By Debbie le Quesne

Archive for the ‘Parkinsons’s’ Category

The time to take part in funding consultation is NOW

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Unless a high-speed railway is about to be directed through your garden, why would a member of the public take the time to respond to a government consultation?

Take, for instance, the consultation from the Department of Health on the rules affecting who qualifies for care and support, which was published in June.

Much too long and boring?

Not so!

Independent Age points out that it’s one of the most important consultations for years but is concerned too little is being done to publicise it.

There is a real danger the only people who are responding will already be known to government. Local government will respond no doubt – and rightly so. And charities will be doing their best to present a powerful case for more funding so adults with significant care needs can receive state-funded care well into the future.

Which, according to Independent Age, begs a burning question” Whose consultation is this anyway?

Where are the voices of older and disabled people, those of care and nursing home owners and what more can we do to ensure people with care needs are directly influencing the consultation outcome?

In particular, the outcome will have a huge effect on the level of local authority bed payments being agreed in the future. Dare we miss having our say” No way.

The Care Act 2014 is an interesting piece of legislation which will change the dynamic of the care industry.

Its impact on the South of England where they rely heavily on the public to fund their own Care will be dramatic and will see the cost of care for the Local Authorities go up. There will be less impact here in the West Midlands, but it could mean that homes will need to introduce larger top-ups as localauthorities will cover less. There are other part of the legislation which will affect the industry, but truth be told, it’s what is being consulted on between now and mid-August that really matters, says Independent Age.

We all have an opportunity to a say about how generous the publicly-funded social care system will be and who it should support.


King’s Fund sound alarm over shortfall in care funding

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Budget cuts of 26 percent will threaten the sustainability of social care the Association of Directors of Adult Social Service warned.

As I have previously blogged the organisation said the results of the annual budget survey show that while spending on adult services has reduced by 12 per cent since 2010, the amount of people needing support has increased by 14 per cent.

Put simply, the figures don’t stack up and councils have had to make savings equivalent to £3.53bn. David Pearson, president of ADASS, was quoted in The Guardian as saying: “As resources reduce and need increases, directors are increasingly concerned about the impact on countless vulnerable people who will fail to receive, or not be able to afford, the social care services they need and deserve.”

The warning has drawn comments from Richard Humphries, assistant director of policy at the King’s Fund: Again quoted in the Guardian online, he says: “This survey once again highlights the enormous pressure on social care budgets.

“Despite the best efforts of local authorities, this will result in further cuts to services and fewer people receiving support.

“Worryingly, half the money being transferred from the NHS budget to support better joint working between health and social care is now being spent on protecting social care services from budget cuts, rather than driving integrated care and other service changes needed to better meet the needs of patients and service-users.”

I would dearly like to bring some positive, creative solution to this ongoing debate, but frankly like so many in the care sector, my day of making savings through working smarter is nearly through. Everyone I know has cut, restructured, re-invented and re-thought the way they work to deliver more efficient care. There has to come an end – it’s an inevitable economic principle – when the wheels will finally drop off social care machine.

The King’s Fund embraces some of the finest minds in the country and the government would do well to heed the alarms.

The only real lifeline we have is the new Care Act and the Better Care Fund that focus resources to help manage their own care and hopefully save billions. Critically, however, we need monies to roll out the new working methodology – cash, it appears that is already spent on “protecting social care services from budget cuts.”

How commissioners can play their part in social care

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In its June bulletin The Social Care Institute for Excellence offers a wealth of care information, comprehensively covering everything from commissioning of home care to whistleblowing.

At the risk of an information overload, the document is well worth a scan. With a growing number of people over 65 in the population, the new SCIE guide suggests what commissioners can do to improve how they assess, plan, contract and monitor home care services for older people with complex needs.

President of the Association of Directors of Adult Social Services, David Pearson, says: “This guide will help commissioners be clear that we are responsible for ensuring that a high quality and sustainable care market exists in our council areas. This is a responsibility which we share with our NHS colleagues.”

