By Debbie le Quesne

Archive for the ‘extra care’ Category

Older people’s care: It’s where you live that counts and . . . if you’re rich

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Did anyone catch the BBC headlines that said older people are paying the price for cuts to social care?

And the faithful old Beeb added (what so many of us already know), the care and support older people receive increasingly depends on where they live and how much money they have rather than their needs,

Last month a new report by The King’s Fund and the Nuffield Trust laid the facts bare.

Six consecutive years of cuts to local authority budgets, rising demand for services and shortages of staff have left the social care system increasingly unable to meet the needs of the older people who depend on it.

Sadly, the findings also highlight the plight of unpaid carers, saying an unacceptable burden was placed on them. According to the BBC this leaves “rising numbers of older people who have difficulty with the basic activities of daily living – such as washing, dressing and getting out of bed – without any support at all.”

What is happening to us as a society? Mrs Thatcher’s infamous “there is no such thing as society” quote is ringing in my ears.

Evidence is presented that reductions in fees paid by local authorities and other cost pressures such as the National Living Wage are squeezing the incomes of residential and home care providers.

And you’ll never guess . . . it warns that an increasing number of providers are likely to leave the market or go out of business as a result.”

A West Midlands Care Association survey showed that some 50 per cent of home owners were considering selling or closing their businesses. And the picture was not much brighter with the dom-care market with commissioners recognizing there is indded a shortage of community caring.

How have we arrived at this crisis point? I’ll tell you how: Because successive governments have failed to listen to our warnings, and it appears they’re still not listening.

The sum total of what colloquially is known in the Midlands as ‘cocking a deaf ‘un’ is leaving our older citizens without the care they depend on.

The squeeze on the budgets of care providers is also prompting some providers in affluent areas to step back from providing care for people funded by local authorities, leaving those who depend on council funding reliant on an increasingly threadbare safety net.

We have to realise that nearly all private sector providers are running businesses, though it’s my experience that many have charitable hearts and subsequently are managing loss-making care enterprises.

The Beeb also noted: “At the same time, more people are having to pay for their own care as a result of cuts to local authority services.”

Indeed they are.

I cannot recall how many times I’ve spoken of the funding gap between the cost of adequate care and what is paid to my members by local authorities, but catch this . . . “The report highlights a growing funding gap within the existing, inadequate system which will reach at least £2.8 billion by 2019/20 as public spending on adult social care shrinks to less than 1 per cent of GDP. “

There’s a call for the government to be honest, to tell it how it is and if it is unwilling to properly fund and expand the current system, should say so.

Richard Humphries, Assistant Director of Policy at The King’s Fund said is reported online by the BBC as saying: ‘‘The failure of successive governments to reform social care has resulted in a failing system that leaves older people, their families and carers to pick up the pieces. “Putting this right will be a key test of the Prime Minister’s promise of a more equal country that works for everyone – there is no more burning injustice in Britain today than older people being denied the care they need to live with independence and dignity.”

I couldn’t agree more.


Why this boss is handing contracts back to the LA

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Alan Long is executive director of Mears Group PLC and in the last few months, has taken the “agonising” decisions to hand back a number of homecare contracts to local authorities, especially in the north of England.

In a Guardian article he explains why he felt it necessary to take such action.

The sense of desperation and frustration is tangible. It’s an argument you’ll have heard before . . . currently being considered by our providers in Birmingham and other Midlands areas.

This is what Mr Long writes: “As painful as this has been for the people we have been providing care for – and for our care workers – we hope others will follow our lead and help to end commissioning practices that should have no place in 21st-century Britain.

“Exiting contracts in this way is always the last resort and follows many months of trying to develop a different solution with a commissioner. But, ultimately, it may be the only means to drive the essential change in services that are life-critical to our most vulnerable citizens.

“We are not happy with the disruption this creates, but we feel that we have to take a stand to lead positive change in the absence of leadership from elsewhere.

“The contracts we have exited are those where simple mathematics shows that the charge rate a council wants to pay will result in a provider either not meeting the requirements of the “national living wage” for care staff, or not delivering the service needed by the user.

“In the homecare world, generally, councils only pay for “contact time” – the time a care worker spends with a service user. They don’t pay for the time it takes the worker to get to the property or move on to the next. They don’t pay for any of the time the worker must spend on training, or for the worker’s “on-costs” to ensure they are looked after if they fall sick. Nor do they help pay into their pensions.

“In recent years, councils have also shortened call lengths in order to cut costs, and many people have lost a service altogether.”

Could this be written about any area of the West Midlands and especially in Birmingham where most of our members have already withdrawn their services from the City? I think so.

