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By Debbie le Quesne

Posts Tagged ‘autumn statement

A ‘deepening crisis’ but where is the antidote?

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Like over-prescribed antibiotics, graphic descriptions of the current care crisis fail to have the desired effect when they become a daily prescription of the news.

I fear many are becoming anaesthetised – indeed, almost indifferent – to the digest of chaos emerging from the sector.

In a joint submission to the Treasury ahead of November’s Spending Review, 20 organisations say the care sector is facing a “deepening crisis”.

Yes, it surely is!

They have called for funding to councils to be protected, as is happening with the NHS, a move that my own WMCA has also taken.

Ministers said investment in health would also benefit the care sector.

The government has pointed out that plans were being put in place to ensure greater joint working between the two sectors and that would relieve some of the pressures.

But those putting their names to the latest warning – leaders of councils, the NHS, care providers and charities – are not convinced the future is safe.

They say the market is “fragile” with councils forced to keep fees low and providers leaving the care sector; this, they add is driving up prices for those who fund themselves and leading to fewer people getting state-funded support.

Let me quote The Guardian piece: “While the government has pledged an extra £8bn a year for the NHS by 2020, social care has received no such assurances.”

Ray James, president of the Association of Directors of Adult Social Services, one of the signatories to the submission, is reported as saying: “It is vitally important that this year’s Spending Review understands the importance of our services to vulnerable people,” adding that the “near-certainty” is that without adequate and sustained finances the ability to carry out their duties will be in jeopardy.

The Care Providers Alliance, adds that the challenges are on an “unprecedented scale,” while Rob Webster, chief executive of the NHS Confederation, which represents health service managers, says: “Having a shiny NHS cog will be no good in a broken health and care machine.

“All these services are interconnected and all need greater financial certainty.”

I’d like to know who the other signatories are, but I think we get the message anyway. . . let’s hope those with real influence for change also do.

We have heard so much now of impending doom, I fear our message is in danger of becoming white noise. Prescribing the antidote when the patient is dead presents an obvious problem.

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Let us work together to secure the future of care

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Like countless others in the care sector I have joined the chorus in the West Midlands calling on councils to  pay a viable rate for care beds purchased from the private, charity and voluntary sectors.

The care landscape is bleak and my WMCA has warned closures are imminent and there is little regional capacity to take up those frail and needy residents who may be displaced. To this end we are desperate to work with local authorities to find mechanisms that will secure the future care of the most vulnerable and the survival of local businesses.

At an emergency meeting of the association, members heard George Osborne’s living wage directives could “be the final nail in the coffin for care as we know it.”

In an attempt to secure a funding lifeline to the industry, we are calling on MPs, councillors, local authority officers and Clinical Commissioning Groups to meet with us to discuss future ring-fenced funding for social care.

The vast majority of Black Country care businesses rely on placements paid for by councils as a primary income generator and more than 26,300 people across the region receive residential care. A similar number have care at home.

In recent weeks, five care home corporates with 1,200 properties between them have written to the Chancellor warning of impending disaster following his Budget reforms on the living wage.

The big five – Four Seasons Health Care, Bupa UK, HC-One, Care UK and Barchester – look after 75,000 frail, old people. They claim a major provider is likely to close within a year to 24 months unless the Government releases its purse strings. The response: Silence.

The national picture is indeed gloomy, but in our region it’s much, much worse and Osborne’s announcement has caused shockwaves across the region. So many are already in crisis . . . and now this.

The legislation impacts massively on all streams of care as indeed it must doe with many other businesses.

A WMCA impact analysis suggests the Osborne wages regulation will add £23 per week to the care cost of every Midlands person in a residential care setting. But we need to add to that figure a further £50, the current average weekly operational deficit on council-funded places.

If the corporates – HC-One is one of our members – are predicting at best only a two-year survival rate under current economies, what chance have my other members, who have much smaller homes and much-depleted resources?”

As for thepromised autumn Government Spending Review . . . I fear too little, too late.

Residential care occupancy levels throughout the Midlands are averaging 97 per cent and there’s not not a member in the association who is not anxious about the future wellbeing of those requiring care.

For those who think we do not want to pay the living wage, think again, please. All of my members would happily apply the living wage, but there is no financial sleeve left in their business models to do so. Care home companies are not just crying wolf. Care is a minimum wage industry and profit margins are extremely tight, especially where council referrals are the main income.

Do you know that for the last nine years fees have fallen below the viable cost of running a care home?

