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By Debbie le Quesne

Archive for the ‘funding for care’ Category

Robots with a human touch . . . will it ever catch on?

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You know the care sector’s in trouble when the media is awash with robot stories.

Apparently they are part of the answer to the care crisis. I’m not convinced, given the time frame in which we need a resolve.

But they are being developed “with cultural awareness” and a good bedside manner, academics say.

An international team is working on a £2m project to develop robots to help look after older people in care homes or sheltered accommodation.

They will offer support with everyday tasks, like taking tablets, as well as offering companionship. I get that.

Researchers from Middlesex University and the University of Bedfordshire will assist in building personal social robots, known as Pepper Robots, which can be pre-programmed to suit the person they are helping.

These “culturally sensitive” robots will be developed within three years, I read.

Prof Irena Papadopoulos, expert in trans-cultural nursing, was reported as saying: “As people live longer, health systems are put under increasing pressure.

“In the UK alone, 15,000 people are over 100 years of age and this figure will only increase.

“Assistive, intelligent robots for older people could relieve pressures in hospitals and care homes as well as improving care delivery at home and promoting independent living for the elderly.

“It is not a question of replacing human support but enhancing and complementing existing care.”

Here’s the rub . . . not designed to replace human support.

I don’t doubt they could be of use, but no matter how well they are programmed to be culturally aware, they will never replace the bond that can exist between carers and those for whom they care.

Pepper Robots are already used in thousands of homes in Japan.

So here’s the future: The robots will communicate through speech and with gestures, be able to move independently and pick up signs the elderly person is unwell or in pain.

Can’t really see my old Aunt Hilda asking her robot for a not-too-milky tea, with the tiniest amount of sugar, served in her favourite porcelain tea cup, can you?

 

 

Higher local taxes not a proper answer

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While Surrey County Council leader David Hodge bleated an apology over his attempt at hiking up council tax bills by 15 per cent to cover spiralling social care costs, more than 90 per cent of councils in England told ITV News that being allowed to raise council tax has made little or no difference to their ability to provide social care.

In December the government announced it planned to increase the social care precept from two to three percent.

But with the crisis surrounding home care deepening, many councils told ITN its no more than a “sticking plaster”.

Interesting, isn’t it, that the Surrye ‘sticking plaster’ has just dropped off the ‘wound’ with the announcement earlier this month that the huge hike had been scrapped.

A survey by the Association of Directors of Adult Social Services (ADASS), commissioned by ITV News, contacted all 152 councils in England.

They were asked whether permission to increase council tax would make a positive impact on social care in their area. Just 112 responded.

Thirty said it would make no difference and 79 agreed it would make very little difference. Just three councils agreed the rise would make a substantial difference to their ability to look after residents needing extra help to cope.

Not a single local authority believed the tax initiative at a local level offered a complete solution.

Last year the Local Government Association claimed Treasury funding cuts of 40 per cent over the last five years have left councils facing a £5 billion funding gap on social care.

Mrs May, will you please listen to what is going on in our sector and help us?

Interestingly, I was in Surrey at an association members’ meeting when the 15 per cent shocker was announced and the care providers with me were as puzzled as everyone else by the move, given that the majority of their clients are self-funders.

 

 

 

CQC: More companies are pulling out of contracts with councils

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Private sector care providers are ditching home care services, the Care Quality Commission (CQC) says.

And the regulator adds companies are pulling out of contracts with councils as they are no longer ‘profitable.’ A national trend, it’s now happening across the West Midlands, but the real crunch will come in April when we see the next increment in the National Living Wage.

According to the Commission the crisis in social care funding means authorities can only afford to pay firms very low rates.

How long has West Midlands Care Association been warning this will happen? Err, years.

David Behan, chief executive of the CQC, was reported in the media as saying several major companies, including Care UK, had pulled out of local home care contracts.

Giving evidence to MPs at the Health Select Committee, he said firms were unable to ‘deliver the quality of care and the volumes of care at the price being offered’.

Association of Directors of Adult Social Services figures show that 57 per cent of councils have reported home care businesses giving up their contracts in the past six months.

The research estimates that this had involved 10,800 elderly and vulnerable residents.

Some 400,000 people in the UK receive council-funded home care.

Quote: “Mr Behan told MPs that companies were ‘leaving the market’ and replacements were ‘not coming in.’ The vast majority of contracts handed back in our experience have been domiciliary care contracts where providers are saying:

‘We can’t deliver the quality of care and the volumes of care at the price being offered.’

The news has drawn comment from Caroline Abrahams, Charity Director at Age UK, who says ‘It’s worrying to hear that some care providers are giving up trying to make existing contracts work as their costs rise but funding fails to keep pace, and if these organisations are losing confidence in the sustainability of the care sector how on earth are older people and their families supposed to put their trust in it?’

Significantly she adds: ‘No care provider would ever walk away unless they felt they had no choice and the fact some are now doing so says a lot about the parlous state of the market at present.’

Very true. Austerity measures have had a catastrophic effect on care and ultimately the economies of council-funded packages don’t stack up with the inevitable failure to release bed-blocking at hospitals.

Estimates suggest that the number of those aged 85 and over will have almost doubled by 2030.

