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By Debbie le Quesne

Archive for the ‘budget’ Category

CQC: More companies are pulling out of contracts with councils

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Private sector care providers are ditching home care services, the Care Quality Commission (CQC) says.

And the regulator adds companies are pulling out of contracts with councils as they are no longer ‘profitable.’ A national trend, it’s now happening across the West Midlands, but the real crunch will come in April when we see the next increment in the National Living Wage.

According to the Commission the crisis in social care funding means authorities can only afford to pay firms very low rates.

How long has West Midlands Care Association been warning this will happen? Err, years.

David Behan, chief executive of the CQC, was reported in the media as saying several major companies, including Care UK, had pulled out of local home care contracts.

Giving evidence to MPs at the Health Select Committee, he said firms were unable to ‘deliver the quality of care and the volumes of care at the price being offered’.

Association of Directors of Adult Social Services figures show that 57 per cent of councils have reported home care businesses giving up their contracts in the past six months.

The research estimates that this had involved 10,800 elderly and vulnerable residents.

Some 400,000 people in the UK receive council-funded home care.

Quote: “Mr Behan told MPs that companies were ‘leaving the market’ and replacements were ‘not coming in.’ The vast majority of contracts handed back in our experience have been domiciliary care contracts where providers are saying:

‘We can’t deliver the quality of care and the volumes of care at the price being offered.’

The news has drawn comment from Caroline Abrahams, Charity Director at Age UK, who says ‘It’s worrying to hear that some care providers are giving up trying to make existing contracts work as their costs rise but funding fails to keep pace, and if these organisations are losing confidence in the sustainability of the care sector how on earth are older people and their families supposed to put their trust in it?’

Significantly she adds: ‘No care provider would ever walk away unless they felt they had no choice and the fact some are now doing so says a lot about the parlous state of the market at present.’

Very true. Austerity measures have had a catastrophic effect on care and ultimately the economies of council-funded packages don’t stack up with the inevitable failure to release bed-blocking at hospitals.

Estimates suggest that the number of those aged 85 and over will have almost doubled by 2030.

 

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

At last, the embattled social care sector is making the headlines it needs

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Billions of pounds are needed to avoid the NHS and social care crisis – that’s the message which has been sent to Secretary of State for Health, Jeremy Hunt.

According to the Daily Mirror, leaders in the care sector have alerted Mr Hunt after three health areas revealed they face a combined shortfall of more than £2.4billion by the end of the decade

As we broke into November, the dire warning outlined that without extra money they will struggle to meet waiting time targets, provide enough hospital beds and basic levels of social care.

Sounds familiar, doesn’t it, and it’s right on our doorstep.

The Mirror reports: “The verdict is contained in the newly published Sustainability and Transformation Plans (STPs) for Birmingham and Solihull, North Central London and South West London.

Sustainability and Transformation Plans were ordered by NHS England boss Simon Stephens in December 2015 and charged 44 regions in England to come up with a five-year programme for providing health and social care in their areas.

I’m not a lover of red-top journalism, but this report is exactly what’s needed.

And it adds: “Of the three reports published so far Birmingham and Solihull warns it faces a £712million shortfall by 2020, South West London £828million and North Central London £876million.”

For the record, West Midlands Care Association is working very closely with Birmingham City Council and assessing the impact throughout the neighbouring Black Country region.

The shortfall will doubtless impact on areas already struggling like Sandwell, Walsall and Dudley.

Mark Rogers, the chief executive of Birmingham Council, says in the piece both health and social care face “huge challenges”. According to Mirror “this includes the need for at least 430 more hospital beds in the region.”

Personally, I’m struggling to find a creative way forward. All the cuts in social care have already been made and I fear the duty of care caveat is lost somewhere in the ether.

Budgets are not just shrinking, they are vanishing and the demand for care is astronomic.

Mr Hunt, I fear lives in a bubble as MP for South West Surrey, and as we all know the social care financial map is very different in his constituency.

There is a laudable push to get people out of hospital and back into their own homes with social care support. But it is catastrophically failing.

