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By Debbie le Quesne

Archive for the ‘sheltered housing’ Category

Memories of year where care reached crisis point

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

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

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

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

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

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

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

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

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

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

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

 

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

Pressure mounts on Chancellor for more cash

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Last month Theresa May’s claims that the government is putting £10bn extra into health was challenged by five MPs. led by the Conservative Dr Sarah Wollaston, the chair of the Commons health select committee.

The impact of not enough money for hospitals and access to social care are written for all to see in rising demand for A&E and missed waiting time targets.

Clearly there are complex reasons that, according to some sources, delayed transfer of care lost 192,000 hospital bed days. But the downgrading of social care in government agendas must be a primary cause.

I am led to understand some NHS number-crunchers believe the real number of people in hospital who should be being cared for in the community is probably four times as many as represented the figures here.

The pressure really is on Mr Hammond to deliver in his Autumn Statement.

Rising costs, the ageing population, difficulties recruiting staff and years of central government reducing its grant have left the service in crisis, the Local Government Association claims.

Surely, there is an unprecedented agreement that social care should be at the very top of the list of Mr Hammond’s priorities for urgent extra funding.

The triple whammy of shrinking budgets, rising demand and the cost of paying the national living wage to care workers has left many councils paring back more and more on care costs.

I’m led to believe that in Walsall last week there were 138 people waiting to leave hospital. There is enough capacity in the region to take them all, but . . . there is not the money to start the funding of new packages.

Before winter pressures kick in we understand discharge managers are looking to get all those people back in the community and free  100 beds for winter. Sadly, if all of those perceived admissions required care in the community or step-down residential beds we’re in trouble. There simply is not the capacity.

Mr Hammond is being urged by senior Tories to give the crumbling care system a double boost in his autumn statement, amid growing alarm that social care and the NHS will be unable to cope with demand this winter.

Rumours suggest that Mr Hammond is examining a plan to plough between £700m and £1.5bn extra into social care services from April to help reduce numbers of older people being admitted to hospital.

Apparently, he is also considering letting councils raise the amount they can add to council tax bills to fund social care through a precept introduced in April, currently capped at two percent.

We’ll see . . .

The LGA has made known that years of cuts to town-hall budgets have left the sector in crisis, with fewer people getting help with basics such as washing and eating at a time when need is rising.

Also, care homes are closing, partly because councils cannot afford high enough fees to allow operators – whose costs have risen because of the national living wage – to make a profit.

Putting further funds into social care, will I’m sure, indirectly relieve some of the difficulties being encountered by the NHS; not lest helping to facilitate a more efficient discharge of patients.

 

LaingBuisson: Plan for the future amidst the gloom

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It is, say some, a bit of a mouthful in a single bite, but Stabilising the Care Home Sector and Preparing for implementation of Part 2 of the Care Act 2020, is a document that should be essential reading for every self-respecting MP and councillor in the UK.

The report, produced by Healthcare expert LaingBuisson tables some bleak forecasts under its ‘Imminent care home capacity crisis’ banner, but despite the emotive language, it is a serious authoritative report.

Market analysis experts L&G are not know for scaremongering or pandering with their PR to the ‘red tops’. But here on the first page of this new white paper we read: “There is a real and imminent danger of a care home bed capacity crisis hitting many localities in the course of the next few years, as the margins of operators serving state-paid residents continue to be squeezed, as investment in new capacity ceases and as existing capacity exits the market, against a background of rising demographic pressure of demand.”

A “real and imminent danger” . . . emotive? Yes, and perhaps a little out of character with L&G. Overplayed? No! Definitely no.

The conclusion for how, as they put it, ‘equilibrium will be restored’ is also a scary read. The Chancellor’s two per cent council tax plan gets well-deserved dismissive treatment and the long-term future solution lands fair and square in the lap of central Government, according to the report.

This is what they say: “Our realistic conclusion is that the 2% Council Tax ‘precept’ flexibility to supplement social care funding, announced in the 2015 Comprehensive Spending Review, will not throw a financial lifeline to the care home sector. It may pay for initial National Living Wage cost increases, but councils will want to spend most of the additional funding on meeting demand pressures (service volumes) and downward pressure on unit prices and margins will in all probability continue, reinforcing provider disinvestment.

Indeed, Sandwell and Dudley have both announced that they will take up the option to increase the Council Tax.

“At some stage, ordinary market forces can be expected to resolve any care capacity crisis, but only when it is full blown. At that stage, falling capacity will make it increasingly difficult for councils to make placements locally at their usual prices. With rising occupancy rates, market power will shift to providers and a point will be reached where central government has no other realistic option but to provide councils with the means to re-incentivise sufficient investment in care home capacity to enable councils to fulfil their statutory duties.

