wmcha

By Debbie le Quesne

Archive for the ‘care in the community’ Category

Higher local taxes not a proper answer

leave a comment »

 

While Surrey County Council leader David Hodge bleated an apology over his attempt at hiking up council tax bills by 15 per cent to cover spiralling social care costs, more than 90 per cent of councils in England told ITV News that being allowed to raise council tax has made little or no difference to their ability to provide social care.

In December the government announced it planned to increase the social care precept from two to three percent.

But with the crisis surrounding home care deepening, many councils told ITN its no more than a “sticking plaster”.

Interesting, isn’t it, that the Surrye ‘sticking plaster’ has just dropped off the ‘wound’ with the announcement earlier this month that the huge hike had been scrapped.

A survey by the Association of Directors of Adult Social Services (ADASS), commissioned by ITV News, contacted all 152 councils in England.

They were asked whether permission to increase council tax would make a positive impact on social care in their area. Just 112 responded.

Thirty said it would make no difference and 79 agreed it would make very little difference. Just three councils agreed the rise would make a substantial difference to their ability to look after residents needing extra help to cope.

Not a single local authority believed the tax initiative at a local level offered a complete solution.

Last year the Local Government Association claimed Treasury funding cuts of 40 per cent over the last five years have left councils facing a £5 billion funding gap on social care.

Mrs May, will you please listen to what is going on in our sector and help us?

Interestingly, I was in Surrey at an association members’ meeting when the 15 per cent shocker was announced and the care providers with me were as puzzled as everyone else by the move, given that the majority of their clients are self-funders.

 

 

 

CQC: More companies are pulling out of contracts with councils

leave a comment »

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.

 

Snapshot on social care: Could it get any worse?

leave a comment »

 

Following the collapse of Southern Cross in 2011, we all though it couldn’t get much worse. The then UK’s biggest care home operator was in utter shambles and the lives of residents in turmoil.

No other big players have folded to date, but smaller firms aplenty are failing across the country. And there’s evidence too of major players in the region feeling economically uncomfortable . . . Four Season have closed in Birmingham and HC one have sold many of their Midland Homes.

The Guardian revealed last year a staggering 380 care homes have been declared insolvent since 2010 (Insolvency Service figures).

The number of failures each year has risen sharply since 2010, when 32 businesses failed. In 2015, 74 were declared insolvent, while another 34 failed in the first six months of 2016.

Large companies are also hurting. Four Seasons, the biggest care home operator in the country with more than 400 properties, is the most at risk, recording a pre-tax loss of £28m in the three months to the end of September 2016, the Guardian announced.

Robbie Barr, the chairman of Four Seasons, warns the industry is “struggling at tipping point” with the company juggling its own challenges.

On the issue of increased council taxes, he says it’s essential that councils use the powers they have been given to raise the social care precept and pass it on to frontline elderly social care services to help offset the additional costs of the national living wage increase and avoid further pressures on a sector.

The national living wage is scheduled to rise by 4.2% in April to £7.50, which is larger than the proposed 3% increase in council tax.

The Local Government Association estimates there will be a £2.6bn funding gap in adult social care by 2020.

A study by the Health Foundation, the King’s Fund and Nuffield Trust estimate the gap would be £1.9bn this year.

The LGA, reported: “The care provider market cannot carry on as it is and there is a real danger of more widespread market failure.”

And CQC . . . the industry regulator warned that adult social care is “approaching a tipping point”.

 

Time for a holiday, or more chocolate biscuits, please. . .

Crisis care letter follow-up swamped by Trump headlines

leave a comment »

 

I see the Select Committee chairs have sent a frank letter to Theresa May urging action to tackle the social care crisis. Their biggest fear, it appears, is that the Brexit circus will crowd out ‘domestic policy.’

Not a chance, I say.

There’s only one headline maker out there at the moment and that’s the Prime Minister’s new American ‘friend’, Donald Trump.

I can recall my seniors shouting at the television, offering running commentary on everything from the news and football referee decisions to the latest saga with long-departed Ena Sharples of Coronation Street.

This weekend I was almost doing the same as Trump seemed to fill every waking hour of newsfeed time. Of course, I’m not decrying that his game-changer on the world stage is not newsworthy, but . . . on home soil the critical nature of the social/NHS care latest seems to have fallen below the radar.

Mrs May must still be under a deal of pressure over the correspondence from three of the most influential Commons select committees urging her to seek a rapid cross-party consensus on the “immense challenge” of paying for health and social care in the future.

But the media frenzy has now a new focus and she must be secretly breathing a sigh of relief – albeit for a just a little while.

The letter – sent jointly by the Conservative MP Sarah Wollaston, of the health committee, Labour MP Meg Hillier, of the public accounts committee and Clive Betts, also a Labour MP, of the communities and local government committee, highlights fears that pressing issues at home are being put on the back burner.

“We are calling for a new political consensus to take this forward,” the letter reads (Guardian). “This needs to be done swiftly so that agreement can be reflected in the next spending round.”

The MPs maintain that any review should target both the health and social care systems, warning that separation of the two is “creating difficulties for individuals and avoidable barriers and inefficiencies”.

Not surprisingly, Mrs May was accused of failing to grasp the scale of the challenge, after the chancellor Philip Hammond ignored the care sector in his autumn statement last November.

And then of course, we had the announcement from Downing Street that local authorities would be able to increase taxers to sort out short-term needs. Bit of a knee-jerk response to associations like mine, I suspect.

The political consensus appears to put the blame for everything at the Brexit door. As the Guardian reported: “The intellectual energy will go into Brexit, the most ambitious civil servants will want to be in the Brexit departments; it will just be the focus of everything.”

The letter concludes: “In short, the problem is widely recognised – we now need political agreement so that a solution for the long term can be found. For our part we shall do what we can to contribute to a consensus. We look forward to hearing from you.”

Backing for the letter has come from The King’s Fund and the Local Government Association.

Memories of year where care reached crisis point

leave a comment »

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

leave a comment »

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.

 

 

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

leave a comment »

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.