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By Debbie le Quesne

Archive for the ‘old people’s homes’ Category

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.

 

Snapshot on social care: Could it get any worse?

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Following the collapse of Southern Cross in 2011, we all though it couldn’t get much worse. The then UK’s biggest care home operator was in utter shambles and the lives of residents in turmoil.

No other big players have folded to date, but smaller firms aplenty are failing across the country. And there’s evidence too of major players in the region feeling economically uncomfortable . . . Four Season have closed in Birmingham and HC one have sold many of their Midland Homes.

The Guardian revealed last year a staggering 380 care homes have been declared insolvent since 2010 (Insolvency Service figures).

The number of failures each year has risen sharply since 2010, when 32 businesses failed. In 2015, 74 were declared insolvent, while another 34 failed in the first six months of 2016.

Large companies are also hurting. Four Seasons, the biggest care home operator in the country with more than 400 properties, is the most at risk, recording a pre-tax loss of £28m in the three months to the end of September 2016, the Guardian announced.

Robbie Barr, the chairman of Four Seasons, warns the industry is “struggling at tipping point” with the company juggling its own challenges.

On the issue of increased council taxes, he says it’s essential that councils use the powers they have been given to raise the social care precept and pass it on to frontline elderly social care services to help offset the additional costs of the national living wage increase and avoid further pressures on a sector.

The national living wage is scheduled to rise by 4.2% in April to £7.50, which is larger than the proposed 3% increase in council tax.

The Local Government Association estimates there will be a £2.6bn funding gap in adult social care by 2020.

A study by the Health Foundation, the King’s Fund and Nuffield Trust estimate the gap would be £1.9bn this year.

The LGA, reported: “The care provider market cannot carry on as it is and there is a real danger of more widespread market failure.”

And CQC . . . the industry regulator warned that adult social care is “approaching a tipping point”.

 

Time for a holiday, or more chocolate biscuits, please. . .

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.

 

 

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

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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.

 

 

‘Jet-in’ carers fly from Benidorm to UK amid care chaos

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I could hardly believe my eyes as I read the in the Telegraph that builders, barmaids and bankrupt businessmen are  flying into Britain from Spanish holiday spots to earn lucrative sums as care workers for the elderly.

What is going on?

A Telegraph investigation tells us that “thousands of expats are funding lifestyles in the sun by jetting in for fortnightly placements to take sole charge of the vulnerable, with, in many cases, “just a few days’ training.”

According to the story, British agencies are trawling popular resorts such as Benidorm and Malaga to lure new recruits with the promise of good earnings, free accommodation and subsidised travel.

And these travel carers are then supposed to give the most intimate of care to our elderly – virtual strangers doing shifts alongside residents with whom they have no real connection.

Figures being banded about, suggest earnings can be up to almost £1,700 a fortnight, with an alleged admission that many of those on their books “did not want to look after the vulnerable, but were driven by the cash.”

Our social care system is breaking down – a shortage of Government investment that’s matched by a growing shortage of workers.

Is this the latest symptom of chaos? Indeed, I believe it is, along with the widespread care home and dom-care service closures and record levels of bed-blocking in hospitals for want of social care packages being in place.

Caroline Abrahams, charity director at Age UK, is reported as saying the revelations were “yet another symptom of a crisis in social care” and I agree.

The Telegraph investigation reveals that “former builders, barmaids and taxi drivers are among thousands of expats flying back to Britain each month to be responsible for elderly people, those with dementia and learning difficulties.”

I am assaulted by a multitude of emotions at this news . . . I’m angry, frustrated, overwhelmed, but mostly sad.

Clearly driven by the downturn in the Spanish economy, we now have the added danger of casual carers – not to be confused by the many other foreign care workers who have chosen to make a career in caring in the UK.

It will be interesting to see what the CQC has to say about this latest trend, which according to the Telegraph is dodging regulation because some of the workers are self-employed.

