By Debbie le Quesne

Archive for October 2016

How social care takes the lead in prevention

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If anyone should ever doubt the value of social care, I suggest they read an online article in Care Talk by Debbie Sorkin, whom I met recently at a Care Alliance meeting in London.

Her theme is simple – prevention is better than cure. Always better.

It is, as she points out, the cornerstone of recent health and social care policy. This is all about keeping people healthy and independent in their own homes – a “defining principle of the 2014 Care Act.”

She makes the point that “It means encouraging people to take more control of their own health and wellbeing: a move that is being supported, if slowly and patchily, through the introduction of Personal Health Budgets.”

But it’s also about supporting people, whether in their own homes or in residential care.

A great concept, this initiative is a pillar of NHS England’s Five Year Forward View – but, as Sorkin says “it should be clear that it’s also been the settled practice of social care for many years.”

But there is a problem. If we want preventative care (and we do). if we want to keep the elderly and frail out of A&E departments, if we want them healthy in body and mind . . . it costs money.

While I applaud Sorkin’s positive approach, she does point to a major cloud of foreboding.

She says: “ . . . Keeping people well, or nipping problems in the bud – is getting harder to do, particularly in relation to older people, where the social care system is struggling to cope.”

Let me quote a little more from her feature: “Six consecutive years of local authority budget cuts have seen 26 per cent fewer people getting help, and no-one has a full picture of what has happened to those older people – around a million strong according to Care UK – who are no longer entitled to publicly funded care. The human and financial costs to them and those who care for them are mounting.”

On the issue of district nurses providing community-based health services that are essential to keeping people with chronic, complex conditions well enough to live independently –there was a 28 per cent reduction in their numbers between 2009 and 2014, despite increased demands.

Sorkin begs the question what our response should be and points to leadership, well, system leadership (new sound bite) as an answer.

She mentions “doing what you can with the resources available.” What resources. Have my members any left?

She also promotes the Leadership Qualities Framework (LQF) for Adult Social Care “central to the section on Managing Resources, using resources effectively and minimising waste.”

All the right words and phrases are there . . . innovation, encouraging improvement, and creating a climate of continuous service.

Successful examples are cited in the West Midlands: New Outlook, a small care provider, teaming up with Nehemiah Housing Association to place a greater emphasis on wellbeing amongst residents and service users.

Results, she says, for the programme that has been running for only about a year, show emergency ambulance calls from the sites where the programme is operating dropped by 66 per cent between 2014 and 2015.

I don’t doubt good practice will always turn in good results and that Sorkin is right to point out the benefits of such management programmes. See http://www.caretalk.co.uk/how-social-care-takes-the-lead-in-prevention/ for the full list of improvements.

But for many care providers they’re well passed this rescue point. As someone said: “You can’t use an umbrella in a typhoon.”

Great leadership, hard choices, programmes of smart thinking, so many of my members have been there, done that, got the T-shirt and are still drowning.

Ultimately, all business needs the oil of finance – proper, fair rates for a proper job. Local authorities don’t want to, or can’t pay it; in many of the poorer areas (like mine) self-funders are thin on the ground and without the necessary viscosity of money the engines of care seize.



Number of relations caring for loved-ones on rise

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Many very elderly people are being cared for by their children, themselves at an age at which they might have expected care

The number of centenarians in the UK has quadrupled in the past 30 years, according to the Office for National Statistics.

In the past decade alone, the number of people reaching the age of 100 has increased by 71%. The number of people over 90 has nearly trebled over the past 30 years.

The rise means there are increasing numbers of very old people being cared for by their children – themselves an age at which they might have expected to be cared for, rather than to care for others.

Family carers over the age of 50 are now being studied by University College London and researchers have found evidence that about one in 20 of those aged over 50 are caring for a grandparent, parent or parent-in-law.

According to separate Age UK research a third of the UK’s 6 million carers are aged 65 and over, and the number of carers aged 75 and over has increased by 35% since 2001.

In another age – and not that many years ago – many of those being cared for at homes would have been in residential care. Not all of those placement were justified, I’m sure, but many were.

Now the pendulum has swung the other direction, with more and more elderly staying at home.

