By Debbie le Quesne

Archive for the ‘blind’ Category

Autumn Statement: My utter disbelief

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Like millions of others, I listened to the Chancellor’s Autumn Statement in a stunned disbelief that after unprecedented pressure he failed to deliver on social care.

Secretly, I’d been hopeful that, as ITV put it, this vital area of funding would be Philip Hammond’s “rabbit out of the hat.”

But the man, who is privileged to represent the constituents of one of the wealthiest areas in the UK, said absolutely nothing on the issue so many of us were pinning our hopes on.

As the Prime Minister pointed out in PMQ’s, local authorities have been allowed to raise council tax by 2% to help plug the funding gap. But, especially in poorer areas where council tax receipts are low, the “social care precept” has barely touched the sides.

The irony of it all I find was in the closing comment calling it a plan that “provides help to those who need it now.”

On what plant does this Chancellor live?

It was no surprise that leader of the opposition Jeremy Corbyn chose to focus on health and social care as he took on the Prime Minister in the Commons before the Autumn Statement.

But is set a stage of clear demarcation – between reality and Cloud Cuckoo Land.

Love him or hate him, Corbyn urged the Government to plug the gap and address the “stress and fear” it causes.

Unremittingly bleak, social care providers have done an amazing job in recent years without the central funding to sustain long-term credible business models.

Local authorities have also been forced to pare provision back, to in the opinion of many, dangerous levels.

For six years there have been unprecedented cuts to LA budgets, with figures suggesting those people eligible for council-funded care falling by 25 per cent.

Teresa May’s almost apologetic herald for the mini-budget of gloom was found in her comment: “We can only afford to pay for the NHS and social care if we have a strong economy”.

My life! This is another George Osborne in this key role.

Well, Mr Hammond, may I congratulate you on your sheer brilliance in ignoring perhaps the most pressing social dilemma since the introduction of the Three-day Week in 1974.

Predictions of “looming chaos” were rejected by the Chancellor.

Philip Hammond said a previously announced NHS funding commitment was in line with what its leaders had wanted.

Health and social care leaders are reeling and unanimous in their condemnation.

Now the Treasury has made its stand, with Mr Hammond confirming that ministers would be sticking with departmental spending announced last year, the official unraveling of social care can begin.

In a new briefing published ahead of the Autumn Statement on 23 November, the Health Foundation, The King’s Fund and the Nuffield Trust analysed the state of health and social care finances, concluding that cuts and rising demand will leave adult social care facing a £1.9 billion funding gap next year.

What a cynical approach to well-founded information in the care sector we have witnessed. Is this bordering on criminal neglect . . . interesting thought.

And finally (for now): For once I am in a position to sympathise with the local authorities in the West Midlands and particularly Birmingham which is £50million in the red already this year.

No lifeline, the extra burden of the living wage  . .  and effectively an abandonment of responsibility for those in need and their care providers. In the industrial West Midlands  there simply are not enough self-funders to keep the sector afloat and bolster the care of those people funded by their local councils.

A budget for the JAM people (just about managing), Mr Hammond. Not in my world, Sir.





– Debbie LeQuesne CEO

Social reform: Are the answers in grassroots debate?

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I recently stumbled on an article by Professor Peter Beresford in The Guardian and his comments are worth sharing in this blog.

He is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives.

He notes that 70 years on from the creation of the welfare state, social care is one of the biggest, most important and yet most neglected social policies.

“Now another new government needs to face up to the vital need for radical reform,” he adds.

Indeed, that’s so true, but also frustrating. We meet up with Ministers(as we did Paul Burstow in London) and suddenly they are gone – taking with them all the good work we have shared. Such is the political arena.

Prof Beresford’s message is clear – social care reform must come from the grassroots

I quote: “The spending cuts made in the name of austerity over the last six years have especially hit local authority social care.

“This in turn has particularly hurt the growing numbers of older and disabled people needing help, including mental health service users and people with learning difficulties. While the rhetoric surrounding social care has been all about integration, the tendency is still to treat it in isolation.”

This is someone who has a good handle on the underlying issues of funding – the root of nearly all social care ills – and the frustration we feel in trying to get joined-up thinking between the NHS and residential and domiciliary care.

