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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.

 

The masterplan for Cumbria . .. and elsewhere?

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I’d never head of the News & Star, but for those who are interested it’s a newspaper. Recently it broke a story of a masterplan for care in Cumbria County Council ‘s area.

It said the council was to carry out its own separate consultation on the future of care homes in Carlisle and Copeland.

Interesting. It also said the Success Regime’s long-term aim is to reduce hospital beds and care for more people at home but can social care cope?

The council wants to close a total of seven homes and replace them with a new £6 million home in each district, focusing on caring for those with the most specialist needs such as dementia. Overall its care beds would reduce, with more people instead being looked after at home.

I accept that a local authority run care homes are not viable as their carers have to be paid the same rate as refuse operatives. My question: How will this new venture be funded and at what cost to the general public?

Have I heard this one before?

How foolish I am, I genuinely though that health and social care were supposed to be working hand in glove, but this plan has all the makings of pushing more people into care in the community and that service is already stretched to the limit.

How desperate is this measure and how shortsighted.

I love the fact that people can remain independent longer, but for that to happen we need well-funded social care going into people’s homes.

Defending their position, Cumbria County Council says although the plans will see beds reduce none of those homes affected have high occupancy rates.

There’s a pledge on jobs too, with staff from the existing homes being transferred alongside current residents to the new centres.

This will make an interesting consultation period I’m sure. Already a

county councillor fears the overhaul of north and west Cumbria’s NHS will put extra pressure o care services.

Whitehaven councilor, Christine Wharrier, who previously worked in the NHS, called for more joined-up thinking.

The Success Regime’s long-term aim is to reduce hospital beds and care for more people at home, but Mrs Wharrier is worried social care will not be able to cope.

Of course, we do need larger care homes, but we don’t want factories or a mentality that views transfers of residents and staff like personnel being offered relocation deals after plant closures.

 

Older people’s care: It’s where you live that counts and . . . if you’re rich

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Did anyone catch the BBC headlines that said older people are paying the price for cuts to social care?

And the faithful old Beeb added (what so many of us already know), the care and support older people receive increasingly depends on where they live and how much money they have rather than their needs,

Last month a new report by The King’s Fund and the Nuffield Trust laid the facts bare.

Six consecutive years of cuts to local authority budgets, rising demand for services and shortages of staff have left the social care system increasingly unable to meet the needs of the older people who depend on it.

Sadly, the findings also highlight the plight of unpaid carers, saying an unacceptable burden was placed on them. According to the BBC this leaves “rising numbers of older people who have difficulty with the basic activities of daily living – such as washing, dressing and getting out of bed – without any support at all.”

What is happening to us as a society? Mrs Thatcher’s infamous “there is no such thing as society” quote is ringing in my ears.

Evidence is presented that reductions in fees paid by local authorities and other cost pressures such as the National Living Wage are squeezing the incomes of residential and home care providers.

And you’ll never guess . . . it warns that an increasing number of providers are likely to leave the market or go out of business as a result.”

A West Midlands Care Association survey showed that some 50 per cent of home owners were considering selling or closing their businesses. And the picture was not much brighter with the dom-care market with commissioners recognizing there is indded a shortage of community caring.

How have we arrived at this crisis point? I’ll tell you how: Because successive governments have failed to listen to our warnings, and it appears they’re still not listening.

The sum total of what colloquially is known in the Midlands as ‘cocking a deaf ‘un’ is leaving our older citizens without the care they depend on.

The squeeze on the budgets of care providers is also prompting some providers in affluent areas to step back from providing care for people funded by local authorities, leaving those who depend on council funding reliant on an increasingly threadbare safety net.

We have to realise that nearly all private sector providers are running businesses, though it’s my experience that many have charitable hearts and subsequently are managing loss-making care enterprises.

The Beeb also noted: “At the same time, more people are having to pay for their own care as a result of cuts to local authority services.”

Indeed they are.

I cannot recall how many times I’ve spoken of the funding gap between the cost of adequate care and what is paid to my members by local authorities, but catch this . . . “The report highlights a growing funding gap within the existing, inadequate system which will reach at least £2.8 billion by 2019/20 as public spending on adult social care shrinks to less than 1 per cent of GDP. “

There’s a call for the government to be honest, to tell it how it is and if it is unwilling to properly fund and expand the current system, should say so.

Richard Humphries, Assistant Director of Policy at The King’s Fund said is reported online by the BBC as saying: ‘‘The failure of successive governments to reform social care has resulted in a failing system that leaves older people, their families and carers to pick up the pieces. “Putting this right will be a key test of the Prime Minister’s promise of a more equal country that works for everyone – there is no more burning injustice in Britain today than older people being denied the care they need to live with independence and dignity.”

I couldn’t agree more.

 

‘Leak’ reveals a savings solution. Is this really the best we can do?

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My recent weekend off had an annoying surprise. Scanning the newspapers to check essential TV viewing, I find a story about a leaked document that allegedly reveals the government is up for motivating people to save for their care in old age.

Just great. How is that going to help us now?

The leaked memo warns of a looming crisis. Looming? Wake up, it’s already here!

Sir Andrew Dilnot offered his solutions and they’ve been shelved. It appears our current elderly population is being somewhat overlooked in these new proposals (if they’re true).

Observer policy editor Daniel Boffey writes: “Ideas include Isa-style savings accounts – known as “care Isas” – with preferential interest rates for a pot of up to £75,000, which you would be able to withdraw to fund your social care or leave, tax-free, in a will. Another plan is that tax incentives could be offered if people wished to take from their pensions to meet social care costs.”

He goes on to say the memo was written last May by the then pensions minister Baroness Altmann in which it’s claimed she says the crisis has been left too long.

Let me quote some more . . . The memo also warns of huge political risks of allowing the crisis to unfold. “There is no money set aside for social care spending by individuals or by local authorities – needs have to be funded as they arise, and if the money is not there the quality and availability of care is compromised, causing scandals and misery that could potentially rebound on policymakers at some point,” it says.

Word has it the Dilnot proposals are dead in the water and I suspect the care industry as we have known it is too.

A savings solution is for too simplistic in my opinion. Would tax breaks encourage it to work? Only for the well off, I suspect.

Newcomers, who are younger . . . would they buy into it? I doubt it. My friends’ kids are too busy surviving the present and trying to get on the property ladder to have disposable income for their care that appears to them light years away.

If this ‘leak’ is the best offering, I think I need stress counseling or maybe anger management therapy . . .