By Debbie le Quesne

Posts Tagged ‘Care Quality Commission

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.

A window on the future marketplace

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The majority of adult social care directors (70 per cent) believe pay pressures will drive up residential’/nursing care costs in 2015/16.

Some 39 per cent believe that local market issues, lack of capacity and competition, will be a major driver in dictating the market trend.

About 50 per cent of Directors do not think that overheads and a premium to cover winter pressures and quality are key for increased unit costs, and only 14 per cent of directors believe that a reduction in cross-subsidisation – the differences between council and self-funder rates – will be a key in changing the costing structure for residential/nursing care “units” in 2015/16.

I note in the ADDAS Budget Survey 2015 report, that councils received only 5.9 per cent (£41m) of the £700m allocated to the NHS to respond to winter pressures in 2014/15. That’s fair, isn’t it!

Why on earth should I feel disgusted by this financial nugget? Stop it, Debbie!

Directors trying to grasp the nettle of deeper cuts

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After a night’s sleep, coffee, golf and the therapy of good company I’ve return to the ADASS Budget Survey 2015. Help!

The big question we’re all asking is how more savings in the industry can be made. It’s a question that’s been lobbied in Parliament and the offices of Whitehall and the responses have been . . . poor.

However, local authority directors are now attempting to grasp the nettle and in responding to the question of how they would make savings, for both 2015/16 and for 2016/17 onwards.

This is their published reply: “Directors report increasing reliance upon integration in making savings going forward (71 per cent as from 2016/17 onwards), and a continued focus upon early intervention and prevention (73 per cent as from 2016/17 onwards).

“There is also an increasing emphasis upon what was described as stopping ‘unnecessary’ services and shifting activity to cheaper settings, along with better procurement.

“The majority of Directors do not see controlling wages or increasing charges as areas of importance in making future savings. This can be explained by firstly that most of adult social care budgets are spent with external providers, many of whom pay staff at or close to the minimum wage and therefore decisions about the level of the minimum are not within the control of local authorities nor providers; and secondly, the survey analysis illustrates that there is limit to how much further councils can increase charges.

“On the contrary, the majority of Directors have reported that wage pressures are key drivers for increased costs of residential & nursing care and home care services in 2015/16.”

Are we all clear on that? Well, not really, Integration reliance – I’m assuming integrated care – is as fantastic concept for efficiency and good delivery of care. It’s joined-up thinking with all care elements coordinated and seamlessly meshing together.

The World Health Organisation noted last year, however, the initial problem of carving up the monies is one of definition.

“A key challenge,” it said in its What is the evidence on the economic impacts of integrated care? document, “remains the lack of common definitions of underlying concepts; as a consequence there is a plethora of terminologies that have variously been described as ‘integrated care’, ‘coordinated care’, ‘collaborative care’, ‘managed care’, ‘disease management’, ‘case management’, ‘health/ social care service user-centred care’, ‘chronic care’, ‘continuity of care’, ‘seamless care’ and others.”

It’s true. Until the borders are care streams are defined – of what’s in, and what’s out – the arguments over who gets what in the budged pool will remain.

And finally (for now). . . How confident are the Directors in making further savings?

Whilst 45 percent of Directors were fully confident that planned savings for 2015/16 would be met, this confidence falls sharply away beyond 2015/16 to only five per cent being fully confident that savings will be met in 2017/18.”

More coffee, please!

Inadequate ratings – how does a business ever come good again?

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Right at the start of this month three Hartlepool care homes were rated inadequate by CQC.

During unannounced inspections at all of the homes in January and February 2015, inspectors found that they were “failing to provide care which was safe, effective, responsive or well led.”

Under CQC’s new programme of inspections, all adult social care services are being given a rating to help people choose care – outstanding, good, adequate and requires improvement. The signposting could be a big help for the general public in assessing how good firms are at compliance exercises, but what effect does such branding have on the care providers who have fallen foul of the new Standards criteria?

My concern is that some with less than ‘outstanding’ ratings could still deliver good care, while being poor at some compliance exercise. What’s more, I fear that a ‘requires improvement’ result could ultimately spell disaster as the need to improve grows against less capacity to generate funds to make them happen.