He observes what he describes as the “grassroots reality which shows the human face of welfare reform like that presented by Ken Loach’s award-winning film I, Daniel Blake.”

Based on research and interviews by the screenwriter Paul Laverty, this movie tells the fictional story of Daniel Blake, a middle-aged widower in the North East who can’t work or get benefits after a near-fatal heart attack.

The internet trailer is challenging and introduced for me a broader horizon of how ‘The Cuts’ – ‘Austerity Measures’ – call it what you will – have impacted our lives and how food banks have become ‘normal’ in an increasing desensitised society.

I find myself questioning: What is social care coming to? How has this been allowed to happen and what more can I do to help educate those who handle the finances of Government and seem unable to find funds for us.

Prof Beresford is the author of a new participatory social policy text, All Our Welfare, and he highlighted that there really are alternatives, both to old-style welfare state and current “neoliberal privatising welfare” reform.

Interesting – mental note; must find out more!

David Brindle, the Guardian’s public service editor who chaired an All Our Welfare launch debate, referred to the post-war welfare state as a revolution and asked what kind of revolution we need now.

On the panel, John McDonnell, shadow chancellor, emphasised the importance of developing a new narrative for a new welfare state, reminding us that its founders not only created a new architecture, but also “won the argument” so that for years Conservative governments continued to protect it.

“It’s narrative that wins,” he said.

Significantly, this was a different kind of debate because it included the groups more often talked about than having a chance to do the talking. Representatives of Disabled People Against Cuts, Shaping Our Lives, other disabled people’s and service user organisations, campaigners and user researchers, were present in force as well as the policymakers, academics and researchers more often encountered.

Is this the way we must go?

Summing up, the professor writes: “This was one occasion that demonstrated that there are very different ideas out there about a future for social care and welfare, which come from the bottom up. But they tend to be hidden or devalued and we need foster these green shoots. This is perhaps already beginning to happen. . . .

“For me, the key question posed by writing All Our Welfare was, how should people look after each other in a 21st century society? The launch debate showed that there are already many answers in the making – if they are only allowed space to surface.”

Wish I could have been there . . .


We need to get the message ‘out there’

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Before anyone gets too excited at the potential headline-grabbing white paper that is doing the rounds in the care sector, it is not of the government variety.

I just need to make it clear, that this piece of work – Stabilising the Care Home Sector and Preparing for implementation of Part 2 of the Care Act 2020 – is a document produced by healthcare experts LainBuisson and is not the esteemed wisdom (I jest) of government research.

It says so much that the industry’s prime player in delivering analysis is now desperately trying to spark discussion with finding that are, for me anyway, terrifying.

I applaud this piece of work, but I note the language is pretty emotive and it’s not in the usual tone for L&G documentation. At best there’s an air of urgency about the work, and worst . . . a sense of panic.

It’s heavy going in parts and long, but in the main accessible. It should be essential reading for every self-respecting MP and elected representative, but I know it won’t be.

It’s our collective responsibility to get this message ‘out there’. In L&G’s own words, the objective is to stimulate debate on two linked topics:

  • What is needed to stabilise those segments of the care home sector which mainly serve older people in receipt of state funding and which are moving into crisis at a variable pace in different parts of the country?
  • How should the Dilnot funding reforms be modified to avoid the pitfalls that became evident in the run up to postponement of Part 2 of the Care Act (if the government carries out its stated intention to implement the Dilnot reforms in 2020)?
  • A third topic can also be added: What new initiatives could be started now to improve the functioning of the care market, within existing legislation and without the need top-down structural reform, on the part of different stakeholders – central government, local authorities, the NHS, regulators and consumers and their advocates?


There used to be a saying locally – “there’s none s’ blind as those who don’t want to see.”

So to put you in the picture, West Midlands Care Association is desperately trying to ensure we are doing everything to make certain the eyes (and ears) of local and national politicians are indeed open.

To this end I’m meeting minister for social care Alistair Burt tomorrow to discuss the viability of the care sector given the current stance of Government.

I’ll let you know how is goes.



It could soon be a providers’ market (but don’t bank on it)

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During next five years a shift in the dynamics of the care market could favour providers, according to an interesting appendix buried at the end latest white paper by industry analysts LaingBuisson.

