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By Debbie le Quesne

Archive for October 2015

Read this, be inspired, be encouraged

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Every now and then I realise afresh why I do my job. Encouragement is a powerful force as I’m reminded, in the words of novelist George Eliot, it’s never too late to be what you might have been.

I have just finished reading a great online piece by Ewan King,

director of business development and delivery at the Social Care Institute for Excellence (see www.theguardian.com/social-care-network/2015/sep/29/despite-finance-troubles-and-media-blame-its-not-all-bad-news-in-social-care).

Acknowledging the care sector is not in its finest hour, King writes: “My grandfather was a minister in the Church of Scotland, and he used to say to his congregation: ‘We must not succumb to hopelessness.’ It was his way of saying that we have to focus on the positives even when times are tough.”

King adds social care is perilously close to “succumbing to hopelessness”, yet despite unremittingly negative news, there are still remarkably good things happening in social care. Oh yes there are!

What I like about this article is that it is earthed in reality and the fears and dire warnings surrounding the care business are genuinely recognised.

Radical changes have not all been bad, he notes, encouraging “it is important to shout loudly about what is working well.”

A whole list of heartening examples follows and as pointed out, they are “the tip of the iceberg.”

King’s words are worth five minutes over coffee. Despite the gloom, media blame, financial turmoil, it’s not all bad. Go on, click the link, be inspired! and if you want more, do a quick search on my blog on the wedding.

Running blind without research into social care

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What a surprise! Austerity measures have created a problem with councils’ ability to carry out research in adult social care.

I read one of the 104 respondents’ comments to the survey which said: “People who supported research and evidence-based decisions have been made redundant.”

Another claimed: “Research in ASC [adult social care] was the first thing to be cut as it is seen as non-essential and will continue to be cut in favour of services and care packages.”

The study, commissioned by the Personal Social Services Research Unit but carried out by the Social Services Research Group, clearly seems to state the obvious as councils struggle to balance their books. We know already that local authorities are between a rock and a hard place.

Focussing on survival mechanics, however, always comes at a price. Expendable research? Probably not, though I’m well aware that duplication is a major problem in the industry and I can understand if local authorities can lock into other information streams their decision-making process on these redundancies.

Without research we have no way of knowing the how and why services are delivered and what difference they make

Without research how can we accurately set budgets and map for the future?

It needs to be done by someone. Without research we are running blind. Finally, can someone tell me please why such few numbers of me ever go into residential care?

Care call times again: Let’s have some vision, please

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Will someone please change the record? We now have the National Institute for Health and Care Excellence criticising short care visits.

Yes, we all know that commissioning visits of 15 minutes and some with even smaller time slots, are under fire. The problem is that most local authorities have outsourced their ‘dom care’ responsibilities and in the same way residential care is underfunded, so is this essential expression of humanity.

Speak to any of my community care providers and they’ll unanimously agree care slots should be longer, but sadly our Government won’t fund them at a rate that represents the true price of the service.

Staff who undertake social care visits to 470,000 mainly elderly people a year must spend 30 minutes helping to keep them well, says Nice.

It wants an end to the situation where many visits are so short and rushed that recipients have to choose between getting washed or dressed. I know, it’s a horrible dilemma.

But it must be noted there is a place for 15-minute calls – check visits and meds calls spring to mind immediately. The economies for employers, however, are mad as travelling time either side of such visits now has to be paid.

If adopted, Nice’s guidance would transform many care calls. I just don’t get it . . . all the evidence points to good social care reducing demands on stretched NHS budgets, but we desperately need a bit of vision here to see how investment with ring-fenced monies at this sharp end could work out.

In its first ever guidance on social care, Nice says that contracts that local councils in England sign with social care providers should allow workers time to provide a good-quality service, including having enough time to talk to the person and their carer, and to travel between appointments. I presume it also says they should be paid properly for this too.

“They should also ensure that workers have time to do their job without being rushed or compromising the dignity or wellbeing of the person who uses services,” says Nice.