“The resolution may be complete by 2020, by which time the cost to the state of paying for long term care for people without the means of their own will probably be substantially higher than it is today.”

The paper goes on to warn that if its conclusions are correct, that the care home sector’s equilibrium will ultimately be restored by market forces rather than pre-emptive financial support from central government, the next few years “are likely to witness a spate of financial failures and home closures.”

With words that drip like honey to the converted, the reports adds: “The development of a ‘stand-off’ between central and local government in which central government argues that it has made adequate financial provision and that it is up to each council to make best use of its (adequate) resources, while councils for their part argue (probably correctly) that the funding is not adequate and therefore they cannot pay providers reasonable prices, and in turn providers cannot afford to pay carers a living wage. In effect, no part of government is taking full responsibility for good market management of the care home sector.”

L&G says there is weakness in the present system of state funding care which has nurtured the growth of polarised economics.

Quote: “It is this absence of good market management (including failure to fund social care adequately) which has allowed the care home sector to evolve into its present highly polarised state, with inadequate profits in areas highly exposed to public pay and super-profits earned by some providers in areas of high private

pay. It is also the root cause of endemic cross subsidisation, with private payers now paying an average 40% plus premium over public payers for like for like.”

If Mr Cameron is not concerned by this forecast he should be and just in case he hasn’t a clue what to do, L&G offers a proposal for government action.

Reforms would include the creation of a national economic regulator for the care homes sector. Its role would include:

 

  • Setting a target rate of return for care home property used for council placements.
  • It would be based based on CQC physical environment standards, establishing a process for determining local capital cost benchmarks per room, taking into account local land prices (and local construction/ maintenance costs if necessary).
  • CQC would be one obvious candidate for this extended economic regulation function since (a) it is already responsible for light touch financial regulation of larger providers and (b) CQC physical environment standards (such as minimum room size) are key determinants of benchmark capital costs per room.

 

  • Another would be Monitor, the economic regulator for the NHS.

 

  • Further options included in the proposal to head of the terminal descent of the industry include;
    Transfer responsibility and funding for paying care home property costs from Councils with Adult Social Service Responsibility (CASSRs) to Housing Benefit. The effect of this would be to rationalise funding for all care modalities, placing care homes on the same basis as extra care for older people and supported living for younger adults with learning disabilities and other needs.
  • Set up a process for classifying each care home with a council contract with an appropriate physical environment grade, linked to a complementary set of locally based care home Housing Benefit bands.

 

 

I cannot begin to image the outcomes of such plans, but at least L&G has one with a rationale I can understand.

 

 

As regional care providers face such a gloomy forecast, they appear to fall three distinct categories:

  1. Those looking to close or make changes to their business plans
  2. Those who are keeping fingers crossed for a better tomorrow, but do nothing
  3. And those who will will increase their costs which must be paid by residents or their families

The problem, however, with areas like Sandwell and Walsall, and indeed other West Midlands regions, few people in care or receiving care have disposable funds to pay more. Sorry, I have no inspired answers, but, believe me, the fight for a fair rate for the care delivered goes on at both regional and national level.

 

There is so, so much more to this paper and I intent to attempt a number of blogs on the ‘hotspot’ subjects. Perhaps in the meantime, the movers and shakers, the policy makers and generally those privileged people who can initiate change and influence events, could make it bedtime reading and enjoy their nightmares.

 

Birmingham Care Awards – get the nominations in NOW

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Here’s a date for the diary: Birmingham Care Awards, June 2, Edgbaston Cricket Ground and it’s all about a celebration of care.

Too many negatives haunt the industry and it’s a timely opportunity to lock up the nasty phantoms of 2015 and remember just how excellently most care plans are delivered.

As a nation we excel in care. By 2022, according to the Institute of Public Policy Research, we will need an army of 2.75 million extra carers, nurses, healthcare assistants, doctors and social workers to service a growing demand.

Care is big business now and for the future and we need desperately to promote just how brilliant individuals, teams and partnerships can perform in this developing workplace.

Awards will recognise the following categories: Children, Home Care, Residential, Nursing, Learning Disability, Mental Health, Dementia and Specialist Care.

They will be presented in a £40-a-ticket gala spectacular and the initiative has the backing of Birmingham City Council. All good!

As you can imagine I’ve jumped at the chance to get on board with this. So how does it work?

  • Complete a form http://www.westmidlandscare.co.uk/members-area/ and email it to the Association. We will then send a reply and an acknowledgment number
  • Talk about what’s happening or happened
  • Provide support testimonials
  • Remember, someone else must nominate you
  • All awards cover all areas of service in the Birmingham area

 

Now here’s the hard bit. Application must be in by February 12, so get a move on . . . please.

