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By Debbie le Quesne

Posts Tagged ‘care industry

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?

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.

A need to recapture some of the past

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Jacqueline Jones is a care worker who wrote a feature in the Guardian on her 40 years in the sector. Between the colourful reflections there emerges a warm, committed woman, who is like so many carers I meet.

The article is a celebration of compassion and marks clearly the changes that have occurred.

Jacqueline has gone from care worker to social worker for Richmond council, to owner and director of a private domiciliary care company in Surrey, she founded in 1994.

Her comment that “these days I barely recognise the care industry” resonated with me.

In the early ’80s, she says “we were called home helps and we provided shopping and cleaning in two-hour blocks. We had freedom to adapt how we cared for people and build proper relationships. We had time, a luxury that care workers today don’t have and we really could be what every company now advertises itself as: part of the family.”

It’s essential that some of that home comfort caring is recaptured and there are pockets of real hope emerging in the Dudley borough through the direct payments system.

A colleague of mine has DP package for his wife who has had MS for 28 years. He employs five PAs and they have, with skillful management of funding, revolutionised the quality of life for this lady.

Talking to me the other day he said: “In a year they have become an essential extension of our family. They have supported us through two family deaths, brought a new sense of life into the home and revolutionised my wife’s outlook on life.

“The secret . . . they have built strong relationships, the care is joined up and even with holiday cover,it’s still seamless.”

In her narrative, Jacqueline refers to a “freedom” to express care in different ways. In my colleague’s case, the freedom of mapping his wife’s care has been a life-changer, with the whole family benefitting.

The package is a fantastic success story and a credit to the social worker who saw the potential, worked it through and made it happen with LST, the support agency of choice.

Community care has changed since the days Jacqueline actually took in a client’s dog when her client was admitted to hospital, but the heart that inspired actions like that still beats strong within the industry.

Looking to the future, Jacqueline says “the vicious circle of low status homecare work must be broken.”

I agree. In my colleague’s case perhaps we’re seeing some sunnier days for his wife now, in what previously had been a very long, dark winter. Let’s hope that example can be replicated.

I agree. In my colleague’s case, perhaps we’re seeing some sunnier days for his wife now in what has previously had been a very long, dark winter. Let’s hope that example can be replicated.

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?

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399,000 extra hospital days – the price of social care cuts

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The National Press has been scaremongering again telling its readers that our care system is “crumbling”.

Whilst I’m aware so much media ‘information’ is politically tweaked, I find myself aligned to its reasoning this time around.

The care system in England has “cost the NHS £669 million over the last five years with hospitals forced to care for elderly patients who could otherwise be discharged,” analysis by Age UK has concluded.

Findings also reveal the NHS lost 2.4 million bed days as a result of “bed-blocking”. Why? Because of a lack of care and support outside hospitals. Now there’s a surprise (not)!

As you’d image the Press has seized on the figures, with the charity concluding the data underlines “the scale of the crisis in the elderly care system and the knock-on effect on institutions like the NHS.”

Cruel cuts to local council budgets, which fund social care for elderly and disabled people, have left the system struggling. Both care providers and service users are feeling the effects.

You’ll may recall my recent attempts to simplify budget research by the Association of Directors of Adult Social Services (Adass) which showed that despite brave efforts by councils to protect care services, cost savings and a rapidly ageing population have effectively wiped out 31 per cent of care budgets in five years.

Age UK says NHS figures reveal that patients collectively spent an estimated 399,000 days in hospital while waiting for a place in a care home or nursing to become available in the last year alone. Can you image the cost?

Surely this kind of information is all Mr Cameron needs to evaluate the value of social care.

Delays while patients waited for special handrails or stairlifts to be installed enabling them to carry on living at home added almost 41,400 days to the total.

Let me quote Age UK statistics: “ While an NHS bed costs taxpayers an average £1,925 per week, a typical place in a residential care home costs a more modest £558 per week for a week or £357 for care at home.”

