By Debbie le Quesne

Archive for the ‘CQC’ Category

Data protection: Does a £100,000 fine sharpen our view?

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Data protection is big business and maintaining compliance critical to avoid some very heavy fines.

Sensitive material included in DBS checks means that we are always diligent and the office kept secure. It may appear at times antisocial, but we don’t make the rules for this particular service we offer.

I must admit , however, I was surprised to see how steep fines can get, having read a piece in the Guardian about a county council being fined £100,000 after files containing highly sensitive personal details of more than 100 people were discovered in a disused building.

These social care files were found along with 45 bags of confidential waste at Town End House in Havant, Hampshire, by the new owners of the building after it was bought in August 2014.

The article stated the forgotten documents were found to contain “highly sensitive” information about adults and children in vulnerable circumstances, according to the Information Commissioner’s Office (ICO).

Officials at the ICO, which levied the fine on Hampshire county council, said there could have been “distressing consequences” if the data had ended up in the wrong hands.

The case appears complex and Hampshire county council is full of apologies. But the bottom line is that the council failed to look after the information for which it was responsible.

It serves as a timely reminder for all social care operators to be diligent over client files.

A single look at the local social care contracts and it is blatantly apparent the local authorities are twitchy about the Data Protection Act.

Data Protection is mentioned about 20 times and care just once or twice. . . it says it all.

The Information Commissioner’s Office is an independent official body whose role is to oversee all information legislation, including promoting access to official information and protecting personal information. All public and private organisations are legally obliged to protect any personal information they hold. Public bodies are also obliged to provide public access to official information.

Information legislation protects the human rights of people using services by ensuring information about individuals is:

  • Held only with consent
  • Held securely
  • Shared only on a ‘need to know’ basis
  • Accessible to them.

Confidentiality of information is a key part of maintaining dignity for those using health and social care services. The Data Protection Act (DPA) 1998 requires public bodies and their data controllers to comply with a range of data protection principles. There are some limits on confidentiality and these apply where there is a risk of harm to other people.

How should data protection affect the way we work?

It is even more important these days that documents, including emails, which contain personal data are:

  • Kept in an orderly fashion
  • Filed on registered electronic devices or in paper files as soon as practicable if they are to be retained;
  • Erased or destroyed when they are no longer required
  • You should not keep random collections of odd papers or old emails. If they need to be retained, they should be properly filed, as mentioned above
  • You should observe a clear desk policy
  • You should satisfy yourself that, if required, you could retrieve personal data for which you are responsible, to answer an enquiry from a data subject

All very legal, I know, but being sorry after the event doesn’t recover fines incurred.

CQC fees: How can they demand to be self-funding?

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Now the The Independent Care Group that serves York and North Yorkshire is calling on the regulator to rethink its planned hike in fees or risk damaging social care. Dead right! At West Midlands Care Association we too are furious and are clearly concerned what implications such a move will have on the sector.

An article in the online magazine Care Industry News says the proposed rise in the fee providers have to pay will add thousands to already stretched budgets.

In the case of homecare providers the increase would be 313 per cent phased over two or four years and for care home owners a huge rise, again phased over similar periods.

The group’s Chair, Mike Padgham, is reported as saying that the proposed rise comes at a time when social care was on its knees and was totally unacceptable.

Quote: “Social care is at an all-time low, with £4bn cut from budgets in recent years, fewer and fewer people receiving the care they need and providers going out of existence,” he said.

“Providers are already having to plan for the introduction of the National Living Wage next spring, without enough funding in the sector to pay for it. For this huge rise in the CQC fee to come on top is adding insult to injury and could be the final straw for many providers.”

And sadly it will be the final straw. David Benham, the chief exec. with CQC has made it clear her wants full recovery of costs, thus making the regulator self financing.

Quite how he has the gall to demand this, knowing that full cost recovery for care providers is not happening with local authorities, astounds me.

I need strong coffee – and chocolate: Always a bad omen!


Black week on a Black Friday

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The working week ending November 20 will forever be a memorable one . . . more of a Black Week rather than Black Friday. Sorry, no bargains in this post, no happy results – just an overload of misery.

That particular week, like every week according to the media, the care sector was in trouble.

