By Debbie le Quesne

Archive for February 2016

Beware the dodgy online home reviews

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TripAdvisor is an easy, accessible way of getting the lowdown on dining, cheap flights hotels and holiday destinations.

This layman’s approach to reviewing and sharing experiences has caught the imagination of the UK public and often is a first point of call to see how good – or bad – things can get.

But what about reviews for care homes? A report in the online magazine, care Industry News, informs us that after engaging constructively with the Competition and Markets Authority (CMA), websites including carehome.co.uk, Care Opinion and Most Recommended Care, have all agreed to tidy up their practices.

These improvements address concerns that were raised following a “call for information” by the CMA on online reviews and endorsements.

Let me quote the article: “A cross comparison with the Care Quality Commission suggests that ‘award’ winning care providers had in many cases received rather more negative inspection results. It makes absolute sesne that when people are searching for care; they are able to see transparent results just as they would if choosing a car.”

Oh dear . . .

Mark Sadler Founder of yourcarehome.co.uk and Hootvox.com advises readers to “look very carefully at how reviews are gathered and how stars and ratings are calculated, you cannot take anything on face value.”

Sad isn’t it?

The article can be found at : http://careindustrynews.co.uk/2016/02/care-home-reference-sites-agree-to-improve-transparency-for-those-looking-for-care/   Well worth a read.


For me, this whole business is frustrating. I spend most of my time passionately supporting the cause for good residential care and I like to think my comments are full of integrity.

Care home reviews are powerful marketing tools, an issue that the Government has addressed with www.nhs.uk/Service-Search/Care-home-with-nursing/Halesowen/Results/576/-2.051/52.45/1831/9261?distance=25

I don’t know what the traffic is on this site, but it desperately needs to be used more.

My advice: Always visit the home in the first instance – just drop in unannounced and note the response well. Then take a look at the reviews.

Some interesting comments come from Andrew Mabbutt, CEO of the feedback platform Feefo, Quote: “While improving practises is always a good step, unless reviews are collected by a trusted, independent third party, there is always the danger that they cannot be trusted.

Incidentally, Feefo provide a closed feedback system for both online and offline businesses. They invite only verified customers to leave their feedback, and ensure that they are unmoderated. This rules out any possibility of fakes, or sweeping negative reviews under the rug.”

Dear me! The care sector really isn’t very good at getting its own PR right.

The CMA’s call for information highlighted a number of general concerns about the review sector, including the potential for some review websites’ practices to prevent some genuine negative reviews from being published, some review websites not checking reviews sufficiently at all, and important information relating to poor CQC inspection results not being brought to the attention of the users of some websites.




Over the border in Shropshire – just as predicted

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It’s always good to keep eyes and ears open in the care sector and part of my remit tis to remain abreast of what’s happening to regions other than my own.

Recently, the Shropshire Star – sister paper of the Express & Star – announced that a social care overspend will soak up £8,5m of Shropshire Council’s extra funding.

Shropshire Council’s leader, Councillor Malcolm Pate was joined by the council’s chief executive Clive Wright on a visit to lobby Government at Westminster.

Their message to Marcus Jones MP, parliamentary undersecretary of state for local government: The council needs £20 million more a year to prevent deep cuts in services over the next three years.

It’s a familiar story across the regions north of the Home Counties.

But it appears, what’s reported as gentlemen’s agreement now exists and Shropshire is to get extra funding  – £8.5m – over two years.

Currently, said the newspaper report, “Shropshire Council’s growing elderly population means it faces a disproportionate bill to pay for adult social care. But Councillor Pate warned that despite the extra funding the council is effectively in the same position it was before the increase in its funding settlement was announced.”

The impact of the extra funding is being investigated by the authority’s officers, the report added.

My worry is that any extra funding that is squeezed from the purse of Government would be a drop in the ocean, but sadly our Cabinet currently holds all the cards.

Interestingly, Shropshire’s over-65-year-old population is growing at a faster rate than the national average. Shropshire can expect to see its population of over 65 year olds grow 14 per cent by 2020, this compares to 12 per cent nationally.