We appear to have penalized social care funding at a catastrophic price, with year on year, more older people being trapped in hospital in ever-greater numbers.

Policymakers desperately need to listen to the facts that are emerging.

Would funding social care properly resolve the bedding crisis in hospitals? Yes.

Would a properly resourced social care system transform many older people’s lives and make sound financial sense long term? Yes.

Would such a move mean a more efficient use of skills and finance within the NHS? Yes.

Care homes . . . and dare we mention sex?

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I’m not one for deliberately grabbing the headlines, or in a knee-jerk way, responding to them. But I just can’t resist this BBC story pointed out to me by a colleague.

Headline: “The taboo of sex in care homes for older people.”

Hooked yet?

A recent study by the University of Manchester found that 54 per cent of men and 31 per cent of women over the age of 70 were still sexually active. Good of ‘em, I say.

The Beeb reported that it was the first nationally representative survey to include people over 80 in its sample, indicating both how attitudes are finally changing and how the sexuality of older people has been historically overlooked.

I find it interesting, though not surprising, that the subject still has an air of taboo, the findings of a study by the Royal College of Nursing a few years ago revealing that sex and relationships are not viewed as a priority in care homes.

“Human contact and sexual need are basic functions of the human being,” Dawne Garrett, older people’s adviser at the Royal College of Nursing, is quoted in the BBC report.

I understand that the subject can be a difficult one and observations in the report that “staff are generally not comfortable with the topic, and not knowledgeable about it either, thus they are powerless to help,” are probably true.

So how do we as care providers facilitate relationships?

I’d like to hear some answers or see a training brief, because sooner or later this is going to be a Human Right Act issue.

Lois Weaver, a performance artist who explores the subject of sex and ageing through her work, is quoted by the BBC: “We have a stigma about age.

“We don’t really treat people like elders. We treat [them] like people [who are] finished with life.”

Her groundbreaking show, What Tammy Needs to Know About Getting Old and Having Sex, seeks to break down the taboo of sex and ageing.

Anyone for a ticket?

Weaver is in her 60s, had been told that losing interest in sex was an inevitable part of getting older, but said she was not ready to accept that. “I was getting different urges and desires,” she was quoted as saying.

Her work is indeed interesting and those wishing to be challenged can find video links aplenty in a Google search. Her attempts to canvas opinion from residents in care homes, however, were generally met with failure which clearly underpins what she has coined the British “maternalistic” approach.

I really do feel I’m opening a proverbial can of worms here, especially as I consider what could happen sexually to dementia patients. We have to assume that homes seeking to have a more liberal approach to relationships sanction only consenting adults with capacity. Even then I suspect safeguarding issues would emerge.

Weaver, a professor of contemporary performance at Queen Mary University of London, a performance artist in her own right, writer, and director, is a seasoned campaigner. It will be interesting to see how she develops this one in the light of the Manchester study.

Government spending review may offer hope to social care

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A critical spending review to determine medium term plans for Governments department will provide a platform for ADASS to air its concerns over funding for social care.

The review has to take place this summer because there are no detailed spending plans in place for the next financial year. Already private discussions are taking place and ADDAS is feeding the key issues into the agenda.

Quoting John Jackson, co-chair of Resources Network, the outcomes of the review could be:

  • Health and social care will be seen as a single entity
  • This will provide some protection for adult social care (but remember that health is not being funded to meet increased demands)
  • It will be accompanied by a requirement to pool budgets (probably under the control of Health and Wellbeing Boards)

So what are the implications for local government? Here are Mr Jackson’s thoughts:

Any new government or ministers will want to pursue eye catching ideas – some of them will be good (e.g. Health and Wellbeing Boards) but others not and will lead to considerable change at a time when systems are under huge pressures

Sadly, he predicts that some local authorities (and some local health and care systems) are under significant risk of falling apart in the next two years. Oh, yes!

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.

ADASS fact-finding budget a worrying snapshot

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The latest document on monies and adult social care was never going to be happy reading.

