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By Debbie le Quesne

Archive for July 2015

399,000 extra hospital days – the price of social care cuts

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The National Press has been scaremongering again telling its readers that our care system is “crumbling”.

Whilst I’m aware so much media ‘information’ is politically tweaked, I find myself aligned to its reasoning this time around.

The care system in England has “cost the NHS £669 million over the last five years with hospitals forced to care for elderly patients who could otherwise be discharged,” analysis by Age UK has concluded.

Findings also reveal the NHS lost 2.4 million bed days as a result of “bed-blocking”. Why? Because of a lack of care and support outside hospitals. Now there’s a surprise (not)!

As you’d image the Press has seized on the figures, with the charity concluding the data underlines “the scale of the crisis in the elderly care system and the knock-on effect on institutions like the NHS.”

Cruel cuts to local council budgets, which fund social care for elderly and disabled people, have left the system struggling. Both care providers and service users are feeling the effects.

You’ll may recall my recent attempts to simplify budget research by the Association of Directors of Adult Social Services (Adass) which showed that despite brave efforts by councils to protect care services, cost savings and a rapidly ageing population have effectively wiped out 31 per cent of care budgets in five years.

Age UK says NHS figures reveal that patients collectively spent an estimated 399,000 days in hospital while waiting for a place in a care home or nursing to become available in the last year alone. Can you image the cost?

Surely this kind of information is all Mr Cameron needs to evaluate the value of social care.

Delays while patients waited for special handrails or stairlifts to be installed enabling them to carry on living at home added almost 41,400 days to the total.

Let me quote Age UK statistics: “ While an NHS bed costs taxpayers an average £1,925 per week, a typical place in a residential care home costs a more modest £558 per week for a week or £357 for care at home.”

We appear to have penalized social care funding at a catastrophic price, with year on year, more older people being trapped in hospital in ever-greater numbers.

Policymakers desperately need to listen to the facts that are emerging.

Would funding social care properly resolve the bedding crisis in hospitals? Yes.

Would a properly resourced social care system transform many older people’s lives and make sound financial sense long term? Yes.

Would such a move mean a more efficient use of skills and finance within the NHS? Yes.

Isolation and loneliness: Please lead by example, Mr Hunt

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Invite lonely elderly strangers into your home, urges Jeremy Hunt – so says a recent headline in The Guardian.

The Health Secretary is advocating that s people should keep in closer touch with older relatives to reduce isolation, and take greater responsibility for their own health.

The cynic in mean can’t help feeling that this family values promotion hides the truth: That there is no political will to pay for such services.

Speaking recently at the annual conference of the Local Government Association, Mr Hunt urged people to keep in closer touch with older relatives, friends and neighbours to battle against elderly loneliness.

The tone is good, the moral standards high, but I’m struggling with this message.

He highlighted the case of a man found in Edinburgh recently, three years after he died, and the eight council-funded “lonely funerals” a day in England, half of which involve over-65s.

He said: “Are we really saying these people had no living relatives or friends? Or is it something sadder, namely that the busy, atomised lives we increasingly lead mean that too often we have become so distant from blood relatives that we don’t have any idea even when they are dying?

“In Japan, nearly 30,000 people die alone every year and they have even coined a word for it, kudokushi, which means ‘lonely death’.

“How many lonely deaths do we have in Britain where, according to Age UK, a million older people have not spoken to anyone in the last month?”

This is powerful, heartstrings-tugging material. Hunt also urged people to be more careful about drawing on “finite NHS resources”, itself a worrying aside.

None of this resonates easily with us. Why should I suddenly feel guilty?

There is a yawning chasm between the need I see and Mr Hunt’s care supply chain. Are people more distant these days? Probably, yes. Are we horrible, uncaring people? No.

The shortfall on properly, economically-derived funding levels for care providers is, I believe, a moral responsibility of Government. Its response to need is the barometer of being civilised.

I can’t help feeling that although I agree with so much of Mr Hunt’s speech, I have a finger wagging in front of me, reminding me of the moral priorities I should choose. The irony of my seeming abdication to meet the need is that Mr Hunt too, is right there at the side of me.

Perhaps he could lead by example and ensure social care is funded well enough to service the needs he is trying to meet on the cheap.

Care homes . . . and dare we mention sex?

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I’m not one for deliberately grabbing the headlines, or in a knee-jerk way, responding to them. But I just can’t resist this BBC story pointed out to me by a colleague.

Headline: “The taboo of sex in care homes for older people.”

Hooked yet?

A recent study by the University of Manchester found that 54 per cent of men and 31 per cent of women over the age of 70 were still sexually active. Good of ‘em, I say.

The Beeb reported that it was the first nationally representative survey to include people over 80 in its sample, indicating both how attitudes are finally changing and how the sexuality of older people has been historically overlooked.

I find it interesting, though not surprising, that the subject still has an air of taboo, the findings of a study by the Royal College of Nursing a few years ago revealing that sex and relationships are not viewed as a priority in care homes.

“Human contact and sexual need are basic functions of the human being,” Dawne Garrett, older people’s adviser at the Royal College of Nursing, is quoted in the BBC report.

I understand that the subject can be a difficult one and observations in the report that “staff are generally not comfortable with the topic, and not knowledgeable about it either, thus they are powerless to help,” are probably true.