I read that over the past seven years the number of carers aged 80 and over has increased from 300,000 to 417,000 – and continues to rise.

Clearly we need to research the needs of this particular carer group and define how they can be helped. But the broader question for me is how as a society have we allowed this to happen?


Written by debbielq

October 21, 2016 at 12:26 pm

Understanding and solving loneliness a play with two scenes

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A pop-up street theatre performance has been turning the focus on what the Guardian has called “the epidemic of loneliness” and the growing isolation of older people.

The Loneliness Street Cabaret, an outdoor street performance from the Beautiful Mess Theatre Company, has been helping to mark the Age UK Lambeth’s Celebrating Age Festival.

The players have performed in different public spaces across the south London borough.

And the central theme is the fact that loneliness is increasing at a time when our cities are becoming ever more crowded.

According to research highlighted by the Campaign to End Loneliness more than half (51%) of all people aged 75 and over live alone, while two-fifths all older people (about 3.9 million) say the television is their main company.

Beautiful Mess creative producer Chloe Osborne was reported as saying: “There was a particular [Guardian] article which initially inspired artistic director Kati Francis to create the work. The article raised the question of how it’s possible to have this rise in loneliness amid an ever-increasing population. In particular we wanted to explore why people can’t – or don’t – connect anymore.”

Development of the performance involved collaborating with older people in Lambeth, community workers and care professionals through Age UK Lambeth.

Research began at a community centre and a local care home, spending time with people and having conversations. This developed this into small group workshops with thoughts about archetypal people who might be isolated; how they behave and the show characters developed from that.

Understanding the problem is vastly important. Giving it a profile is all good. But resolving it will take more than street theatre.

Key to solving loneliness at a primary level is effective social care. Those who are helped to stay in their own homes and interact with their native communities need care that’s affordable and home care providers working in LA contracts need to be rewarded fairly for their work.

Osborne’s themes aim is to provoke people to consider the issues highlighted by the performance and their response to it.

None of us choose to be isolated, but circumstances change with age.

Befriending schemes are all good, along with kindly neighbours, but I believe their needs to be a much more structured approach through social caring.

But to do any proper work it needs government money and ironically community care has been the funding most neglected by local authorities. No rises for ‘domcare’ services I hear. How terribly shortsighted.


Written by debbielq

October 21, 2016 at 12:24 pm

The price of getting older and we’re in serious trouble

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Have you ever thought how much it costs to be old. One million people with care needs go with out care

  • One million people with care needs go without help
  • 4 in 10 people in care homes pay for themselves
  • 300,000 fewer people receive council-funded help within four years
  • £100,000 or more is now spent on care in later years for 1 in 10 people

The data is published in the latest joint King’s Fund and Nuffield Trust report on the state of the care sector.

The BBC has done a great job of decanting so much information into bite-sized reads. Did you know, for instance, that a £5bn pot of money has been set aside to encourage joint work between the NHS and care sector, with an additional £1.5bn being added to that by 2019.

That comes on top of the more common knowledge of increases in council tax by 2 per cent a year to invest in care.

As part of the report a number of interviews have been carried out and these two are well worth repeating . . . they simply say it all.


Ray James, of the Association of Directors of Adult Social Services, reports councils simply did not have enough money.

“We’re now at a tipping point where social care is in jeopardy.

“Unless the government addresses the chronic underfunding of the sector, there will be worrying consequences.”

Caroline Abrahams, of Age UK, says: “Social care is in serious trouble, and this is putting the health and dignity of today’s older people at risk.”

The “reports highlight the need for serious reform to a system that is being starved of the cash and the attention that it deserves.”



Written by debbielq

October 21, 2016 at 12:22 pm

Care cuts ‘leave frail elderly fending for themselves’

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Frail old people in England are being left to fend for themselves because government-funded care is being scaled back, a review suggests.

That’s the news that recently greeted me care of the BBC.

The number of over-65s being helped by councils had fallen by a quarter in the four years to 2014, the joint King’s Fund and Nuffield Trust report claims.

Wait a minute, I’ve already read this report, I thought. But then I became aware that because of the information overload, I’d missed this crucial point.

