alone are challenging. Add on top of that living wage margins and there is scope for real trouble.

The debate will doubtless rumble on and I have no magic wand. Sorry.

Intermediate care – please light the touch paper

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Caring Times Editor Geoff Hodgson recently blogged about the value of intermediate care – an election firework, I suspect, that’s not yet seen a box of matches.

He writes: “Several years ago I visited a privately-run rehabilitation centre in Germany. The clientele was varied – a lot of older people recovering from strokes and hip operations, middle-aged people getting over their bypass surgery and young motorcyclists and skiers with an assortment of fractures, all tended by a small army of specialist physios, OTs and highly trained care workers.”

He was left in no doubt that this model works, one official telling him: “We get people back home or back to work very quickly.

“The intensive rehabilitation we deliver means we maximise the benefit of the hospital treatment they have had, reducing the risk of complications and greatly minimising readmission to hospital.”

This is a model that, according to Geoff’s German health service people, wins financial support from the state because it had proved its worth both economically and in terms of clinical outcomes. Sensible!

I recall, like Geoff, that a decade or so ago ‘intermediate care’ was a buzzword. It seems to be on the back burner now, though any politician with an eye to getting publicity may want to resurrect the concept. As Geoff points out “whatever the outcome of the General Election, it is to be hoped that ministers will start banging some heads together. Health and social care integration remains a dream. A commitment to intermediate care would go a long way towards making it a reality.” Well said.

Rising cost of care cannot be ignored

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Alison Holt, social affairs correspondent with the BBC, recently wrote an online piece telling her experience of a man in his 80s whose wife was diagnosed with dementia.

It was a heart-rending read about the man’s solitude and the slipping into “another world, the world of social care.”

As a rule of thumb she notes that although the NHS delivered the diagnosis, with a condition like dementia one largely steps into the social care arena.

Using this personal encounter as a hook for the reader, she rightly observes “whatever strains there are on the social care system now will only increase”

We’ve seen the headlines recently about the pressures on A&E and what happens to the health service when there isn’t enough care in place in the community to either prevent problems or to help people recover at home.

Social care certainly isn’t the only reason why hospitals started the year struggling, but it is a significant factor.

Fact: Local authorities are chronically underfunded. Holt notes in response the government says it has provided an extra £1.1bn in funding in the last year alone and that it is for councils to set their spending priorities.

But the ageing population is growing and with that comes care needs – and a lot of them

The King’s Fund think tank fears the current outlook is far bleaker than most people realize and doubles much play will be made of care as the General Election spin machinery gets into top gear.

All the main parties agree there has to be better integration of health and social care.

The new Care Act now places a duty on local authorities to provide people with information about services, even if they aren’t entitled to council help. That’s good news. But the news I really want to hear, along with my West Midland Care Association members, is that realistic funding is being provided to allow care for our most vulnerable to continue at the proper level.

The private sector takes up the lion’s share of social care and frankly too many businesses have not got their just rewards for the care they deliver.

Holt adds: “The number of people aged 65 and over in England has increased by 1.4 million since 2004

“All the main parties say that there has to be better integration of health and social care. They each have their plan to draw the two systems closer, but it will demand real change if we are to cope with the increases in the elderly population that lie ahead.”

I join with her fears when she writes: “If we ignore the problem or make piecemeal changes around the edges, then the fear is that it will leave many more people struggling to cope, facing huge financial and emotional pressures until something gives.”

Her comment I suspect addresses personal costs of care. The same observation can equally be applied to care providers, for many of them are indeed struggling to cope.

Election looming: I wonder what vain promises on care funding will tumble from the lips of our politicians. Can I believe any of them? Not any more.

Spark of life that lit torch in hearts of thousands

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Our televisions and newspapers gave plenty of time and space to the funeral of a war veteran Bernard Jordan who found fame when he left his care home to attend last year’s 70th anniversary D-Day events in France.

He was laid to rest after joint service with wife Irene – they died just seven days apart following more than 50 years of marriage. I was touched by the whole story.

Here was a man, who on his 90th birthday, days after he returned from his escapade, was inundated with more than 2,500 birthday cards from around the world.

For me he captured the spirit of epitomises the Second World War generation.

Mourners, reporters and TV crews packed St Michael and All Angels Church in Brighton, East Sussex, bid farewell to the Bernie and his wife.

What a great spark of life Bernie revealed to us all as he went to pay his respects to his fallen mates.

He had decided to join British veterans, most making their final pilgrimage to revisit the scene of their momentous invasion, to remember the heroes of the liberation of Europe.

It was timely for him and his escapade a timely reminder that our elderly are a great treasure who can still contribute untold colour into our lives. His spark of life lit a torch in the hearts of thousands across the world and he never really knew it. Please can we have more like him!

 

Rising cost of care cannot be ignored

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Alison Holt, social affairs correspondent with the BBC, recently wrote an online piece telling her experience of a man in his 80s whose wife was diagnosed with dementia.

It was a heart-rending read about the man’s solitude and the slipping into “another world, the world of social care.”

As a rule of thumb she notes that although the NHS delivered the diagnosis, with a condition like dementia one largely steps into the social care arena.

