By Debbie le Quesne

Archive for January 2017

Dementia clients – the business challenge

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Dementia is now the leading cause of death England and Wales, and is thought to affect more than 850,000 people in the UK.

Caring for them is one of the biggest headaches facing the NHS and social care and the economies of the task are hugely complex, with Government austerity measures effectively strangling the private sector’s preferred responses.

It’s a fact of life that the majority of Care Homes and Home Care Providers Clients and Residents will now have degrees of dementia. Integrity may cost a much-needed placement/client, but we must accept the limits of provision in place. Factoring in the necessary Fee to be Commission-compliant with dementia takes carefully assessed

It is, therefore, paramount we get our business reaction right – embracing dementia clients can have profound ramifications on existing business models and understanding dementia is a steep learning curve

We need to be educators and ambassadors, be clear on the impact of the severity of dementia with which we’re dealing and the potential impact on our residential homes or domiciliary businesses. Also, families and Local Authority Brokerage have no idea why this specialised care so costly. Again, be clear and avoid the aggravation of unpaid invoices.

To run a successful business you need to consider, one or all of the following;

Possible collateral damage to the building:

Apart from the work needed to get the building Dementia Friendly you will need to have a much more exhaustive maintenance plan to ensure standards are preserved and this element needs to be included in costs.

Additional staffing:

Staffing numbers need to reflect the extra support and extended hands-on care time required. There needs to be enough personnel to allow for breaks, as dementia care can be hugely stressful. Many individuals with the memory-loss condition have irregular sleep patterns and will require one-to-one companionship/conversation and feeding. Ensure that the maths stack up on staffing costs.

Secure buildings and safe gardens:

People with dementia need to be able to move round the building and grounds without constant supervision. To have sensory stimulants – things they can touch, feel and smell to help enrich their lives.

Additional staff training:

All staff, who work in the care Industry need and understanding of dementia, but senior staff and owners need a more in-depth knowledge so that they can competently tackle issues as they arise, be able to stand their ground with professionals and safeguarding, and engage innovative and very person-sensitive ideas. You will also need additional cleaning hours to keep the home/building up to standard.

Irregular dietary requirements:

Food needs to be provided when it’s required and in a format that people with dementia can access.

Extended record keeping:

If you are trying different ways to support an individual, you will need to ensure that everything you try is recorded to show it is in their best interest. You should also try to engage family and friends and record their comments. An understanding of additional care support mechanisms, such as professional groups and representative bodies and dementia cafes are useful.

Hospital escorting policy:

You will need a clear escort policy budgeted carefully into the business plan. For instance, do you send a member of staff to all external appointments; emergency A&E visits; what’s the policy on appointments that require an extended stay beyond normal shift patterns; do you charge the family for one or all such accompanying trips as this is not included in the Local Authority fees; and do you have enough skilled staff to do this kind of care?

Tailored activities:

Traditional group activities are not ideal for many people with dementia, so you will need to have capacity for one-to-one initiatives and ensure all staff can engage with residents as they care for them. This is particularly vital in the stretched Home Care Market.

As care providers we need to clearly grasp the reality that symptoms of dementia are progressive and on an unknown time scale. Being fiscally cute and planning responsibly for such a capricious condition is immensely problematic, but it’s one that must be addressed. We need to ensure that there is a vibrant dementia market for the future and we can only do that if we are resolute in the knowledge of provision.

Visit carefitforvips.co.uk for help on person-centred dementia care, a site the Association recommends for its members.


Written by debbielq

January 18, 2017 at 7:51 am

Angela Rippon gets CBE for services to dementia care

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Angela Rippon, who made national headlines last year by going public that she’d made provision in her will incase she fell victim to dementia, has been awarded the CBE for her work with the Alzheimer’s Society.

Angela was inspired to help the 850,000 people living with dementia in the UK by her own experiences caring for her mother Edna, who was diagnosed with dementia in 2004 and died in 2009.

The broadcaster, journalist and presenter is a dedicated supporter of Alzheimer’s Society and became an official Ambassador of the charity in 2009.

The former BBC newsreader co-chairs The Prime Minister’s Champion Group on Dementia Friendly Communities, alongside Alzheimer’s Society Chief Executive Jeremy Hughes.

I met Angela when she came to Wolverhampton to deliver a Dementia Friendly City talk. She has put her whole being into the dementia cause and passionately wants to help make life easier for those diagnosed.

