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By Debbie le Quesne

Archive for the ‘extra care’ Category

Crisis care letter follow-up swamped by Trump headlines

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

Not a chance, I say.

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

 

 

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

At last, the embattled social care sector is making the headlines it needs

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Billions of pounds are needed to avoid the NHS and social care crisis – that’s the message which has been sent to Secretary of State for Health, Jeremy Hunt.

According to the Daily Mirror, leaders in the care sector have alerted Mr Hunt after three health areas revealed they face a combined shortfall of more than £2.4billion by the end of the decade

As we broke into November, the dire warning outlined that without extra money they will struggle to meet waiting time targets, provide enough hospital beds and basic levels of social care.

Sounds familiar, doesn’t it, and it’s right on our doorstep.

The Mirror reports: “The verdict is contained in the newly published Sustainability and Transformation Plans (STPs) for Birmingham and Solihull, North Central London and South West London.

Sustainability and Transformation Plans were ordered by NHS England boss Simon Stephens in December 2015 and charged 44 regions in England to come up with a five-year programme for providing health and social care in their areas.

I’m not a lover of red-top journalism, but this report is exactly what’s needed.

And it adds: “Of the three reports published so far Birmingham and Solihull warns it faces a £712million shortfall by 2020, South West London £828million and North Central London £876million.”

For the record, West Midlands Care Association is working very closely with Birmingham City Council and assessing the impact throughout the neighbouring Black Country region.

The shortfall will doubtless impact on areas already struggling like Sandwell, Walsall and Dudley.

Mark Rogers, the chief executive of Birmingham Council, says in the piece both health and social care face “huge challenges”. According to Mirror “this includes the need for at least 430 more hospital beds in the region.”

Personally, I’m struggling to find a creative way forward. All the cuts in social care have already been made and I fear the duty of care caveat is lost somewhere in the ether.

Budgets are not just shrinking, they are vanishing and the demand for care is astronomic.

Mr Hunt, I fear lives in a bubble as MP for South West Surrey, and as we all know the social care financial map is very different in his constituency.

There is a laudable push to get people out of hospital and back into their own homes with social care support. But it is catastrophically failing.

Let me quote the Mirror again: The North Central London STP says it is not “able to deliver universally for everyone to the standards we would like.

“Our analysis tells us that too many people stay longer in hospital than is medically necessary. There are challenges with meeting acute standards, as well as issues workforce sustainability.

“Some of our estates aren’t fit for purpose. Additionally, we face a financial challenge of £876million across health commissioners and providers by 20/21 if we do nothing,” the STP is reported as saying.

This could have been written of any number of LAs throughout the UK.

Chancellor Philip Hammond has a chance to help next week with his mini Budget on November 23.

In the light of bleak analysis, I truly hope he will understand his responsibilities towards care providers and those receiving care.

WE are working with Birmingham to look at the consequences for Domicilairy and Care Homes. The shortfall in Birmingham has impact on the Black Country with many people being placed in Sandwell Walsall and Dudley

Dementia now the leading cause of death

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It’s a subject close to my heart, and after nursing both parents who suffered with dementia I’m not surprised to hear the memory-loss condition, including Alzheimer’s disease, has overtaken heart disease as the leading cause of death in England and Wales.

Last year, more than 61,000 people died of dementia – 11.6 per cent of all recorded deaths.

The Office for National Statistics says the change is largely due to an ageing population.

People are living for longer and deaths from some other causes, including heart disease, have gone down.

And of course, doctors are now much better at diagnosing dementia and the condition is now given more weight on death certificates.

The majority of beds now taken in our nursing homes are for those with some form of dementia, though this may not be the primary condition.

Hilary Evans of Alzheimer’s Research UK was reported in the Press as saying: “These figures once again call attention to the uncomfortable reality that currently, no-one survives a diagnosis of dementia.

“Dementia is not an inevitable part of ageing, it’s caused by diseases that can be fought through research, and we must bring all our efforts to bear on what is now our greatest medical challenge.”

Martina Kane of the Alzheimer’s Society said: “It is essential that people have access to the right support and services to help them live well with dementia and that research into better care, treatments and eventually a cure remain high on the agenda.”

