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By Debbie le Quesne

Archive for the ‘care fees’ Category

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.

 

 

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As the Red Cross intervene with the NHS, what will it take force a social care lifeline?

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The other Saturday I watched the television news with a stunned sense of disbelief as the chief executive of the British Red Cross announced the NHS was in the middle of a “humanitarian crisis”.

I’d never thought of the Red Cross intervening in UK affairs in such a way – don’t the images of this worthy, brave orgaisation invade our news from far flung places where there’s famine and the ravages of conflict? Not any more it seems.

To hear its top man, Mike Adamson, explaining exactly what defines a humanitarian crisis and that it’s is now in England, stopped me in my tracks.

His definition was along the lines of . . .

“It affects many people over a prolonged period of time, something of threat to their health or wellbeing. Just think about the situation of someone, for example, waiting on a trolley in and A&E department for several hours, perhaps with no family around them after a fall, probably quite frightened. . . .”

The warning came as it emerged two patients died in the same A&E department within a week during “extremely busy” periods.

In December A&E department shut their doors 140 times and now cancer ops are being cancelled, I read in the newspapers.

Mr Adamson added extra cash was needed for health and social care to make the system sustainable.

What was that? Extra cash for social care. Indeed!

Sadly, at the root of the NHS crisis is a failing social care . . . and we have warned for years that it was terribly broken. They would not listen, and I’m not convinced they are listening now.

The official response from the NHS is predictable: What crisis? And this still remains the official line.

I find it odd that hospitals like Russells Hall, Dudley, is allegedly paying a company to try to help sort out their funding, either by pressurising care homes to drop their fees, or getting patients’ families to become fiscally involved. Surely this could never catch on after the government’s stalled attempt to get the public to invest in care insurance policies. The elephant in the room, of course, is a properly functioning social care system. Everyone knows it. The government, however, steadfastly refuses to acknowledge it.

Mr Adamson explained: “The British Red Cross is on the front line, responding to the humanitarian crisis in our hospital and ambulance services across the country.

“We have been called in to support the NHS and help get people home from hospital and free up much needed beds.” Called in by whom? I suspect the Department of Health.

Shadow health secretary Jonathan Ashworth said it was “staggering” that the Red Cross had been drafted in to help. I think so too, though I would add that his Government did precious little to grasp the nettle of social care during its term.

Of course, there’s much politicking to be had over this development in the care saga so we need to focus on facts.

Just about a year ago bed blocking was costing the NHS about £820 million per year.

Last summer the National Audit Office said delays in discharging patients from hospitals in England had risen by nearly a third over two years. Delayed transfers (bed blocking) have not improved and there’s a resigned approach that’s punching through that deeply disturbs me.

Across England, the audit office found that for every 100 beds, three days of use were taken by patients who no longer needed to be in hospital between March 2015 and February 2016.

Quite what 2017 analytics will deliver terrifies me, because it is in direct correlation to the ability of social care to unblock beds – something it can no longer do. And we all know the reasons why.

The question now is this: Exactly what will it take for the Government to intervene? Will it deliver the much-needed financial lifeline to social care, which could not only rescue struggling care providers, but also our hospitals and . . . dare I say, those people who need either one or both of those services,

 

 

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

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.

 

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.

 

 

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