The work of the Champion group has seen almost 220 Dementia Friendly communities established across the nation and Dudley has been in the vanguard of this great initiative.

The recent 2016 Dementia Friendly Awards, which Angela hosted, showcased the outstanding achievements of the work – ranging from the airport industry improving travel for people with dementia to Dementia Friendly football clubs helping football fans with dementia continue to enjoy their favourite past-time.

Angela has also backed Alzheimer’s Society’s Memory Walk campaign and supported the Counting the Cost project, which aimed to improve the quality of care for people with dementia on hospital wards.

There is nothing I can say about the great work she has already done that has not been said by others. But I would like to add my thanks and I do understand her motivation, having cared for both of my parents who suffered the memory-loss condition.

Undoubtedly she has made a difference. As the dementia issues escalate in society, I’m sure it won’t be that long before we all know someone who has been touched by this challenging condition. I’d like to think we can all do just a little to help this great work.

Volunteers, funding, acts of compassion and kindness . . . the creative expressions of caring are limited only by our own imaginations.

Also in the New Year honours was Care Quality Commission chief David Behan, who was awarded the CBE for his transforming work with the regulatory body.




Written by debbielq

January 17, 2017 at 9:15 am

LGA campaigning on our behalf

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At the end of last November the LGA ‘state of the nation’ report highlighted a £5.8bn funding gap in social care by 2019/20. Ouch!

This report from the Local Government Association (LGA) provides an overview of current issues for adult social care and it’s not light reading.

It says the core local government grant has been reduced by 40 per cent in real terms since 2010 and councils have been set a ‘flat cash’ settlement for the remaining years of the decade.

“This, the LGA explains, leaves councils exposed to the pressures from general inflation, increases in demand from population growth and increase in care costs, such as national insurance, the National Living Wage and pension contributions,” the report explains.

So we’re told the funding gap will be hitting £5.8 billion by 2020.

The Better Care Fund springs to mind . . . but has any local Authority seen any of this cash? Over the Christmas/New Year ‘hump’ there has been so much information arriving on my desk and I’m swamped in pile of data – only some which is relevant.

Ultimately, the industry needs hard cash, local authorities require the same and the only paymaster with that kind of financial clout is central Government.

I used to be struck that so many local authority offices in the West Midlands were bursting at the seams with busy, stressed employees. Not anymore – their work has been  outsourced and offices are empty. Whole departments gone and we’re well past the point of sensible economies here.

Politicians really must now decide if social care is a real priority that will cut through rhetoric, depleted LA resource  and deliver solutions.

The Guardian recently stated that adult social care accounts for around 35 per cent of total budget spending by local governments, so with such a high percentage of outgoing, it seems impossible for such a service to contribute significantly to savings.

Like never before the LGA is gaining traction with the media and the headlines being written can only help our case. I’ve seen so many figures that are beyond Monopoly money accounting it leaves me in a financial fog. Over the UK we’re looking at multi-billions of pounds of shortfall.

Ahead of the NHS, social care desperately needs attention as repairing it will have monumental benefits for our health service.

In a nutshell, the LGA report concludes unanimously that social care is chronically underfunded. Interestingly, it highlights that this vital service, that helps define our nation as civilised, does not seem a priority amongst the public. Is it because all parties have failed in the PR and the public really doesn’t understand the implications? Personally, I don’t think so. But I do believe the sheer scale of the problem has remained hidden by successive Government because of their refusal to respond realistically to the ‘help us’ calls of West Midlands Care Association and other similar representative bodies.

More and more I find myself juggling both national and local agendas that straggle both the NHS and social care. For me it appears perverse that over a decade the NHS quota has risen by about 25 per cent while social care has been flat-lined.

Quite what the financial rescue framework will become over the next months is a mystery, but I am certain history will write some pretty damning stuff if we don’t get it right very soon.


Written by debbielq

January 17, 2017 at 9:09 am

Memories of year where care reached crisis point

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Taking a look back is always dangerous. Nostalgia of ‘better days’ and being transfixed with what has been is never good for moving on efficiently.

But we really can’t escape the fact the 2016 put up some of the bleakest headlines for care that I’ve ever seen.

Funding gaps in community services for older people, which could increase to £2.6bn by 2020; delays in discharging medically fit patients from hospital; regular breaches of safe hospital bed occupancy levels;  and the government and the health and care sectors misaligned (what ever happened to the single budget for NHS and social care?).