The economic forecast (an excerpt from Care of Older People Market Report – 27th edition, published in September 2015) goes like this: “The care home market is subject to a self-righting mechanism like any other market. Investment is curtailed when prices (as now) are insufficient to offer a reasonable return in areas of high public pay. As a result, against a background of rising demand, shortages can be expected to appear.

“Market power will shift towards providers, prices will rise and public authorities will be forced to find extra resources if they are to meet statutory duties.”

The timescale? Likely over the next five years, the analysts say.

As you’d expect with any economic prediction there’s a get out jail clause or two, and here they are: “Market imperfections (including non-transparency of market information together with development time lags) will predispose the market to overshooting equilibrium in both the contraction phase (which the care home market appears to have entered now) and any past or future expansion phase.

“There is also historical evidence of such cyclical patterns in the care home sector in the last two decades . . .”

And there’s more:

The Conservative administration may feel the crisis justifies a pre-emptive injection of substantial new funding – the National Living Wage (£7.20 from April 2016, rising to £9.00 by 2020) would certainly be a driver.

Without an at least partly compensating increase in government grants to allow councils to raise the care home fees they pay, the government can expect – here we go – a “wave of financial failures in the care sector.”

And finally in this post, L&B come up with a stunning nugget of information which may be the real reason for the postponement of the Dilnot elements in the Care Act. At a stroke, the delay (2020 is now the target date) some £2 billion can expect to be saved over the next four years.

Money saved, yes, but at a cost. Those residents who live in the less affluent parts of the West Midlands will certainly not be able to take up the slack, so it stands to reason that those residential and domiciliary businesses will be the first to go.

And the next in line will be those providers who have indeed followed the rules and regulations to the letter and discover too late the cost of doing so does not make for a viable business model. You know, I still can’t help thinking how callous and shortsighted such decisions are. Are we not ultimately penalising the most frail and vulnerable and those who care for them?



Personalised care: Financial limitations DO inflect pain

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Nestling in the pages of The Guardian online I recently found a Jeremy Hughes piece which every person who holds the purse strings on care should read. Hughes opens with the statement that we increasingly expect personalised service.

Spending a weekend in a care home “provided me with a valuable reminder of what providing truly individual care for people with dementia should mean,” he writes, adding . . .

“During my stay, I witnessed a care assistant spend over an hour helping a resident to get nourishment through puréed food when she could neither chew nor swallow.

“There is an art to caring for someone who can no longer communicate verbally and reassuring someone who is anxious and confused.

“One-to-one care was evident day and night. As I watched, I was struck by the fact that you can earn more in a supermarket than a care home. Recently, care home companies have been saying that paying the chancellor’s national living wage could put them out of business. Whether or not this is correct, it’s surely wrong that as a society we cannot afford £9 an hour to look after someone’s wife, husband, mother or father.

“No long-term fix for social care can succeed without addressing how undervalued the people who provide it are.”

I believe there are those who naturally make good carers, but this should never be an excuse not to reward them, or worse, undervalue them.

As Hughes says in his piece it’s time for us, as a society, to accept that the financial limitations we put on the funding of care inflict real pain.

With a real insight, Hughes adds that carers “have been left to pick up the pieces of our broken social care system.”

Indeed it is broken, along with the myriad of promises that were made to fix it. Only the dedication and goodwill of underpaid staff, and indeed some of their employers, allows the system to continue.

But for how long?

What price can we put on personalised care? Recently I read a piece about Starbucks’ £35 million dollar training programme to make their frontline workers “brand evangelists”. Training for managers includes a “theatre experience” and a ‘leadership lab.” Over the top? I think so for a cup of posh coffee, but it highlights just how much this company values personalised service.

Puts the care sector in the shade, doesn’t it! Sadly the care sector cannot compete. Theatre-type interviews by some companies that motivate newcomers with the promise of proper wages and great conditions do exist in the sector. But so much is just ‘spin’. The real scenario is generally one of a perpetual struggle to make business viable enough to pay already depleted wages.


Care workforce forecast showing 1m shortfall

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The social care sector could face a shortfall of a million workers in the next 20 years, I’m informed.