Let me quote the Mirror again: The North Central London STP says it is not “able to deliver universally for everyone to the standards we would like.

“Our analysis tells us that too many people stay longer in hospital than is medically necessary. There are challenges with meeting acute standards, as well as issues workforce sustainability.

“Some of our estates aren’t fit for purpose. Additionally, we face a financial challenge of £876million across health commissioners and providers by 20/21 if we do nothing,” the STP is reported as saying.

This could have been written of any number of LAs throughout the UK.

Chancellor Philip Hammond has a chance to help next week with his mini Budget on November 23.

In the light of bleak analysis, I truly hope he will understand his responsibilities towards care providers and those receiving care.

WE are working with Birmingham to look at the consequences for Domicilairy and Care Homes. The shortfall in Birmingham has impact on the Black Country with many people being placed in Sandwell Walsall and Dudley

‘Billions’ needed to avoid social care meltdown

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Billions of pounds are needed to avoid the NHS and social care crisis – that’s the message which has been sent to Secretary of State for Health, Jeremy Hunt.

According to the Daily Mirror, leaders in the care sector have alerted Mr Hunt after three health areas revealed they face a combined shortfall of more than £2.4billion by the end of the decade

As we broke into November, the dire warning outlined that without extra money they will struggle to meet waiting time targets, provide enough hospital beds and basic levels of social care.

Sounds familiar, doesn’t it, and it’s right on our doorstep.

The Mirror reports: “The verdict is contained in the newly published Sustainability and Transformation Plans (STPs) for Birmingham and Solihull, North Central London and South West London.

Sustainability and Transformation Plans were ordered by NHS England boss Simon Stephens in December 2015 and charged 44 regions in England to come up with a five-year programme for providing health and social care in their areas.

I’m not a lover of red-top journalism, but this report is exactly what’s needed.

And it adds: “Of the three reports published so far Birmingham and Solihull warns it faces a £712million shortfall by 2020, South West London £828million and North Central London £876million.”

For the record, West Midlands Care Association is working very closely with Birmingham City Council and assessing the impact throughout the neighbouring Black Country region.

The shortfall will doubtless impact on areas already struggling like Sandwell, Walsall and Dudley.

Mark Rogers, the chief executive of Birmingham Council, says in the piece both health and social care face “huge challenges”. According to Mirror “this includes the need for at least 430 more hospital beds in the region.”

Personally, I’m struggling to find a creative way forward. All the cuts in social care have already been made and I fear the duty of care caveat is lost somewhere in the ether.

Budgets are not just shrinking, they are vanishing and the demand for care is astronomic.

Mr Hunt, I fear lives in a bubble as MP for South West Surrey, and as we all know the social care financial map is very different in his constituency.

There is a laudable push to get people out of hospital and back into their own homes with social care support. But it is catastrophically failing.

Let me quote the Mirror again: The North Central London STP says it is not “able to deliver universally for everyone to the standards we would like.

“Our analysis tells us that too many people stay longer in hospital than is medically necessary. There are challenges with meeting acute standards, as well as issues workforce sustainability.

“Some of our estates aren’t fit for purpose. Additionally, we face a financial challenge of £876million across health commissioners and providers by 20/21 if we do nothing,” the STP is reported as saying.

This could have been written of any number of LAs throughout the UK.

Chancellor Philip Hammond has a chance to help next week with his mini Budget on November 23.

In the light of bleak analysis, I truly hope he will understand his responsibilities towards care providers and those receiving care.

WE are working with Birmingham to look at the consequences for Domicilairy and Care Homes. The shortfall in Birmingham has impact on the Black Country with many people being placed in Sandwell Walsall and Dudley

Pressure mounts on Chancellor for more cash

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Last month Theresa May’s claims that the government is putting £10bn extra into health was challenged by five MPs. led by the Conservative Dr Sarah Wollaston, the chair of the Commons health select committee.

The impact of not enough money for hospitals and access to social care are written for all to see in rising demand for A&E and missed waiting time targets.

