By Debbie le Quesne

Posts Tagged ‘Care costs capping

Running blind without research into social care

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What a surprise! Austerity measures have created a problem with councils’ ability to carry out research in adult social care.

I read one of the 104 respondents’ comments to the survey which said: “People who supported research and evidence-based decisions have been made redundant.”

Another claimed: “Research in ASC [adult social care] was the first thing to be cut as it is seen as non-essential and will continue to be cut in favour of services and care packages.”

The study, commissioned by the Personal Social Services Research Unit but carried out by the Social Services Research Group, clearly seems to state the obvious as councils struggle to balance their books. We know already that local authorities are between a rock and a hard place.

Focussing on survival mechanics, however, always comes at a price. Expendable research? Probably not, though I’m well aware that duplication is a major problem in the industry and I can understand if local authorities can lock into other information streams their decision-making process on these redundancies.

Without research we have no way of knowing the how and why services are delivered and what difference they make

Without research how can we accurately set budgets and map for the future?

It needs to be done by someone. Without research we are running blind. Finally, can someone tell me please why such few numbers of me ever go into residential care?

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?

Dudley and Walsall lead in response to Living Wage bombshell

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There is a deep concern among care providers that the introductions of George Osborne’s Living Wage will sink many independent businesses.

Surveys have offered a whole array of gloomy forecasts with one stating the following:

  • 9% of respondents are deeply ‘concerned’ about their businesses
  • 3% of them felt that the increase would have a ‘significant’ impact on their businesses
  • 72% were very concerned about their ability to continue in business
  • The majority of people responding to the survey did not feel able to pay their staff the Living Wage of £9.00 per hour by 2020 in the timescales without a ‘substantial’ increase from commissioners

And what is more worrying, a press release from the National Care Association claims 24 per cent of respondents indicated that they would consider exiting the marketplace if their local authorities did not make a significant move to increase the fees they pay over the next five years.

The strategy we adopt from hereon is critical, as it will determine the fate of so many providers and their clients.

It is a heavy burden that has not lifted from my shoulders since the Osborne bombshell. I am convinced the care sector was invisible to him when he set in stone his plans.

Let me add at this point, I applaud any move to upgrade the status and salaries of carers, but there must be an impact analysis and a cohesive strategy – funding – to make it work.

Sadly, we’re floundering and again lacking in leadership from Government. The local authorities with which we work are clearly in the same position.

Following the Living Wage announcement, West Midlands Care Association contacted councilors and directors in all the membership authorities and outlined the real impact of the legislation. There has been a deafening silence in response, except for Walsall and Dudley.

Walsall has indicated that unless extra funds are released the thresholds of care funding will have to change. A pragmatic approach, I know, but at least our overtures have been acknowledged and there have been strong indications that they understand our dilemma.

Dudley has been exemplary in its reply. Both councillors and officers recognise the position of our members and the pivotal role of West Midlands Care Association plays in working though the difficulties.

The authority has agreed to meet with us as soon as its own impact analysis is complete. The authority also recognises that it is essential the Government provide “appropriate funding.”

We have enjoyed a creative e working relationship with Dudley for many years and I am heartened at its realisation we need to talk and pool knowledge if we have any chance of delivering a sustainable lifeline to care providers and those who are currently receiving care.

The most basic and powerful way to connect is to listen to each other. If there was ever a time in the care sector when dialogue between WMCA . . . and local authorities was needed, it’s now. Silence is not an option, as the funding issue has become a complication for cash-strapped authorities, as they are obliged to navigate their legal care market management responsibilities outlined in the Care Act.

What can I add? We will do all we can to help and for those who perhaps have nothing to say: Please don’t shut the door on us.

It is true that only those who harm the care industry really make the headlines, Essentially, all the providers I daily meet are good, honourable people. So good, in fact, I worry that for the very best intentions they will carry on to dispense care even without sufficient resources. Cutting corners . . . giving something out of nothing . . . need I say more?


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.

Joseph Rowntree Foundation: Indeed, worthy reading

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I have plenty of regard for Geoff Hodgson, editor of the Caring Times. He appears to have a balanced overview of the care sector and, more importantly for me, is in touch with the realities of life.

I’m also equally impressed by the many findings of the Joseph Rowntree Foundation and its recent report on social care. Geoff blogged that the document was worthy of an enthusiastic response. Indeed it is.

In particular, there’s a section on what should be a bedrock of principles for all care whether providers, regulators, local or central government or the NHS.

