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By Debbie le Quesne

Posts Tagged ‘Cameron

GPs a gateway to social care and more

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The role of GPs is changing. No longer are their practices just treating medical conditions and referring patients to hospitals.

Primary care is at last being driven by an integration which seeks a greater level of collaboration across frontline services – everything from companionship advice for the isolated to social service and end of life referrals.

This is the new face of primary care service, but it’s not everywhere – not yet.

Increasingly, patients are able to access GP-led hubs offering a range of services, or are given a social prescription that provides them with access to non-medical support, such as social clubs, peer networks or arts therapy.

However, even with growing evidence that these models of care can reduce long-term demand on acute services, we have still not yet seen a major national shift in this direction.

An NHS report – the General Practice Forward View – endorses this broader remit and as well as setting out detailed plans for the recruitment of more GPs, argues for a refocus of the GP’s role on to prevention rather than cure, and the promotion of community-based care and support.

Social care is getting NHS backing. Am I dreaming?

The report calls for more areas to incorporate the multi-specialty community providers (MCPs) model of care – a programme of integrated primary, out-of-hospital and preventative care that is being piloted in 14 regions of the UK. Social prescriptions should also be more frequently used, it adds, to provide patients with access to organisations that can provide advice on employment, housing, debt and other support services.

For me, this is an exciting breakthrough, and could mean GPs become the gateway to social care.

Mmm . . . which pot of money will be used to fund this?

 

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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.

Ombusdsman’s fees report: Providers are not the villain of the piece

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The cost of care is always going to be a hot potato. For a start, many people wrongly think it should always be wholly funded by local authorities and then, of course, there’s a whole load of confusion over fees.

Enter the faithful BBC with its story that families are paying too much for care in England “all too often” . . . because of confusing or incorrect information from councils.

That’s the verdict of the Local Government Ombudsman, which noted that some people were not offered an affordable care option in their area.

It said: “The decision to place a loved one in a care home can be one of the hardest any family has to make, but all too often families are paying too much for their care because they are not getting the correct, timely information.”

Thrown into the mix are top-up fees, one of the main reasons confusion exists, according to Andrew Kaye, from the charity Independent Age.

Care England says top-up fees are helping to mask a funding crisis in social care, with some of the poorest people and their families being asked to fill holes in the budgets of local authorities. I agree, but must add that this is the only way many care businesses are able to survive in these difficult times.

The moral argument will doubtless run and run, but the fact remains until such times council fees paid equal the realistic cost of care I see little changing.

In addressing the moral high ground critics, I would ask them to consider what options there would be for non-top-up residents if homes closed because such fees were not levied.

It really would not take much to push so many of our providers into an economic tailspin.

Professor Martin Green, of Care England, argues care should be available “at a cost which the local authority should be happy to pay.”

Of course that should be the case. It’s important, however, that care providers are not seen as the villain of the piece here.

Central Government with its sweeping fiscal restraint within the care sector has forced councils and the care marketplace into a dire corner, the likes which I have never seen. Mr Cameron and his cohorts clearly know of our crisis and the fact local authorities are between a rock and hard place, They could and should bring it to an end.

Ring-fenced social care monies . . . etc, etc. . .

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.

Adult social care a human necessity

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Has anyone noticed that it’s gone spookily quiet on issues relating to the ‘single pot’ budget response to the NHS and social care?

Before the election there appeared to be good display of headlines and news bulletins on this initiative, but now: Silence.

Perhaps I have selective deafness, but if I have the condition is share by Zoe Williams writing in The Guardian.

She too, has picked up the vibes of change, observing that although the care sector was “beset with injustices, and the NHS was often having to fill cracks at vast and unnecessary expense, and services would have to be joined up if they were ever to work,” the tone for public consumption is different now.

Andrea Sutcliffe, the chief inspector of adult social care, has described a sector “under stress and strain” in which an ageing population with increasingly complex needs was “only half the story.” Really!

Regulators receive more than 150 allegations of abuse of the elderly every day, Williams reports. Quoting the response from a department of health spokesperson . . . “Treating somebody with dignity and compassion doesn’t cost anything.” But it does, a point Williams also makes.

The language of compassion, she writes, involves funding care and wages and conditions and so on.

As much as £4.6bn has been cut from social care budgets over the past five years, I read. I’d hoped that the current shortfall might be made good with a single NHS/social care fund, despite misgivings over its administration.

Where has news on the single fund gone? Adult social care is not a bolt-on option. It is a human necessity.

In February Greater Manchester and the NHS announced plans around the future of health and social care with a signed memorandum agreeing to bring together health and social care budgets – a combined sum of £6bn.

