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By Debbie le Quesne

Archive for the ‘carers’ Category

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.

 

 

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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.

 

 

‘Jet-in’ carers fly from Benidorm to UK amid care chaos

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I could hardly believe my eyes as I read the in the Telegraph that builders, barmaids and bankrupt businessmen are  flying into Britain from Spanish holiday spots to earn lucrative sums as care workers for the elderly.

What is going on?

A Telegraph investigation tells us that “thousands of expats are funding lifestyles in the sun by jetting in for fortnightly placements to take sole charge of the vulnerable, with, in many cases, “just a few days’ training.”

According to the story, British agencies are trawling popular resorts such as Benidorm and Malaga to lure new recruits with the promise of good earnings, free accommodation and subsidised travel.

And these travel carers are then supposed to give the most intimate of care to our elderly – virtual strangers doing shifts alongside residents with whom they have no real connection.

Figures being banded about, suggest earnings can be up to almost £1,700 a fortnight, with an alleged admission that many of those on their books “did not want to look after the vulnerable, but were driven by the cash.”

Our social care system is breaking down – a shortage of Government investment that’s matched by a growing shortage of workers.

Is this the latest symptom of chaos? Indeed, I believe it is, along with the widespread care home and dom-care service closures and record levels of bed-blocking in hospitals for want of social care packages being in place.

Caroline Abrahams, charity director at Age UK, is reported as saying the revelations were “yet another symptom of a crisis in social care” and I agree.

The Telegraph investigation reveals that “former builders, barmaids and taxi drivers are among thousands of expats flying back to Britain each month to be responsible for elderly people, those with dementia and learning difficulties.”

I am assaulted by a multitude of emotions at this news . . . I’m angry, frustrated, overwhelmed, but mostly sad.

Clearly driven by the downturn in the Spanish economy, we now have the added danger of casual carers – not to be confused by the many other foreign care workers who have chosen to make a career in caring in the UK.

It will be interesting to see what the CQC has to say about this latest trend, which according to the Telegraph is dodging regulation because some of the workers are self-employed.

Dr Sarah Wollaston, chairman of the Commons health select committee rightly says we need to “completely rethink the way we care for the vulnerable; we should be growing our own workforce, not relying on short-term stints from people flying in from overseas.”

I understand only too well the need to improve the supply of care workers, but this development worries me.

By 2020, a shortfall of more than 200,000 care workers is forecast in the UK.

For some, that’s a business opportunity, but if this is the emerging model we must stay vigilant.

Such a system raises obvious questions about consistency, accountability and care inquiry follow-ups – the regular dialogue between carers about patient needs and changes in condition.

I need chocolate, another coffee and the heater on my feet . . . all bad signs, I’m afraid, as a reach for crumbs of comfort.

  • Have you heard? This winter, the gaps in Britain’s stretched social care services have seen some of the most extreme measures on record.
  • Every NHS hospital has been ordered to cease most planned operations for a month until mid-January, in a desperate attempt to empty hospital beds, many of which are filled with pensioners for want of care packages at home.

 

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

The masterplan for Cumbria . .. and elsewhere?

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I’d never head of the News & Star, but for those who are interested it’s a newspaper. Recently it broke a story of a masterplan for care in Cumbria County Council ‘s area.

It said the council was to carry out its own separate consultation on the future of care homes in Carlisle and Copeland.

Interesting. It also said the Success Regime’s long-term aim is to reduce hospital beds and care for more people at home but can social care cope?

The council wants to close a total of seven homes and replace them with a new £6 million home in each district, focusing on caring for those with the most specialist needs such as dementia. Overall its care beds would reduce, with more people instead being looked after at home.

I accept that a local authority run care homes are not viable as their carers have to be paid the same rate as refuse operatives. My question: How will this new venture be funded and at what cost to the general public?

Have I heard this one before?

How foolish I am, I genuinely though that health and social care were supposed to be working hand in glove, but this plan has all the makings of pushing more people into care in the community and that service is already stretched to the limit.

How desperate is this measure and how shortsighted.

I love the fact that people can remain independent longer, but for that to happen we need well-funded social care going into people’s homes.

Defending their position, Cumbria County Council says although the plans will see beds reduce none of those homes affected have high occupancy rates.

There’s a pledge on jobs too, with staff from the existing homes being transferred alongside current residents to the new centres.

This will make an interesting consultation period I’m sure. Already a

county councillor fears the overhaul of north and west Cumbria’s NHS will put extra pressure o care services.

Whitehaven councilor, Christine Wharrier, who previously worked in the NHS, called for more joined-up thinking.

The Success Regime’s long-term aim is to reduce hospital beds and care for more people at home, but Mrs Wharrier is worried social care will not be able to cope.

Of course, we do need larger care homes, but we don’t want factories or a mentality that views transfers of residents and staff like personnel being offered relocation deals after plant closures.

 

New working partnership to help skills shortage . . . and much more

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Creative solutions – a sound bite of the 80s – is alive and ticking with two northern employers coming together to help tackle the care industry skills shortage.

TyneMet College and Age UK North Tyneside’s EveryDay Home Care service have launched a new training programme to upskill workers in the healthcare sector and develop the next generation of industry talent.

I love it!

Health and social care staff from EveryDay Home Care’s workforce and Age UK North Tyneside Wellbeing Services will undergo a structured training programme that covers a range of disciplines including health and safety, medication awareness, customer service, food safety, nutrition and first aid. The employees will study for a health and social care apprenticeship, which will combine on-the-job work experience with classroom learning at TyneMet.

The partnership with TyneMet comes as demand for homecare services is on the rise and providers are struggling to recruit suitably skilled staff.

Alma Caldwell, group chief executive at Age UK North Tyneside and EveryDay Home Care, was reported in the media as saying: “We recognise the importance of increasing the skills base of our workforce, particularly as there is a shortage of suitably qualified workers in our industry.

“That’s why we’ve teamed up with TyneMet College to upskill our current workforce and provide an opportunity for other aspiring care staff to make their way in the sector.”

What can I say? Well, surprisingly quite a bit. . .

All care staff have to go through a structured training programme and many newcomers are signed up to apprenticeship schemes.

My West Midlands Care Association has always worked with local authorities, which have helped us to ensure that we get the right quality training and that it is easyily accessible when needed.

This year we are pushing boundaries and seeking to access training through other routes.

Our problem is that LAs are limited on what they can supply.

Currently we are working with ACCTV a company that produces interactive television training for care staff.

Previously, this has been the preserve of the Southern, well-funded areas, but we have now managed to secure a service with a realistic offer.

Our members will get a very good deal, be assured. Providers will get a taster and access to the dementia training program as September is Dementia Month.

We’ll keep you posted. This is our own creative solution.