In a letter to Cabinet last December, local authority, NHS, provider and charity leaders, warned there was not enough cash in the system and called for urgent action.

In the letter to George Osborne, health secretary Jeremy Hunt and communities secretary Greg Clarke, the Association of Directors of Adult Social Services (Adass), NHS Confederation, Care and Support Alliance (CSA) and Care Providers Alliance (CPA) warned that the Better Care Fund initiative and the opportunity for LAs to up council taxes would not be enough to deal with current and future pressures.

The same drum was sounded by West Midland Care Association . . . and guess what? We were all spot on with predictions.

Inevitably we are going to see an acceleration of the failure of domiciliary, residential and nursing home providers; less support to needs the needs of the elderly within community and residential setting; and unbearable pressure on NHS beds.

No wonder in places like Wolverhampton the CCG is desperately trying to keep our elderly a whole lot healthier.

I’m a great believer in keeping things in context, so here’s a parting thought. I’m not diminishing Shropshire’s problem, but it’s nothing compared to those in Sandwell and Walsall where the older population is not only getting disproportionately bigger, but also much poorer than their Shropshire counterparts.



Cuts blamed on huge hike in deaths

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We said it may happen: Government cuts to social services could lead to more deaths. As they say, ‘it’s a given.’

Not surprisingly, the Telegraph has reported it could be the “largest factor” in the biggest annual rise in deaths in England and Wales for nearly half a century.

The data comes from the Office for National Statistics, which says that mortality rates last year rose by 5.4 per cent compared with 2014 – equivalent to almost 27,000 extra deaths.

This increase is the highest since 1968 and took the total number of deaths in 2015 to 528,340.

Interestingly, death rates in England and Wales have been steadily falling since the 1970s but the trend took a turnaround in 2011.

Advisers to Public Health England are calling for an investigation and add that the figures show the elderly, especially women, were now bearing the brunt of a growing crisis in the National Health Service and cuts to social care.

Quote – Professor Danny Dorling, from Oxford University and an adviser to Public Health England on older age life expectancy: “When we look at 2015, we are not just looking at one bad year. We have seen excessive mortality – especially among women – since 2012.”

He adds: “I suspect the largest factor here is cuts to social services – to meals on wheels, to visits to the elderly.”

Last year there was a £1.1bn cut in adult social care budgets.

We appear to have an ageing population that’s now more vulnerable to death and according to Age Concern: “These figures suggests something is going badly wrong.”

Predictably the DoH respond with a vague, meaningless reply, stating “excess winter deaths can be due to a number of causes and deaths can fluctuate from year to year.”

Oh yes. I hated physics at school, but I can remember this: Newton’s third law of motion says “for every action there is an equal and opposite reaction.”

I’m sure social care was never envisaged as being part of this equation by Isaac Newton, but I’m prepared to be a trailblazer here.



Written by debbielq

February 25, 2016 at 10:19 am

Depression in care homes: Unmasking the hidden ‘spin’

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I quite like the Telegraph, perhaps because in my experience it’s a little less vicious than the Daily Mail when it comes to reporting on care homes.

But I might be persuaded to change my mind.

Front page: Almost half of all older people in care homes are depressed and think condition is a ‘normal part of ageing.’

In a report commissioned by NHS England and supported by the Government, it found “older people’s needs are neglected” with most of them not even seeking treatment.

It also informed us that most in residential care settings think that depression is now a “normal part of ageing”.

The Telegraph said it was a “ landmark NHS report.”

Now for the figures: “Four in 10 people in nursing homes are depressed while one in five older people who live in their own homes suffer from the condition, with rates among older women even higher.”

Mr Cameron told The Telegraph: “Mental health is a major problem in our country and it must be properly addressed.

“By providing this extra £1bn a year for mental health care we will make sure it gets the attention in the NHS it needs.

“But I want to go even further and end the status quo that sees more than half of people with mental health conditions unable to find a job – ensuring tens of thousands are able to find or return to work over the next five years.”

The report concludes that people with mental health conditions suffer from poor physical health and that those with severe mental illnesses die on average 15-20 years earlier than the rest of the population.

