By Debbie le Quesne

Archive for the ‘elder abuse’ Category

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

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.



We need to get the message ‘out there’

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Before anyone gets too excited at the potential headline-grabbing white paper that is doing the rounds in the care sector, it is not of the government variety.

I just need to make it clear, that this piece of work – Stabilising the Care Home Sector and Preparing for implementation of Part 2 of the Care Act 2020 – is a document produced by healthcare experts LainBuisson and is not the esteemed wisdom (I jest) of government research.

It says so much that the industry’s prime player in delivering analysis is now desperately trying to spark discussion with finding that are, for me anyway, terrifying.

I applaud this piece of work, but I note the language is pretty emotive and it’s not in the usual tone for L&G documentation. At best there’s an air of urgency about the work, and worst . . . a sense of panic.

It’s heavy going in parts and long, but in the main accessible. It should be essential reading for every self-respecting MP and elected representative, but I know it won’t be.

It’s our collective responsibility to get this message ‘out there’. In L&G’s own words, the objective is to stimulate debate on two linked topics:

  • What is needed to stabilise those segments of the care home sector which mainly serve older people in receipt of state funding and which are moving into crisis at a variable pace in different parts of the country?
  • How should the Dilnot funding reforms be modified to avoid the pitfalls that became evident in the run up to postponement of Part 2 of the Care Act (if the government carries out its stated intention to implement the Dilnot reforms in 2020)?
  • A third topic can also be added: What new initiatives could be started now to improve the functioning of the care market, within existing legislation and without the need top-down structural reform, on the part of different stakeholders – central government, local authorities, the NHS, regulators and consumers and their advocates?


There used to be a saying locally – “there’s none s’ blind as those who don’t want to see.”

So to put you in the picture, West Midlands Care Association is desperately trying to ensure we are doing everything to make certain the eyes (and ears) of local and national politicians are indeed open.

To this end I’m meeting minister for social care Alistair Burt tomorrow to discuss the viability of the care sector given the current stance of Government.

I’ll let you know how is goes.



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.

Personalised care: Financial limitations DO inflect pain

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Nestling in the pages of The Guardian online I recently found a Jeremy Hughes piece which every person who holds the purse strings on care should read. Hughes opens with the statement that we increasingly expect personalised service.

Spending a weekend in a care home “provided me with a valuable reminder of what providing truly individual care for people with dementia should mean,” he writes, adding . . .

“During my stay, I witnessed a care assistant spend over an hour helping a resident to get nourishment through puréed food when she could neither chew nor swallow.

“There is an art to caring for someone who can no longer communicate verbally and reassuring someone who is anxious and confused.

“One-to-one care was evident day and night. As I watched, I was struck by the fact that you can earn more in a supermarket than a care home. Recently, care home companies have been saying that paying the chancellor’s national living wage could put them out of business. Whether or not this is correct, it’s surely wrong that as a society we cannot afford £9 an hour to look after someone’s wife, husband, mother or father.

“No long-term fix for social care can succeed without addressing how undervalued the people who provide it are.”

I believe there are those who naturally make good carers, but this should never be an excuse not to reward them, or worse, undervalue them.

As Hughes says in his piece it’s time for us, as a society, to accept that the financial limitations we put on the funding of care inflict real pain.

With a real insight, Hughes adds that carers “have been left to pick up the pieces of our broken social care system.”

Indeed it is broken, along with the myriad of promises that were made to fix it. Only the dedication and goodwill of underpaid staff, and indeed some of their employers, allows the system to continue.

But for how long?

What price can we put on personalised care? Recently I read a piece about Starbucks’ £35 million dollar training programme to make their frontline workers “brand evangelists”. Training for managers includes a “theatre experience” and a ‘leadership lab.” Over the top? I think so for a cup of posh coffee, but it highlights just how much this company values personalised service.

Puts the care sector in the shade, doesn’t it! Sadly the care sector cannot compete. Theatre-type interviews by some companies that motivate newcomers with the promise of proper wages and great conditions do exist in the sector. But so much is just ‘spin’. The real scenario is generally one of a perpetual struggle to make business viable enough to pay already depleted wages.


Care workforce forecast showing 1m shortfall

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The social care sector could face a shortfall of a million workers in the next 20 years, I’m informed.

The system for adults in England faces a gap of 200,000 care workers by the end of this parliament due to restrictions on immigration and a failure to attract British workers, a report from the charity Independent Age and the International Longevity Centre – UK (ILC-UK), warns.

It adds that this figure will grow unless efforts are made to recruit more overseas staff and retain those already working.

Almost one in five adult social care workers (18.4 per cent) in England were born outside the UK, including 150,000 working in residential care homes.

People from outside the EU account for the largest percentage of migrants working in adult social care – around one in every seven care workers.