It’s all very laudable. Nice describes itself as an independent Government body, but I wonder how much clout it will muster in this latest endeavor and whether politics will eventually see its teeth pulled. After all, isn’t Nice funded by the Government?

With councils facing average budget cuts of 40 per cent, I can’t see much chance of the Nice reforms being carried through any time soon.

I read that between 2010 and 2011, eight councils commissioned 593,000 care visits lasting five minutes or less, and three-quarters of councils commission care workers to visit for just 15 minutes. Goodness knows what the latest figures are.

I find it deeply worrying that already I’m hearing cries of “idealism” over the Nice proposal. Surely our elderly and frail are worthy of proper care and not least, social care idealism.

Can we afford to just carry on they way we are going? I think not. Our careers do a great job in the community, with many giving over and above what they’re actually paid for. It’s been referred to as “emotional extortion” and I hate the term because it infers some kind of financial racket or leverage. Truth is, most carers do what they do because they’re genuinely lovely people working in a financially screwed profession.

The cheap option – cutting back on care package times – is terribly short-sighted as the amount of first line care intervention will reflect, I believe wholly proportionally, further up the care ladder. As I’ve said, it’s all about vision and not least expectations. Often the call time is crammed in a desperate attempt to meet care plan outlines . . . and personal commitments to just trying to do the job properly.

A ‘deepening crisis’ but where is the antidote?

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Like over-prescribed antibiotics, graphic descriptions of the current care crisis fail to have the desired effect when they become a daily prescription of the news.

I fear many are becoming anaesthetised – indeed, almost indifferent – to the digest of chaos emerging from the sector.

In a joint submission to the Treasury ahead of November’s Spending Review, 20 organisations say the care sector is facing a “deepening crisis”.

Yes, it surely is!

They have called for funding to councils to be protected, as is happening with the NHS, a move that my own WMCA has also taken.

Ministers said investment in health would also benefit the care sector.

The government has pointed out that plans were being put in place to ensure greater joint working between the two sectors and that would relieve some of the pressures.

But those putting their names to the latest warning – leaders of councils, the NHS, care providers and charities – are not convinced the future is safe.

They say the market is “fragile” with councils forced to keep fees low and providers leaving the care sector; this, they add is driving up prices for those who fund themselves and leading to fewer people getting state-funded support.

Let me quote The Guardian piece: “While the government has pledged an extra £8bn a year for the NHS by 2020, social care has received no such assurances.”

Ray James, president of the Association of Directors of Adult Social Services, one of the signatories to the submission, is reported as saying: “It is vitally important that this year’s Spending Review understands the importance of our services to vulnerable people,” adding that the “near-certainty” is that without adequate and sustained finances the ability to carry out their duties will be in jeopardy.

The Care Providers Alliance, adds that the challenges are on an “unprecedented scale,” while Rob Webster, chief executive of the NHS Confederation, which represents health service managers, says: “Having a shiny NHS cog will be no good in a broken health and care machine.

“All these services are interconnected and all need greater financial certainty.”

I’d like to know who the other signatories are, but I think we get the message anyway. . . let’s hope those with real influence for change also do.

We have heard so much now of impending doom, I fear our message is in danger of becoming white noise. Prescribing the antidote when the patient is dead presents an obvious problem.

Ombusdsman’s fees report: Providers are not the villain of the piece

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The cost of care is always going to be a hot potato. For a start, many people wrongly think it should always be wholly funded by local authorities and then, of course, there’s a whole load of confusion over fees.

Enter the faithful BBC with its story that families are paying too much for care in England “all too often” . . . because of confusing or incorrect information from councils.

That’s the verdict of the Local Government Ombudsman, which noted that some people were not offered an affordable care option in their area.

It said: “The decision to place a loved one in a care home can be one of the hardest any family has to make, but all too often families are paying too much for their care because they are not getting the correct, timely information.”

Thrown into the mix are top-up fees, one of the main reasons confusion exists, according to Andrew Kaye, from the charity Independent Age.

Care England says top-up fees are helping to mask a funding crisis in social care, with some of the poorest people and their families being asked to fill holes in the budgets of local authorities. I agree, but must add that this is the only way many care businesses are able to survive in these difficult times.

