By Debbie le Quesne

Archive for the ‘challenging behaviour’ Category

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 . . .


Exceptional success at the double for care workers

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Brum care awards

Above: Nicholas Nolan and Cherry Harvey, centre, with ITV weather presenter Emma Jesson, left, and Jag Khatkar


Many of us in the care sector recently attended a glittering evening to celebrate the best of caring at the Edgbaston Cricket Ground. It was a great night that celebrated excellence in care and a night I was pleased for West Midlands Care Association to be part of.

Out of that event, one story has been prominent in my mind. Two newcomers to the care sector were honoured with an industry award for their outstanding commitment to the job after judges failed to decide on a clear winner.

The selection panel was so impressed with the nominations for support worker Cherry Harvey and community carer Nicolas Nolan it decided they both deserved the Exceptional Newcomer’s Award. The couple were shortlisted from hundreds of entrant across the city for the Birmingham Care Awards.

Support worker Cherry, who is part of the Precious Homes’ Kings Heath team in Birmingham, had no idea she had been nominated and was thrilled when her name was called out.

Judges commended Cherry’s dedication, commitment, compassion and loyalty, specifically in a first-time role within the care sector.

The awards ceremony was a joint venture between Birmingham City Council, West Midlands Care Association, Skills for Care and the Care Consortium. A regional event, its aim was to celebrate and reward excellence in social care.

Joint winner Nicolas, a community worker with Trident Reach The People’s Charity, caught the judges’ attention for his “rapid learning ability and willingness to better himself.”

With no previous domiciliary care experience, he joined Trident’s Birmingham Home Care team based on Hagley Road, Edgbaston, in January.

Already he handles a customer base of varying needs, working alongside people with learning disabilities, mental health issues and the physically disabled.

His award nomination said: “Nicholas’s understanding of all his customer needs and the nature of how domiciliary care services work is highly admirable, given he started with no care experience. He is a valuable member of the service who is always willing to help customers achieve, always puts customers first and applies a personalised approach to every customer he works with.”

This pair represent everything what good care is about and I thoroughly endorse the decision that both have been declared winners. Birmingham Care Awards is about celebrating care excellence.

They are the kind of role models the industry needs and proof that quality care is out there, valued and right on our doorstep.


£820 million a year – the shocking price of bed-blocking

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Management of the discharging older patients from hospital does not represent value for money, according to a report by the National Audit Office.

In a recent report, the spending watchdog estimates the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million. What!

In turn, the delays rack up extra pressure on the financial sustainability of our NHS and local government. Frankly, few boroughs I visit have got cash to invest in social care, but to fix this problem the Government must find some ‘wriggle room’.

Longer stays in hospital, as we know, can have a negative impact on older patients’ health as they quickly lose mobility and the ability to do everyday tasks.

The report echoes findings of the Alzheimer’s Society Fix Dementia Care: Hospitals campaign, which zooms in on poor care for people with dementia in hospitals and poor practice in the discharging of patients.

George McNamara, Head of Policy at Alzheimer’s Society, has been very vocal about the poor discharge processes.

Data suggest that bed-blocking has risen by a third in two years.

Not wishing to say ‘we told you so’, West Midlands Care Association was forecasting this problem six years ago.

Interesting isn’t it, that according to the Alzheimer’s people with dementia occupy a quarter of hospital beds.

I have heard of cases where residential homes have been expected to take in discharged patients beyond teatime, where pick-ups have been delayed because of hospital pharmacy backlogs and, not least, because funding for care packages has not come through.

I can actually recall cases where dementia homes have been expected to take admissions beyond 10pm.

It seems to me we are focusing on the end problem rather than the cause. Support in the community and good lines of communication between care homes and hospitals will naturally allow patients to be discharged in the knowledge that they will receive the necessary level of care.

I regularly travel to other parts of the country – some local authorities are better placed than we are in the Midlands – but there is a recurring parallel. Poorer areas, much like those in the West Midlands, get a poor deal. There simply is not the wealth sleeve to support privately funded care packages in many of our industrial towns.