Business are getting progressively militant it seems as they are driven into impossible corners. I started this post thinking of using just a few comments, but the article makes compelling reading without embellishes from myself.

Mr Long continues: “The “national living wage” is, of course, the bare minimum we need to pay – and rightly so. Being a care worker is an increasingly skilled job, requiring staff who can provide highly intimate personal care as well as support with medication. It is not for the faint-hearted and requires talent, dedication and strength.

“It is no surprise then that there is a national shortage of care staff. In the last 12 months alone, a lack of homecare capacity in the community has caused delayed discharges from hospitals to increase by 40 per cent.

“At a time when the NHS is creaking at the seams, there is an inherent short-sightedness in a system that focuses on cutting support for individuals, reducing call lengths and keeping charge rates for providers below sustainable levels.

“Unfortunately, many care providers still choose to accept very low charge rates from councils. This could be due to a lack of understanding of the minimum wage law, but is often simply caused by local businesses feeling they have no choice but to accept the terms offered, or risk going under. These businesses are often small and rely on a single contract just to exist.

“I have huge sympathy for councils on this issue, especially as many have been forced to cut other services to protect social care budgets. However, there is no excuse for setting charge rates that will almost certainly lead to breaches of the minimum wage or poor service.

“The last few governments have talked about reconsidering how we, as a society, fund social care – but nothing material has happened. Ultimately, this means we are failing to examine how we want to look after older and vulnerable people who need our support. All demographics point to an increasingly elderly population over the next 10 to 20 years, many of whom will be living with multiple long-term conditions. Surely it is a measure of a good society that we provide proper care for those people, at a time when they need it most?”

Mr Long suggests: “If we had given even 1 per cent of the time spent discussing Brexit on trying to reach a solution to the social care crisis, we might have one by now” and majors on the importance of having a sustainable care system.

Mears Group PLC is a major care industry player. Sadly, many of my members are independent, small businesses that do not have the wherewithal to join such a protest.

I fear for our future if we fail to move the hand of this government. I hope sincerely that Mrs May, a self-confessed champion of fairness, gets the message the care sector is sending out and administers fairly over our current needs.


Rising cost of care: Don’t shoot the providers, please

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Those people needing to go into a care home now face average fees of £30,000 a year as costs are rising ten times faster than pensioner incomes, writes The Telegraph consumer affairs editor Katie Morley.

A study by Prestige nursing, one of the UK’s biggest care agencies, found a “desperate and worsening” care crisis, with the annual cost of a care home room increasing by £1,536, or 5.2pc over the past year.

The article points out this is almost ten times more than the average £156 (1pc) income gains earned by pensioners over the same period.

Logically then, it suggests that paying for care without spending savings is becoming unaffordable even for the wealthiest pensioners.

Record low interest rates mean pensioners living off cash savings and buying guaranteed incomes in the form of annuities are struggling to generate monies which will not devalue as the price of goods and services gradually rises.

According to the Telegraph “the cost of the average single room in a full-time care home has pushed past £30,000 for the first time and is now £30,926, some £16,470 more than the average pensioner income of £14,456.

“It means pensioners are short by an average of £290 a week if they require residential care,” states the article.

Not surprisingly, the article adds: “London is the region with the most expensive care homes with the average cost now at £38,896 a year. It has overtaken the East of England as the most expensive as a result of experiencing the biggest annual rise in care costs of any UK region at 19pc.”

Before we go any further with this, I must add that every region has a different story to tell on the costs of care, often mirroring the social wealth of the area. We need to be careful how we take up this information and how it is used. For example, in the West Midlands it is more likely to be £24,000 per year, but still many try to provide quality care for less.

Nevertheless, the statistics in the media make compelling reading.

Ros Altmann, the former pensions minister, is quoted in the article, saying: “We have an increasingly desperate crisis in social care in this country. Nobody has set money aside to cover care needs for the increasing numbers of older people who cannot manage to look after themselves.”

Not a lot is made of why we are in this mess in Morley’s work, so I’ll add a nugget or two . . . Simple: Government no longer wants to fund social care in a fair and realistic way. To survive, care providers have to pass on costs. We’re not talking fat cat owners here, either; this is simple economics of survival.

In a separate article carried in the Guardian, Care England, lambasted the government for the crisis in the industry, accusing ministers of not having a strategy for older adult care and allowing local authorities to pay well below the cost of care for residents with state funding.

Martin Green, the chief executive of Care England, is quoted as saying: “I have great sympathy [for residents]. There is a dynamic in this called ageism. Why is it that when you get old and get a disease called dementia, you have to pay for it? I don’t know how in the age of the Equality Act you have older people having to pay for a service that younger people get for free.