Call me a cynic, but the timing of Mr Cameron’s plans to invest £1billion a year in improving people’s mental health, were unveiled just as the report was released. And I have to ask too: When residents were asked to partake in this survey, just how ere the questions asked. . . and that’s key to findings.

For example, leading questions could hardly be trusted to deliver proper clinical data, could they?

If I were to ask any elderly person in a care setting if they felt depressed about having to give up their own home, we all know what the answer would be.

I’m pretty sure I’d know the answer too if I asked a housebound person if they felt depressed about not being able to get out and about. Degrees of depression are in layman’s terms hard to define, but I suspect those isolated in their own homes are probably more depressed that those in a residential setting.

And how fortunate the timing is . . just right to make Government look like they doing so much for mental health with a pledge that “nearly 30,000 people with mental health problems will be given extra support to help them find work or help them keep their jobs.”

What’s this have to do with our elderly?

Then we read Ministers will spend more than £300million on “talking therapies” – psychological support for people with mental health problems. And . . . a further £55million on doubling the number of employment advisers in psychological therapy centres, while also encouraging more therapists to work in job centres.

This is not a story about depression in our care homes at all. It’s a collection of political sound bites about employment and the general issues of getting the mentally ill back to work.

I’m genuinely shocked the Telegraph is so obviously clumsy in the way it’s own political allegiance is displayed here.

Oh, and by the way, thanks for spreading the good word about our care homes (not).



Do GPs see residents as a soft option for rationed services?

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Earlier in the month, Caring Times editor Geoff Hodgson posted a blog http://www.careinfo.org/?p=20214  and asked the question: Do GPs see residents as a soft option for rationed services?

Here’s my view . . .

Indeed, high quality care is needed more than ever before for our elderly and the option to bale out from such responsibilities is unthinkable.

Changes in the economy, political preferences and medical funding have each had their way of reshaping residential care in recent years. But what – quite literally is critical – is the escalating clinical need this people group require and, not least, our response to it.

As the name suggests, I recall my first encounters with social care as being much social than medical. Elderly people, in care homes were generally quite mobile, being cared for because they couldn’t manage safely on their own, or families could not commit to the support required.

In 20 years so much has changed and now a GP is, as Geoff says, “a key member of the team.”

Some of those residents back in the day, who would be categorised as requiring nursing care, are currently often found in residential homes all over the UK. The bar has been raised exponentially for qualifying for nursing care.

For example, applications for continuing NHS funding appear to be increasingly unsuccessful.

I am a realist and know there is just not enough money in the care system. However, I believe some morals are sacred and, not putting too fine a point on it, the law indeed upholds a duty of care. Our homes will not be allowed to leave residents without a registered GP.

These are the things that define us as being civilised and caring for our elders is one of them. To deny these worthy people the same primary medical intervention less demanding members of our communities have, is scandalous. You’re right, Geoff, there’s no justification.


Debbie Le Quesne CEO West Midlands Care Association

Social care cuts – now London feels the pinch

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London, once famed for its Trafalgar pigeons that have sparked a number of campaigns to reduce their numbers, is fighting a losing battle with these feral scavengers.

Forgive me for using this analogy for the capital’s unraveling social care policies, but . . . as they say, ‘they’re coming home to roost.’

The Evening Standard reported Town hall cuts could lead to a  £1.7 billion gap in adult social care funding within four years – with 170,000 vulnerable Londoners “the worst hit.”

Of course, this has become a political hard-ball game with Labour saying elderly, ill and disabled people who are looked after in their homes or in residential care would be the worst hit.

In fairness, the Standard just promotes the political spin without comment, but suddenly Islington, one of the capital’s up-and-coming wealth centres (some would say now getting very posh and trendy in parts) is feeling the pinch of Government social care policy.

New powers will allow local authorities to raise council tax by two per cent – a potential rise of almost £200 a family, it is claimed – but councils say that even then they will not be able to make up the difference, raising only £570 million by 2020.