Our older people deserve better; our care providers deserve better; and for me and countless other too, it unacceptable that there appears to be a deliberate tactic of inertia from Government funding pools.

The Fix Dementia Care campaign is worthy of our support, but so too are those who continue to fight for real funding help as Government ministers look on and play politics. Are they representing us and the people for whom we care? I’m sure they’d all say “yes . . but . . .”

Poor discharge processes can have devastating, life-changing consequences for people with dementia and those who are frail. Whatever happened to the bright horizon of a health and social care system with joined-up thinking?

Preventative measures need to be in place. Sadly every last one of these initiatives will cost money. Seems to me it’s a ‘given’ that £820 million year would be a good wedge of funding to make it happen. How stupid of me: Guess it must be the collateral damage cost for stringently enforcing austerity measures.


Osborne’s social care cash ‘used to balance books’

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In any other scenario, you’d expect legal exchanges and the Press to be shouting ‘scandal’ from front pages.

But this is the care sector – often unde-gunned and always under-funded.

It’s incredulous, but has been claimed by reliable sources, that funds being raised by Dudley Council to shore up the costs of social care are to be used to help balance the books on the previous year’s overspend.

Under Chancellor George Osborne’s plan to fund care sector needs, he sanctioned a two per cent hike in council taxes during the Spending Review last November.

But it emerged at an emergency members’ meeting of the West Midlands Care Association, which represents private and charitable care providers, the new monies will have no impact on the current industry crisis that has seen 1,000 social care beds lost across the country since January.

Neither will there be any new monies generated for social care from Mr Osborne’s 2016 Budget proposals.

Hopes that he would heed calls by the Directors of Adult Social Services (ADASS) to bring forward £700m of social care funding never materialised.

Sadly, the outlook can only get worse as care providers struggle to make ends meet.

The West Midlands Care Association understands 50 per cent of the public in Dudley agree with the Chancellor’s precept of two per cent in the belief that it will help adults requiring social care packages to continue to receive them in a sustainable way.

But the truth is that the two per cent is just not enough and is being directed towards last year’s accounts shortfall.

How can they get away with this?

There are no provision margins from such funding for the current financial year.

A packed meeting at the Quality Hotel, Dudley, delegates from across the Midlands, heard the next three to four years would be “critical to the survival of social care as we know it.”

For the last nine years fees have fallen below the viable cost of running a care home.

Figures from Industry analysts LaingBuisson reveal English councils pay on average £91 a week less than what is needed to provide fully compliant care.

I’m sure the survival rate will tumble very soon as the living wage outlays start to hit home and the number of private funders, who shore up the shortfalls on the cost of care being paid for by local authorities, remain static.

At best, I believe, we have three to four years before the landscape of care changes beyond recognition and there will be no way back to the required bed levels our ageing population needs to provide some kind of fluid service to hospital discharge managers wanting to avoid bed blocking.

In a desperate attempt to secure a funding lifeline to the industry, MPs, councillors, local authority officers and Clinical Commissioning Groups (CCGs) have been asked to meet with us to discuss ring-fenced funding for social care. It’s the only way we’ll ever see any monies decanted from Government.

The vast majority of Black Country care businesses rely on placements paid for by councils as a primary income generator. More than 26,300 people across the region are receiving residential care. A similar number have care at home.

In September last year my association revealed Dudley Social services had given rises totalling 8.9 per cent over a five year period while, the Consumer Prices Index was at 11.6 per cent, the Retail Price Index at 15 per cent and wage rises hitting 12.3 per cent.

I’m wholly persuaded our local authorities understand the dilemma, but are working under a Government that is hopelessly adrift of reality.



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?



Birmingham Care Awards – get the nominations in NOW

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Here’s a date for the diary: Birmingham Care Awards, June 2, Edgbaston Cricket Ground and it’s all about a celebration of care.

Too many negatives haunt the industry and it’s a timely opportunity to lock up the nasty phantoms of 2015 and remember just how excellently most care plans are delivered.