Produced by the Association of Directors of Adult Social Services (ADASS), it gives a harrowing insight of what could be the future for care providers and their clients.

After reading and digesting a plethora of graphs and words in the ADASS Budget Survey 2015 I need a drink – well, at least a proper coffee.

The annual ADASS Budget digest is promoted as “an authoritative analysis of the state of adult social care finances” and indeed does provide in-depth intelligence on how adult social care is responding to the challenges of meeting increased demand and managing reducing resources.

The survey, with some 147 of the 155 local authorities in England responding, is a snapshot – albeit a very complex one – of the current state of play.

We all know that more people are living longer with more complex needs that require vital care, support and protection from adult social care in councils.

But this year (2015/16) councils are running out of “efficiencies”, warns the report and “will make service reductions of £420 million to people needing that care and support and their carers.”

The figure is eye-watering for a social care market that is creaking.

Note this well: There have been five years of funding reductions totalling £4.6 billion and representing 31 per cent of real terms net budgets. This year, adult social care budgets will reduce by a further £0.5 billion in cash terms.

Taking the growth in numbers of older and disabled people into account, this means that an additional £1.1 billion would be needed to provide the same level of service as last year, the report says.

There are more than 400,000 fewer people receiving social care services since 2009-10, and of those who are still supported, a significant number will get less care. Most directors expect that still fewer people will get access to services over the next two years.

We’re a creative thinking bunch – those who manage in the care sector – but every one is now struggling to carve more costs away and not least, local authorities.

Listen to this: The proportion of savings secured through efficiency has fallen from 80 per cent in 2014/15 to 75 per cent in 2015/16 and at the same time savings from income has increased from 4 per cent to 6 per cent, and from service reductions from 16 per cent to 18 per cent over the same period. Simply put, it means fewer savings are proportionately being made from efficiencies and more from charges and reducing frontline services.

There is so much material in this non-political document, I’m proposing to post a number of blogs on what I believe are the salient points.

Where’s the chocolate . . . I need sweet tea or may be a stiff coffee. Now!

Dudley grabbing good headlines over dementia care

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Good headlines in care are hard to find and as rare as hen’s teeth. I was thrilled, therefore, to see that Prime Minister David Cameron has praised Dudley’s approach to caring for people with dementia.

In his  ‘Challenge on Dementia’ published just before the start of Dementia Awareness Week, Dudley Council working in partnership with Dudley CCG, has been highlighted for developing “an innovative, integrated approach to the diagnosis, care and support offered to people with dementia, their carers and families.”

Good, isn’t it?

The report goes on to commend the borough’s three Dementia Gateways, which provide care and support for those affected by dementia throughout all stages of the condition.

Dudley’s Dementia Gateway Service has been shortlisted for a national award in the Great British Care Awards in the personalisation category, having been awarded the West Midlands award in December. The results will be announced in June and I wish the local authority my very best.

As part of the awareness week (May 18 – 24), led by the Alzheimer’s Society to raise awareness of the condition and to help address the fear that many people feel about it, a host of activities were arranged at gateway centres: Roseville gateway, Tunnel Street, Coseley, The Crystal gateway, Brettell Lane, Brierley Hill and Brett Young Centre, Old Hawne Lane, Halesowen.

They are open from 10am until 3pm during the week and people are invited to pop in and find out more from the team of dementia experts.

Dudley Libraries are also supporting the initiative and are launching a new collection of books and resources for people with dementia.

The Reading Agency has worked with dementia healthcare experts, people with dementia and carer groups to select a list of 25 titles that provide support and advice for people with dementia and their carers. Health professionals will be able to use the list to prescribe books to their patients.

I applaud Dudley’s joined-up approach to dementia care and this week has presented another opportunity for the town to shine. Happy news that makes me smile about an initiative that I’ve watched develop and succeed. A great inspiration for the area, my association will be working with the authority, CCG and care providers to ensure there is enough training and support to service the borough’s dementia needs.