Over the last five years, for example, Dudley Social services has given rises totalling 8.9 per cent while the Consumer Prices Index is at 11.6 per cent, the Retail Price Index at 15 per cent and wage rises are hitting 12.3 per cent. The rises don’t track cost and we clearly need some Government benevolence to help both councils and care providers.

Recently Sandwell Council’s cabinet met to respond to a WMCA call for a fees increase of 16 per cent – residential care from £378 per week to £438.46; dementia care from £428 per week to 496.48; and residential nursing care from £490 per week to £568.00.

What do we get? A 1.5 per cent rise for residential care and a 2.5 per cent rise for nursing.

Latest figures from Industry analysts LaingBuisson reveal English councils pay £91 a week less than what is needed for fully compliant care.

In 2013 Birmingham City Council commissioned accountants and analysts KPMG LLP to establish the true cost of care through the Open Book initiative where care providers were asked to submit their accounts.

Some 380 homes were targeted and the results showed to meet escalating costs commissioners would need to pay £460 per week.

Two years on, and not including the implications of the living wage, It would take an l increase of six per cent to bring homes to the minimum figures used by the Association of Directors of Adult Social Care (ADASS) as the threshold for safe care announced this spring. An extra three per cent would allow homes to cover increases in operational costs.

Sadly, if a major employer were to make this kind of warning there would be huge interest over the potential loss to the economy. What we have here is a bunch of businesses across the region that create about 125,00 carer jobs for adult social care (figures from Skills for Care).

“That dwarfs the employment stats of say Jaguar LandRover and it’s deeply worrying that few of these jobs are secure under present funding models.

Listen, councils do have choices what to do with funds and government austerity can no longer be an excuse for not addressing the finances of care.

I would call upon our local councilors to make decisions of conscience on funding that will directly impact on the most vulnerable people in the electorate they serve.

It is a fact that a dog walker can earn more than we can pay our carers. There is something radically wrong.

Our work empowers and really does make a difference

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Today, as I’m often inclined, I scanned online the social care section of the Guardian newspaper and was attracted to the headline ‘Our work makes the lives of older people better’.

I confess to rarely reading day-in-the-life-of features, but the heading alone had a resonance with the work of the West Midlands Care Association where I’m the CEO.

Sue Ash works for Age UK’s national advice line, a free, confidential service that supports older people as well as their families and friends. In her story, she simply outlines the contents of her day.

The type of calls she receives make interesting reading, though there’s nothing in them that surprises me.

I quote: “We speak to all sorts of people, from those who are struggling to receive practical support at home, to people who don’t know what funding is available to help them to pay for care. We specialise in advice regarding care rights and regulations, and are able to support people to get the services they need.

“We recently helped a man who needed to move into a care home and thought he needed to sell his property to pay for this. He was extremely worried, but we reassured him that this was not correct for his situation, providing him with advice on the best action to take. He told us he and his wife slept better that night than they had in weeks!

“We regularly deal with calls from older people who feel lonely and want someone to talk to. Age UK offers a number services that can benefit older people who feel they have no one to turn to; our local Age UK partners offer a range of hands-on services such as lunch clubs for older residents living nearby.”

Sue then adds “we are often able to help people claim pension credit or benefits they were unaware of and regularly hear how valuable this extra income has been.”

Care, rights, benefits, regulations, worries over fees, loneliness and social engagement. These are huge issues and just like Sue, WMCA encounters many of them on a daily basis.

It’s an agenda that should be up there with the NHS, taxes and national debt in the General Election political debates. Perhaps I’ve missed it all, but I doubt it. Potato too hot? Perhaps.

I applaud the work of Age UK in empowering our older people. Like Sue, who feels proud to be part of the work that helps so many, I too feel privileged to play my part. We’re in a business that can change the quality of life for the better, it’s about hope, it’s about winding up the clock of old age and keep going with as much quality of life as possible, it’s about high standards, innovation and securing the very best for society’s greatest treasure – our elderly.

More worries over the Autumn Statement

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It is true that the recent Autumn Statement is proving as big a bombshell as expected and the impact on the care sector will be felt soon I’m sure.

With less money available, who will fund the provision? And my abiding question is: Will the welfare reforms be sustainable?

Columns have already been written and pressure groups are agitated about the possible long-term effects.

Many of our care providers deal with the disabled, but some of their charges suffer conditions which are not always visible. Illnesses like bi-polar disorder are unpredictable and many people who have it cannot plan for their future precisely because of that.

On a good day, would someone who suffers such a condition be deemed fit for work?