As a nation we excel in care. By 2022, according to the Institute of Public Policy Research, we will need an army of 2.75 million extra carers, nurses, healthcare assistants, doctors and social workers to service a growing demand.

Care is big business now and for the future and we need desperately to promote just how brilliant individuals, teams and partnerships can perform in this developing workplace.

Awards will recognise the following categories: Children, Home Care, Residential, Nursing, Learning Disability, Mental Health, Dementia and Specialist Care.

They will be presented in a £40-a-ticket gala spectacular and the initiative has the backing of Birmingham City Council. All good!

As you can imagine I’ve jumped at the chance to get on board with this. So how does it work?

  • Complete a form http://www.westmidlandscare.co.uk/members-area/ and email it to the Association. We will then send a reply and an acknowledgment number
  • Talk about what’s happening or happened
  • Provide support testimonials
  • Remember, someone else must nominate you
  • All awards cover all areas of service in the Birmingham area


Now here’s the hard bit. Application must be in by February 12, so get a move on . . . please.

This is a showcase opportunity to give good care a public airing. Let’s do it and make it an event to be proud of.

Awards will be made for: Excellence in Care, Excellence in Support Servies, Excellence in Supporting Citizens Award, Meaningful Activities Award, Excellence in Leadership and Management, Commitment too Workforce Development, Exceptional Newcomer, Exceptional Dignity in Care, Success in Parnership, and Lifetime Achievement (Over 25 years).

Come on, let’s get those nominations in and give the panel of judges a really hard time.

Good old Beeb wading in to help with the message

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In a response to the Osborne funding solution to a gaping hole in social care funding, some of the industry’s top brass have waded in with their response.

Along with representations made by the West Midlands Care Association in the lead to Christmas, a letter –signed by the Association of Directors of Adult Social Services, the Care Provider Alliance, and the NHS Confederation – has formed the basis of a BBC piece.

It points out that the amount of money council tax brings in varies greatly, with local authorities in poorer areas worse off.

The Beeb noted George Osborne said his plans would lead to an above-inflation rise in care budgets.

But council chiefs, NHS managers and care bosses have cast doubt on those claims in a letter to the chancellor.

It warned his plans “would leave a funding gap and put vulnerable people at risk.”

Of course, this is denied by the government.

In the none-too-helpful Spending Review, Mr Osborne said he was protecting social care budgets by allowing local authorities to raise council tax by 2 per cent and increasing the amount of money available for the Better Care Fund, a joint pot of money used by councils and the NHS to support care services.

Hmmm . . . He also said that with other changes, it would mean care budgets would rise, adding the NHS could not “function effectively without good social care”.

Good old BBC reported: “But now those involved in providing care services are questioning those claims.”

I can’t think of a single person in the care sector who is not questioning the claims.

No extra money (£1.5bn) from the Better Care Fund – it will not kick in until 2019 and according to the Local Government Association two of its main funding streams, the income it gets from the central government grant and business rates, down 24 per cent in real terms this Parliament term.

Together these account for about a third of council funding.

Again the warning is bleak. Ray James, president of the Association of Directors of Adult Social Services, is reported as saying the result will see councils struggle to maintain care spending at its current level, never mind increase it.

Critically, James added: “We have an ageing population which is increasing demand and have to cope with the introduction of National Living Wage. Without action, we will see care homes close and vulnerable people not getting care.”

A spokesman for the Department for Communities and Local Government said councils had enough for care services, according to the report.


For months all I appear to be reading are warnings of closure and the perils of failing care because the cash is just not there. God forbid that it will take another national chain to go bust before the purse strings are released.

Do these government spokespeople really believe there is sufficient in the pot? Like Dickens’ character Oliver with his meager rations of gruel, the industry dare cries for more. I recall they wanted to hang young Oliver. I recall the other day, in a response to the Autumn Statement, one care provider saying “We’re being hung . . . out to dry.” Nothing much changed from the days of Dickens then (I jest, of course).