It should have been the year that social care and healthcare finally start working together effectively . . . but we’re still waiting. There are, however, some green shoots of promise where the integration model has been pioneered.

As for funding for the future – the 6 per cent council tax rise announced in December is a start, but it diverts funds from housing and will leave some taxpayers  out of pocket.

More significantly it will do little to solve the ageing population problem and overstretched care system.

Currently there’s a lot of behind the scenes talk of more joined-up care between the NHS and social and it’s this hope that keeps me motivated. Indeed, 2017 could be a year of promise (but only if you catch me on a good day).

Obviously, by melding the two streams of care – something that had never happened since the NHS was founded in 1948 – care can become the seamless experience our elderly population deserves.

Despite the protests over who is taking what out of combined budgets, there are already promising signs – local authorities should look to Greater Manchester which, in April 2016, became the first locality in England to merge its health and social care sectors and control its budgets.

In the west Midlands there have been snippets of joint funding news, but not always good as I hear of health always having the upper hand and snatching monies back into its pot.

Without change, social care as we know it will inevitably die and so will those for whom it cares. Reinventing budget mechanics can be achieved, I believe, and bring harmony between social and NHS care. Bring it on – the sooner the better.


King’s Fund: Another year of challenges

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Looking to be inspired for 2017 and needing that shot in the arm to pep you up for the months ahead? Take heart (or a pill) – here’s the news from the much respected Kings Fund: “2017 promises to be another challenging year for the health and care system, with demand for care increasing faster than the supply of resources.”

The January bulletin adds: “A system already stretched to its limits will have to work even harder to maintain current standards of care and to balance budgets.

“This requires a continuing focus on operational performance and renewed efforts to transform the delivery of care at a time when frontline staff are working under intense pressure.”

I’m already wilting, even though I know it’s true.

The Fund points out that the NHS five year forward view (Forward View) will be “tested to its limits as leaders work to improve performance and transform care.” And it adds: “The NHS locally has to deliver £15 billion of the £22 billion efficiency improvements required under the Forward View, with the remaining £7 billion to be delivered nationally. It also has to provide evidence that new care models are delivering benefits. Failure to do so will raise serious questions about the assumptions on which the Forward View was based and on the ability of leaders to deliver their plans.”

The popular think tank highlights five main priorities for 2017.

Here we go and I’m summarising . . .


Supporting new care models centred on the needs of patients


  • People should be much more involved in their own health and care and be offered the information and support to manage their medical conditions
  • More care should be delivered in people’s homes or closer to home
  • Much greater priority should be given to public health and prevention through partnerships between local government, the NHS and other organisations
  • Action by government is also needed to reverse the rising tide of obesity and other major risk factors.
  • Building on the Forward View – programmes of integrated care that are sustainable.


Strengthening and implementing sustainability and transformation plans


  • Sustainability and transformation plans (STPs) are a practical expression of care that offer the best opportunity for the NHS and its partners to work together to transform the delivery of care, but there’s a need to strengthen leadership as they move from planning to implementation.


Improving productivity and delivering better value


  • As an organisation with an annual budget of more than £100 billion, the NHS has plenty of scope to be more productive. Increasing productivity has become more urgent as funding increases have fallen and deficits among NHS providers have risen. Key issues include better value, involving patients more in decision-making and reducing unwarranted variations in care and to improve care


Developing and strengthening leadership at all levels


  • Improving care depends in large part on the quality of leadership throughout the NHS and the ability of leaders to engage and support staff to improve care. There is a need for compassionate and inclusive styles of leadership
  • The success of STPs and the new care models hinges on experienced organisational leaders developing into system leaders, who are able to work across boundaries to negotiate and implement improvements in care. There is a need for leaders ‘comfortable with chaos’ to make things happen



Securing adequate funding for health and social care


  • In April the NHS will enter the eighth year of unprecedented constraints on funding while adult social care is rapidly becoming little more than a threadbare safety net for the poorest and most needy older and disabled people. The prospects for the remainder of this parliament remain bleak, with limited scope for raising more funds for social care and the NHS having to plan for infinitesimal growth in 2018/19 and 2019/20.
  • The government must choose between finding additional resources for health and care or being honest with the public about the consequences of continuing austerity for patients and users of publicly funded social care. Finding additional resources means being willing either to increase taxation or to reallocate funds from other areas of spending. Being honest about the consequences of continuing austerity requires acknowledgement that current performance standards and new commitments like seven-day working cannot be delivered within available funding.
  • The more important challenge is to initiate a debate about a new settlement for health and social care, building on the work of the Barker Commission.