The moral argument will doubtless run and run, but the fact remains until such times council fees paid equal the realistic cost of care I see little changing.

In addressing the moral high ground critics, I would ask them to consider what options there would be for non-top-up residents if homes closed because such fees were not levied.

It really would not take much to push so many of our providers into an economic tailspin.

Professor Martin Green, of Care England, argues care should be available “at a cost which the local authority should be happy to pay.”

Of course that should be the case. It’s important, however, that care providers are not seen as the villain of the piece here.

Central Government with its sweeping fiscal restraint within the care sector has forced councils and the care marketplace into a dire corner, the likes which I have never seen. Mr Cameron and his cohorts clearly know of our crisis and the fact local authorities are between a rock and hard place, They could and should bring it to an end.

Ring-fenced social care monies . . . etc, etc. . .

Wedding bells tonic brings happier headlines

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A filthy care home described as “a waiting room to die”, more dire warnings on the future of care provision. CQC complaining that too many social care services are not up to the mark . . . it’s enough to make anyone lose heart.

But wait a minute. In a plethora of headlines gloom, I spot a story that sums up so much of the good caring that is never in the public gaze. Contrary to what the media would have us believe, there are good care homes, in fact most of them, and extremely kind carers do exist.

Aileen Sharples, aged 89, desperately wanted to be part of her son’s wedding and was disappointed that she would not be able to attend the ceremony and watch the happy couple exchange their vows.

But staff at the Belong Wigan Care community where she lives were determined she wouldn’t miss a moment.

Aileen was treated to a front row view of the Gloucestershire wedding from the comfort of her home, thanks to the dedication and ingenuity of care staff and a bit of clever technology.

Overjoyed for her son, Paul, on his Big Day, Aileen was disappointed she’d miss the ‘do’. But staff quickly stepped in, making arrangements for the wedding to be seen via an iPad and FaceTime.

But they didn’t just provide the technical link, staff entered into the spirit of the occasion with flowers and decorations in abundance. They also put on their best clothes – complete with hats and fascinators – ­­and ensured residents did the same to share the moment.

A champagne toast followed with wedding cake and Aileen was able to chat to Paul and her new daughter-in-law, Julia, wishing them both a wonderful honeymoon.

This is not an everyday occurrence, but in my experience acts of selfless kindness from carers happen fairly regularly.

This story cheered my heart, and not for one moment do I believe it was a cynical stunt to get some media interest.

Global trend on care not a good one to follow

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In 1969 (too many years ago for me to remember, of course) Mick Jagger strutted onto the stage at Hyde Park wearing a white dress.

Our  parents asked: What is the world coming to? They were both shocked and challenged by what they saw as the Rolling Stones performed their concert.

Today, I’m asking the same question as I read that more than half the world’s elderly lack access to long-term care, though sadly the news doesn’t appear to warrant the same media interest as that legendary 60s’ moment.

The data has been produced by the International Labour Organisation which condemns the “deplorable” situation facing rapidly ageing populations.

A new report from the United Nations agency shows that some 300 million people over the age of 65 cannot easily access long-term care when needed.

The report comes just days after America announced an army of carers aged 75 and over was growing daily and now constitute seven per cent of those who provide unpaid care to a relative or friend, the survey found.

We face a global problem and I’m stunned to learn that the world’s most “generous” countries, found in Europe, spend only two per cent or less of their GDP on long-term care.

It’s cold comfort, I know, given the troubles in our industry, but in comparison to some nations the UK care deals are pretty good.

We have, however, an awesome responsibility to preserved what we have. Reading an article in the New York Times of how a 75-year-old shoulders the role of caring for her immobile husband without a care package makes me all the more determined to fight tooth and nail to ensure care providers get enough resources to do their job properly.

The fact care, as we have known it, is under threat and the changes being forced by market manipulation are not in the best interests of clients of providers.

We need to remain vigilant that long-term care indeed stays accessible to our elderly, sick and frail and does not become another ‘inevitable victim’ of austerity measures. The global trend, if we believe all these figures, is not a good one to follow.