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By Debbie le Quesne

Posts Tagged ‘care cost capping

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.

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.

Isolation and loneliness: Please lead by example, Mr Hunt

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Invite lonely elderly strangers into your home, urges Jeremy Hunt – so says a recent headline in The Guardian.

The Health Secretary is advocating that s people should keep in closer touch with older relatives to reduce isolation, and take greater responsibility for their own health.

The cynic in mean can’t help feeling that this family values promotion hides the truth: That there is no political will to pay for such services.

Speaking recently at the annual conference of the Local Government Association, Mr Hunt urged people to keep in closer touch with older relatives, friends and neighbours to battle against elderly loneliness.

The tone is good, the moral standards high, but I’m struggling with this message.

He highlighted the case of a man found in Edinburgh recently, three years after he died, and the eight council-funded “lonely funerals” a day in England, half of which involve over-65s.

He said: “Are we really saying these people had no living relatives or friends? Or is it something sadder, namely that the busy, atomised lives we increasingly lead mean that too often we have become so distant from blood relatives that we don’t have any idea even when they are dying?

“In Japan, nearly 30,000 people die alone every year and they have even coined a word for it, kudokushi, which means ‘lonely death’.

“How many lonely deaths do we have in Britain where, according to Age UK, a million older people have not spoken to anyone in the last month?”

This is powerful, heartstrings-tugging material. Hunt also urged people to be more careful about drawing on “finite NHS resources”, itself a worrying aside.

None of this resonates easily with us. Why should I suddenly feel guilty?

There is a yawning chasm between the need I see and Mr Hunt’s care supply chain. Are people more distant these days? Probably, yes. Are we horrible, uncaring people? No.

The shortfall on properly, economically-derived funding levels for care providers is, I believe, a moral responsibility of Government. Its response to need is the barometer of being civilised.

I can’t help feeling that although I agree with so much of Mr Hunt’s speech, I have a finger wagging in front of me, reminding me of the moral priorities I should choose. The irony of my seeming abdication to meet the need is that Mr Hunt too, is right there at the side of me.

Perhaps he could lead by example and ensure social care is funded well enough to service the needs he is trying to meet on the cheap.

The axeman cometh ­– Osborne’s summer Budget looms

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If you believe the harbingers of doom, a fresh £3bn Government cuts spree will see libraries, leisure centres and . . . elderly care for the chop.

The Local Government Association fears councils will need to slash 12 per cent of costs in 2016-17 to meet the demand.

Libraries could close, bus services could be slashed and potholes could be left unfixed as town halls face £3.3billion of fresh Tory cuts, council leaders have warned.

Leisure centres, bin collections and . . . caring for the elderly in their homes could all be threatened if budgets are hit, the Local Government Association fears.

With a growing reluctance, it says authorities will need to slash 12 per cent of costs in 2016-17 because of the new measures expected in the autumn.

LGA chairman David Sparks has already said there are no efficiencies left to be made for many councils, but the proverbial axeman cometh. July 8 will see George Osborne’s Tory-only Government budget rolled out.

Mr Sparks has said: “Vital services, such as caring for the elderly, protecting children, collecting bins and filling potholes, will struggle to continue at current levels.”

The LGA’s annual Future Funding Outlook report predicts councils in England will have a £9.5billion black hole by the end of the decade.

As I recall, local authorities have already made £20billion in savings since 2010 following reductions in government funding of 40 per cent.

Many LAs have worked hard to shield the most vulnerable from this austerity, but it’s not a sustainable premise.

Is it time for chocolate, cupcake and sweet tea served in china cups? Is there any good news out there?

The state of the nation with social care

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Whether we like it or not, we are beset with humongous financial problems in social care. It’s a fact of life for us and the problem is not going to dissipate overnight.

To sum up the ADASS budget report for 2015, John Jackson, co-chair of Resources Network, presented Adult Social Care in an Age of Austerity: the impact and some thoughts on the future John Jackson.

So much of what ADASS says in their comprehensive report is, in my opinion, a true representation of what’s happening in the care sector. I’m impressed too that publicity drives by the body have not been, to quote Mr Jackson, “shroud waving.”

The budget analytics have not been skewed to win public opinion – they are served cold, but nonetheless are still very worrying.

In a PowerPoint presentation, let me include this pane from Mr Jackson:

What do the budget surveys tell us? Impact to date?

  • Total annual savings from adult social care of £3.53bn by March 2014 – 26% of net spending
  • 12% reduction in spending combined with 14% increase in demand
  • Most of the savings are through “Efficiency savings” but significant pain involved: providers squeezed on prices; care packages reviewed and often reduced; services outsourced; providers changed

Research also shows (another PP pane):

  • Councils have protected adult social care rather than targeted it for extra savings
  • Investment in prevention stayed the same at just over £900m
  • Funding 83% of demographic pressures (£391m)
  • As a result 35% of council spending in 2014/15 now spent on adult social care compared with 30% in 2010/11
  • Including children’s social care means that almost half council spending is spent on just over 2% of the population

Remarkably, despite savage cuts, 87 per cent of councils claim quality of life for service users had not been lowered. Just 6% of local authorities said care quality had fallen. However, numbers of those supported with social care fell by 18 per cent between 2010/11 and 2012/13, with further decline in 2013/14 of 5.8%.

