By Debbie le Quesne

Archive for the ‘George Osborne’ Category

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.



Osborne’s chaos: A local view

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Spent too much time yesterday thinking about my Osborne blogs and what really needed to be posted is the local angle.

A two per cent council tax increase . . . what planet does he think we are on? It would pinch everyone a little – yes, but will it make any difference at all? No. Emphatically, no.

I understand that Dudley is considering raising the level of council tax, while Sandwell will probably not. Whatever the decision in these two key West Midland boroughs, the great financial divide between the real and notional costs of care will not be plugged.

We have turned into the New Year and the Government still appears rudderless when it comes to the care sector. Local authorities, Mr Cameron, do not have sufficient monies to pay proper rates for the services the private sector provide. What is so hard to understand? Tinkering with council tax is like dressing a critical wound lightly when invasive surgery is prescribed.

So many of my members are relatively small players and their market resilience is just about gone. These people are not the fat-cat operators many perceive. The bigger operators are also struggling as the fees don’t cover their costs either. Caught in a financial and moral dilemma, they are struggling to survive on economics that don’t stack up, while still trying to care for an ever-growing pool of needy people.

Self-help is a common and much over used term. Well, let me say the industry has been self-helping now for a good decade. Ironically, many local authorities once perceived as the enemies of delivering a fare rate to care providers, now genuinely see the need to pay it. But they can’t, Mr Cameron – because central Government administer the real money and it’s not being decanted downwards.

How are these essential social care businesses to survive? They have used their reserves a long time ago, most have no properties to sell off, and oh yes, a new raft of outgoings – the living wage – faces them in April.

An impact survey by the association suggests any benefits found with reductions in Corporation tax – a fall to 19 per cent in 2017 and 18 per cent in 2002 – will not plug an ever-widening chasm between realistic operational costs and fees paid for care by local authorities.

Under the Chancellor’s plans, workers aged over 25 will get a minimum of £7.20 an hour from April, rising to £9 by 2020.

The Government says this will mean a direct pay rise for 2.5 million workers of an average of £5,000 by 2020.

It’s a great concept and I applaud the sentiments of this initiative. But there needs to be some Goverment financial lubrication in the care market to make it happen without the inevitability of home closures.

The cost to my members? Let me remind you: It will add £23 per week to the care of every Midlands person in a residential care setting.

It will also mean there will be little or no pay differential between domestic staff will little responsibility and experienced Diploma Level 2 carers.

For those businesses offering community care, my association concludes there will be an additional £1.50 per hour cost for each member of staff. This figure does not include the additional expenses of travel time, which is not funded in the local authority rate.

There simply isn’t anywhere amongst us for extra savings to be made. Years of austerity have taken their toll and the creative thinking is through.

Our calculations regarding the timing of and potential savings on Corporation tax just don’t work as an offset to this extra expenditure, over which members have no control.

WMCA is pressing Government for a speedy response. Along with other national representative bodies we are doing all we can. I really do believe its now the time for Mr Cameron to intervene and, likewise, do all he can.

King’s Fund warning on the rich-poor care divide

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George Osborne’s decision to sanction a two per cent rise in council tax to offset cuts to social care will lead to thousands more older people missing out on vital services, the Guardian newspaper has revealed.

For many the bible of social care, the newspaper said the chancellor’s spending review attempt to plug the hole in care funds, will only widen the gap in provision between richer and poorer areas and “raise at most only £800m a year – far less than the £2bn he predicted.”

The King’s Fund is a non-political body that harnesses the thinking of some of the finest minds in the UK. It needs to be heard.

In a detailed critique of the policy, the thinktank has found “that disadvantaged places in the north, Midlands and inner London with the greatest need for social care will lose out because they will be able to raise too little extra revenue from it to make any difference.” How true! We had said for years the Midlands has some of the most impoverished boroughs in the country and they are deserving of a ‘special case’ approach.

Quote from Richard Humphries, the King’s Fund’s assistant director of policy, who has undertaken the analysis: “Relying on councils to plug the gap in social care funding won’t be equitable or effective because of the inverse social care law that councils that have the greatest need for publicly funded social care are least able to meet it [because their council tax bases are so low]. George Osborne’s new policy is of very limited help for them,”

Do I hear an amen?

Humphries adds the precept is a “shortsighted” response to the growing crisis in social care,

And delivering more criticism, Humphries says the plan is ”very opaque, complicated and messy option, which, crucially, will not much help areas at greatest need. It’s a very high-risk strategy.”

Humphries then warns social care providers collapsing, more people going without the care they need or having to pay for it themselves, and even more pressure on families and the NHS to pick up the pieces when there’s a breakdown support.

Quote: “Older people will be more likely to end up in hospital.”