And we must also be aware that almost one in 20 (4.8 per cent) of positions in adult social care in England are vacant. That’s nearly twice the rate in the UK’s labour force as a whole.

Simon Bottery, director of policy at Independent Age, is reported as saying: “Without action, there is a real risk of care services worsening as providers fail to fill job vacancies and staff struggle to cope with increasing demand.”

Depressing, or what? But there’s a common chorus in this report we’ve all heard before: The Government must use its influence to invest in social care so it can attract more UK workers, while at the same time exploring new ways of caring for our ageing population in the future.

I’m afraid the tiresome response of the D of H is predictable. Cue keywords “better” and “smarter”.

Frankly, I think all of our care providers have done better than expected and indeed, are pretty smart to still survive in such crippling economic conditions.

What does appear to be an obvious question, however, is this: How are all these extra carers going to be paid? From where will this funding come? No doubt the Government has factored in the numbers (joke).

Care homes . . . and dare we mention sex?

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I’m not one for deliberately grabbing the headlines, or in a knee-jerk way, responding to them. But I just can’t resist this BBC story pointed out to me by a colleague.

Headline: “The taboo of sex in care homes for older people.”

Hooked yet?

A recent study by the University of Manchester found that 54 per cent of men and 31 per cent of women over the age of 70 were still sexually active. Good of ‘em, I say.

The Beeb reported that it was the first nationally representative survey to include people over 80 in its sample, indicating both how attitudes are finally changing and how the sexuality of older people has been historically overlooked.

I find it interesting, though not surprising, that the subject still has an air of taboo, the findings of a study by the Royal College of Nursing a few years ago revealing that sex and relationships are not viewed as a priority in care homes.

“Human contact and sexual need are basic functions of the human being,” Dawne Garrett, older people’s adviser at the Royal College of Nursing, is quoted in the BBC report.

I understand that the subject can be a difficult one and observations in the report that “staff are generally not comfortable with the topic, and not knowledgeable about it either, thus they are powerless to help,” are probably true.

So how do we as care providers facilitate relationships?

I’d like to hear some answers or see a training brief, because sooner or later this is going to be a Human Right Act issue.

Lois Weaver, a performance artist who explores the subject of sex and ageing through her work, is quoted by the BBC: “We have a stigma about age.

“We don’t really treat people like elders. We treat [them] like people [who are] finished with life.”

Her groundbreaking show, What Tammy Needs to Know About Getting Old and Having Sex, seeks to break down the taboo of sex and ageing.

Anyone for a ticket?

Weaver is in her 60s, had been told that losing interest in sex was an inevitable part of getting older, but said she was not ready to accept that. “I was getting different urges and desires,” she was quoted as saying.

Her work is indeed interesting and those wishing to be challenged can find video links aplenty in a Google search. Her attempts to canvas opinion from residents in care homes, however, were generally met with failure which clearly underpins what she has coined the British “maternalistic” approach.

I really do feel I’m opening a proverbial can of worms here, especially as I consider what could happen sexually to dementia patients. We have to assume that homes seeking to have a more liberal approach to relationships sanction only consenting adults with capacity. Even then I suspect safeguarding issues would emerge.

Weaver, a professor of contemporary performance at Queen Mary University of London, a performance artist in her own right, writer, and director, is a seasoned campaigner. It will be interesting to see how she develops this one in the light of the Manchester study.

Conditional living wage contract adrift from reality

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Islington council appears to be the only local authority that has gone as far as offering a conditional contract based on living wages being paid to staff.

I hear a whisper too that Birmingham is considering following the same path.

As Birmingham providers do not have the extra £30 per week per resident to cover this cost, it would mean residents and their families would have to find deeper pockets.


In the Guardian online Social Care Network, Janet Burgess, deputy leader of Islington council, is quoted as saying: “I am really pleased we have got one care home to pay the London living wage. It is frustrating other care homes do not see the great value there is in paying a decent wage for what is a very demanding job – the benefits affect not only the care workers themselves but also the organisation.”

She concedes that local authorities should recognise that they have to contribute some of the extra costs of the living wage. That’s big of her.

Sadly for me, some of the comments that follow in this piece are adrift of reality.

Charlotte Fischer from Citizens UK, which founded the Living Wage Foundation, would like to see non-payment of the living wage in the care sector tackled “to restore dignity for both the care recipient and the care worker.”

I’m obliged to ask: How Charlotte would propose to fund this extra outgoing.

Heather Wakefield, head of local government for Unison, wants the owners of care homes to “stop looking to provide care on the cheap, Care home employees often work long hours and their jobs can be challenging – any employer who recognises this by paying their lowest paid staff no less than the living wage will certainly reap the benefits,” she says.