According to the CQC website the purpose of such measures are to:

  • Ensure that providers found to be providing inadequate care do not continue to do so.
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.

Okay, I understand. But a question asked of me continues to haunt me: How does a home, when rated inadequate, improve? The pressure is racked up considerably for such providers as failure to improve initiates a special measures process.

It seems to me that perhaps we should be taking a lesson from education where additional resources are made available to failing schools.

Not so it seems with social care. In this scenario special measures could potentially involve multiple agencies all making their separate demands. For example, as well as the CQC rigour, there could be additional issues with Health and Safety, Infection Control and, of course, the local authority inspectorate. Each could legally demand their own response, while no doubt referrals from authority commissioners would be frozen.

The question which was put to me is a valid one and deserves more than a ‘should do better’ answer.

With potentially less income, a planned raft of reforms essentially drafted as directives by CQC, and inevitable low morale, there appears to be only one miserable conclusion unless extra funding is magically spirited out of the ether. Fact: Investment is needed to improve and perhaps the reason for failure has been the inability to do just that.

Of course, in some rare cases, the scenario could be very different, but my professional experience tells me that money troubles are generally the precursor to falling standards.

Support for schools that fail comes in various forms and in some cases a new management committee is drafted in. Resources for recovery are by the bucketful.

The public sector does seem to have an unfair advantage over private care business in this respect even though both are dealing with public ‘consumers’.

My answer to the question is typically political as I pose another: How is anyone supposed to do much more as potential for generating extra revenue is diminished?

Care providers are an ever-resourceful, creative and inventive breed.

My organisation is there to advise those who find themselves needing help and while we can’t predict winning Lottery numbers, please remember we have access to a huge pool of wisdom and professional advice from our membership and those agencies with which we work.

Bring on the coffee and cheering chocolate now please . . .

Our work empowers and really does make a difference

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Today, as I’m often inclined, I scanned online the social care section of the Guardian newspaper and was attracted to the headline ‘Our work makes the lives of older people better’.

I confess to rarely reading day-in-the-life-of features, but the heading alone had a resonance with the work of the West Midlands Care Association where I’m the CEO.

Sue Ash works for Age UK’s national advice line, a free, confidential service that supports older people as well as their families and friends. In her story, she simply outlines the contents of her day.

The type of calls she receives make interesting reading, though there’s nothing in them that surprises me.

I quote: “We speak to all sorts of people, from those who are struggling to receive practical support at home, to people who don’t know what funding is available to help them to pay for care. We specialise in advice regarding care rights and regulations, and are able to support people to get the services they need.

“We recently helped a man who needed to move into a care home and thought he needed to sell his property to pay for this. He was extremely worried, but we reassured him that this was not correct for his situation, providing him with advice on the best action to take. He told us he and his wife slept better that night than they had in weeks!

“We regularly deal with calls from older people who feel lonely and want someone to talk to. Age UK offers a number services that can benefit older people who feel they have no one to turn to; our local Age UK partners offer a range of hands-on services such as lunch clubs for older residents living nearby.”

Sue then adds “we are often able to help people claim pension credit or benefits they were unaware of and regularly hear how valuable this extra income has been.”

Care, rights, benefits, regulations, worries over fees, loneliness and social engagement. These are huge issues and just like Sue, WMCA encounters many of them on a daily basis.

It’s an agenda that should be up there with the NHS, taxes and national debt in the General Election political debates. Perhaps I’ve missed it all, but I doubt it. Potato too hot? Perhaps.

I applaud the work of Age UK in empowering our older people. Like Sue, who feels proud to be part of the work that helps so many, I too feel privileged to play my part. We’re in a business that can change the quality of life for the better, it’s about hope, it’s about winding up the clock of old age and keep going with as much quality of life as possible, it’s about high standards, innovation and securing the very best for society’s greatest treasure – our elderly.

Facts the Telegraph Justice for Elderly campaign overlooked

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The Telegraph – bastion of what we often believe to be proper journalism – has in recent time fired a broadside at the care industry in a new campaign.

A report headlined ‘Elderly at risk at hundreds of care homes’ graced its pages in at the tailend of last year with a warning that more than 500 care homes and services for the elderly put frail residents at risk.