At the risk of overloading this blog, let me quote some more of the Guardian piece: “The thinktank believes that the 2% precept is based on ‘completely implausible assumptions made by the Treasury’. For example, the expected £2bn figure is based on all of England’s 152 councils levying it, but many councils are highly reluctant to raise council tax at all and quite a few were elected after specifically promising no rises. Only half of councils increased their rates this year.”

Humphries found that the two councils that would receive the least extra income from the levy would be Wandsworth, at £3.70-a-head, and Westminster at £4.90. But neither is typical because council tax rates in the two Conservative-run London boroughs are already so unusually low.

If you require more information look up the following link http://www.theguardian.com/society/2015/nov/20/osborne-plans-to-allow-2-council-tax-rises-to-plug-social-care-holes

It’s harrowing stuff, but we know that news, by its definition, is rarely good.

In a letter to the Guardian, the King’s Fund chief executive, Prof Chris Ham, and Nigel Edwards, his counterpart at the Nuffield Trust thinktank, say the spending review “represents another setback for people who need social care. [The] new powers to raise council tax will provide local authorities with some financial flexibility but … will disadvantage deprived areas with high needs for publicly funded care.”

Joining the chorus of criticism, along with our selves (WMCA) are charities such as Age UK and Alzheimer’s Society and bodies such as the Local Government Association and Care and Support Alliance.

It’s another example of central government dodging the bullet and putting the responsibility on already struggling local councils to raise more money for social care. Clearly, it should be the role of government to provide it to the growing number of people in need due to the UK’s ageing population.

I don’t doubt there are some politicians who do recognise the huge chorus of complaint, but additional money is still not with us.

The Better Care Fund won’t come into effect until 2017!

As the social care sector we still remain the Cinderella of caring with no frontloading of cash, unlike the NHS.

Okay . . . where’s cream cakes, biscuits? How I need something to ease the pain of reality! Returning to work after a break is that never easy.


Mr Osborne, you’ve failed us yet again

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Let me set the scene: Paul Burstow is a social policy entrepreneur. He chairs the Tavistock & Portman NHS Foundation Trust and is professor of health & social care at City University, London.

Between 1997 and 2015 he was Liberal Democrat MP for Sutton and Cheam. He served as the minister of state for care services between 2010 and 2012. In the latter role he covered a wide range of social policy issues including mental health, adult social care, carers, personal health budgets, safeguarding vulnerable adults, end of life care and long term conditions.

I think he has more than a good idea of what’s going on in social care.

Writing in the Guardian last month he bluntly announced what we already know: That the George Osborne funding plan for social care won’t work.

He writes: “Yet again social care is the poor relation of the NHS. Rather than committing any extra exchequer funds, the chancellor announced he was giving permission to town halls to raise a social care precept from council tax to bridge the funding gap.

“The problem is that the precept will not bridge the gap. At best it will raise around £1.7bn a year by 2020, but because it is council tax it will raise the money in the wrong places. Poorer areas get much less money from council tax than their richer counterparts. Those councils most desperate for extra funding to meet the needs of their working-age disabled and frail older people will be left struggling to cope.“

He adds: “Worse than that, the chancellor has pulled off the classic conjurer’s trick of misdirection. While telling us to look at a 2% council tax rise, he hopes to distract attention from the 6.7% real-terms cut in local authority budgets. It’s a bit like sticking a plaster on a leaky bucket. The irony is that the NHS, with more unplanned admissions and delayed discharges, will feel the consequences that in turn will lead to higher social care costs – a classic false economy.


“Earlier this year, the government postponed the implementation of the cap on care costs to ease the pressure on councils. But where has the money saved gone? Not into social care.”


Poor social care investment stacks up heaps of trouble. So far the weather has been mild for the time of year, but if the temperatures dip and our underfunded elderly get sick, there will be a catastrophic gridlock in our hospitals. When is comes to discharge, where will we find the necessary step-down beds and for new admissions for residential care, where will the beds be found?

The care pool is shrinking and the laudable notion of keeping people at home in many cases is not a civilised option.

Guardian quote: “Despite the talk of more integration, the drive towards pooled budgets has stalled. The Better Care Fund is frozen for next year, so there will be no funding to plug the social care gap from that source. It is not until 2017 that an extra £1.5bn will be injected into the fund.”

I genuinely have no idea how local authorities and care providers are supposed to close the funding gap, yet it appears we are the only ones left with the responsibility of doing so. I’d hoped for better. The fragile care market needs help. We’re sending out the messages, doing all we can to stay afloat, but the raft is sinking and it’s just a matter of time before we see another Southern Cross disaster.

My New Year message: Act speedily Mr Cameron . . .


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).