On Wednesday (Nov 18) another set of reports sounded sirens of crisis to the Government. To sum up, this is how it went . . . NHS facing 37,000-strong influx of elderly as care homes close – the victims of cash-strapped councils (think-tank ResPublica).

The Resolution Foundation also reported that just to cover the new minimum wage, the government needed to stump up £1,4bn to ensure it goes to the care workers.

And that’s just “stand-still” money, as one newspaper said.

Despite a sharp rise in the number of those aged over 80, the private care home sector lost 1,500 beds in the year to September due to closures, added industry analysts LaingBuisson.

The highly respected number crunchers warned of a “wave of closures” to come. Some 90 per cent are private, with nearly half their beds largely paid for by the state.

ResPublica’s figures claimed 37,000 more beds would be lost by 2020/21.

Then of course we had the CQC bombshell that inspections on 54 homes across the north found that 28 “required improvement” or were “inadequate”, and none were “outstanding”.

Unfortunately, the general public really haven’t a clue what’s going on. Closures make headlines only when old people are tipped out of their nursing homes.

And almost finally, private-equity company Terra Firma, owner of Four Seasons, which runs 450 care homes, announced they are selling off 53 homes due to sharp cuts in what councils pay.

Finally, I promise no more gloom for the day, the 46-bed Stoke House in Gedling, Nottinhamshire, has been put into special measures by the Care Quality Commission. Staff were just “too busy” to take patients to the toilet. Shameful business.

Disclaimer: I will not be held accountable for the mental health of those who have bravely read this blog.

Let us work together to secure the future of care

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Like countless others in the care sector I have joined the chorus in the West Midlands calling on councils to  pay a viable rate for care beds purchased from the private, charity and voluntary sectors.

The care landscape is bleak and my WMCA has warned closures are imminent and there is little regional capacity to take up those frail and needy residents who may be displaced. To this end we are desperate to work with local authorities to find mechanisms that will secure the future care of the most vulnerable and the survival of local businesses.

At an emergency meeting of the association, members heard George Osborne’s living wage directives could “be the final nail in the coffin for care as we know it.”

In an attempt to secure a funding lifeline to the industry, we are calling on MPs, councillors, local authority officers and Clinical Commissioning Groups to meet with us to discuss future ring-fenced funding for social care.

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

In recent weeks, five care home corporates with 1,200 properties between them have written to the Chancellor warning of impending disaster following his Budget reforms on the living wage.

The big five – Four Seasons Health Care, Bupa UK, HC-One, Care UK and Barchester – look after 75,000 frail, old people. They claim a major provider is likely to close within a year to 24 months unless the Government releases its purse strings. The response: Silence.

The national picture is indeed gloomy, but in our region it’s much, much worse and Osborne’s announcement has caused shockwaves across the region. So many are already in crisis . . . and now this.

The legislation impacts massively on all streams of care as indeed it must doe with many other businesses.

A WMCA impact analysis suggests the Osborne wages regulation will add £23 per week to the care cost of every Midlands person in a residential care setting. But we need to add to that figure a further £50, the current average weekly operational deficit on council-funded places.

If the corporates – HC-One is one of our members – are predicting at best only a two-year survival rate under current economies, what chance have my other members, who have much smaller homes and much-depleted resources?”

As for thepromised autumn Government Spending Review . . . I fear too little, too late.

Residential care occupancy levels throughout the Midlands are averaging 97 per cent and there’s not not a member in the association who is not anxious about the future wellbeing of those requiring care.

For those who think we do not want to pay the living wage, think again, please. All of my members would happily apply the living wage, but there is no financial sleeve left in their business models to do so. Care home companies are not just crying wolf. Care is a minimum wage industry and profit margins are extremely tight, especially where council referrals are the main income.

Do you know that for the last nine years fees have fallen below the viable cost of running a care home?

Over the last five years, for example, Dudley Social services has given rises totalling 8.9 per cent while the Consumer Prices Index is at 11.6 per cent, the Retail Price Index at 15 per cent and wage rises are hitting 12.3 per cent. The rises don’t track cost and we clearly need some Government benevolence to help both councils and care providers.