The scheme saw NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities agree a framework for health and social care.

My question: After such a trailblazing start to the initiative, what is happening in the rest of UK, and of course, more specifically, the Midlands?

Care capping delay – U-turn costing us up to £100m

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After all the spin over the capping of care costs, we now find it’s been delayed until 2020. But the hold-up on the £72,000 cap, originally due to come into force in April 2016, is set to cost up to £100m – and we, the public are footing the bill.

It was delayed after councils wrote to the Department of Health asking for the launch to be deferred, due to funding pressures faced by local authorities – and they have plenty of it.

Care England’s Prof Martin Green tweeted: “Care cap postponed. We need extra money to fund new living wage and a long term approach to funding the true cost of care NOW.”

Indeed, we do!

We could argue all day whether the delay is justifiable. Personally, with the additional costs looming driven by the Living Wage, I believe the strain on introduction would have been intolerable for the LAs.

But I’m baffled by a Government policy on social care funding that appears to be deliberately undermined by Budget legislation.

I’m all for strong, decisive leadership as we map the future of care, but with such an ambitious agenda on pay it almost appears that the real consequences of such action were just not thought through. That could never be . . .could it?

Singing from the same hymn sheet on issue of fees

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I’m not a musician, but I do know when people can hold a note, or when a choral piece is more of a discord than a pleasing harmony.

The care sector is renowned for its fragmentation, mixed messages and entrenched differences of opinion.

For those unfamiliar with my blogging, the West Midlands Care Association has campaigned long and hard for a more realistic response to fees from local authorities.

Sometimes, when the care sector is so embattled, it’s just nice to get a shot of encouragement and at the start of the month I received mine.

Professor Martin Green OBE, Chief Executive of Care England, a representative body for independent care services, has written a letter to the Directors of Adult Social services, reminding councils of the legal responsibilities regarding fees. Without collusion, Prof Green’s message is in perfect harmony with that of my association.

Acknowledging local authorities face unprecedented financial pressure – and that it is to continue – he spells out clearly the legal obligations those responsible for the caring purse.

Le me quote: “With respect to fees, these responsibilities are set out most clearly in the Care Act 2014.

“Paragraph 4.35 of this Act states clearly that: ‘Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality – for example, by setting fee levels below an amount which is not sustainable for provider in the long-term’.

“In other words, local authorities must take steps to ensure that the fee levels at which they commission state funded care enable the provider in question to offer services to that individual for however long that person requires the level of care being provided.

“We do not see how sustainability can be achieved through below inflationary fee increases, and are yet to see an assurance process that indicates this would even be remotely possible.”

Prof Green observes that Councils “cannot remain static” in this respect and the impact of providers Budget responsibilities for the Living Wage serves only to compound issues.

Let me quote some more: “In its analysis of the July Budget, the independent Office for Budget Responsibility provided four possible actions that employers could take in light of the introduction of a National Living Wage. These are:

  • Reducing the number of hours worked by their existing employees;
  • Reducing the number of people employed, either by firing existing employees or by hiring fewer people until attrition has reduced the workforce by the desired amount;
  • Changing the composition of their workforce, potentially by replacing those who are 25 years old or older with those aged 24 or less;
  • Increasing prices in order to pass on the higher wage costs to their customers.

“As the provision of care services are codified in statute, the first two of these options cannot be pursued by independent care providers.

“The fact that the average age of people working in the sector is well above 25 means that it would be impractical to pursue option 3.

Increasing prices is irrelevant in this context as the issue that this letter deals with is the setting of fees for state funded residents, not for self-funders. Therefore, option 4 is not considered, but is a measure that providers will almost certainly have to adopt for residents funding their own care.

“If self-funders have no choice but to pay higher fees, it follows that local authorities also have no option but to commission care at higher rates to reflect the increase in the minimum wage. We do not allow consideration of the possibility of self-funder fees being used to subsidise council fees, which has been happening with increasing frequency across the country. As well as being unethical, this practice is also unlawful. “

Industry annalists LaingBuisson project that care home fees must be increased by five per cent to accommodate the statutory minimum wage.

Concluding, Prof Green adds that the introduction of the National Living Wage in accordance with the Low Pay Commission’s own data would be “completely unsustainable for care home providers without an increase in fees from local authorities. “

I agree wholeheartedly.

Prof Green is asking adult social care to work with him, noting that many “understand the pressures that providers are facing.”

My approach is unashamedly coequal – singing from the same hymn sheet – please, help us as both directors and care providers face this enormous financial challenge that simply cannot be ignored.