King’s Fund warning on the rich-poor care divide

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George Osborne’s decision to sanction a two per cent rise in council tax to offset cuts to social care will lead to thousands more older people missing out on vital services, the Guardian newspaper has revealed.

For many the bible of social care, the newspaper said the chancellor’s spending review attempt to plug the hole in care funds, will only widen the gap in provision between richer and poorer areas and “raise at most only £800m a year – far less than the £2bn he predicted.”

The King’s Fund is a non-political body that harnesses the thinking of some of the finest minds in the UK. It needs to be heard.

In a detailed critique of the policy, the thinktank has found “that disadvantaged places in the north, Midlands and inner London with the greatest need for social care will lose out because they will be able to raise too little extra revenue from it to make any difference.” How true! We had said for years the Midlands has some of the most impoverished boroughs in the country and they are deserving of a ‘special case’ approach.

Quote from Richard Humphries, the King’s Fund’s assistant director of policy, who has undertaken the analysis: “Relying on councils to plug the gap in social care funding won’t be equitable or effective because of the inverse social care law that councils that have the greatest need for publicly funded social care are least able to meet it [because their council tax bases are so low]. George Osborne’s new policy is of very limited help for them,”

Do I hear an amen?

Humphries adds the precept is a “shortsighted” response to the growing crisis in social care,

And delivering more criticism, Humphries says the plan is ”very opaque, complicated and messy option, which, crucially, will not much help areas at greatest need. It’s a very high-risk strategy.”

Humphries then warns social care providers collapsing, more people going without the care they need or having to pay for it themselves, and even more pressure on families and the NHS to pick up the pieces when there’s a breakdown support.

Quote: “Older people will be more likely to end up in hospital.”

At the risk of overloading this blog, let me quote some more of the Guardian piece: “The thinktank believes that the 2% precept is based on ‘completely implausible assumptions made by the Treasury’. For example, the expected £2bn figure is based on all of England’s 152 councils levying it, but many councils are highly reluctant to raise council tax at all and quite a few were elected after specifically promising no rises. Only half of councils increased their rates this year.”

Humphries found that the two councils that would receive the least extra income from the levy would be Wandsworth, at £3.70-a-head, and Westminster at £4.90. But neither is typical because council tax rates in the two Conservative-run London boroughs are already so unusually low.

If you require more information look up the following link http://www.theguardian.com/society/2015/nov/20/osborne-plans-to-allow-2-council-tax-rises-to-plug-social-care-holes

It’s harrowing stuff, but we know that news, by its definition, is rarely good.

In a letter to the Guardian, the King’s Fund chief executive, Prof Chris Ham, and Nigel Edwards, his counterpart at the Nuffield Trust thinktank, say the spending review “represents another setback for people who need social care. [The] new powers to raise council tax will provide local authorities with some financial flexibility but … will disadvantage deprived areas with high needs for publicly funded care.”

Joining the chorus of criticism, along with our selves (WMCA) are charities such as Age UK and Alzheimer’s Society and bodies such as the Local Government Association and Care and Support Alliance.

It’s another example of central government dodging the bullet and putting the responsibility on already struggling local councils to raise more money for social care. Clearly, it should be the role of government to provide it to the growing number of people in need due to the UK’s ageing population.

I don’t doubt there are some politicians who do recognise the huge chorus of complaint, but additional money is still not with us.

The Better Care Fund won’t come into effect until 2017!

As the social care sector we still remain the Cinderella of caring with no frontloading of cash, unlike the NHS.

Okay . . . where’s cream cakes, biscuits? How I need something to ease the pain of reality! Returning to work after a break is that never easy.


Mr Osborne, you’ve failed us yet again

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Let me set the scene: Paul Burstow is a social policy entrepreneur. He chairs the Tavistock & Portman NHS Foundation Trust and is professor of health & social care at City University, London.