This is a showcase opportunity to give good care a public airing. Let’s do it and make it an event to be proud of.

Awards will be made for: Excellence in Care, Excellence in Support Servies, Excellence in Supporting Citizens Award, Meaningful Activities Award, Excellence in Leadership and Management, Commitment too Workforce Development, Exceptional Newcomer, Exceptional Dignity in Care, Success in Parnership, and Lifetime Achievement (Over 25 years).

Come on, let’s get those nominations in and give the panel of judges a really hard time.

Good old Beeb wading in to help with the message

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In a response to the Osborne funding solution to a gaping hole in social care funding, some of the industry’s top brass have waded in with their response.

Along with representations made by the West Midlands Care Association in the lead to Christmas, a letter –signed by the Association of Directors of Adult Social Services, the Care Provider Alliance, and the NHS Confederation – has formed the basis of a BBC piece.

It points out that the amount of money council tax brings in varies greatly, with local authorities in poorer areas worse off.

The Beeb noted George Osborne said his plans would lead to an above-inflation rise in care budgets.

But council chiefs, NHS managers and care bosses have cast doubt on those claims in a letter to the chancellor.

It warned his plans “would leave a funding gap and put vulnerable people at risk.”

Of course, this is denied by the government.

In the none-too-helpful Spending Review, Mr Osborne said he was protecting social care budgets by allowing local authorities to raise council tax by 2 per cent and increasing the amount of money available for the Better Care Fund, a joint pot of money used by councils and the NHS to support care services.

Hmmm . . . He also said that with other changes, it would mean care budgets would rise, adding the NHS could not “function effectively without good social care”.

Good old BBC reported: “But now those involved in providing care services are questioning those claims.”

I can’t think of a single person in the care sector who is not questioning the claims.

No extra money (£1.5bn) from the Better Care Fund – it will not kick in until 2019 and according to the Local Government Association two of its main funding streams, the income it gets from the central government grant and business rates, down 24 per cent in real terms this Parliament term.

Together these account for about a third of council funding.

Again the warning is bleak. Ray James, president of the Association of Directors of Adult Social Services, is reported as saying the result will see councils struggle to maintain care spending at its current level, never mind increase it.

Critically, James added: “We have an ageing population which is increasing demand and have to cope with the introduction of National Living Wage. Without action, we will see care homes close and vulnerable people not getting care.”

A spokesman for the Department for Communities and Local Government said councils had enough for care services, according to the report.

What?

For months all I appear to be reading are warnings of closure and the perils of failing care because the cash is just not there. God forbid that it will take another national chain to go bust before the purse strings are released.

Do these government spokespeople really believe there is sufficient in the pot? Like Dickens’ character Oliver with his meager rations of gruel, the industry dare cries for more. I recall they wanted to hang young Oliver. I recall the other day, in a response to the Autumn Statement, one care provider saying “We’re being hung . . . out to dry.” Nothing much changed from the days of Dickens then (I jest, of course).

 

The new Care Certificate: Another big hurdle

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The new Care Certificate that came on stream in April this year identified set of standards that health and social care workers should adhere to in their daily working life. Good.

It was designed with the non-regulated workforce in mind to enable and empower newcomers to the sector. Also good, though the driver was the Francis Report and that highlighted improvement for the practical skills of care staff . . . and nurses, whose role is completely different.

It is aimed at delivering a comprehensive induction, and indeed, is much better than its former model. Again, good.

The outline of learning is supposed to facilitate compassionate, safe and high quality care and support. Well, yes . . .

And all this within three months induction period. You must be joking!

This ‘tool’ for care is cumbersome, taking so much time it’s impractical as a way in to essential knowledge. I know of plenty of cases where providers are still struggling to complete the induction after six months. Surely there’s something wrong!

Critically, does it really give us better carers? No, and what’s more it’s a big turn-off for sector recruitments.

Where previous induction initiatives were centred on essentials (all be it too regulatory focussed) about each area of the industry which enable people to start work within the first six weeks and then build on their knowledge as they worked, now new recruits have a huge block of learning to go through.

Come on, real world dynamics need to apply here!

So, what have we achieved? We have successfully created an industry running round in circles to get as much of the learning tasks completed as possible in the shortest possible time.

What’s more, the process is costing far more that the previous model at a time when the providers have far less to spend. Failure, sadly is inevitable.

Is this a step forward? No, it’s just another hurdle for us the struggle over, where attempts to wholesale avoid risk by the age-old tradition of training on the job actually denies caring.