wmcha

By Debbie le Quesne

Archive for August 2015

Adult social care a human necessity

leave a comment »

Has anyone noticed that it’s gone spookily quiet on issues relating to the ‘single pot’ budget response to the NHS and social care?

Before the election there appeared to be good display of headlines and news bulletins on this initiative, but now: Silence.

Perhaps I have selective deafness, but if I have the condition is share by Zoe Williams writing in The Guardian.

She too, has picked up the vibes of change, observing that although the care sector was “beset with injustices, and the NHS was often having to fill cracks at vast and unnecessary expense, and services would have to be joined up if they were ever to work,” the tone for public consumption is different now.

Andrea Sutcliffe, the chief inspector of adult social care, has described a sector “under stress and strain” in which an ageing population with increasingly complex needs was “only half the story.” Really!

Regulators receive more than 150 allegations of abuse of the elderly every day, Williams reports. Quoting the response from a department of health spokesperson . . . “Treating somebody with dignity and compassion doesn’t cost anything.” But it does, a point Williams also makes.

The language of compassion, she writes, involves funding care and wages and conditions and so on.

As much as £4.6bn has been cut from social care budgets over the past five years, I read. I’d hoped that the current shortfall might be made good with a single NHS/social care fund, despite misgivings over its administration.

Where has news on the single fund gone? Adult social care is not a bolt-on option. It is a human necessity.

In February Greater Manchester and the NHS announced plans around the future of health and social care with a signed memorandum agreeing to bring together health and social care budgets – a combined sum of £6bn.

The scheme saw NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities agree a framework for health and social care.

My question: After such a trailblazing start to the initiative, what is happening in the rest of UK, and of course, more specifically, the Midlands?

Advertisements

Care capping delay – U-turn costing us up to £100m

leave a comment »

After all the spin over the capping of care costs, we now find it’s been delayed until 2020. But the hold-up on the £72,000 cap, originally due to come into force in April 2016, is set to cost up to £100m – and we, the public are footing the bill.

It was delayed after councils wrote to the Department of Health asking for the launch to be deferred, due to funding pressures faced by local authorities – and they have plenty of it.

Care England’s Prof Martin Green tweeted: “Care cap postponed. We need extra money to fund new living wage and a long term approach to funding the true cost of care NOW.”

Indeed, we do!

We could argue all day whether the delay is justifiable. Personally, with the additional costs looming driven by the Living Wage, I believe the strain on introduction would have been intolerable for the LAs.

But I’m baffled by a Government policy on social care funding that appears to be deliberately undermined by Budget legislation.

I’m all for strong, decisive leadership as we map the future of care, but with such an ambitious agenda on pay it almost appears that the real consequences of such action were just not thought through. That could never be . . .could it?

A need to recapture some of the past

leave a comment »

Jacqueline Jones is a care worker who wrote a feature in the Guardian on her 40 years in the sector. Between the colourful reflections there emerges a warm, committed woman, who is like so many carers I meet.

The article is a celebration of compassion and marks clearly the changes that have occurred.

Jacqueline has gone from care worker to social worker for Richmond council, to owner and director of a private domiciliary care company in Surrey, she founded in 1994.

Her comment that “these days I barely recognise the care industry” resonated with me.

In the early ’80s, she says “we were called home helps and we provided shopping and cleaning in two-hour blocks. We had freedom to adapt how we cared for people and build proper relationships. We had time, a luxury that care workers today don’t have and we really could be what every company now advertises itself as: part of the family.”

It’s essential that some of that home comfort caring is recaptured and there are pockets of real hope emerging in the Dudley borough through the direct payments system.

A colleague of mine has DP package for his wife who has had MS for 28 years. He employs five PAs and they have, with skillful management of funding, revolutionised the quality of life for this lady.

Talking to me the other day he said: “In a year they have become an essential extension of our family. They have supported us through two family deaths, brought a new sense of life into the home and revolutionised my wife’s outlook on life.

“The secret . . . they have built strong relationships, the care is joined up and even with holiday cover,it’s still seamless.”

In her narrative, Jacqueline refers to a “freedom” to express care in different ways. In my colleague’s case, the freedom of mapping his wife’s care has been a life-changer, with the whole family benefitting.

The package is a fantastic success story and a credit to the social worker who saw the potential, worked it through and made it happen with LST, the support agency of choice.

Community care has changed since the days Jacqueline actually took in a client’s dog when her client was admitted to hospital, but the heart that inspired actions like that still beats strong within the industry.

Looking to the future, Jacqueline says “the vicious circle of low status homecare work must be broken.”

I agree. In my colleague’s case perhaps we’re seeing some sunnier days for his wife now, in what previously had been a very long, dark winter. Let’s hope that example can be replicated.

I agree. In my colleague’s case, perhaps we’re seeing some sunnier days for his wife now in what has previously had been a very long, dark winter. Let’s hope that example can be replicated.

Dudley and Walsall lead in response to Living Wage bombshell

leave a comment »

There is a deep concern among care providers that the introductions of George Osborne’s Living Wage will sink many independent businesses.

Surveys have offered a whole array of gloomy forecasts with one stating the following:

  • 9% of respondents are deeply ‘concerned’ about their businesses
  • 3% of them felt that the increase would have a ‘significant’ impact on their businesses
  • 72% were very concerned about their ability to continue in business
  • The majority of people responding to the survey did not feel able to pay their staff the Living Wage of £9.00 per hour by 2020 in the timescales without a ‘substantial’ increase from commissioners

And what is more worrying, a press release from the National Care Association claims 24 per cent of respondents indicated that they would consider exiting the marketplace if their local authorities did not make a significant move to increase the fees they pay over the next five years.