And as I’ve said before, they also point out the Better Care Fund, which will total £410 million within four years, is taken from existing council funding and it will not all go on adult social care.

I’m always suspicious of political data, but this is worth rolling out. Labour’s Red Lines campaign claims that even if every borough raised council tax and all the Better Care Fund money was ring-fenced, there would still be a £750 million funding gap for social care.

Something about judging society by the way it cares for its most vulnerable springs to mind . . . again.

Well, with elections for London”s Mayor in May there’s plenty of campaign material for all parties given that the social care crisis appears to be getting closer and closer to the corridors of power In Westminster.

And forgive me for being a little hard, but in general terms (dangerous, I know) London’s local authorities do have the luxury of property capital . . . something we have precious little of in the Midlands.

Another blow for our elderly in benefits plan

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So the Government plans to transfer responsibility of a £5bn social care benefit to councils . . .

Not surprisingly this plan is now being exposed as disguised cost-cutting and could restrict the number of older people getting care at home, campaigners claim.

Just before Christmas the whole business of attendance allowances (AA) was in the news and there are more rumblings now.

Nearly 1.5 million people receive the allowance, paid at a rate of £55.10 or £82.30 a week, to help with personal care for those who have a physical or mental disability.

Now Care home owner Michael Vaughan has launched a petition  https://petition.parliament.uk/petitions/119787  to halt the move, fearing it will removes valuable financial support from people who may not meet the increasingly substantial criteria that Social Services use when deciding if a person is entitled to their support.

Currently AA is a non-means tested benefit for people over 65 who need help with personal care (i.e. washing, dressing and eating etc), because they are physically or mentally disabled.

It helps people to remain at home for longer and enables them to decide how, where and when their care is delivered. What’s more, it helps remove pressure on an already overstretched NHS.

Our ‘dom-care’ providers are quick to point out the new proposal will diminish independence and choice for the elderly.

Quite rightly, Michael Vaughan says it will have a hugely negative impact on our elderly’s health.

AA can make all the difference between living and existing – and without it people will suffer. It’s a vital benefit that helps deliver what I think the Government wants . . . for people to be able to stay in their own homes longer.

I have a question: Will these monies that are passed on the LAs be ring-fenced? If not, I guess it’s another way of saying ‘more cuts on the way, Debbie’.

Not surprisingly, our Supported Living providers – some of them huge national charities who support housing scheme residents – are all with fingers crossed that the outcome will not be devastating.

As far as I can ascertain, models are geared towards the attendance allowance, but there appears to be scant impact analysis on the plans out there.


GPs’ NO vote on care home calls – it’s not all bad locally

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According to the stats care home residents are an estimated 50 per cent more likely than the average older person to be admitted to hospital as an emergency case.

Now there’s a desperate push to improve on these figures, but the latest stance from the GPs’ Local Medical Committees where delegates voted to not do residential home calls has thrown a serious spanner in the works. I have long been a supporter of improving conditions under which doctors work, but this I perceive as a gross dereliction of duty of care and I know there’s a legal groundswell supporting this stance.

‘Blue light’ cases are costly to the NHS and there are various initiatives afoot to cut back on the numbers of elderly admitted this way.

The financial burden on NHS Trusts appears to have sparked a response that is appears contrary to wishes of the Local Medical Committees’ recent vote.

Wolverhampton Clinical Commissioning Group (WCCG) is proposing a system where 12 GP-led practices work together in supporting care homes which have residents with long-term health conditions such as asthma, COPD, and diabetes. Primarily the aim to prevent any unnecessary admissions to hospital.

Under the name Primary Care in Reach Teams (PITs), the service pledges to provide hands-on support to residential care homes in the clinical management of chronic conditions.

These GP practices will work in co-junction with the Rapid Response service, pharmacy and community teams to “enhance the level of care to patients provided by registered GPs.”

This new service will run from this month (February) as a pilot until January 2017. In the first instance to test how beneficial it is to you and therefore a pilot. In a letter sent out to patients, benefits anticipated by WCCG are:

  • “Improving your health and wellbeing by ensuring that you are receiving the most appropriate care
  • “Reducing ill health by intervening earlier
  • “Reducing unnecessary admissions to hospital. “

Care home patients who fall outside of GPs delivering the scheme can register with a participating practice.