An input of £1.1bn from the NHS for adult social care has stopped things being worse.

As for the future?

Let’s look at this PowerPoint pane:

  • 14% councils think quality will be lower
  • 48% think that fewer people will be able to access adult social care services in two years time
  • 47% fear that people will be getting smaller personal budgets
  • 55% think providers will be facing greater financial problems
  • 59% anticipate more legal challenges (big increase from the previous year)

With the summing up of the report comes a clear warning over Government fiscal policy and its impact on care. These directors truly believe the cuts are now at their limit.

I quote: “Adult social care services in England will soon be unsustainable if current budgetary pressures continue and significant measures are not taken to inject new money into local social care economies,” – ADASS.

Change is paramount if adequate social care is to continue

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Local authorities are assuming significant reductions in social care budgets. They’re also assuming the cuts will be “ongoing”. Just what I want to hear (not).

The recent ADASS Budget Survey 2015 report shows that this year, as last, 35 per cent of council budgets relate to adult social care. Councils, ADASS notes, have tried to protect social care spending at the cost of other services but are running out of ability to do this in the future. I believe this to be true in many instances.

The report goes on to says that In the context of the NHS, health funding has increased from £97.5billion in 201-11 to £116.4billion in 2015-16, an increase of 19.3per cent. Over the same period, social care funding has decreased from £14.9billion to £13.3billion, a reduction of 10.7 per cent and “more in real terms when demography is taken into account.”

Significantly, “the money being transferred from the NHS is not enough to mitigate these spending reductions.”

This surely must be in the ears of David Cameron.

Senior NHS leaders have already publically shared concerns about the funding for social care services to support people in greatest need. They have added their voices to a growing chorus of concerns over the much-heralded £8 billion NHS funding gap figure that’s being forecast.

In an open letter to the Prime Minister, the NHS Confederation said in May 2015:

“Our deep concern over social care funding must be addressed if we are to meet people’s needs, never mind the impact that social care has on the ability of the NHS to provide safe, quality and timely treatment to those who need it.”

I applaud the fact that ADASS wants to see a social care system that is protected, aligned and re-designed.

To achieve this, ADASS is calling upon the Government to urgently ensure that social care funding is protected and aligned with the NHS, including making provision for the social care funding gap alongside the funding gap for the NHS.

This is brave, campaigning talk and I wish every success on those who are left to do the hand-to-hand fighting in Parliament.

ADASS concludes by saying: “This is paramount to securing adequate health and wellbeing outcomes for individuals and their carers and to ensuring that councils do not run out of money.”

The truth, the whole truth and nothing but the truth . . . I really do hope that this latest document, which shows a falling barometer on the state of the nation’s care, will impact the decision makers to reassess the austerity course we are on – and particularly how it impacts our most vulnerable people.

Should social care survive this ordeal by fire, should the good times ever roll again for care providers, should there ever be a season of plenty, perhaps local authorities could not be so eager to financially squeeze care businesses, thus allowing reserves to build for such a time that we might just have to navigate this way once again.

The challenge for new Care Minister Alistair Burt

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Goodbye Norman Lamb, the former Lib Dem Care Minister: hello Conservative Alistair Burt, who has now been appointed to the role.

Under Lamb’s watch he juggled a heavy Westminster workload – not least ensuring passage of the watershed Care Act – with a remorseless programme of visits to observe care practice.

Was he the best care minister ever? It’s too early to say, but he had a good innings, which will also be remembered for his work on mental health reform. Paul Farmer, chief executive of mental health charity Mind, describes him as “a fantastic advocate,”

As for his social care achievements, I genuinely believe he wanted to do more, but under the whip of a coalition Cabinet he was always going to be hamstrung by council grant cuts of some 40 per cent.

With Burt in the chair, who know what will emerge.

For sure, local government leaders will be keen to lobby the new minister to address ongoing concerns over a shortage of funding for social care. That chorus will also be echoes in other quarters, and not least my West Midlands Care Association.

Commenting on Twitter he expressed his appreciation for the role and the chance to work with “extraordinary” people within the sector. Indeed, care industry people are extraordinary . . . extraordinarily patient as they wait for much-need Government financial aid, extraordinarily resourceful as they wait seemingly forever for market-driven fee levels to be paid by local authorities buying care, and extraordinarily committed to the clients they serve.

Burt has a chance to shine, but has he got the political leverage to challenge the party line on social care cuts? We’ll have to see.