He publication highlights latest research findings on social care and offers some practice examples of good work in this area. Aimed at health and social care commissioners of home care services for older people with complex needs, the guide lists more than 20 tasks to ensure people get what they need to keep them out of more costly hospital and nursing environments.

So much of it is commonsense, with recommendations falling into the areas of assessment, planning, contracting, monitoring and further research. But is does – and very successfully – underpin what should always be fundamental criteria.

A dignified life, supported in the community, is what everyone wants to aim for. And the cost of doing so must be seen as an investment into the NHS.

My concern is that all investment monies will be viewed as overspend, but the economies of scale here are huge. Initiatives like the Vitality Partnership to assess needs in the community, particularly for the elderly, and head off costly hospital admissions.

We must drive forward flexibility, person-centred packages that marry successfully social care and the NHS, create diversity among providers and monitor outcomes against emerging needs.

The SCIE is just one of many wheels in the cogs of change. It’s heartening to see that funding issues have also been addressed, but that’s worth a blog in its own right.

Clearly apparent is a genuine commitment to partnership, something that West Midlands Care Association has been driving forward for years. I can only hope that every commissioner takes the time to read the SCIE observations, findings and advisories.

‘Make or break’ time looms for social care

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Councils in England face a funding gap of £5.8 billion between March 2014 and the end of 2015/16, new Local Government Association analysis shows.

The figures are scary and according to Care Industry News, the online magazine, local authorities will need to make huge savings equivalent to 12.5 per cent on their total budgets before next April.

Successful integration of health and social care is vital, says the LGA to stop the care system from collapsing.

The £5.8 billion shortfall in council budgets will be caused by a combination of reduced government funding and rising demand on services – particularly from the elderly.

The funding gap in adult social care alone already amounts to £1.9 billion by 2015/16 – based on council adult social care budgets in 2013/14, says the Care Industry News report.

My abiding fear is where new saving will be made. Already we have heard pledges to protect spending on adult social care next year as much as possible, but I can’t help worrying worse is to come.

Next April, will mark a critical point for adult social care in England with the pooling of £5.4 billion from councils and the health service. The Better Care Fund will aim to improve care for older people and reduce financial pressure on councils and the health system through stopping lengthy waits for discharge from hospitals and avoiding unnecessary admissions to care homes.

Initiatives like the Vitality Partnership are already under way to make a difference in the community and funding for such work has been assigned for the year.

But the scale of savings which need to be found next year illustrate the urgent need for the Better Care Fund to “quickly succeed in radically improving the way public money is spent on looking after England’s elderly,” says Care Industry News.

Indeed, 2015 I believe will be make or break for social care and council leaders are saying the same.

Quoted din the online article, LGA Chairman Sir Merrick Cockell says: ”In recent years, local government has worked tirelessly to save billions while protecting services for those who need them most. But the scale of the challenge facing local authorities next year is stark. Council finances are on a knife-edge and the old way of doing things – including the way we care for our elderly population – just won’t work anymore.

“Next year will be a make or break moment for adult social care, for local services provided by councils and for the NHS.”

Central to the rescue mission is the introduction of the Better Care Fund (BCF).

“Neither councils, the NHS or England’s elderly can afford for this not to work,” he adds.

And I have just returned from a meeting about the Better Caring Fund. Interesting – it seems the Government is still “deciding and discussing,” while local authorities and CCG’s are now too far down the line to stop in what seems a perfectly reasonable use of money. Spend the money to help people stay healthy in their own homes or care homes and spend a whole load less on acute hospital admissions.

More cuts to an already financially struggling industry or cutting back on the BCF would be catastrophic.  The challenge ahead is enormous and I for one have everything crossed that all will be well.


Extra £2bn ‘needed to integrate NHS and social care’

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The chairman of the Local Government Association has warned that the NHS needs an extra £2bn to help integrate its services with social care.