Despite more people needing help because of the ageing population, we’re helping less and less it seems.

The BBC assured that Ministers were “taking measures to address the problems.”

The reality – highlighted in the report – means there are growing numbers left with no care or having to pay for support themselves.

The report was released on the day the BBC published an online guide to care, which details the costs people face wherever they live in the UK.

Care is means-tested, with only the poorest getting help to pay for services.


The Beeb reported (quote):

  • The numbers getting help from their council with care had fallen by 26% to 850,000 in the four years to 2014
  • Spending on care by councils had fallen by 25% in real terms in the five years to 2015, to £5.1bn
  • Additional money from the NHS and increased contributions from individuals had topped this up to £7.2bn, but that still represented a cut of 9%
  • Over 40% of money paid to care homes came from people paying for themselves
  • One million people with care needs now receive no formal or informal help – a rise of 10% in a year


The report also warned that the cuts by councils were a risk to the future of the market. I’d say so. It was noted that providers had walked away from council contracts in 59 local authority areas.

I’m not shocked – providers have walked away from contracts in all the West Midlands regions

Social care for older people – home truths

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There’s another new report – my desk is awash with them – Social Care for Older People. It’s been put together by The King’s Fund and the Nuffield Trust.

A serious piece of work, key is the current state of social care services for older people in England.

Analysis is through a combination of national data and interviews with local authorities, NHS and private providers, Healthwatch and other groups.

It considers the impact of cuts in local authority spending on social care providers and on older people, their families and carers. Alongside this work, the authors were commissioned by the Richmond Group of Charities to interview older people about their experiences of social care.

The picture that emerges is of social care providers under pressure, struggling to retain staff, maintain quality and stay in business; local authorities making unenviable choices about where to make reductions; a complex set of causes of delays in discharging older people from hospital; and the voluntary sector keeping services going even when funding was curtailed.

What else need be said? Well, for the brave there’s plenty to include:

Social care for older people under massive pressure; increasing numbers of people are not receiving the help they need, which in turn puts a huge strain on carers.

And on it goes . . . Access to care depends increasingly on what people can afford – and where they live – rather than on what they need.

Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care,

The Care Act 2014 has created new demands and expectations but funding has not kept pace, we learn.

And what about local authorities? They have little room to make further savings, and most will soon be unable to meet basic statutory duties, the report warns.

Based on the evidence in the report, the authors recommend that policy-makers need to address three major challenges in shaping the development of social care over the next five years, focusing on how to: achieve more with fewer resources – for example, through better commissioning and integrated care – and critically, recognising that these initiatives will not be enough to close the funding gap.

It’s clear from this work that the care sector remains fragmented and those who are most vulnerable come off worse.

I really do wonder what history will pen about our generation and the response to our elders. Does anyone really listen to what we say? Think I’ll blog again from this report.



Written by debbielq

October 21, 2016 at 12:16 pm

Council ranks break as care pressure forces hard decisions

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Part of my responsibility is to keep abreast with developments in the industry, something that is increasingly difficult to do.

Plotting trends and observing responses in a fast moving marketplace is hugely challenging.

It has not escaped my radar, however, that Wigan Council’s cabinet has forced through a care charges hike in the face of opposition from Labour colleagues.

In what has been reported in Wigan Today as “a rare show of disunity, the town hall’s top table overruled recommendations from the health scrutiny committee to think again.”

It appears bosses didn’t want to get into the same predicament as neighbouring Lancashire County Council – predicted to run out of money in three years’ time. Interesting! It appears more and more that local authorities across the West Midlands are calculating their care costs – essentially the rates they pay to members – in this way. It’s a crazy economic model.

The reforms bring the borough’s rates in line with other Greater Manchester authorities.

The reforms, bringing the borough’s rates in line with other Greater Manchester authorities, were approved by cabinet despite being rejected by the health scrutiny committee.

The council has said charges will increase only for those who can afford it.

No doubt the politicking will run and run, but I read the council has said charges will only increase for those able to afford it.

For me, the biggest issue here is that a Labour stronghold council is having to respond to the funding crisis in such a way and it is, indeed, a sign of the perilous times we’re in.