Dr Sarah Wollaston, chairman of the Commons health select committee rightly says we need to “completely rethink the way we care for the vulnerable; we should be growing our own workforce, not relying on short-term stints from people flying in from overseas.”

I understand only too well the need to improve the supply of care workers, but this development worries me.

By 2020, a shortfall of more than 200,000 care workers is forecast in the UK.

For some, that’s a business opportunity, but if this is the emerging model we must stay vigilant.

Such a system raises obvious questions about consistency, accountability and care inquiry follow-ups – the regular dialogue between carers about patient needs and changes in condition.

I need chocolate, another coffee and the heater on my feet . . . all bad signs, I’m afraid, as a reach for crumbs of comfort.

  • Have you heard? This winter, the gaps in Britain’s stretched social care services have seen some of the most extreme measures on record.
  • Every NHS hospital has been ordered to cease most planned operations for a month until mid-January, in a desperate attempt to empty hospital beds, many of which are filled with pensioners for want of care packages at home.

 

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,

 

 

Autumn Statement: My utter disbelief

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Like millions of others, I listened to the Chancellor’s Autumn Statement in a stunned disbelief that after unprecedented pressure he failed to deliver on social care.

Secretly, I’d been hopeful that, as ITV put it, this vital area of funding would be Philip Hammond’s “rabbit out of the hat.”

But the man, who is privileged to represent the constituents of one of the wealthiest areas in the UK, said absolutely nothing on the issue so many of us were pinning our hopes on.

As the Prime Minister pointed out in PMQ’s, local authorities have been allowed to raise council tax by 2% to help plug the funding gap. But, especially in poorer areas where council tax receipts are low, the “social care precept” has barely touched the sides.

The irony of it all I find was in the closing comment calling it a plan that “provides help to those who need it now.”

On what plant does this Chancellor live?

It was no surprise that leader of the opposition Jeremy Corbyn chose to focus on health and social care as he took on the Prime Minister in the Commons before the Autumn Statement.

But is set a stage of clear demarcation – between reality and Cloud Cuckoo Land.

Love him or hate him, Corbyn urged the Government to plug the gap and address the “stress and fear” it causes.

Unremittingly bleak, social care providers have done an amazing job in recent years without the central funding to sustain long-term credible business models.

Local authorities have also been forced to pare provision back, to in the opinion of many, dangerous levels.

For six years there have been unprecedented cuts to LA budgets, with figures suggesting those people eligible for council-funded care falling by 25 per cent.

Teresa May’s almost apologetic herald for the mini-budget of gloom was found in her comment: “We can only afford to pay for the NHS and social care if we have a strong economy”.

My life! This is another George Osborne in this key role.

Well, Mr Hammond, may I congratulate you on your sheer brilliance in ignoring perhaps the most pressing social dilemma since the introduction of the Three-day Week in 1974.

Predictions of “looming chaos” were rejected by the Chancellor.

Philip Hammond said a previously announced NHS funding commitment was in line with what its leaders had wanted.

Health and social care leaders are reeling and unanimous in their condemnation.

Now the Treasury has made its stand, with Mr Hammond confirming that ministers would be sticking with departmental spending announced last year, the official unraveling of social care can begin.

In a new briefing published ahead of the Autumn Statement on 23 November, the Health Foundation, The King’s Fund and the Nuffield Trust analysed the state of health and social care finances, concluding that cuts and rising demand will leave adult social care facing a £1.9 billion funding gap next year.

What a cynical approach to well-founded information in the care sector we have witnessed. Is this bordering on criminal neglect . . . interesting thought.

And finally (for now): For once I am in a position to sympathise with the local authorities in the West Midlands and particularly Birmingham which is £50million in the red already this year.

No lifeline, the extra burden of the living wage  . .  and effectively an abandonment of responsibility for those in need and their care providers. In the industrial West Midlands  there simply are not enough self-funders to keep the sector afloat and bolster the care of those people funded by their local councils.

A budget for the JAM people (just about managing), Mr Hammond. Not in my world, Sir.

 

 

 

 

– Debbie LeQuesne CEO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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