Crisis talks on future of care homes

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Yesterday’s BBC news tells us that crisis talks were taking place between care home owners and council leaders “amid mounting concern a large number of providers are preparing to pull out of the market.”

I am not surprised.

Latest figures reveal 37,000 beds – nearly 10 per cent – could be lost by 2020.

Why? Inadequate fees paid by councils and the additional costs of meeting the national living wage.

The Beeb informs that charities will also be represented at the meeting in London “with all sides calling for extra funding ahead of next week’s spending review.”

Pressure on the Chancellor really is mounting . . . Good, I say.

Martin Green, chief executive of Care England, is reported as saying: “Faced with increasing costs and falling fee levels, many smaller care providers will go to the wall, jeopardising the care of thousands of vulnerable people.”

On the agenda was contingency planning for mass home closures and the collapse of many small providers.

Age UK and Carers UK were represented alongside some of the big care companies and council chiefs.

And here’s a nugget: There are more than 400,000 elderly care home residents in England with more than half council-funded in part.

In the West Midlands the picture is worse with somewhere near 80 per cent of homes reliant on council-funded occupancy. And of course, at West Midlands Care Association we too are lobbying and presenting data to support better funding. Martin Green is doing a good job here, but be assured he’s not the only one in the fight.

Currently WMCA is in talks with all our local authorities and members are being encouraged to respond to council surveys on the specific costs of care. We have a duty to be public on this and ‘tell it as it is’. Not responding, sadly, serves only to strengthen the argument for not hiking up fees.

A Department of Health spokeswoman said future spending on care would be decided by the spending review and assured “no-one will be left without care if a home close.”

Cold comfort, indeed, don’t you think?

Singing from the same hymn sheet on issue of fees

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I’m not a musician, but I do know when people can hold a note, or when a choral piece is more of a discord than a pleasing harmony.

The care sector is renowned for its fragmentation, mixed messages and entrenched differences of opinion.

For those unfamiliar with my blogging, the West Midlands Care Association has campaigned long and hard for a more realistic response to fees from local authorities.

Sometimes, when the care sector is so embattled, it’s just nice to get a shot of encouragement and at the start of the month I received mine.

Professor Martin Green OBE, Chief Executive of Care England, a representative body for independent care services, has written a letter to the Directors of Adult Social services, reminding councils of the legal responsibilities regarding fees. Without collusion, Prof Green’s message is in perfect harmony with that of my association.

Acknowledging local authorities face unprecedented financial pressure – and that it is to continue – he spells out clearly the legal obligations those responsible for the caring purse.

Le me quote: “With respect to fees, these responsibilities are set out most clearly in the Care Act 2014.

“Paragraph 4.35 of this Act states clearly that: ‘Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality – for example, by setting fee levels below an amount which is not sustainable for provider in the long-term’.

“In other words, local authorities must take steps to ensure that the fee levels at which they commission state funded care enable the provider in question to offer services to that individual for however long that person requires the level of care being provided.

“We do not see how sustainability can be achieved through below inflationary fee increases, and are yet to see an assurance process that indicates this would even be remotely possible.”

Prof Green observes that Councils “cannot remain static” in this respect and the impact of providers Budget responsibilities for the Living Wage serves only to compound issues.

Let me quote some more: “In its analysis of the July Budget, the independent Office for Budget Responsibility provided four possible actions that employers could take in light of the introduction of a National Living Wage. These are:

  • Reducing the number of hours worked by their existing employees;
  • Reducing the number of people employed, either by firing existing employees or by hiring fewer people until attrition has reduced the workforce by the desired amount;
  • Changing the composition of their workforce, potentially by replacing those who are 25 years old or older with those aged 24 or less;
  • Increasing prices in order to pass on the higher wage costs to their customers.

“As the provision of care services are codified in statute, the first two of these options cannot be pursued by independent care providers.

“The fact that the average age of people working in the sector is well above 25 means that it would be impractical to pursue option 3.

Increasing prices is irrelevant in this context as the issue that this letter deals with is the setting of fees for state funded residents, not for self-funders. Therefore, option 4 is not considered, but is a measure that providers will almost certainly have to adopt for residents funding their own care.

“If self-funders have no choice but to pay higher fees, it follows that local authorities also have no option but to commission care at higher rates to reflect the increase in the minimum wage. We do not allow consideration of the possibility of self-funder fees being used to subsidise council fees, which has been happening with increasing frequency across the country. As well as being unethical, this practice is also unlawful. “

Industry annalists LaingBuisson project that care home fees must be increased by five per cent to accommodate the statutory minimum wage.

Concluding, Prof Green adds that the introduction of the National Living Wage in accordance with the Low Pay Commission’s own data would be “completely unsustainable for care home providers without an increase in fees from local authorities. “

I agree wholeheartedly.