Written by JRF’s director of care services John Kennedy, the report (simply titled John Kennedy’s Care Home Enquiry), used social media to harvest the broadest possible comments.

Let me quote Geoff: “By far the most emphatic of the findings in the report is that care workers are undervalued, undertrained and underpaid, echoing the sentiment of Baroness Kingsmill in her report earlier this year.” Err . . . yes!

As Geoff adds, reading such reports do taken a determined efforts but among the dross there is pure gold to be found and this is one such gem.

At the risk of repeating the ‘important stuff’ raised by Geoff and being pilloried by my peers for doing so, I find myself almost agreeing with the report’s author that “regulation should be more than inspection . . . it should look at pay and working conditions, staffing levels, mission, commissioning practices and transparency of tariffs, in order to improve the quality of care.“

But before I’m stoned, what better way would there be to expose the government shortcomings on funding?

The report offers other nuggets too and asks its readers to consider the following principles – and I quote:

  1. Be appreciative of the million and a half people who work in our social care sector. They are your friends, relatives and neighbours. They care for us and our own. Judge them by the reality of humanity not by an idealised, unattainable expectation.
  2. Be proportionate about risk. Share the risks, don’t just try and pass it on.

Much of this report is about right attitudes, culture and better futures. Below is a snippet or two lifted from Kennedy’s work and you may even wish to read it (I do hope so).

For care homes:

  • Providing care is not the same as making widgets: it comes with a wider social responsibility of national importance. If your business model is driven solely by profit, you shouldn’t be in the business. The vision, values and attitudes required to run a care home start in the board room and proprietor’s office. Your business has a significant social and community impact. Take responsibility.
  • Be active in your representative organisations. It is time to step up and help create a vision for the 21st century care home. Stop being passive. Care homes will only get better if you are part of creating the solutions.
  • Be open, honest and transparent. Be candid about your strengths and your failings. Resist defensiveness.

For government:

  • Declare the care sector a ‘sector of primary national strategic importance’ for the country, the economy and ourselves.
  • Recognise that social care on the cheap is very expensive. The opportunity cost of low investment in our social care system is simply pushing higher cost onto the NHS. It is also inhibiting our national economic potential by failing to effectively support a modern labour force.
  • Regulate the market, don’t just inspect. We need to take a ‘whole system’ approach. We need proper regulation of the market as a whole. Regulation should encompass pay and working conditions; staffing levels, commissioning practices and transparent tariffs. These are the factors that directly impact on quality of care. Only with firm foundations can the care sector deliver. Regulate the market to compete on quality. Regulate for success not failure.
  • Care managers need a professional body. Managers should be registered and have a licence to practise. The body should set professional standards, have disciplinary powers and provide a voice at a national policy level.
  • To give assurance and to raise the status of the profession, care workers should be registered and have a licence to practise.
  • Introduce a single assessment instrument to provide real data on quality indicators, dependency profile and resource needs. Understand the care home sector. This would give valuable data in measuring quality. It would also provide a national statistical database to inform strategic planning for health and social care.

For the system: regulators, local authorities, the NHS:

  • Ensure that your requirements support the ‘mission’ of the care home. Be mindful that whatever extra you ask them to do takes time away from relationships and people. Find out about your local social care providers. Engage with the care sector in partnership.
  • Rationalise the ‘paperwork’ burden on care. Work together to ensure a proportionate bureaucracy that supports ‘people time’ not ‘office time’. It is people who make the difference in the end, not paper.
  • Share what is good. You need to be more ‘in the game’ – don’t just point out what is wrong; engage in finding solutions too. Listen. Share your experience.
  • Be collaborative and involve the care sector at the inception stage of new requirements and initiatives – not just a consultation at the end of the process. Care homes have a lot of experience to share.
  • Ensure there is someone on your boards with direct experience of working in and running care homes.

Scope takes a swipe at the Budget

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Disability charity Scope has issued a stinging attack on this week’s Budget, saying there is “no place for disabled people” in the “aspiration nation.”

Wow – no punched pulled here.

Ina website statement and reports in the national media, Richard Hawkes, Chief Executive of the charity says: “Disabled people want to live independently. But the support they need to get up, get dressed and get out and about is being squeezed due to chronic under-funding of social care.

“Neither the £72,000 cap on costs nor £118,000 means test will resolve the care crisis for disabled people, who make up a third of the people who use social care.

In the Budget speech Chancellor George Osborne reiterated plans to speed up the introduction on the cap of social care.