Hmm . . . For many, Charlotte, especially in small business environments, the economic outcomes would be certain closure. How then would care providers care providers reap ‘benefits’?

I have campaigned a lifetime for quality, sustainable care and my comments here are drawn from a wealth of experience. I applaud the ethic of a living wage, but reality tells me that although Government nods approvingly at such initiatives, there is no release of purse strings that could make it happen. Ultimately, local authorities can spend only what monies they are given or raise at a regional level and for many of them the pot is empty.

If LA’s raise the fees, ages will go up – it’s as simple as that. However, in care nothing is black and white. Many carers work part-time and their incomes are supported with tax credits. It appears by paying the living wage, tax credits could be compromised and some would actually be worse off.

Guilty until proved innocent – how the law works with residential care

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The care industry is getting very twitchy over the new raft of regulatory demands and possible inspection outcomes that can now be deemed criminal offences.

High levels of corporate accountability that could end in the courts have racked up insurance policy bills and according to Caring Times editor Geoff Hodgson’s blog insurers seem to “rank care homes with paragliding and rodeo work.”

At odds with all of the UK justice system, the biggest problem is that provider are assumed guilty until they can prove their innocence.

Geoff point out, quite rightly, that we rarely hear much of lack of accountability of the public agencies involved in the investigation of safeguarding incidents.

Let me quote this incident he highlights in his blog: “In a letter published in the June issue of Caring Times, Paul Simic of the Lancashire Care Association recounts the sorry saga of Palatine Lodge in Burnley where a patient died in early 2012.

“The home had been cleared of any fault by the Coroner, the police, CQC and the local authority, but as a consequence of the safeguarding investigation, all the residents were moved and the proprietor of the home, its reputation in tatters, was compelled to sell the business at a substantial loss.

“In his letter Mr Simic asks: ‘How can it be that all this time on – with what happened to the other residents, to the proprietor, to the manager, to the staff, to any family and friends of Mrs A who also may have had to travel this unhappy road to the Coroner’s verdict – that no fault is found in a provider with an established good name, those who made such consequential judgments en route are subject to no independent review or scrutiny or consequence?

‘Where is the justice or fairness in this instance? Without the right checks and balances in place, the SME provider sector is too easily a secondary level victim.’”

I know too of another case where a male career was accused anonymously of sexual assault with a client in a nursing home. A massive, often hostile, police inquiry followed. The carer was suspended for months, his domestic life fell apart, the home’s manager was devastated and the owners distraught. Outcome: No case to answer – the letter believed to be sent by a former disgruntled employee.

Issues of a legal nature in safeguarding sometimes have catastrophic consequences, which, as these cases show, are not always fair.

Geoff quotes 
“All are punished,” – the Duke in Romeo and Juliet after the lovers’ joint demise’ and notes well it’s not so in the safeguarding scenario. I have a quote to add here too: “The law is an ass” – Charles Dickens (Oliver Twist).

Is this the evidence for poor social care funding?

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I’m sorry, but the whole business of the Local Government Ombudsman seeing a 130% increase in adult social care complaints since 2009 has got to me.

I read there were almost 2,500 complaints made about adult social care to the ombudsman last year alone,

And I also learn that more complaints are made about assessment and care planning than any other issue.

Well, what a surprise! As local authorities struggle to balance their books with ever-decreasing funds for social care, something must give.

And is this the evidence? Probably. Assessments are, after all, the place where monies are spent or saved.

Last year, 442 complaints included concerns in this area, a 7% increase on the previous year, the Guardian online reports.

The newspaper highlights the case of Peter, who lives at home with his mother. He has autism, epilepsy and learning disabilities. “After his NHS funding was withdrawn, the council assessed his needs but failed to comply with its legal duty to agree an aftercare plan,” the article says.

I desperately feel for social workers because many I now acting unwillingly, I believe, as frontline auditors. What a mess we are in!

The 2013 LGO review notes, according to the newspaper, that the 2,456 complaints for that year are “a small number in the context of 1.3 million users of adult social care in England. However, 40% of the total number of complaints the LGO receives are concentrated on 25 council areas.”

As for care reviews, the report shows councils “are getting this basic obligation wrong.”

Dr Jane Martin, local government ombudsman, is quoted as saying: “Over the last few years there have been a number of reviews that have looked at healthcare complaints. We must not wait for a crisis in adult care to examine more closely the way social care commissioners and providers deal with complaints.”

The LGO received 218 complaints and enquiries from private providers, just 9% of all adult social care complaints.

The review adds that while this may reflect good satisfaction, it may also mean that the public is unclear about how and where to raise concerns.

I’m sorry to keep beating the same old drum about funding, but I’ve been saying for years that if we cut, cut, cut in the way we are doing now, there are serious consequences.

Remember: The barometer of society is measured in how we treat (indeed, fund) its most vulnerable.