Prof Green is asking adult social care to work with him, noting that many “understand the pressures that providers are facing.”

My approach is unashamedly coequal – singing from the same hymn sheet – please, help us as both directors and care providers face this enormous financial challenge that simply cannot be ignored.

Isolation and loneliness: Please lead by example, Mr Hunt

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Invite lonely elderly strangers into your home, urges Jeremy Hunt – so says a recent headline in The Guardian.

The Health Secretary is advocating that s people should keep in closer touch with older relatives to reduce isolation, and take greater responsibility for their own health.

The cynic in mean can’t help feeling that this family values promotion hides the truth: That there is no political will to pay for such services.

Speaking recently at the annual conference of the Local Government Association, Mr Hunt urged people to keep in closer touch with older relatives, friends and neighbours to battle against elderly loneliness.

The tone is good, the moral standards high, but I’m struggling with this message.

He highlighted the case of a man found in Edinburgh recently, three years after he died, and the eight council-funded “lonely funerals” a day in England, half of which involve over-65s.

He said: “Are we really saying these people had no living relatives or friends? Or is it something sadder, namely that the busy, atomised lives we increasingly lead mean that too often we have become so distant from blood relatives that we don’t have any idea even when they are dying?

“In Japan, nearly 30,000 people die alone every year and they have even coined a word for it, kudokushi, which means ‘lonely death’.

“How many lonely deaths do we have in Britain where, according to Age UK, a million older people have not spoken to anyone in the last month?”

This is powerful, heartstrings-tugging material. Hunt also urged people to be more careful about drawing on “finite NHS resources”, itself a worrying aside.

None of this resonates easily with us. Why should I suddenly feel guilty?

There is a yawning chasm between the need I see and Mr Hunt’s care supply chain. Are people more distant these days? Probably, yes. Are we horrible, uncaring people? No.

The shortfall on properly, economically-derived funding levels for care providers is, I believe, a moral responsibility of Government. Its response to need is the barometer of being civilised.

I can’t help feeling that although I agree with so much of Mr Hunt’s speech, I have a finger wagging in front of me, reminding me of the moral priorities I should choose. The irony of my seeming abdication to meet the need is that Mr Hunt too, is right there at the side of me.

Perhaps he could lead by example and ensure social care is funded well enough to service the needs he is trying to meet on the cheap.

Latest calculations – the Budget impact on social care

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Oh my life . . . I knew the Budget was bad news, but I’ve just read a piece from a recent edition of The Guardian and I think I feel sick.

I’m trying to console myself with the fact that this publication does not align itself with the Conservative government, but I know some of the figures presented are credible.

The piece suggests that the care sector has been “invisible” to George Osborne. I agree. I cannot image any politician setting in stone anything like the national living wage knowing the impact it could have.

Let me quote: “Let’s suppose Osborne had done all his sums, however. In that case, the logical conclusion can only be good news for social care because he must have realised he would have to factor in a hefty bung of taxpayers’ money to meet the sharply rising costs of paying the NLW from next April. Any other way lies disaster.”

As the article says “there simply isn’t the money in the system to meet the costs without it.”

According to initial calculations by the Local Government Association, indemnifying care contractors against the new minimum would cost councils in England an extra £330m next year, rising to £1bn extra by 2020 (Guardian).

But rightly, as stated “at a time when, the association says, the funding gap in adult social care is widening by £700m annually.”

The article goes on: “The Resolution Foundation thinktank, which has carried out previous detailed analysis of the implications of ending the low-pay scandal in social care, puts the UK-wide extra costs to the public purse of Osborne’s plan at £1.3bn by 2020 – on top of another £1bn already pencilled in for increases in the original national minimum wage.

“In net terms, deducting savings to the exchequer after tax and benefits, the foundation reckons the additional costs to be £675m by 2020, or just over £1.2bn including the amount already allocated for the national minimum wage.”

Oh my life!

Already we have seen hospital admissions soaring since the austerity measures began and a strong argument presented that social care funding cuts are to blame. I fear sores is to come, though there will be regional differences.

My members and I in the West Midlands are particularly concerned over the issue and we are busy putting together figures to ensure that local councilors, our MPs and the LA staff are aware of the impact.

The West Midlands is more dependent than many other areas on local authority care funding and throughout the region it’s the prime source of business.

As the main funders in the marketplace – there are very limited self-funder opportunities – authority fees are calculated to allow only a small profit for providers, which these wage increases will easily wipe out. Simply, there is currently no money left in the pot for my members, or, indeed, the LAs.

I wonder how we will remember Mr Osborne: Will he be the one who has managed to unstick the whole fabric of social care in the UK, despite his government’s pledge that “social care is a priority”?