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By Debbie le Quesne

Posts Tagged ‘care quality

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 . . .

 

GPs’ NO vote on care home calls – the national scene

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A landmark decision by GPs affecting their commitment to residential care homes and nursing homes is another crippling blow to the care sector. In this blog I want to look at the national scene and then post a second piece on the local picture.

Recently the BBC announced that the plight of care home residents “has pretty much slipped below the radar in recent years.”

It noted while there is “close scrutiny of everything from A&E waiting times to access to the latest cancer drugs, the support – or rather lack of it – care home residents receive from the NHS has gone almost unnoticed.”

I couldn’t have put it better myself.

  • Now for a few facts to set the scene of the latest bombshell to drop on the private care sector:
  • There are 16,500 care homes in England, looking after more than 300,000 residents
  • If nursing homes are included, the number of residents exceeds 400,000 (500,000 across the whole UK)
  • Nursing homes have to have a registered nurse on staff
  • Both care homes and nursing homes work with local GPs, hospital doctors and district nurses

Given the figures, it is obvious any major shift in the way NHS primary care is delivered into this clinically need-laden sector, would have major repercussions.

Announced by the Daily Mail on its front page, I discovered at the beginning of the month “GPs vote to axe care home visits”.

Up to 300 GPs’ representatives from powerful regional bodies voted at a crisis summit to end being responsible for care homes. Simply put: They want to ditch this responsibility.

The British Medical Association union may now lobby the Government to remove the responsibility of looking after residents from the GP contract.

The implications are huge to both service providers and users.

Historically, the care sector has had patchy service from GP practices.

In 2012 the Care Quality Commission reported 81 care homes looked at were not receiving regular visits from GPs. But now that frail commitment is going – or at least going in the way we have come to expect.

These patients are among the frailest, most vulnerable members of society. Many are living with a complex range of conditions, including dementia, heart disease and diabetes, with residents, according to the BBC, on an average of nine medications each.

Like many problems not given the media attention they deserve, the issue has been developing gradually over time.

What concerns me greatly is how quickly this news has dropped out of media interest. Anyone seen anything in the last couple of weeks?

It’s a ‘given’, isn’t it, that many of the people who decant into care and nursing homes are there because of clinical needs.

Doubtless, before that move, these people would probably have been among a GP’s most frequent visitors.

West Midlands Care Association has been flagging up the problem for years along with other representative bodies such as Care England and Age UK.

The bottom line, as with most problems in social care and the NHS, is money and the problem is two-fold, adding unbearable weight to care providers’ responsibility and costs and potentially subtracting essential care from our elderly.

I’ve seen reports of care homeowners paying GP retainer fees of £20,000 a year to provide regular doctor visits for residents. These figures are prohibitive to most providers within my region, but about a third of homes are in expensive surgery retainer agreements.

My fear is that again it’s our most vulnerable who get the worst of deals by default as our GPs push for the right to opt out of being responsible for frail, vulnerable and highly dependent people.

Issues like continuity of care immediately spring to mind and doubtless the cost of bringing in private providers will be loaded. But we have a legal responsibility to register every resident with a GP, and what’s more, my members want to care for their residents properly.

There’s a trend of moving seriously ill patients out of hospitals into care homes and nursing homes, what will happen to them?

Who are their advocates? Increasingly, it’s our care homes who are taking up their causes, but there must be a limit on just how much fighting we can do . . . Fighting to stay open, fighting to pay bills, fighting to fund the living wage, fighting to change a broken system, fighting . . . fighting . . . fighting. Sometimes I just get tired.

 

 

 

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. . .

Wedding bells tonic brings happier headlines

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A filthy care home described as “a waiting room to die”, more dire warnings on the future of care provision. CQC complaining that too many social care services are not up to the mark . . . it’s enough to make anyone lose heart.

But wait a minute. In a plethora of headlines gloom, I spot a story that sums up so much of the good caring that is never in the public gaze. Contrary to what the media would have us believe, there are good care homes, in fact most of them, and extremely kind carers do exist.

Aileen Sharples, aged 89, desperately wanted to be part of her son’s wedding and was disappointed that she would not be able to attend the ceremony and watch the happy couple exchange their vows.

But staff at the Belong Wigan Care community where she lives were determined she wouldn’t miss a moment.

Aileen was treated to a front row view of the Gloucestershire wedding from the comfort of her home, thanks to the dedication and ingenuity of care staff and a bit of clever technology.

Overjoyed for her son, Paul, on his Big Day, Aileen was disappointed she’d miss the ‘do’. But staff quickly stepped in, making arrangements for the wedding to be seen via an iPad and FaceTime.

But they didn’t just provide the technical link, staff entered into the spirit of the occasion with flowers and decorations in abundance. They also put on their best clothes – complete with hats and fascinators – ­­and ensured residents did the same to share the moment.

A champagne toast followed with wedding cake and Aileen was able to chat to Paul and her new daughter-in-law, Julia, wishing them both a wonderful honeymoon.

This is not an everyday occurrence, but in my experience acts of selfless kindness from carers happen fairly regularly.

This story cheered my heart, and not for one moment do I believe it was a cynical stunt to get some media interest.