I genuinely wanted some rays of sunshine in this bleak report, but the skies are still dark. Here’s hoping things will get better and we’ll see more integrated approaches between the NHS and social care. . . it surely must be the way forward.



Robots (again) and the challenge to help the care sector

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I see robotic care development is moving up a gear with the announcement of the Social Care Robot Challenge 2017.

Billed as a “national cooperative venture”, its aim is to pool knowledge from UK experts in social care robotics from both education and industry. The goal: To advance our knowledge of how robots can be integrated into the healthcare services of the future. Hmmm . . .

Both Bristol Robotics Lab and Sheffield University are already heavily promoting the venture that will, according to the blurb, “address the predicted steeply rising costs and strain of healthcare provision and services in the UK.”

Sorry guys, I think it will take more than robotic technology to get us out of the social care mess.

The robot connection to caring is not new, but this fresh attempt at harvesting intelligence to move to the next level is another indicator that the care sector needs help. I’m not a geek, but I do embrace technology. However, I do believe not interavtive care robot can substitute human kindness . . . or a decision to release the Government purse strings.

There’s talk of “a motivation to create an architecture for social cognition in care robotics.” I think that means developing robots that store information and can apply it socially in a caring environment. If I’m wrong, will someone please tell me, please.

Robotics Week, 24-30th June 2017 will be a must for geeks and the Social Care Challenge will be a centerpiece.

Research issues to be addressed from a robot social cognition perspective could include one or more of the following:


  • Assisted mobility
  • Personal hygiene
  • Social support
  • Preventative and rehabilitation monitoring
  • Remote assistance
  • Food preparation


My mind boggles, but we all must be grateful if ultimately this technology is the lifeline the care sector so desperately requires. Can someone please tell me why I can’t get the thought of Star Wars’ R2D2 out of my head?

Sorry, I don’t wish to trivialise, but we do need a much quicker solution to the care meltdown than what I believe robotic development can deliver.

Written by debbielq

January 17, 2017 at 8:33 am

The state we’re in – time for a reality check

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Britain’s elderly population is soaring, but there’s a big problem: Not all the latter years afforded by better care and medicinal advances are healthy.

There are one million more people over the age of 65 than five years ago, and the number of those aged 80 and over has risen by almost 10 per cent.

The demographic shift means an increasing number of extremely frail and elderly people who are unable to carry out daily tasks unaided.

And social care is in demand like never before.

In 2010, the Coalition government promised to protect the NHS from cuts and the

Conservative administration has continued to ensure that the health service receives increases in funding, with an extra £8bn a year by 2020, I read.

Despite the NHS ‘protection’ policy, just like its poor relative, social care is also in trouble.

With social care funding at an all-time low, care businesses failing weekly, reduced capacity in the private sector and a growing unwillingness among care provider survivors to take council-funded candidates, bed-blocking is now seizing the mechanics of good hospital caring.

Simply, medically fit people are being left on wards because there are no community beds available, or the necessary support care packages at home cannot be established.

Austerity measures have hit councils badly and social care has been an easy target on which to save money. It sounds harsh, but it’s the way it is.

In real terms, figures suggest budgets for social services have fallen by 11 per cent in five years, as the elderly population has surged.

We have been warning of the winter crisis for months and now we find operations are being cancelled in a bid to ease the hospital beds shortage.

I understand that ahead of Christmas there was a clamour to free up hospital beds.

But returning pensioners to their homes requires far more care to be available; from home-helps, to full-time live-in personal assistants and carers with advanced skills.

What’s more, since 2009, the number of people receiving state-funded help for care has fallen by 25 per cent. So many are struggling to pay-as-you go as self-funders.

And there’s another issue. “Social care sector roles now have turnover rates of more than 25 per cent a year, with more than 300,000 workers walking away from such work every year. It is an ageing workforce too – one in five of those in the field are approaching retirement age,” a national press report said.

Remarkably, so many of my West Midlands Care Association members and those with whom I work in other care organisations, stoically press on providing excellent standards of caring.

Yes, we do need a new architecture for care finances, but proposals are so far short-term and a realistic solution is notably missing from any political New Year goodwill message that I’ve seen.