In Dudley, a senior CCG spokesperson told West Midlands Care Association a comprehensive response to the doctors’ vote will be announced, but pointed out that the news broken by the Daily Mail “neglects to state that patients will remain registered with the GP practice and therefore the doctor will continue with the responsibilities that fall under primary care.”

In other words, despite the apparent willingness to leave care and nursing homes to their own devices, doctors’ surgeries will still be bound by a legal duty of care responsibility.


GPs’ NO vote on care home calls – the national scene

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A landmark decision by GPs affecting their commitment to residential care homes and nursing homes is another crippling blow to the care sector. In this blog I want to look at the national scene and then post a second piece on the local picture.

Recently the BBC announced that the plight of care home residents “has pretty much slipped below the radar in recent years.”

It noted while there is “close scrutiny of everything from A&E waiting times to access to the latest cancer drugs, the support – or rather lack of it – care home residents receive from the NHS has gone almost unnoticed.”

I couldn’t have put it better myself.

  • Now for a few facts to set the scene of the latest bombshell to drop on the private care sector:
  • There are 16,500 care homes in England, looking after more than 300,000 residents
  • If nursing homes are included, the number of residents exceeds 400,000 (500,000 across the whole UK)
  • Nursing homes have to have a registered nurse on staff
  • Both care homes and nursing homes work with local GPs, hospital doctors and district nurses

Given the figures, it is obvious any major shift in the way NHS primary care is delivered into this clinically need-laden sector, would have major repercussions.

Announced by the Daily Mail on its front page, I discovered at the beginning of the month “GPs vote to axe care home visits”.

Up to 300 GPs’ representatives from powerful regional bodies voted at a crisis summit to end being responsible for care homes. Simply put: They want to ditch this responsibility.

The British Medical Association union may now lobby the Government to remove the responsibility of looking after residents from the GP contract.

The implications are huge to both service providers and users.

Historically, the care sector has had patchy service from GP practices.

In 2012 the Care Quality Commission reported 81 care homes looked at were not receiving regular visits from GPs. But now that frail commitment is going – or at least going in the way we have come to expect.

These patients are among the frailest, most vulnerable members of society. Many are living with a complex range of conditions, including dementia, heart disease and diabetes, with residents, according to the BBC, on an average of nine medications each.

Like many problems not given the media attention they deserve, the issue has been developing gradually over time.

What concerns me greatly is how quickly this news has dropped out of media interest. Anyone seen anything in the last couple of weeks?

It’s a ‘given’, isn’t it, that many of the people who decant into care and nursing homes are there because of clinical needs.

Doubtless, before that move, these people would probably have been among a GP’s most frequent visitors.

West Midlands Care Association has been flagging up the problem for years along with other representative bodies such as Care England and Age UK.

The bottom line, as with most problems in social care and the NHS, is money and the problem is two-fold, adding unbearable weight to care providers’ responsibility and costs and potentially subtracting essential care from our elderly.

I’ve seen reports of care homeowners paying GP retainer fees of £20,000 a year to provide regular doctor visits for residents. These figures are prohibitive to most providers within my region, but about a third of homes are in expensive surgery retainer agreements.

My fear is that again it’s our most vulnerable who get the worst of deals by default as our GPs push for the right to opt out of being responsible for frail, vulnerable and highly dependent people.

Issues like continuity of care immediately spring to mind and doubtless the cost of bringing in private providers will be loaded. But we have a legal responsibility to register every resident with a GP, and what’s more, my members want to care for their residents properly.

There’s a trend of moving seriously ill patients out of hospitals into care homes and nursing homes, what will happen to them?

Who are their advocates? Increasingly, it’s our care homes who are taking up their causes, but there must be a limit on just how much fighting we can do . . . Fighting to stay open, fighting to pay bills, fighting to fund the living wage, fighting to change a broken system, fighting . . . fighting . . . fighting. Sometimes I just get tired.