Clearly there are complex reasons that, according to some sources, delayed transfer of care lost 192,000 hospital bed days. But the downgrading of social care in government agendas must be a primary cause.

I am led to understand some NHS number-crunchers believe the real number of people in hospital who should be being cared for in the community is probably four times as many as represented the figures here.

The pressure really is on Mr Hammond to deliver in his Autumn Statement.

Rising costs, the ageing population, difficulties recruiting staff and years of central government reducing its grant have left the service in crisis, the Local Government Association claims.

Surely, there is an unprecedented agreement that social care should be at the very top of the list of Mr Hammond’s priorities for urgent extra funding.

The triple whammy of shrinking budgets, rising demand and the cost of paying the national living wage to care workers has left many councils paring back more and more on care costs.

I’m led to believe that in Walsall last week there were 138 people waiting to leave hospital. There is enough capacity in the region to take them all, but . . . there is not the money to start the funding of new packages.

Before winter pressures kick in we understand discharge managers are looking to get all those people back in the community and free  100 beds for winter. Sadly, if all of those perceived admissions required care in the community or step-down residential beds we’re in trouble. There simply is not the capacity.

Mr Hammond is being urged by senior Tories to give the crumbling care system a double boost in his autumn statement, amid growing alarm that social care and the NHS will be unable to cope with demand this winter.

Rumours suggest that Mr Hammond is examining a plan to plough between £700m and £1.5bn extra into social care services from April to help reduce numbers of older people being admitted to hospital.

Apparently, he is also considering letting councils raise the amount they can add to council tax bills to fund social care through a precept introduced in April, currently capped at two percent.

We’ll see . . .

The LGA has made known that years of cuts to town-hall budgets have left the sector in crisis, with fewer people getting help with basics such as washing and eating at a time when need is rising.

Also, care homes are closing, partly because councils cannot afford high enough fees to allow operators – whose costs have risen because of the national living wage – to make a profit.

Putting further funds into social care, will I’m sure, indirectly relieve some of the difficulties being encountered by the NHS; not lest helping to facilitate a more efficient discharge of patients.

 

Branson wins £700m contract to run 200 care services

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There is no more burning injustice today than older and disabled people being denied the care they need to live with independence and dignity, but what is the way ahead for a cash-strapped system that is currently failing to meet needs?

Perhaps one of the answers lies in the hands of the billionaires. But will they repeat commercial history  just like the supermarket chains, which with huge buying powers, rode roughshod over the corner shop traders?

Currently, however, the national/local cost structures are very similar at the consumer end and what the big boys save on bulk buying goes on additional overheads.

I do read with interest though that Sir Richard Branson’s health firm, Virgin Care, has won a £700m contract to deliver 200 types of NHS and social care services to more than 200,000 people in Bath and north-east Somerset.

The contract has sparked new fears about private health firms expanding their role in the provision of publicly funded health services. Clearly I can understand the concerns regarding the NHS, but for the social care sector, could this be a lifeline?

Virgin Care has been handed the contract by both Bath and North East Somerset NHS clinical commissioning group. It is worth £70m a year for seven years and the contract includes an option to extend it by another three years.

It means that from 1 April Virgin Care will become the prime provider of a wide range of care for adults and children.

That will include everything from services for those with diabetes, dementia or who have suffered a stroke, as well as people with mental health conditions. It will also cover care of children with learning disabilities and frail, elderly people who are undergoing rehabilitation to enable them to go back to living at home safely after an operation.

Outsourcing, especially with the NHS, has a bad reputation and it appears the Virgin initiative is a big step towards the empire dominating the supply of community health across England.

The Mirror online newspaper reported that the Virgin deal includes dementia and end of life care and a “hospital from home” service for recently discharged patients.

Sir Richard has an impressive record of successful investments, so I’ll be monitoring this one with interest.

Certainly he is not short of the financial sleeve to bring a large fresh broom to social care provision, but if this is the future, I fear the conglomerate approach will inevitably destroy that indefinable ‘homeliness’ of some smaller residential care settings.

 

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