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By Debbie le Quesne

Posts Tagged ‘care funding

Discharge delays again: New measures needed to fix problem

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The Government body for scrutinising value for money on public spending has concluded “patients and the NHS have a right to expect better” on the issue of hospital discharge delays for the elderly.

The recent Public Accounts Committee report challenges the Government to address the scale and cost of the problem.

It urges new measures to tackle discharge delays, which are bad for both patients’ health and the financial sustainability of the NHS and local government.

I have campaigned long and hard on this issue and clearly made known my views that in many cases hospitals are really not that switched on to getting the elderly back into the community or care homes. Discharge managers need to have a good understanding of how care homes deal with admissions and how care packages are processed.

The Committee found there was a poor understanding of the scale of discharge problems, with official data substantially under-estimating the range of delays and the number of older patients affected.

There is unacceptable variation in local performance on discharging such patients, said the Committee, finding that while good discharge practice is well understood, “implementation is patchy across local areas”.

It concluded poor sharing of patient information is a significant barrier to improving performance, while “the fragility of the adult social care provider market” exacerbates discharge difficulties.

All this is true, but there is I believe a bigger problem. Care costs money and the sanctioning of care packages becomes, it appears, more and more protracted. It’s not just a case of finding a step-down bed or a care or nursing home, the big issue is getting it funded.

However, while the Committee recognises there is pressure on funding, it does not accept this necessarily blocks efforts to make further improvements and urges a greater commitment to step up the pace of change.

It concluded: “NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement.”

Harsh words.

Those regions which are doing best are the ones where “all the local system owns all of the problem” but this practice is all too rare. NHS and social care sing off the same hymn sheet, but who’s going to be choirmaster to create some harmony here?

Here we go . . . the reports adds: “The Department, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice. The result is unacceptable variation in local performance.”

West Midlands Care Association is available to help resolve the discharge problems. Getting the right people to talk to us . . . now there’s another challenge.

Local health and social care organisations need to work together effectively, in fully integrated systems, to make this work.

The National Audit Office (NAO) has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there.

 

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New PM downgrades care minister’s role

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Theresa May has an unenviable challenge. We have the Brexit issue, the unstable British economy, welfare issues, immigration problems . . . and social care all clamoring for her attention.

What’s going on, I ask. The minister of Care responsibilities have been downgraded and are now the remit of a parliamentary under-secretary. It’s the first time in eight years this has happened and I’m hugely disappointed.

The news appears to have caught the imagination of only a few journalists, but not surprisingly, the ones at the Guardian.

“This downgrade comes at a time when there is acceptance that social care is in crisis and there is unprecedented demand on care services,” I read in the paper’s online columns.

And the article points out the obvious. As we live longer and have more complex needs in later life, it is crucial that social care remains high on the political agenda.

The downgrading appears to suggest otherwise – this is now a post on the bottom rung of the ministerial ladder. I was hoping that things would be so much better with Mrs May.

According to the Association of Directors of Adult Social Services, to maintain care at the same level as last year would require more than an extra £1.1bn. But the National Audit Office, says the Guardian, has previously reported that councils increasingly pay less than the actual cost of the care provided.

Here we beat the same old drum: It is not a financially viable a situation.

Additional pressure on care provider budgets comes with the Living Wage and the fact that demand for care is only going to increase.

Jane Ashcroft is chief executive of Anchor, England’s largest not-for-profit provider of care and housing for older people, writes: “With a rising population and longer life expectancy, the number of people over 65 is set to rise by more than 40 per cent in the next 17 years.

“This will take the number of older people in the UK from 11.4 million to more than 16 million. This demographic change is welcome; it signals improving living conditions and advances in medicine. But if the funding of services is not updated for these new demands, we are undoubtedly heading towards an age of suffering and loneliness for older people.”

Rightly so she calls for a minister of state role – “someone with the power to make real change.”

I fully understand that good social care reduces the financial burden on NHS care. It cuts hospital admissions and heads off expensive health troubles with our vulnerable and elderly. Critically, it can also cut hospital bed blocking.

According to Ashcroft these combined woes cost the taxpayer £820m a year.

Can we have our minister back please. I think we need one, urgently. The downgrading of this portfolio is a huge step in the wrong direction.

 

The haves and have-nots: Bizarre economics of care

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The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .

 

Now docs say bring forward the £700m Better Care Fund monies

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Fourteen doctors’ leaders have written to George Osborne asking for further funding for social care in next week’s Budget, the BBC has reported.

In a letter to the chancellor, they warn cuts in social care funding were putting real pressure on the NHS.

And they said investing in social care was “vital to the success of the NHS”. Err . . . yes.

The government response in the BBC report was that it was already giving local authorities access to up to £3.5bn of new funding for adult social care by 2019-20. By when? Far too late, I’m afraid.

The signatories to the letter are led by Clare Marx, president of the Royal College of Surgeons of England, and include the leaders of a number of royal medical colleges and societies.

In their letter to the Chancellor, they describe health and social care as “two sides of the same coin”.

It’s heartening that the letter describes the impact of an underfunded social care system on the NHS, saying patients fit to be discharged are unable to leave hospital because social support is unavailable at home. How long has the Association been saying this?

“This increases the likelihood of infections and falls,” the letter says.

The knock-on effect is that beds are blocked to new patients, they continue, “leading to cancelled appointments and operations”.

“This impacts on our ability to provide timely treatment and meet treatment targets, risking patient wellbeing, and is ultimately detrimental to the economy through delayed returns to work,” they wrote.

And here’s the bit I just love. In the letter, the doctors suggest bringing forward the extra £700m from the Better Care Fund to this year rather than waiting until 2017, when the money was due to be spread over three years.

NHS chief executive Simon Stevens has previously said that the success of the Five Year Forward View is dependent on adequate funding for social care.

 

The signatories to the letter are:

Miss Clare Marx, president of the Royal College of Surgeons of England

Prof Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges

Prof John Ashton, president of the Faculty of Public Health

Dr Anna Batchelor, dean of the Faculty of Intensive Care Medicine

Dr Liam Brennan, president of the Royal College of Anaesthetists

Prof Jane Dacre, president of the Royal College of Physicians

Mr Michael Lavelle-Jones, president of the Royal College of Surgeons of Edinburgh

Dr Suzy Lishman, president of the Royal College of Pathologists

Prof Carrie MacEwen, president of the Royal College of Ophthalmologists

Dr Giles Maskell, president of the Royal College of Radiologists

Prof Neena Modi, president of the Royal College of Paediatrics and Child Health

Prof David Oliver, president of the British Geriatrics Society

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists

Prof Sir Simon Wessely, president of the Royal College of Psychiatrists

Note: If this letter was on social media, I’d be adding my name to the list . . .

 

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?

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.