The reason: Because staff were just not good enough, the paper claimed.

The Telegraph ammunition comes from new figures from industry regulator the Care Quality Commission.

Let me quote the figures: “. . .of the 5,332 care homes and home-help services assessed in the last 12 months, 522 failed to meet the most basic legal standards for staffing.”

Journalists Tim Ross, John Bingham and Patrick Sawer then conclude (care of the CQC) that “tens of thousands of elderly and disabled adults across England are being looked after by workers who are not properly trained, have no relevant experience, or in some cases may even have criminal records.”

The Telegraph cites among its Justice for the Elderly campaign that it aims to ensure care staff are properly trained and licensed, properly trained, better regulated, and for the establishing of a “highly publicised care advice service.”

This latest news comes just a few days after more than 60 residents were evacuated from Merok Park Care Home, in Banstead, after the Commission shut it down.

As a seasoned campaigner and provider of tools for care excellence, I applaud any initiative to bring justice to the vulnerable, elderly of society. But I’m alarmed, though not surprised, by the scaremongering of such campaigning journalism.

Clearly The Telegraph has invested heavily into this work with three writers on the case.

I am therefore surprised that a more rounded and balanced approach has not been taken.

However we interpret the data, the fact remains that care and nursing homes, special needs and dementia care, and community care providers deliver many cameos of excellence across the UK.

The article fails to address the current whirlwind of mandatory training and assessment for carers covering dignity, safeguarding, first aid, health and safety, food hygiene, manual handling, mental capacity, issues of law and infection prevention to name but a few.

And of course, those providers with specialised interests would be expected to furnish the proper knowledge to staff to enable them to work fin the best care interest of their charges. For example, care staff in a dementia home would be expected to have relevant training.

I am surprised too that no mention is made of the new Care Certificate which has been introduced and will be mandatory for all care staff from April 1 next year.

I’m left asking: How much more skill education can we possibly deliver?

The Telegraph doubtless concludes that informing readers of such a wealth of training out there has no place in its article. Indeed, the decanting of such facts into its readership may even get them questioning the tone of the copy. Sadly, with so much bad publicity aimed at the care sector, I believe the general public is becoming anaesthetised to the sensationalism of this kind of work. With the Press crying wolf at every possible opportunity for a juicy care headline it would do well to consider that its own integrity may well be eroded as well as that of its victims.

Care Alliance takes concerns to the DoH

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Along with other representatives of the newly-formed Care Association Alliance I have met with Department of Health officials in Westminster to discuss the pegging of fees with learning disability providers and other industry problems.

It is hoped the talks on the grass-root issues of care provision will foster a future working relationship between government and the Alliance.

With Erica Lockhart from Surrey Care Association, David Smallcombe from Avon and Roger Wharton from Somerset I met with Paul Richardson, Head of Quality and Safety and Karen Dooley, the Policy Lead for Adult and Social Care.

The Alliance was set up last November with a mandate to represent and help local care association support each other.

Key to its aim is a focus to resolve day-to-day issues of care provision and to enhance quality for those in need of it.

The meeting at the DoH headquarters targeted five main issues including the financial restrains driven by government policy and the pegging of fees for four years for those offering learning disability services.

Deprivation of liberty was also on the agenda as the Care Quality Commission has been penalising providers for not having enough DOLS in place. Many local authorities across the UK, unable to keep up with demand, have asked members to prioritise cases and “send through applications gradually” which has added to the regulatory problem.

Misuse of safeguarding orders by some local authorities; the National Skills Academy’s Registered Manager Programme for driving up care standards; and nursing shortages which continue to dog the industry were also discussed.

The Alliance already done a lot of work on the affects of nursing shortages on the care industry and need to ensure we are at the table when discussions are held so we can provide as much pertinent information to the DoH as possible.

In these most recent talks we discussed the sort of information that the associations could gather to feed into the various meetings being held by the DoH in an attempt to impact some of the sector difficulties. It was clearly apparent the DoH is aware of the challenges we face.

There are plans for specific meetings with the DoH with the most appropriate Alliance representatives in the short term and the Alliance has been assured there will be a continued working together as other matters emerge.