Sir Merrick Cockell says the money is needed on top of Better Care Fund – the £3.8bn project to make this difficult union happen.

And, with what I believe is good insight, he’s also demanding that the fund gets five-year commitment, rather than the year it is officially scheduled to last.

He believes the money would “ease the short term disruption to residents and to patients.”

Speaking at conference organised by the King’s Fund thinktank in London, and reported in The Guardian, he does add that the Better Care Fund is “our best answer to the questions asked of us in these testing times”.

The Better Care Fund relies on pooled funding from local authorities and the NHS, with the intention of reducing pressure on hospitals by providing more care and support in people’s homes.

Not wishing to dampen enthusiasm here, but on weekly basis I seem to hear or read that local authorities have no spare cash.

The fund launches next April, and Cockell is reported as saying that the coming year is “the crunch year in all respects … we simply can’t fall apart in that year.”

I agree with Mr Cockell that we are, indeed, in “testing times” but I feel I’m missing something here. Local authorities throughout the UK have decimated social care budgets, closed care homes, day centres and libraries as central government finances have been revised downwards,

Can someone tell me please, just where is this extra money coming from? I’m fully supportive of an integrated NHS and social care system and the West Midlands Care Association has excellent working relationships with both of these care streams. I fear, however, the financial juggling is already beginning to unravel as the austerity measures deepen.

Care providers are struggling with unrealistic fees and my NHS colleagues are wincing as their budgets shrink. Too much hard work has gone into this for it to fail.

I have seen first hand some of the effort that the NHS and local authorities have put into getting this to work in the West Midlands as everyone sees the benefits of not dragging people into hospital when they can be better helped where they are.

Dudley have some very exciting ideas emerging, including a Community Rapid Response Team that will help people in their own home and care homes to be treated ‘locally’ if possible.

Do we need a rethink, Mr Cameron, on this pressing matter of funding? I think so.

Is this the evidence for poor social care funding?

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I’m sorry, but the whole business of the Local Government Ombudsman seeing a 130% increase in adult social care complaints since 2009 has got to me.

I read there were almost 2,500 complaints made about adult social care to the ombudsman last year alone,

And I also learn that more complaints are made about assessment and care planning than any other issue.

Well, what a surprise! As local authorities struggle to balance their books with ever-decreasing funds for social care, something must give.

And is this the evidence? Probably. Assessments are, after all, the place where monies are spent or saved.

Last year, 442 complaints included concerns in this area, a 7% increase on the previous year, the Guardian online reports.

The newspaper highlights the case of Peter, who lives at home with his mother. He has autism, epilepsy and learning disabilities. “After his NHS funding was withdrawn, the council assessed his needs but failed to comply with its legal duty to agree an aftercare plan,” the article says.

I desperately feel for social workers because many I now acting unwillingly, I believe, as frontline auditors. What a mess we are in!

The 2013 LGO review notes, according to the newspaper, that the 2,456 complaints for that year are “a small number in the context of 1.3 million users of adult social care in England. However, 40% of the total number of complaints the LGO receives are concentrated on 25 council areas.”

As for care reviews, the report shows councils “are getting this basic obligation wrong.”

Dr Jane Martin, local government ombudsman, is quoted as saying: “Over the last few years there have been a number of reviews that have looked at healthcare complaints. We must not wait for a crisis in adult care to examine more closely the way social care commissioners and providers deal with complaints.”

The LGO received 218 complaints and enquiries from private providers, just 9% of all adult social care complaints.

The review adds that while this may reflect good satisfaction, it may also mean that the public is unclear about how and where to raise concerns.

I’m sorry to keep beating the same old drum about funding, but I’ve been saying for years that if we cut, cut, cut in the way we are doing now, there are serious consequences.

Remember: The barometer of society is measured in how we treat (indeed, fund) its most vulnerable.

Ombudsman complaints soaring over social care

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Social care complaints to the ombudsman have rocketed in the last five years.

In fact, I read in the Guardian online that they have more than doubled.