The system for adults in England faces a gap of 200,000 care workers by the end of this parliament due to restrictions on immigration and a failure to attract British workers, a report from the charity Independent Age and the International Longevity Centre – UK (ILC-UK), warns.

It adds that this figure will grow unless efforts are made to recruit more overseas staff and retain those already working.

Almost one in five adult social care workers (18.4 per cent) in England were born outside the UK, including 150,000 working in residential care homes.

People from outside the EU account for the largest percentage of migrants working in adult social care – around one in every seven care workers.

And we must also be aware that almost one in 20 (4.8 per cent) of positions in adult social care in England are vacant. That’s nearly twice the rate in the UK’s labour force as a whole.

Simon Bottery, director of policy at Independent Age, is reported as saying: “Without action, there is a real risk of care services worsening as providers fail to fill job vacancies and staff struggle to cope with increasing demand.”

Depressing, or what? But there’s a common chorus in this report we’ve all heard before: The Government must use its influence to invest in social care so it can attract more UK workers, while at the same time exploring new ways of caring for our ageing population in the future.

I’m afraid the tiresome response of the D of H is predictable. Cue keywords “better” and “smarter”.

Frankly, I think all of our care providers have done better than expected and indeed, are pretty smart to still survive in such crippling economic conditions.

What does appear to be an obvious question, however, is this: How are all these extra carers going to be paid? From where will this funding come? No doubt the Government has factored in the numbers (joke).

How the Government is saving £132bn on care

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No-one these days appears to be arguing that carers should not be paid more for the invaluable work they do. The exchanges are more about where the funding will emerge to reward this valuable social asset.

As head of the West Midlands Care Association, I’ve campaigned with many others for the Government to throw a lifeline to the industry. I am aware good care saves our nation an absolute fortune.

Our media man has some great carers for his ailing wife on a direct payments arrangement. The care is so good nursing calls have been reduced form an average of 4.3 x2 visits per week, averaging eight hours of clinical time, to 1 x1 every three months for a catheter change.

Saving to the NHS in this single case are awesome. Do you know the majority of care for ill, older and disabled people is provided not by doctors, nurses or care workers but by family and friends. More people are caring for a loved one than ever before, with one in eight people providing unpaid care to loved ones. From taking a partner with an illness to hospital appointments, to helping a disabled sibling with washing and dressing, to caring full time for an elderly parent, we are, increasingly, a nation of carers.

New Carers UK figures show that this help is worth £132bn per year – more than double its value in 2001.  This figure is calculated by adding up all of the care provided by carers and working out the cost of the state providing the same amount of support.  And this unprecedented figure of £132bn – more than the value of HSBC Holdings, or Visa plc – does not appear to reflect nursing costs.

The outpouring of caring is indeed something to be proud of, but I’m equally appalled that such a huge burden is placed on so many without any professional, paid carers on the scene. For some, that will be a choice. For the majority, I fear, it’s because the bar is now too high for them to warrant a funded care package.

The figure is confetti money – the cost of a second NHS service. So, what is driving the increase in the value of care? Demographic change now means means that the numbers of those in need of care and support is beginning to exceed the numbers of working age family members able to provide it.  But more critically is the fact that cuts to social security and local care services means people are receiving less support. It’s ticking time bomb, I fear, for surely this amount of ‘unofficial’ caring cannot be sustained indefinitely without some major support.

One wonders how long it will be before the carers crumble and their charges are, by default, neglected. I know of family carers who are struggling to make ends meet financially. Ordinary people, fighting to balance their domestic books, they are desperate for social services’ funding, but the pool of money to fund such intervention has evaporated.

Government has broken too many promises on the care issue to mention, but I will bring your attention to the hypocrisy of David Cameron. Did you know he protested about frontline cuts to public services suggested by his own Conservative local council?

A leaked letter shows Cameron chastised Ian Hudspeth, leader of Oxfordshire County Council, for considering cuts to elderly day centres and other services. ‘Not in my back yard,’ springs to mind.

A whopping £132bn . . . the yield for zero investment. It surely doesn’t take a lot of imagination to envisage more savings longterm if monies could be poured in to social care to fund a more professional approach. Goodness knows, those heroic and stoic people who care for their loved-ones out of a seemingly endless pool of compassion and love deserve it!