How many employers are going to tolerate someone who suffers from a hidden disability or a mental illness? Do the Atos team – the company individuals doing the reassessments – have good clinical understanding?

I admit to disliking a lout, work-shy culture, but not all who don’t work could and it’s not their fault.

I recently picked up on a comment from a Labour councilor for Hulme in Manchester.

Amina Lone was quoted: “These cuts are punishing those who have often done nothing wrong but have had the misfortune to be born with a disability that they could not control. Maybe that is Cameron’s next policy initiative: Make sure you get your genes right otherwise you are going to be stuffed when you get out in to the big bad world.“

The planned shift from Disability Living Allowance (DLA) to Personal Independent Payments (PIPs) will be worth keeping under close scrutiny.

Each share many similarities, for instance the inclusion of a daily living allowance and mobility component that are essential to ensure that individuals can maintain control over their own lives by taking responsibility through personal choice.

But organisations such as Disability Rights UK believe that the main driver is to cut allowance and reduce public expenditure.

Will this cut care too? Undoubtedly, with both recipients and providers losing out.

It’s estimated by the Government that some 300,000 disabled will have their benefits cut, though the move has been delayed for two years.

The domino effect on caring of austerity Britain already seems at a critical level, but I’m increasingly persuaded that this is just the tip of the iceberg.

Benefit caps: Are we dishonouring the honourable?

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The government’s proposed benefit cap will apply to careres who look after their disabled children.

And the result will inevitably mean some will be forced to move out of their home or put their child into care, according to a piece in The Guardian.

As I understand it, ministers had said disabled people were exempt from the £500-a-week benefit cap that is due to come into force in April.

But in politics nothing is constant and now they have now accepted that if a parent is still looking after a disabled child after they reach adulthood, even if the child’s mental age is as low as eight, the parent and the child will be treated separately, and the parent will be subject to the cap.

The news broke in In the Commons when the Work and Pensions minister Esther McVey said: “In practice most carers will be exempt [from the cap] because their partner or child is in receipt of disability living allowance.”

She was then challenged by Labour MP Andrew Gwynne to look at the rules again. He said: “Close reading of the regulations indicates that a household comprising parents and a disabled adult dependent receiving disability living allowance will not be exempt from the cap, despite the minister’s promises that they would be.”

McVey then admitted: “Should there be another adult in the house, that is then a separate household, so both have to be assessed separately.”

Already letters are being sent out, so the government is acting speedily.

The newspaper cites the case of Jacqueline Smirl from London, who has been told she is to lose roughly £80 a week even though she looks after her 20-year-old son, who is in need of 24-hour care and has the mental age of an eight-year-old owing to autism.

She argues that because she looks after her son, she is saving the government money.

Ms Smirl has lived in Maida Vale since 1984. She lives in a £400-a-week private rented property and says her son is willing to move to a council property but none are available, forcing her either to leave the area or to put her son into care.

She said the threat of disruption to her already difficult life was putting intense pressure on her and she was receiving counselling.

The anomaly appears to be striking – if she were looking after a partner, spouse or “child” she would be exempt from the cap.

Surely these benefit caps were aimed at getting people back into the jobs market. But this poor woman already does a 24/7 job for a ‘wage‘ which must be a saving to government.

Another observer notes: “Cost of rent at £400PW is £20,800 PA.
Cost of Carers’ Allowance at £55PW is £2,860 PA.
Cost of DLA at the highest rates £131PW is £6,838PA.

“Total – £30,498PA. Plus a bit more for council tax, probably.

“Cost of full-time residential care £150,000 to £200,000PA.

“This mother is SAVING the taxpayer at least £120,000 every single year; like millions of other selfless individuals all over the UK.”

Benefit changes like these are never going to be popular, but I can’t help feeling it would be cheaper to let this mother do the caring which is driven by her love for her son.”

Surely these are the very people we should be honouring and supporting?

Unpopular Mr Osborne’s backlash

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George Osborne is not a popular man in the care industry and today the headlines keep coming, spelling out a chorus of warnings of what his budget cuts will mean to the most vulnerable of our society.

We know that social care in on the verge of collapse, but George Osborne failed to announce any new funding to help support older people, or those who have long-term conditions and need professional nursing intervention at home.

In a statement on their website, Age UK said: “While it’s reassuring that the National Health Service budget has been protected from the cuts falling on other areas of government spending, unless funding for social care is urgently addressed then the knock on costs to the NHS will continue to grow.