In an interesting twist, East Sussex Council believes that rather than being evidence of a worsening service, it all to do with people being able to make their voices heard.

In a new ombudsman report the council is sited as the English authority that generated most social care complaints per head of population to the local government watchdog.

And according to East Sussex, the trend is because of “excellent signposting” for complaints. If this is not wholly true, this is very clever media spin. I do note, however, that the number of complaints upheld was below average.

Quoting the council, the local authority is reported as saying in the Guardian: “In East Sussex people’s right to go to the LGO is actively encouraged as a positive step if they are unhappy with our approach.”

The report goes on to say that others may take a different view of the figures, which “show a rise of 130% between 2009 and 2013 in all social care complaints received by the ombudsman.

“Almost 2,500 complaints and inquiries were dealt with last year. This has made social care the fastest growing area of the LGO’s work and also the area with the highest rate of complaints upheld (46%).”

It worries me that the Guardian report tells us that the majority of complaints concern assessment of need, care planning and funding or charges. However, it adds, complaints about residential care are rising fastest and last year accounted for more than twice the number of grievances about home care.

It’s the first time the LGO has named councils that attract most complaints. In the top five are Walsall, East Sussex, Redbridge in east London, Blackpool, and Bromley in south London.

It is true that like never before, people are aware of the complaints mechanism and I believe the majority of local authorities with which I deal have a robust information system in place to inform clients of their complaints mechanisms.

But I can’t help feeling disappointed, I know that East Sussex is a long drive from the Midlands where much of my work is done, but to me the geography is immaterial. Everyone needing this kind of care intervention should be happy with all aspects of its delivery, but we live in an imperfect world. That imperfection in social care is fuelled, I believe, not only by flaws in humanity, but by an on-going unwillingness to fund the industry properly.

With a General Election now on the horizon, let’s see what political pledges for change will be made.

As ever, the West Midlands Care Association will be happy to remind politicians of all persuasions just what they have committed themselves to.

NCA survey to help strengthen fee negotiations

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Our colleagues at The National Care Association want our help to strengthen the case for better local authority fees.

The aim is to harvest key information about settlement trends over the last five years in in each area they represent.

It’s emerged that last year when the NCA was meeting with a group of care homes about local authority fees in the South East, homeowners there were able to pinpoint exactly what the increases had been over the previous four years and the proposal from April 2014.

  • In this five-year period the breakdown was:
  • For two years, an increase of 1 per cent each year
  • For one year an increase of 0.5 per cent was agreed
  • For two years no increase at all was offered

Clearly over a five-year period they had therefore received an increase of 2.5 per cent in total. 
 Inflationary increases in care homes have risen at 3 per cent each year, according to the NCA.

With an effective inflationary drain at 15 per cent, in real terms the care home operators in that region had suffered a 12.5 per cent loss.

Fired by this financial cameo, the NCA has asked members to take part in a survey to identify key fee increments in operational costs against the local authority settlements.

Filling in the form is a five-minute job and anything that strengthens our arm in negotiation a more prosperous future must be worth our time.

I’m sure chairman Nadra Ahmed OBE and Sheila Scott OBE, the chief executive, will appreciate our cooperation.

Please click here for the survey.

BBC goes on the frontline of caring for our elderly

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Reality TV has a way of tugging at heartstrings and I suspect the documentary due to be screened by the BBC on Thursday evening will be no different.

Just reading the preamble on Protecting Our Parents leaves me with a lump in my throat. The programme follows cases over a year from the perspective of professionals, families and the elderly.

The film crew has been given unprecedented access to the NHS and Social Services’ older adults care teams in Birmingham and I’m not too sure how I feel about it.

We have a social care system that is at breaking point for lack of funds and a government that offers a lot of fine oratory, but little hard cash to help.

It appears this broadcast promises a ‘warts ‘n’ all’ look at how it is on the front line for all the parties involved as pressure on the care system continues to mount.