There are around 850,000 people living with dementia in the UK.

My question to those who hold the purse strings for social care: How are we expected to care for them correctly without more money coming our way?

Vanity projects have been the hallmark of many governments. The breaking of the miners’ union under Mrs Thatcher, the Millennium Dome, Heathrow’s new runway expansion, Trident and not least HS2, have all be cited as political legacy monuments.

But let’s get something clear here. The West Midlands Care Association is not, to use a term, “a political animal” and we’ll work with whatever party to enhance the delivery of social care. Truth is, however, every political persuasion has a desire to leave it’s mark, but perhaps now is a time to fix sights on a massive national problem – the state of social care.

The government currently says HS2 will cost £55.7 billion. In 2010 the original estimates were put at £32bn.

A foolish thought, I know, but shouldn’t we be shelving this scheme and diverting the money into resolving the care crisis that has gripped the nation?

That way, those locked into the distressing and surreal battle with dementia could be properly cared for. Have I got the social and economic values all so wrong? Clearly, things are never so simplistic, but at this time it appears a pretty good option to me.

We need to stop thinking about the expressions of dementia – it’s a condition that can be frightening to both carer and patient, it can be hard to be around it, it can be violent and it can destroy those who are simply under-gunned in the fight to deliver compassionate care.

Perhaps our MPs will note that all care needs to be respectful, but it costs and funding needs to come from somewhere. Also, perhaps they could take on board that the dementia drain on diminishing social care funds is for a people group which never chose to be such a burden on society.

The Association is acutely aware of the growing workload for dementia care and the social skills it needs.

Last month (October) – Dementia Month – we worked with all of our care providers and the Aged Care Channel TV (ACCTV) to get additional training to the carers.

Pressure mounts on Chancellor for more cash

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Last month Theresa May’s claims that the government is putting £10bn extra into health was challenged by five MPs. led by the Conservative Dr Sarah Wollaston, the chair of the Commons health select committee.

The impact of not enough money for hospitals and access to social care are written for all to see in rising demand for A&E and missed waiting time targets.

Clearly there are complex reasons that, according to some sources, delayed transfer of care lost 192,000 hospital bed days. But the downgrading of social care in government agendas must be a primary cause.

I am led to understand some NHS number-crunchers believe the real number of people in hospital who should be being cared for in the community is probably four times as many as represented the figures here.

The pressure really is on Mr Hammond to deliver in his Autumn Statement.

Rising costs, the ageing population, difficulties recruiting staff and years of central government reducing its grant have left the service in crisis, the Local Government Association claims.

Surely, there is an unprecedented agreement that social care should be at the very top of the list of Mr Hammond’s priorities for urgent extra funding.

The triple whammy of shrinking budgets, rising demand and the cost of paying the national living wage to care workers has left many councils paring back more and more on care costs.

I’m led to believe that in Walsall last week there were 138 people waiting to leave hospital. There is enough capacity in the region to take them all, but . . . there is not the money to start the funding of new packages.

Before winter pressures kick in we understand discharge managers are looking to get all those people back in the community and free  100 beds for winter. Sadly, if all of those perceived admissions required care in the community or step-down residential beds we’re in trouble. There simply is not the capacity.

Mr Hammond is being urged by senior Tories to give the crumbling care system a double boost in his autumn statement, amid growing alarm that social care and the NHS will be unable to cope with demand this winter.

Rumours suggest that Mr Hammond is examining a plan to plough between £700m and £1.5bn extra into social care services from April to help reduce numbers of older people being admitted to hospital.

Apparently, he is also considering letting councils raise the amount they can add to council tax bills to fund social care through a precept introduced in April, currently capped at two percent.

We’ll see . . .

The LGA has made known that years of cuts to town-hall budgets have left the sector in crisis, with fewer people getting help with basics such as washing and eating at a time when need is rising.

Also, care homes are closing, partly because councils cannot afford high enough fees to allow operators – whose costs have risen because of the national living wage – to make a profit.

Putting further funds into social care, will I’m sure, indirectly relieve some of the difficulties being encountered by the NHS; not lest helping to facilitate a more efficient discharge of patients.