wmcha

By Debbie le Quesne

Archive for the ‘Making it Real’ Category

Higher local taxes not a proper answer

leave a comment »

 

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.

 

 

 

Advertisements

Crisis care letter follow-up swamped by Trump headlines

leave a comment »

 

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.

LGA campaigning on our behalf

leave a comment »

At the end of last November the LGA ‘state of the nation’ report highlighted a £5.8bn funding gap in social care by 2019/20. Ouch!

This report from the Local Government Association (LGA) provides an overview of current issues for adult social care and it’s not light reading.

It says the core local government grant has been reduced by 40 per cent in real terms since 2010 and councils have been set a ‘flat cash’ settlement for the remaining years of the decade.

“This, the LGA explains, leaves councils exposed to the pressures from general inflation, increases in demand from population growth and increase in care costs, such as national insurance, the National Living Wage and pension contributions,” the report explains.

So we’re told the funding gap will be hitting £5.8 billion by 2020.

The Better Care Fund springs to mind . . . but has any local Authority seen any of this cash? Over the Christmas/New Year ‘hump’ there has been so much information arriving on my desk and I’m swamped in pile of data – only some which is relevant.

Ultimately, the industry needs hard cash, local authorities require the same and the only paymaster with that kind of financial clout is central Government.

I used to be struck that so many local authority offices in the West Midlands were bursting at the seams with busy, stressed employees. Not anymore – their work has been  outsourced and offices are empty. Whole departments gone and we’re well past the point of sensible economies here.

Politicians really must now decide if social care is a real priority that will cut through rhetoric, depleted LA resource  and deliver solutions.

The Guardian recently stated that adult social care accounts for around 35 per cent of total budget spending by local governments, so with such a high percentage of outgoing, it seems impossible for such a service to contribute significantly to savings.

Like never before the LGA is gaining traction with the media and the headlines being written can only help our case. I’ve seen so many figures that are beyond Monopoly money accounting it leaves me in a financial fog. Over the UK we’re looking at multi-billions of pounds of shortfall.

Ahead of the NHS, social care desperately needs attention as repairing it will have monumental benefits for our health service.

In a nutshell, the LGA report concludes unanimously that social care is chronically underfunded. Interestingly, it highlights that this vital service, that helps define our nation as civilised, does not seem a priority amongst the public. Is it because all parties have failed in the PR and the public really doesn’t understand the implications? Personally, I don’t think so. But I do believe the sheer scale of the problem has remained hidden by successive Government because of their refusal to respond realistically to the ‘help us’ calls of West Midlands Care Association and other similar representative bodies.

More and more I find myself juggling both national and local agendas that straggle both the NHS and social care. For me it appears perverse that over a decade the NHS quota has risen by about 25 per cent while social care has been flat-lined.

Quite what the financial rescue framework will become over the next months is a mystery, but I am certain history will write some pretty damning stuff if we don’t get it right very soon.

 

Written by debbielq

January 17, 2017 at 9:09 am

King’s Fund: Another year of challenges

leave a comment »

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.

 

 

The state we’re in – time for a reality check

leave a comment »

Britain’s elderly population is soaring, but there’s a big problem: Not all the latter years afforded by better care and medicinal advances are healthy.

There are one million more people over the age of 65 than five years ago, and the number of those aged 80 and over has risen by almost 10 per cent.

The demographic shift means an increasing number of extremely frail and elderly people who are unable to carry out daily tasks unaided.

And social care is in demand like never before.

In 2010, the Coalition government promised to protect the NHS from cuts and the

Conservative administration has continued to ensure that the health service receives increases in funding, with an extra £8bn a year by 2020, I read.

Despite the NHS ‘protection’ policy, just like its poor relative, social care is also in trouble.

With social care funding at an all-time low, care businesses failing weekly, reduced capacity in the private sector and a growing unwillingness among care provider survivors to take council-funded candidates, bed-blocking is now seizing the mechanics of good hospital caring.

Simply, medically fit people are being left on wards because there are no community beds available, or the necessary support care packages at home cannot be established.

Austerity measures have hit councils badly and social care has been an easy target on which to save money. It sounds harsh, but it’s the way it is.

In real terms, figures suggest budgets for social services have fallen by 11 per cent in five years, as the elderly population has surged.

We have been warning of the winter crisis for months and now we find operations are being cancelled in a bid to ease the hospital beds shortage.

I understand that ahead of Christmas there was a clamour to free up hospital beds.

But returning pensioners to their homes requires far more care to be available; from home-helps, to full-time live-in personal assistants and carers with advanced skills.

What’s more, since 2009, the number of people receiving state-funded help for care has fallen by 25 per cent. So many are struggling to pay-as-you go as self-funders.

And there’s another issue. “Social care sector roles now have turnover rates of more than 25 per cent a year, with more than 300,000 workers walking away from such work every year. It is an ageing workforce too – one in five of those in the field are approaching retirement age,” a national press report said.

Remarkably, so many of my West Midlands Care Association members and those with whom I work in other care organisations, stoically press on providing excellent standards of caring.

Yes, we do need a new architecture for care finances, but proposals are so far short-term and a realistic solution is notably missing from any political New Year goodwill message that I’ve seen.

 

 

Autumn Statement: My utter disbelief

leave a comment »

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

leave a comment »

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