 

Memories of year where care reached crisis point

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Taking a look back is always dangerous. Nostalgia of ‘better days’ and being transfixed with what has been is never good for moving on efficiently.

But we really can’t escape the fact the 2016 put up some of the bleakest headlines for care that I’ve ever seen.

Funding gaps in community services for older people, which could increase to £2.6bn by 2020; delays in discharging medically fit patients from hospital; regular breaches of safe hospital bed occupancy levels;  and the government and the health and care sectors misaligned (what ever happened to the single budget for NHS and social care?).

It should have been the year that social care and healthcare finally start working together effectively . . . but we’re still waiting. There are, however, some green shoots of promise where the integration model has been pioneered.

As for funding for the future – the 6 per cent council tax rise announced in December is a start, but it diverts funds from housing and will leave some taxpayers  out of pocket.

More significantly it will do little to solve the ageing population problem and overstretched care system.

Currently there’s a lot of behind the scenes talk of more joined-up care between the NHS and social and it’s this hope that keeps me motivated. Indeed, 2017 could be a year of promise (but only if you catch me on a good day).

Obviously, by melding the two streams of care – something that had never happened since the NHS was founded in 1948 – care can become the seamless experience our elderly population deserves.

Despite the protests over who is taking what out of combined budgets, there are already promising signs – local authorities should look to Greater Manchester which, in April 2016, became the first locality in England to merge its health and social care sectors and control its budgets.

In the west Midlands there have been snippets of joint funding news, but not always good as I hear of health always having the upper hand and snatching monies back into its pot.

Without change, social care as we know it will inevitably die and so will those for whom it cares. Reinventing budget mechanics can be achieved, I believe, and bring harmony between social and NHS care. Bring it on – the sooner the better.

 

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.

 

 

Dementia clients – the business challenge

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Last week I was asked to write an article for a business publication. Here we go . . .

Dementia is now the leading cause of death England and Wales, and is thought to affect more than 850,000 people in the UK.

Caring for them is one of the biggest headaches facing the NHS and social care and the economies of the task are hugely complex, with Government austerity measures effectively strangling the private sector’s preferred responses.

It’s a fact of life that the majority of care homes and home care providers clients and residents will now have degrees of dementia. Integrity may cost a much-needed placement/client, but we must accept the limits of provision in place. Factoring in the necessary fee to be Commission-compliant with dementia takes carefully assessed scrutiny.

It is, therefore, paramount we get our business reaction right – embracing dementia clients can have profound ramifications on existing business models and understanding dementia is a steep learning curve

We need to be educators and ambassadors, be clear on the impact of the severity of dementia with which we’re dealing and the potential impact on our residential homes or domiciliary businesses. Also, families and Local Authority Brokerage have no idea why this specialised care so costly. Again, be clear and avoid the aggravation of unpaid invoices.

To run a successful business you need to consider, one or all of the following;

Possible collateral damage to the building:

Apart from the work needed to get the building dementia friendly, you will need to have a much more exhaustive maintenance plan to ensure standards are preserved and this element needs to be included in costs.

Additional staffing:

Staffing numbers need to reflect the extra support and extended hands-on care time required. There needs to be enough personnel to allow for breaks, as dementia care can be hugely stressful. Many individuals with the memory-loss condition have irregular sleep patterns and will require one-to-one companionship/conversation and feeding. Ensure that the maths stack up on staffing costs.

Secure buildings and safe gardens:

People with dementia need to be able to move round the building and grounds without constant supervision. To have sensory stimulants – things they can touch, feel and smell to help enrich their lives.

Additional staff training:

All staff, who work in the care Industry need and understanding of dementia, but senior staff and owners need a more in-depth knowledge so that they can competently tackle issues as they arise, be able to stand their ground with professionals and safeguarding, and engage innovative and very person-sensitive ideas. You will also need additional cleaning hours to keep the home/building up to standard.

Irregular dietary requirements:

Food needs to be provided when it’s required and in a format that people with dementia can access.

 Extended record keeping:

If you are trying different ways to support an individual, you will need to ensure that everything you try is recorded to show it is in their best interest. You should also try to engage family and friends and record their comments. An understanding of additional care support mechanisms, such as professional groups and representative bodies and dementia cafes are useful.

Hospital escorting policy:

You will need a clear escort policy budgeted carefully into the business plan. For instance, do you send a member of staff to all external appointments; emergency A&E visits; what’s the policy on appointments that require an extended stay beyond normal shift patterns; do you charge the family for one or all such accompanying trips as this is not included in the Local Authority fees; and do you have enough skilled staff to do this kind of care?

Tailored activities:

Traditional group activities are not ideal for many people with dementia, so you will need to have capacity for one-to-one initiatives and ensure all staff can engage with residents as they care for them. This is particularly vital in the stretched Home Care Market.

As care providers we need to clearly grasp the reality that symptoms of dementia are progressive and on an unknown time scale. Being fiscally cute and planning responsibly for such a capricious condition is immensely problematic, but it’s one that must be addressed. We need to ensure that there is a vibrant dementia market for the future and we can only do that if we are resolute in the knowledge of provision.

Visit carefitforvips.co.uk for help on person-centred dementia care, a site the Association recommends for its members.

 

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,