The strategy we adopt from hereon is critical, as it will determine the fate of so many providers and their clients.

It is a heavy burden that has not lifted from my shoulders since the Osborne bombshell. I am convinced the care sector was invisible to him when he set in stone his plans.

Let me add at this point, I applaud any move to upgrade the status and salaries of carers, but there must be an impact analysis and a cohesive strategy – funding – to make it work.

Sadly, we’re floundering and again lacking in leadership from Government. The local authorities with which we work are clearly in the same position.

Following the Living Wage announcement, West Midlands Care Association contacted councilors and directors in all the membership authorities and outlined the real impact of the legislation. There has been a deafening silence in response, except for Walsall and Dudley.

Walsall has indicated that unless extra funds are released the thresholds of care funding will have to change. A pragmatic approach, I know, but at least our overtures have been acknowledged and there have been strong indications that they understand our dilemma.

Dudley has been exemplary in its reply. Both councillors and officers recognise the position of our members and the pivotal role of West Midlands Care Association plays in working though the difficulties.

The authority has agreed to meet with us as soon as its own impact analysis is complete. The authority also recognises that it is essential the Government provide “appropriate funding.”

We have enjoyed a creative e working relationship with Dudley for many years and I am heartened at its realisation we need to talk and pool knowledge if we have any chance of delivering a sustainable lifeline to care providers and those who are currently receiving care.

The most basic and powerful way to connect is to listen to each other. If there was ever a time in the care sector when dialogue between WMCA . . . and local authorities was needed, it’s now. Silence is not an option, as the funding issue has become a complication for cash-strapped authorities, as they are obliged to navigate their legal care market management responsibilities outlined in the Care Act.

What can I add? We will do all we can to help and for those who perhaps have nothing to say: Please don’t shut the door on us.

It is true that only those who harm the care industry really make the headlines, Essentially, all the providers I daily meet are good, honourable people. So good, in fact, I worry that for the very best intentions they will carry on to dispense care even without sufficient resources. Cutting corners . . . giving something out of nothing . . . need I say more?

.

Singing from the same hymn sheet on issue of fees

leave a comment »

I’m not a musician, but I do know when people can hold a note, or when a choral piece is more of a discord than a pleasing harmony.

The care sector is renowned for its fragmentation, mixed messages and entrenched differences of opinion.

For those unfamiliar with my blogging, the West Midlands Care Association has campaigned long and hard for a more realistic response to fees from local authorities.

Sometimes, when the care sector is so embattled, it’s just nice to get a shot of encouragement and at the start of the month I received mine.

Professor Martin Green OBE, Chief Executive of Care England, a representative body for independent care services, has written a letter to the Directors of Adult Social services, reminding councils of the legal responsibilities regarding fees. Without collusion, Prof Green’s message is in perfect harmony with that of my association.

Acknowledging local authorities face unprecedented financial pressure – and that it is to continue – he spells out clearly the legal obligations those responsible for the caring purse.

Le me quote: “With respect to fees, these responsibilities are set out most clearly in the Care Act 2014.

“Paragraph 4.35 of this Act states clearly that: ‘Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality – for example, by setting fee levels below an amount which is not sustainable for provider in the long-term’.

“In other words, local authorities must take steps to ensure that the fee levels at which they commission state funded care enable the provider in question to offer services to that individual for however long that person requires the level of care being provided.

“We do not see how sustainability can be achieved through below inflationary fee increases, and are yet to see an assurance process that indicates this would even be remotely possible.”

Prof Green observes that Councils “cannot remain static” in this respect and the impact of providers Budget responsibilities for the Living Wage serves only to compound issues.

Let me quote some more: “In its analysis of the July Budget, the independent Office for Budget Responsibility provided four possible actions that employers could take in light of the introduction of a National Living Wage. These are:

  • Reducing the number of hours worked by their existing employees;
  • Reducing the number of people employed, either by firing existing employees or by hiring fewer people until attrition has reduced the workforce by the desired amount;
  • Changing the composition of their workforce, potentially by replacing those who are 25 years old or older with those aged 24 or less;
  • Increasing prices in order to pass on the higher wage costs to their customers.

“As the provision of care services are codified in statute, the first two of these options cannot be pursued by independent care providers.

“The fact that the average age of people working in the sector is well above 25 means that it would be impractical to pursue option 3.

Increasing prices is irrelevant in this context as the issue that this letter deals with is the setting of fees for state funded residents, not for self-funders. Therefore, option 4 is not considered, but is a measure that providers will almost certainly have to adopt for residents funding their own care.

“If self-funders have no choice but to pay higher fees, it follows that local authorities also have no option but to commission care at higher rates to reflect the increase in the minimum wage. We do not allow consideration of the possibility of self-funder fees being used to subsidise council fees, which has been happening with increasing frequency across the country. As well as being unethical, this practice is also unlawful. “

Industry annalists LaingBuisson project that care home fees must be increased by five per cent to accommodate the statutory minimum wage.

Concluding, Prof Green adds that the introduction of the National Living Wage in accordance with the Low Pay Commission’s own data would be “completely unsustainable for care home providers without an increase in fees from local authorities. “

I agree wholeheartedly.

Prof Green is asking adult social care to work with him, noting that many “understand the pressures that providers are facing.”

My approach is unashamedly coequal – singing from the same hymn sheet – please, help us as both directors and care providers face this enormous financial challenge that simply cannot be ignored.