The programme blurb notes “there are more pensioners than children living in Britain.” True!

In an online teaser it adds: “Betty Williams, Jim Page and Henry Robinson, like thousands of older people in the UK each year, are in hospital following a fall. They want to return home but the challenge for the professionals is balancing their safety and independence.

“Betty has been living alone since the death of her husband four years ago. After her latest fall she lay undiscovered for 24 hours, but she is determined to return home.

“Her niece, doctors and social workers are worried that the cluttered state of her house is dangerous. They want her to accept help to put it straight, or move into respite care. But Betty fears this will compromise her independence.

“After the death of his wife of 50 years and main carer, Jim, who suffers from dementia, was admitted to hospital. Despite having to return to an empty house his family feels he’d be happier in his own surroundings and the hospital team agree it’s in his best interests.

“While Henry is recovering, plans are made for his discharge. But his condition starts to deteriorate rapidly after contracting pneumonia in hospital.”

The intimate personal crises filmed at Heartlands hospital demonstrate the myriad ways the health and social care systems attempt to treat and support people despite not being designed to cope with the rapidly increasing demand.

My worry is that these poor souls have been filmed at their most vulnerable, yet I want the public – and indeed our politicians – to know just how bad it is. It’s only way to lever change.

The pros and cons of residential care, hospital admissions, community packages and supporting person choice will continue to rumble on.

In a Guardian piece, series producer Alice Perman says that she and the team felt “pretty despondent” after finishing the project

Why? Because “there isn’t enough discussion across society as a whole about what we want to happen to us as we get older,” she says. I agree.

CQC seeking care providers’ views on new inspections

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The Care Quality Commission (CQC) is asking people who use and manage the running of adult social care services for their opinions on the regulator’s plans for inspecting and rating care services.

The general public is also being invited to pitch in with views along with health service professionals.

It all seems wonderfully inclusive as the commission heads for its new approach on inspections.

New elements include larger, more specialist and expert inspection teams led by chief inspectors, greater involvement in inspections by members of the public with personal experience of services, better use of information to identify risks and plan inspections, and ratings for all health and adult social care services.

A fresh consultation this week zones in on the detailed guidance on how CQC will regulate, inspect and rate NHS acute hospitals, mental health services, community health services, GP practices, out of hours services, care homes; home care services; and hospice services.

  • And the regulator wants to know your views on the following:
    The proposals for a rating system . . . CQC’s view of what a service looks like for any of the rating categories – outstanding, good, requires improvement, inadequate.
  • The questions inspectors need to ask to determine if a service is safe, effective, caring, responsive to people’s needs and well-led,
  • The core services always addressed during inspections.
  • The methods used to gather information about services from the public.
  • The sources of information drawn upon to help assess risk and decide when and where to inspect – the ‘Intelligent monitoring’ tool.
  • The frequency of inspections.

Three overview documents have been published that introduced detailed draft guidance for seven different types of services: · Acute hospitals; Community health services; Domiciliary care (care in the home); NHS GP and Out of Hours services; Hospice care; Mental health services; and Residential adult social care (care homes).

CQC Chief Executive David Behan says the changes are vital to care services “provide people with safe, effective, compassionate, high quality care and encourage care services to improve.”

He makes no bones about the fact that these new inspections will be on the side of service users.

Secretary of State for Health, Jeremy Hunt was reported last week as saying: “A new, independent and rigorous inspection regime will give the public vital information on health and social care performance, and the Chief Inspectors will shine a light on areas where improvement is needed.

“The CQC is seeking views on important elements of their inspection programme and I would encourage patients and all other interested parties to respond. This will help to drive up quality.”

I find myself nodding at all these proposals and agreeing with many, but it appears no secret that the bar is being set ever higher at a times when funding is in crisis with regular closures of both community and residential services.

One wonders, given the current funding dearth how my members will be rated. The jury is still out on this trial . . . will it really drive up quaility – I’d suggest some extra funding would go amiss to achieve this goal.