Recently Sandwell Council’s cabinet met to respond to a WMCA call for a fees increase of 16 per cent – residential care from £378 per week to £438.46; dementia care from £428 per week to 496.48; and residential nursing care from £490 per week to £568.00.

What do we get? A 1.5 per cent rise for residential care and a 2.5 per cent rise for nursing.

Latest figures from Industry analysts LaingBuisson reveal English councils pay £91 a week less than what is needed for fully compliant care.

In 2013 Birmingham City Council commissioned accountants and analysts KPMG LLP to establish the true cost of care through the Open Book initiative where care providers were asked to submit their accounts.

Some 380 homes were targeted and the results showed to meet escalating costs commissioners would need to pay £460 per week.

Two years on, and not including the implications of the living wage, It would take an l increase of six per cent to bring homes to the minimum figures used by the Association of Directors of Adult Social Care (ADASS) as the threshold for safe care announced this spring. An extra three per cent would allow homes to cover increases in operational costs.

Sadly, if a major employer were to make this kind of warning there would be huge interest over the potential loss to the economy. What we have here is a bunch of businesses across the region that create about 125,00 carer jobs for adult social care (figures from Skills for Care).

“That dwarfs the employment stats of say Jaguar LandRover and it’s deeply worrying that few of these jobs are secure under present funding models.

Listen, councils do have choices what to do with funds and government austerity can no longer be an excuse for not addressing the finances of care.

I would call upon our local councilors to make decisions of conscience on funding that will directly impact on the most vulnerable people in the electorate they serve.

It is a fact that a dog walker can earn more than we can pay our carers. There is something radically wrong.

Dudley and Walsall lead in response to Living Wage bombshell

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There is a deep concern among care providers that the introductions of George Osborne’s Living Wage will sink many independent businesses.

Surveys have offered a whole array of gloomy forecasts with one stating the following:

  • 9% of respondents are deeply ‘concerned’ about their businesses
  • 3% of them felt that the increase would have a ‘significant’ impact on their businesses
  • 72% were very concerned about their ability to continue in business
  • The majority of people responding to the survey did not feel able to pay their staff the Living Wage of £9.00 per hour by 2020 in the timescales without a ‘substantial’ increase from commissioners

And what is more worrying, a press release from the National Care Association claims 24 per cent of respondents indicated that they would consider exiting the marketplace if their local authorities did not make a significant move to increase the fees they pay over the next five years.

The strategy we adopt from hereon is critical, as it will determine the fate of so many providers and their clients.

It is a heavy burden that has not lifted from my shoulders since the Osborne bombshell. I am convinced the care sector was invisible to him when he set in stone his plans.

Let me add at this point, I applaud any move to upgrade the status and salaries of carers, but there must be an impact analysis and a cohesive strategy – funding – to make it work.

Sadly, we’re floundering and again lacking in leadership from Government. The local authorities with which we work are clearly in the same position.

Following the Living Wage announcement, West Midlands Care Association contacted councilors and directors in all the membership authorities and outlined the real impact of the legislation. There has been a deafening silence in response, except for Walsall and Dudley.

Walsall has indicated that unless extra funds are released the thresholds of care funding will have to change. A pragmatic approach, I know, but at least our overtures have been acknowledged and there have been strong indications that they understand our dilemma.

Dudley has been exemplary in its reply. Both councillors and officers recognise the position of our members and the pivotal role of West Midlands Care Association plays in working though the difficulties.

The authority has agreed to meet with us as soon as its own impact analysis is complete. The authority also recognises that it is essential the Government provide “appropriate funding.”

We have enjoyed a creative e working relationship with Dudley for many years and I am heartened at its realisation we need to talk and pool knowledge if we have any chance of delivering a sustainable lifeline to care providers and those who are currently receiving care.

The most basic and powerful way to connect is to listen to each other. If there was ever a time in the care sector when dialogue between WMCA . . . and local authorities was needed, it’s now. Silence is not an option, as the funding issue has become a complication for cash-strapped authorities, as they are obliged to navigate their legal care market management responsibilities outlined in the Care Act.

What can I add? We will do all we can to help and for those who perhaps have nothing to say: Please don’t shut the door on us.