‘We already see hospitals under severe pressure because of a lack of community and social care services for older people who are left to struggle to cope without the vital support they need.

“’The Chancellor’s announcement that, in two years’ time, councils will have to cut another 2 per cent from their budgets is likely to lead to more cuts to frontline care and support services that are already in many cases stripped to the bone.

‘Allowing the social care system to limp along leaving too many older people isolated and afraid of what tomorrow might bring, is not only morally questionable but makes no financial sense.”

I think that just about sums up my sentiments.

Chief executive of the Alzheimer’s Society Jeremy Hughes said: “The decision to cut local authority funding by two per cent in 2015 will have a devastating impact on a social care system which is breaking at the seams and crying for investment and reform.

“Many people are already being forced to go without essential support and care they rely on to live well. We understand the need for austerity in combating the deficit, but with Britain’s ageing population, there will be over a million people with dementia by 2021. We can’t afford to continue to let down the most vulnerable in society.”

He too adds that the shortsighted nature of the cuts will load pressure on the NHS.

National Pensioners Convention general secretary Dot Gibson was even more scathing, saying: “George Osborne might gloat about how he intends to give older people a guaranteed 2.5 per cent increase in the state pension next April – but that guarantee was only put in place to avoid a repeat of the 75p debacle that happened 12 years ago. What he didn’t make clear was that this is just £2.70 a week extra and only £1.60 a week more for millions of older women who don’t get a full pension.

“Even with this increase, one in five older people continue to live in poverty, 3m pensioner households are in fuel poverty and millions more are struggling just to make ends meet.”

Ms Gibson continues: “His refusal to address these issues signals another twelve months of belt tightening amongst Britain’s pensioners – at a time when the super rich are still getting a 5 per cent reduction in their tax rate. It’s frankly immoral, but if he thinks we’ll go away by ignoring us, he’s got another thing coming.”

Well, that’s just the tip of the iceberg. What do we have to do to get this government to hear us? Clearly, they have no deep awareness of the suffering ‘out there’. I would remind the Chancellor of a Dalai Lama quote I learned at school: “ Love and compassion are necessities, not luxuries. Without them humanity cannot survive.” 

Pain for social care: Thank you Mr Osborne

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The season of goodwill is almost upon us, but it seems to have bypassed the care sector.

Social care is now facing deeper cuts after chancellor George Osborne announced he would slash an extra half a billion pounds from local authority budgets in 2014.

Oh yes . . . and the austerity measures will go on for an additional year until 2018.

Quite how the new cuts will drill down to care at the sharp end, I’m not sure, but suffice to say that the Local Government Association has already dubbed the move as “unsustainable”.

In his autumn statement, Mr Osborne said government funding for councils in 2014-15 would be reduced by a further two per cent than planned.

I want cheer, peace on Earth, festive favourites and life is La La Land, but what do I get? Gloom.

The new financial plans have prompted a warning from the Association of Directors of Adult Social Services president Sarah Pickup. She says in a Community Care Online article : “All does is make the problem worse. We need additional resources, for adult social care in particular.”

Additional resources. I’d say so! How does Mr Osborne think we can deliver more for not just less, but a pittance?

Ms Pickup said councils faced limited options in making further cuts to adult care. “Some councils are already in a place where they are doing things that they couldn’t keep doing, like holding down fees for providers. You can’t keeping doing that because the providers will not be able to deliver the care.”

True. So why can’t Mr Osborne relies that. Or perhaps, the government really doesn’t care a damn about those needing our services.

Critically, Ms said the reduction announced yesterday would also make it harder for councils to implement plans to transform social care. I fear all we’ll be doing now is responding to crisis rather than paving a new way forward. Do you remember Mr Dilnot . .  .?

Community care reports; “The 2010 spending review set out cuts to local authorities of 28 per cent in real terms from 2011-15, partially compensated by annual transfers of NHS funding – worth £648m in 2011-12 and £622m in 2012-13 – to fund adult social care. The 2 per cent cut to council budgets announced is in addition to this.

“And though the chancellor did not announce further cuts to council funding in 2013-14, the Local Government Association said measures previously announced had added a possible £1bn in cuts for next year to the 2010 spending review plans.”

Merrick Cockell, chair of the Local Government Association, was quoted as saying: “So far local authorities have largely restricted the impact of cuts to discretionary areas such as culture and environmental services, with councils working hard to protect spending on social care for children and the elderly. But even these areas are now facing reductions. That impact will only increase in line with any further cuts.”

I need a strong coffee . . .