So how do we as care providers facilitate relationships?

I’d like to hear some answers or see a training brief, because sooner or later this is going to be a Human Right Act issue.

Lois Weaver, a performance artist who explores the subject of sex and ageing through her work, is quoted by the BBC: “We have a stigma about age.

“We don’t really treat people like elders. We treat [them] like people [who are] finished with life.”

Her groundbreaking show, What Tammy Needs to Know About Getting Old and Having Sex, seeks to break down the taboo of sex and ageing.

Anyone for a ticket?

Weaver is in her 60s, had been told that losing interest in sex was an inevitable part of getting older, but said she was not ready to accept that. “I was getting different urges and desires,” she was quoted as saying.

Her work is indeed interesting and those wishing to be challenged can find video links aplenty in a Google search. Her attempts to canvas opinion from residents in care homes, however, were generally met with failure which clearly underpins what she has coined the British “maternalistic” approach.

I really do feel I’m opening a proverbial can of worms here, especially as I consider what could happen sexually to dementia patients. We have to assume that homes seeking to have a more liberal approach to relationships sanction only consenting adults with capacity. Even then I suspect safeguarding issues would emerge.

Weaver, a professor of contemporary performance at Queen Mary University of London, a performance artist in her own right, writer, and director, is a seasoned campaigner. It will be interesting to see how she develops this one in the light of the Manchester study.

Latest calculations – the Budget impact on social care

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Oh my life . . . I knew the Budget was bad news, but I’ve just read a piece from a recent edition of The Guardian and I think I feel sick.

I’m trying to console myself with the fact that this publication does not align itself with the Conservative government, but I know some of the figures presented are credible.

The piece suggests that the care sector has been “invisible” to George Osborne. I agree. I cannot image any politician setting in stone anything like the national living wage knowing the impact it could have.

Let me quote: “Let’s suppose Osborne had done all his sums, however. In that case, the logical conclusion can only be good news for social care because he must have realised he would have to factor in a hefty bung of taxpayers’ money to meet the sharply rising costs of paying the NLW from next April. Any other way lies disaster.”

As the article says “there simply isn’t the money in the system to meet the costs without it.”

According to initial calculations by the Local Government Association, indemnifying care contractors against the new minimum would cost councils in England an extra £330m next year, rising to £1bn extra by 2020 (Guardian).

But rightly, as stated “at a time when, the association says, the funding gap in adult social care is widening by £700m annually.”

The article goes on: “The Resolution Foundation thinktank, which has carried out previous detailed analysis of the implications of ending the low-pay scandal in social care, puts the UK-wide extra costs to the public purse of Osborne’s plan at £1.3bn by 2020 – on top of another £1bn already pencilled in for increases in the original national minimum wage.

“In net terms, deducting savings to the exchequer after tax and benefits, the foundation reckons the additional costs to be £675m by 2020, or just over £1.2bn including the amount already allocated for the national minimum wage.”

Oh my life!

Already we have seen hospital admissions soaring since the austerity measures began and a strong argument presented that social care funding cuts are to blame. I fear sores is to come, though there will be regional differences.

My members and I in the West Midlands are particularly concerned over the issue and we are busy putting together figures to ensure that local councilors, our MPs and the LA staff are aware of the impact.

The West Midlands is more dependent than many other areas on local authority care funding and throughout the region it’s the prime source of business.

As the main funders in the marketplace – there are very limited self-funder opportunities – authority fees are calculated to allow only a small profit for providers, which these wage increases will easily wipe out. Simply, there is currently no money left in the pot for my members, or, indeed, the LAs.

I wonder how we will remember Mr Osborne: Will he be the one who has managed to unstick the whole fabric of social care in the UK, despite his government’s pledge that “social care is a priority”?

The axeman cometh ­– Osborne’s summer Budget looms

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If you believe the harbingers of doom, a fresh £3bn Government cuts spree will see libraries, leisure centres and . . . elderly care for the chop.

The Local Government Association fears councils will need to slash 12 per cent of costs in 2016-17 to meet the demand.

Libraries could close, bus services could be slashed and potholes could be left unfixed as town halls face £3.3billion of fresh Tory cuts, council leaders have warned.

Leisure centres, bin collections and . . . caring for the elderly in their homes could all be threatened if budgets are hit, the Local Government Association fears.

With a growing reluctance, it says authorities will need to slash 12 per cent of costs in 2016-17 because of the new measures expected in the autumn.

LGA chairman David Sparks has already said there are no efficiencies left to be made for many councils, but the proverbial axeman cometh. July 8 will see George Osborne’s Tory-only Government budget rolled out.

Mr Sparks has said: “Vital services, such as caring for the elderly, protecting children, collecting bins and filling potholes, will struggle to continue at current levels.”

The LGA’s annual Future Funding Outlook report predicts councils in England will have a £9.5billion black hole by the end of the decade.

As I recall, local authorities have already made £20billion in savings since 2010 following reductions in government funding of 40 per cent.

Many LAs have worked hard to shield the most vulnerable from this austerity, but it’s not a sustainable premise.

Is it time for chocolate, cupcake and sweet tea served in china cups? Is there any good news out there?