It is true that only those who harm the care industry really make the headlines, Essentially, all the providers I daily meet are good, honourable people. So good, in fact, I worry that for the very best intentions they will carry on to dispense care even without sufficient resources. Cutting corners . . . giving something out of nothing . . . need I say more?


Government spending review may offer hope to social care

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A critical spending review to determine medium term plans for Governments department will provide a platform for ADASS to air its concerns over funding for social care.

The review has to take place this summer because there are no detailed spending plans in place for the next financial year. Already private discussions are taking place and ADDAS is feeding the key issues into the agenda.

Quoting John Jackson, co-chair of Resources Network, the outcomes of the review could be:

  • Health and social care will be seen as a single entity
  • This will provide some protection for adult social care (but remember that health is not being funded to meet increased demands)
  • It will be accompanied by a requirement to pool budgets (probably under the control of Health and Wellbeing Boards)

So what are the implications for local government? Here are Mr Jackson’s thoughts:

Any new government or ministers will want to pursue eye catching ideas – some of them will be good (e.g. Health and Wellbeing Boards) but others not and will lead to considerable change at a time when systems are under huge pressures

Sadly, he predicts that some local authorities (and some local health and care systems) are under significant risk of falling apart in the next two years. Oh, yes!

Change is paramount if adequate social care is to continue

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Local authorities are assuming significant reductions in social care budgets. They’re also assuming the cuts will be “ongoing”. Just what I want to hear (not).

The recent ADASS Budget Survey 2015 report shows that this year, as last, 35 per cent of council budgets relate to adult social care. Councils, ADASS notes, have tried to protect social care spending at the cost of other services but are running out of ability to do this in the future. I believe this to be true in many instances.

The report goes on to says that In the context of the NHS, health funding has increased from £97.5billion in 201-11 to £116.4billion in 2015-16, an increase of 19.3per cent. Over the same period, social care funding has decreased from £14.9billion to £13.3billion, a reduction of 10.7 per cent and “more in real terms when demography is taken into account.”

Significantly, “the money being transferred from the NHS is not enough to mitigate these spending reductions.”

This surely must be in the ears of David Cameron.

Senior NHS leaders have already publically shared concerns about the funding for social care services to support people in greatest need. They have added their voices to a growing chorus of concerns over the much-heralded £8 billion NHS funding gap figure that’s being forecast.

In an open letter to the Prime Minister, the NHS Confederation said in May 2015:

“Our deep concern over social care funding must be addressed if we are to meet people’s needs, never mind the impact that social care has on the ability of the NHS to provide safe, quality and timely treatment to those who need it.”

I applaud the fact that ADASS wants to see a social care system that is protected, aligned and re-designed.

To achieve this, ADASS is calling upon the Government to urgently ensure that social care funding is protected and aligned with the NHS, including making provision for the social care funding gap alongside the funding gap for the NHS.

This is brave, campaigning talk and I wish every success on those who are left to do the hand-to-hand fighting in Parliament.

ADASS concludes by saying: “This is paramount to securing adequate health and wellbeing outcomes for individuals and their carers and to ensuring that councils do not run out of money.”

The truth, the whole truth and nothing but the truth . . . I really do hope that this latest document, which shows a falling barometer on the state of the nation’s care, will impact the decision makers to reassess the austerity course we are on – and particularly how it impacts our most vulnerable people.

Should social care survive this ordeal by fire, should the good times ever roll again for care providers, should there ever be a season of plenty, perhaps local authorities could not be so eager to financially squeeze care businesses, thus allowing reserves to build for such a time that we might just have to navigate this way once again.

A window on the future marketplace

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The majority of adult social care directors (70 per cent) believe pay pressures will drive up residential’/nursing care costs in 2015/16.

Some 39 per cent believe that local market issues, lack of capacity and competition, will be a major driver in dictating the market trend.

About 50 per cent of Directors do not think that overheads and a premium to cover winter pressures and quality are key for increased unit costs, and only 14 per cent of directors believe that a reduction in cross-subsidisation – the differences between council and self-funder rates – will be a key in changing the costing structure for residential/nursing care “units” in 2015/16.

I note in the ADDAS Budget Survey 2015 report, that councils received only 5.9 per cent (£41m) of the £700m allocated to the NHS to respond to winter pressures in 2014/15. That’s fair, isn’t it!