Using this personal encounter as a hook for the reader, she rightly observes “whatever strains there are on the social care system now will only increase”

We’ve seen the headlines recently about the pressures on A&E and what happens to the health service when there isn’t enough care in place in the community to either prevent problems or to help people recover at home.

Social care certainly isn’t the only reason why hospitals started the year struggling, but it is a significant factor.

Fact: Local authorities are chronically underfunded. Holt notes in response the government says it has provided an extra £1.1bn in funding in the last year alone and that it is for councils to set their spending priorities.

But the ageing population is growing and with that comes care needs – and a lot of them

The King’s Fund think tank fears the current outlook is far bleaker than most people realize and doubles much play will be made of care as the General Election spin machinery gets into top gear.

All the main parties agree there has to be better integration of health and social care.

The new Care Act now places a duty on local authorities to provide people with information about services, even if they aren’t entitled to council help. That’s good news. But the news I really want to hear, along with my West Midland Care Association members, is that realistic funding is being provided to allow care for our most vulnerable to continue at the proper level.

The private sector takes up the lion’s share of social care and frankly too many businesses have not got their just rewards for the care they deliver.

Holt adds: “The number of people aged 65 and over in England has increased by 1.4 million since 2004

“All the main parties say that there has to be better integration of health and social care. They each have their plan to draw the two systems closer, but it will demand real change if we are to cope with the increases in the elderly population that lie ahead.”

I join with her fears when she writes: “If we ignore the problem or make piecemeal changes around the edges, then the fear is that it will leave many more people struggling to cope, facing huge financial and emotional pressures until something gives.”

Her comment I suspect addresses personal costs of care. The same observation can equally be applied to care providers, for many of them are indeed struggling to cope.

Election looming: I wonder what vain promises on care funding will tumble from the lips of our politicians. Can I believe any of them? Not any more.

CQC special measures – too heavy handed

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The Care Quality Commission intends that special measures for failing adult social care providers will be introduced in April this year.

An online feedback for the proposals closed on January 30. A draft special measures policy will be issued in this month (February), with the final policy being rolled in March 2015.

Doubtless, the proposals will have a significant impact for all registered providers.

My biggest fear is that it will be all too easy to enter special measures and risk cancellation of registration.

LesterAldridge LLP last month issued a healthcare alter warning providers of what’s to come.

The keys points are – stick with it – I know it’s a long read, but it’s important:

  • Entry point of special measures: When CQC carries out a comprehensive inspection against the five “key questions” (i.e. is the service safe, caring, responsive, effective and well led?) and two of those key questions are rated as Inadequate, CQC states that not only will the entire service be rated as Inadequate but this will also result in immediate entry into the special measures process.
  •  Special measures can be entered even if a comprehensive inspection results in only one of the key questions being rated Inadequate. For example, a service might well have an overall Requires Improvement rating following a comprehensive inspection but have a rating of inadequate against just one of the key questions. Where this happens, CQC will carry out a further focused inspection after six months and if this shows the key question to be still rated Inadequate then special measures will automatically follow.
  •  What are the immediate consequences of special measures? CQC state that it will “signpost providers to potential improvement agency support (where they exist) and monitor progress against their plans. The onus is on the service to resolve the issues of concern”. CQC is silent on what exactly “potential improvement agency support” is. Will CQC for example have an approved list of potential care home consultants, lawyers and other specialists or will this be left to the individual discretion of inspectors?
  •  It is significant that CQC state that when a service is placed into special measures CQC will “liaise with the local authority and the CCG so that they can begin planning for service continuity (if they are not doing so already)”. Such notification will almost certainly result in a contractual embargo which might make improvements that much more difficult to achieve.
  • How long will special measures last? CQC states that the process will usually be limited to a period of six months, following which there will be a further comprehensive inspection. At this stage there will be three possible options: (a) If there are no inadequate ratings remaining, the provider comes out of special measures. (b) If there is sufficient improvement made, the provider “may be given an additional six months to improve”. (c) If there is insufficient improvement, CQC will issue a Notice of Proposal to Cancel Registration.

 

In the light of these ‘big stick’ approaches, I would like to see some proper dialogue between CQC and associations like mine. There have been talks about a Provider Improvement Agency and clearly local associations need to be at the table if these plans press ahead.

I’m also concerned that there appears to be an awful lot of importance being placed by inspectors on the Mental Capacity Act and Deprivation of Liberty Safeguards. Being quizzed about such legalities immediately sparks panic amongst my members.

Like so many, they too struggle with the bigger issues of the law, but are perfectly capable of operating within the legislation they know. I suppose a parallel can be drawn if I was to ask you about knowledge of the Road Traffic Act. Not knowing every chapter and verse does not stop a person from adhering to the sections of the Act that allows them to drive safely.

I wonder too about the ability for providers to improve once they are in special measures. Inundated with inspectors, from the Local Authority, CCG, infection prevention, pharmacy, Health and Safety etc – all seeking their improvement as priority – is this a good atmosphere for betterment? I think not.

Inspectors who wish to be heavy handed in these circumstances can expect little co-operation. Micro management of someone’s personal investments by a third-party regulator is never going to be easy.

It clearly erodes already battered confidence and would stop providers recovering in a way they feel part of.

A lighter touch all round please . . . and some dialogue would not go amiss.