“The government needs to have a proper approach to social care. Just pumping money into the NHS isn’t going to work. They need a clear approach, saying that this is what good social care costs. The government needs to show a bit of leadership, I am sick of them hiding behind localism and saying it is about local councils.”

Strong words., which I’d be willing to echo.

There will be those who will blame this current batch of figures on the greed of owners. Frankly, that’s rubbish. It’s just too easy to blame providers when all the facts are not present.

Some local authorities are paying just £330 a week for residents, the equivalent of less than £2 an hour.

Is that a fair rate for caring? Will that really cover hands-on care, laundry costs, food, lighting heating etc? Of course it won’t.



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 . . .


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.



Another blow for our elderly in benefits plan

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So the Government plans to transfer responsibility of a £5bn social care benefit to councils . . .

Not surprisingly this plan is now being exposed as disguised cost-cutting and could restrict the number of older people getting care at home, campaigners claim.

Just before Christmas the whole business of attendance allowances (AA) was in the news and there are more rumblings now.

Nearly 1.5 million people receive the allowance, paid at a rate of £55.10 or £82.30 a week, to help with personal care for those who have a physical or mental disability.

Now Care home owner Michael Vaughan has launched a petition  https://petition.parliament.uk/petitions/119787  to halt the move, fearing it will removes valuable financial support from people who may not meet the increasingly substantial criteria that Social Services use when deciding if a person is entitled to their support.

Currently AA is a non-means tested benefit for people over 65 who need help with personal care (i.e. washing, dressing and eating etc), because they are physically or mentally disabled.

It helps people to remain at home for longer and enables them to decide how, where and when their care is delivered. What’s more, it helps remove pressure on an already overstretched NHS.

Our ‘dom-care’ providers are quick to point out the new proposal will diminish independence and choice for the elderly.

Quite rightly, Michael Vaughan says it will have a hugely negative impact on our elderly’s health.

AA can make all the difference between living and existing – and without it people will suffer. It’s a vital benefit that helps deliver what I think the Government wants . . . for people to be able to stay in their own homes longer.

I have a question: Will these monies that are passed on the LAs be ring-fenced? If not, I guess it’s another way of saying ‘more cuts on the way, Debbie’.

Not surprisingly, our Supported Living providers – some of them huge national charities who support housing scheme residents – are all with fingers crossed that the outcome will not be devastating.

As far as I can ascertain, models are geared towards the attendance allowance, but there appears to be scant impact analysis on the plans out there.


GPs’ NO vote on care home calls – it’s not all bad locally

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According to the stats care home residents are an estimated 50 per cent more likely than the average older person to be admitted to hospital as an emergency case.

Now there’s a desperate push to improve on these figures, but the latest stance from the GPs’ Local Medical Committees where delegates voted to not do residential home calls has thrown a serious spanner in the works. I have long been a supporter of improving conditions under which doctors work, but this I perceive as a gross dereliction of duty of care and I know there’s a legal groundswell supporting this stance.

‘Blue light’ cases are costly to the NHS and there are various initiatives afoot to cut back on the numbers of elderly admitted this way.

The financial burden on NHS Trusts appears to have sparked a response that is appears contrary to wishes of the Local Medical Committees’ recent vote.

Wolverhampton Clinical Commissioning Group (WCCG) is proposing a system where 12 GP-led practices work together in supporting care homes which have residents with long-term health conditions such as asthma, COPD, and diabetes. Primarily the aim to prevent any unnecessary admissions to hospital.

Under the name Primary Care in Reach Teams (PITs), the service pledges to provide hands-on support to residential care homes in the clinical management of chronic conditions.

These GP practices will work in co-junction with the Rapid Response service, pharmacy and community teams to “enhance the level of care to patients provided by registered GPs.”

This new service will run from this month (February) as a pilot until January 2017. In the first instance to test how beneficial it is to you and therefore a pilot. In a letter sent out to patients, benefits anticipated by WCCG are:

  • “Improving your health and wellbeing by ensuring that you are receiving the most appropriate care
  • “Reducing ill health by intervening earlier
  • “Reducing unnecessary admissions to hospital. “

Care home patients who fall outside of GPs delivering the scheme can register with a participating practice.

In Dudley, a senior CCG spokesperson told West Midlands Care Association a comprehensive response to the doctors’ vote will be announced, but pointed out that the news broken by the Daily Mail “neglects to state that patients will remain registered with the GP practice and therefore the doctor will continue with the responsibilities that fall under primary care.”

In other words, despite the apparent willingness to leave care and nursing homes to their own devices, doctors’ surgeries will still be bound by a legal duty of care responsibility.