Why on earth should I feel disgusted by this financial nugget? Stop it, Debbie!

Savings will have impact on care – and that’s now official

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Tell us what we already know . . . 83 per cent of Directors report that over the next two years there will be impacts as the result of savings being made.

It’s a significant hike on the 54 per cent of Directors reporting in the ADASS Budget Survey 2015 that the savings they are making to date will have an impact (the document fails to say whether such an impact would be negative or otherwise).

Surprisingly, it is noted that a number of Directors (45 per cent) are reporting that there have been no, or minimal impacts to date, but this falls to only seven per cent believing this over the next two years.

ADASS reported that its members think that the savings to date will not affect their ability to meet their essential statutory duties. However, the scene changes dramatically over the coming two years, with increasing scepticism that savings can be made (down from 81 per cent to date to 39 per cent) believing planned savings can be made met.

Sadly, this view is further confirmed with 50 per cent of Directors reporting that they believe fewer people will get access to services, and 58 percent believing personal budgets will shrink over the next two years.

Directors think that there will be more legal challenges and 17 per cent think that quality of care will worsen also over this period.

The view of Directors correlates with a recent report by Carers UK (State of Caring- May 2015) which noted of the 4,500 carers responding to survey, 55 per cent say that they are worried about the impact of cuts to care and support services over the next year. I

AgeUK last year estimated that 900,000 people in England between the age of 65 and 89 have unmet social care needs, Experts at the charity now believe the figure is closer to one million.

Quite what analysis says about society’s commitment to the sick, frail and vulnerable, I dread to think.

Cue relaxing music, light scented candles . . . soothing head massage, please.

Directors trying to grasp the nettle of deeper cuts

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After a night’s sleep, coffee, golf and the therapy of good company I’ve return to the ADASS Budget Survey 2015. Help!

The big question we’re all asking is how more savings in the industry can be made. It’s a question that’s been lobbied in Parliament and the offices of Whitehall and the responses have been . . . poor.

However, local authority directors are now attempting to grasp the nettle and in responding to the question of how they would make savings, for both 2015/16 and for 2016/17 onwards.

This is their published reply: “Directors report increasing reliance upon integration in making savings going forward (71 per cent as from 2016/17 onwards), and a continued focus upon early intervention and prevention (73 per cent as from 2016/17 onwards).

“There is also an increasing emphasis upon what was described as stopping ‘unnecessary’ services and shifting activity to cheaper settings, along with better procurement.

“The majority of Directors do not see controlling wages or increasing charges as areas of importance in making future savings. This can be explained by firstly that most of adult social care budgets are spent with external providers, many of whom pay staff at or close to the minimum wage and therefore decisions about the level of the minimum are not within the control of local authorities nor providers; and secondly, the survey analysis illustrates that there is limit to how much further councils can increase charges.

“On the contrary, the majority of Directors have reported that wage pressures are key drivers for increased costs of residential & nursing care and home care services in 2015/16.”

Are we all clear on that? Well, not really, Integration reliance – I’m assuming integrated care – is as fantastic concept for efficiency and good delivery of care. It’s joined-up thinking with all care elements coordinated and seamlessly meshing together.

The World Health Organisation noted last year, however, the initial problem of carving up the monies is one of definition.

“A key challenge,” it said in its What is the evidence on the economic impacts of integrated care? document, “remains the lack of common definitions of underlying concepts; as a consequence there is a plethora of terminologies that have variously been described as ‘integrated care’, ‘coordinated care’, ‘collaborative care’, ‘managed care’, ‘disease management’, ‘case management’, ‘health/ social care service user-centred care’, ‘chronic care’, ‘continuity of care’, ‘seamless care’ and others.”

It’s true. Until the borders are care streams are defined – of what’s in, and what’s out – the arguments over who gets what in the budged pool will remain.

And finally (for now). . . How confident are the Directors in making further savings?

Whilst 45 percent of Directors were fully confident that planned savings for 2015/16 would be met, this confidence falls sharply away beyond 2015/16 to only five per cent being fully confident that savings will be met in 2017/18.”

More coffee, please!