He also said that ministers plan to extend the means test for residential care costs from April 2016.

The cap on care costs, originally planned to be set at £75,000 and introduced in 2017, will now also be introduced in 2016 at a level of £72,000.

Mr Hawkes adds: “Disabled people want to be able to pay for essentials without turning to credit. But in 2013 they are struggling to make ends meet.

“Life costs more if you’re disabled and this is being compounded as living costs spiral and incomes flat-line. What’s the Government’s response? A squeeze on financial support, which means many disabled people, face not one, but two, three or four different cuts to vital support.  

“In this context it’s a frightening prospect that welfare could be capped in the June spending review – having already been slashed by billions.  Some people need benefits, get over it. It doesn’t make them a scrounger, it doesn’t make them work-shy and it doesn’t make them a lay-about.

“Surely an aspiration nation should be a place where disabled people can pay the bills and live independently?”

The Budget document says that the reforms should help an extra 100,000 people who would not receive any support under the current system.

Speaking in the Independent newspaper, Michelle Mitchell, charity director general at Age UK, added: “Whilst we welcome the earlier implementation of the care costs cap to April 2016, this will do nothing to help the 800,000 older people who need help with everyday tasks but receive no formal support.

“Since this Government came to power, in real terms £700 million has been cut from social care spending, mostly as a consequence of the slashing of local authorities budgets at a time when need is rising due to our ageing population.

“The Government must urgently address the spiralling crisis in social care by ensuring that every older person gets the help that they need when they need it.”

Will they get it? Will the disabled be helped? I have no confidence that funding will be made available to local authorities. We have a hard-line government with only one agenda: To cut.

Morally, those cuts trouble me. The care sector sees first-hand the daily toll those financial restraints are taking and yes, they are depriving our most vulnerable of quality of life.

I can’t recall too clearly, but wasn’t there something in the coalition manifesto about protecting the elderly and vulnerable?  

Written by debbielq

March 21, 2013 at 7:59 am

Why the magic £75,000 figure may be ‘con of worst sort’

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According to the news, today’s the day (Monday) health secretary Jeremy Hunt unveils the masterplan of how care is going to be funded in the future.

But campaigners have warned that older people could be in for a “rude shock” when the government announcement on a cap on long-term care costs is officially revealed.

The consensus is that £75,000 is the magic figure – the amount people will be expected to pay for care before the state steps in.

Critics say it’s too high and would still mean many would have to sell their homes. I agree.

The Dilnot commission recommended a cap of between £35,000 and £50,000.

Our faithful BBC reported that Stephen Burke, director of United for All Ages, which has been calling for a lower cap, said: “When families realise what is being proposed, they will be in for a rude shock.

“The government is sneakily shifting the cost of care further and further onto older people and their families. The £75,000 cap is the dampest of damp squibs. It is a con of the worst sort.”

This is heavy criticism by any standard, but he goes on with another salvo: “There are fairer and better alternatives. The government for example could have raised the capital threshold for paying for care to £200,000 or higher.

“The failure by this government to meet the care challenge means that the next government will have to sort this out to meet the care needs of our ageing population.”

For my money, there’s a ring of truth in his quotes. I am persuaded there’s no real solution in this government initiative.

The Labour peer Lord Warner, who sat on the Dilnot commission, was reported as saying: “Essentially, we thought that the fairest way of doing this, and it wasn’t a precise science setting the cap, but we thought it was somewhere in that range, £35,000 to £50,000.

“At that level, give or take, you would actually mean on average no-one would have to dispose of more than about a third of the value of their housing assets.”

If there is any worth in having the cap set, it will be principally for the insurance companies, who will now be able to offer ‘products’.

But I suspect many of the baby boomer generation will be left foundering. Caught out by failing pensions, endowment policies and the capricious housing market, many will be too old or too poor to make worthwhile investments.

In short: It’s bit of a mess.

The Department of Health has reiterated its pledge to solve the problem, but my own reading of the situations leads me to align my thoughts with the Alzheimer’s Society that said a £75,000 cap would only help “the few”.

“Today’s reports may mean an important step forward in making the system of charging for care fairer but the devil will be in the detail,” it said in a statement.

That detail may come to today in the commons announcement, but I expect a clot of it will be emerging from the woodwork a long way down the road from here.

Telly at the ready, radio on – chamomile tea to sooth the jangled nerves . . .  

Written by debbielq

February 10, 2013 at 11:36 pm