Between 1997 and 2015 he was Liberal Democrat MP for Sutton and Cheam. He served as the minister of state for care services between 2010 and 2012. In the latter role he covered a wide range of social policy issues including mental health, adult social care, carers, personal health budgets, safeguarding vulnerable adults, end of life care and long term conditions.

I think he has more than a good idea of what’s going on in social care.

Writing in the Guardian last month he bluntly announced what we already know: That the George Osborne funding plan for social care won’t work.

He writes: “Yet again social care is the poor relation of the NHS. Rather than committing any extra exchequer funds, the chancellor announced he was giving permission to town halls to raise a social care precept from council tax to bridge the funding gap.

“The problem is that the precept will not bridge the gap. At best it will raise around £1.7bn a year by 2020, but because it is council tax it will raise the money in the wrong places. Poorer areas get much less money from council tax than their richer counterparts. Those councils most desperate for extra funding to meet the needs of their working-age disabled and frail older people will be left struggling to cope.“

He adds: “Worse than that, the chancellor has pulled off the classic conjurer’s trick of misdirection. While telling us to look at a 2% council tax rise, he hopes to distract attention from the 6.7% real-terms cut in local authority budgets. It’s a bit like sticking a plaster on a leaky bucket. The irony is that the NHS, with more unplanned admissions and delayed discharges, will feel the consequences that in turn will lead to higher social care costs – a classic false economy.


“Earlier this year, the government postponed the implementation of the cap on care costs to ease the pressure on councils. But where has the money saved gone? Not into social care.”


Poor social care investment stacks up heaps of trouble. So far the weather has been mild for the time of year, but if the temperatures dip and our underfunded elderly get sick, there will be a catastrophic gridlock in our hospitals. When is comes to discharge, where will we find the necessary step-down beds and for new admissions for residential care, where will the beds be found?

The care pool is shrinking and the laudable notion of keeping people at home in many cases is not a civilised option.

Guardian quote: “Despite the talk of more integration, the drive towards pooled budgets has stalled. The Better Care Fund is frozen for next year, so there will be no funding to plug the social care gap from that source. It is not until 2017 that an extra £1.5bn will be injected into the fund.”

I genuinely have no idea how local authorities and care providers are supposed to close the funding gap, yet it appears we are the only ones left with the responsibility of doing so. I’d hoped for better. The fragile care market needs help. We’re sending out the messages, doing all we can to stay afloat, but the raft is sinking and it’s just a matter of time before we see another Southern Cross disaster.

My New Year message: Act speedily Mr Cameron . . .


The new Care Certificate: Another big hurdle

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The new Care Certificate that came on stream in April this year identified set of standards that health and social care workers should adhere to in their daily working life. Good.

It was designed with the non-regulated workforce in mind to enable and empower newcomers to the sector. Also good, though the driver was the Francis Report and that highlighted improvement for the practical skills of care staff . . . and nurses, whose role is completely different.

It is aimed at delivering a comprehensive induction, and indeed, is much better than its former model. Again, good.

The outline of learning is supposed to facilitate compassionate, safe and high quality care and support. Well, yes . . .

And all this within three months induction period. You must be joking!

This ‘tool’ for care is cumbersome, taking so much time it’s impractical as a way in to essential knowledge. I know of plenty of cases where providers are still struggling to complete the induction after six months. Surely there’s something wrong!

Critically, does it really give us better carers? No, and what’s more it’s a big turn-off for sector recruitments.

Where previous induction initiatives were centred on essentials (all be it too regulatory focussed) about each area of the industry which enable people to start work within the first six weeks and then build on their knowledge as they worked, now new recruits have a huge block of learning to go through.

Come on, real world dynamics need to apply here!

So, what have we achieved? We have successfully created an industry running round in circles to get as much of the learning tasks completed as possible in the shortest possible time.

What’s more, the process is costing far more that the previous model at a time when the providers have far less to spend. Failure, sadly is inevitable.

Is this a step forward? No, it’s just another hurdle for us the struggle over, where attempts to wholesale avoid risk by the age-old tradition of training on the job actually denies caring.