By Debbie le Quesne

Posts Tagged ‘change in law

Latest calculations – the Budget impact on social care

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Oh my life . . . I knew the Budget was bad news, but I’ve just read a piece from a recent edition of The Guardian and I think I feel sick.

I’m trying to console myself with the fact that this publication does not align itself with the Conservative government, but I know some of the figures presented are credible.

The piece suggests that the care sector has been “invisible” to George Osborne. I agree. I cannot image any politician setting in stone anything like the national living wage knowing the impact it could have.

Let me quote: “Let’s suppose Osborne had done all his sums, however. In that case, the logical conclusion can only be good news for social care because he must have realised he would have to factor in a hefty bung of taxpayers’ money to meet the sharply rising costs of paying the NLW from next April. Any other way lies disaster.”

As the article says “there simply isn’t the money in the system to meet the costs without it.”

According to initial calculations by the Local Government Association, indemnifying care contractors against the new minimum would cost councils in England an extra £330m next year, rising to £1bn extra by 2020 (Guardian).

But rightly, as stated “at a time when, the association says, the funding gap in adult social care is widening by £700m annually.”

The article goes on: “The Resolution Foundation thinktank, which has carried out previous detailed analysis of the implications of ending the low-pay scandal in social care, puts the UK-wide extra costs to the public purse of Osborne’s plan at £1.3bn by 2020 – on top of another £1bn already pencilled in for increases in the original national minimum wage.

“In net terms, deducting savings to the exchequer after tax and benefits, the foundation reckons the additional costs to be £675m by 2020, or just over £1.2bn including the amount already allocated for the national minimum wage.”

Oh my life!

Already we have seen hospital admissions soaring since the austerity measures began and a strong argument presented that social care funding cuts are to blame. I fear sores is to come, though there will be regional differences.

My members and I in the West Midlands are particularly concerned over the issue and we are busy putting together figures to ensure that local councilors, our MPs and the LA staff are aware of the impact.

The West Midlands is more dependent than many other areas on local authority care funding and throughout the region it’s the prime source of business.

As the main funders in the marketplace – there are very limited self-funder opportunities – authority fees are calculated to allow only a small profit for providers, which these wage increases will easily wipe out. Simply, there is currently no money left in the pot for my members, or, indeed, the LAs.

I wonder how we will remember Mr Osborne: Will he be the one who has managed to unstick the whole fabric of social care in the UK, despite his government’s pledge that “social care is a priority”?

Duty of candour – exploring the real cost of legalities

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Duty of candour – exploring the real cost of legalities

Like all computer users, the Google search engine is never far away from my fingertips, but I was amazed at the rash of links I found when I typed “CQC duty of candour.”

Page after page popped up – mostly because of some comprehensive work by the Commission search engine optimisation techy geeks. Clearly this is something CQC is going big about.

But these top of the pile listings were followed by law firm information articles, sinking in legal jargon and promoting their compliance services to avoid big trouble.

Some care observers branded the new regulation, introduced as ‘live’ at the start of the month, as “the rebirth of the CQC.” Indeed, the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 makes important changes to health and social care standards which now being regulated with fresh zeal.

They represent one of the main ways in which the Government is responding to the Francis Inquiry that recommended the enforcement of fundamental standards to prevent problems like those at Mid Staffordshire, Winterbourne View and elsewhere.

Lets get legal (promise I’ll be short): The new Fundamental Standards of Care replace the 2010 regulations and are a response to the Second Francis Report into events at Mid Staffordshire.

Whilst the 2014 regs cover, in broad terms, the same subject matter as those dealt with under the 2010 regulations, the ‘Standards’ are now much more focused, the language is more direct and they set out clearly the higher bars which all health and social care providers must adhere. This dovetails with the requirement in the newly- enacted Health and Social Care (Quality and Safety) Act 2015 which “will in the future require the Secretary of State to make any regulations considered necessary to secure that services cause no avoidable harm to those that use them.”

As part of that raft of change, the new duty of candour has been implemented. This provides that where a notifiable safety incident – basically those that cause harm –occurs within a service, there are certain notification requirements which must be followed.

Already emerging is confusion over the definition of ‘a notifiable safety incident’ and it’s critical all care workers are up to speed with this knowledge.

Under the Health and Social Care Act 2008 (Regulated Activities)(Amendments) Regulations 2015 the definition of ‘harm’ for independent sector health and social care providers is as follows:

  • Death of the service user, where the death relates directly to the incident rather than to the natural course of the service user’s illness or underlying condition;
  • An impairment of the sensory, motor or intellectual functions of the service user which has lasted or is likely to last, for a continuous period of more than 28 days;
  • Changes to the structure of the service user’s body;
  • Prolonged pain or prolonged psychological harm;
  • The shortening of the life expectancy of the service user;
  • The service user requires treatment by a healthcare professional to prevent death or any of the above injuries.

Already the lawyers must be rubbing their hands at the potential money-spinning services they can offer providers to ensure the procedural steps in satisfying the duty, and evidencing it to demonstrate compliance, are in place.

It’s early days, but the impact of this new legal duty already appears to be looming as an extra training cost for managers and their staff. Who could possibly afford the consequence of getting this wrong?

Checklist: Having defined the notifiable incident, care providers must:

  1. Notify, and support, the relevant person as soon as reasonably practicable after becoming aware of a notifiable safety incident
  2. Provide an account of the incident as known at the time
  3. Advise what further enquiries the provider will be taking
  4. Offer an apology
  5. Follow up the above in writing, and provide an update on the enquiries
  6. Keep a written record of all communications

Guess WMCA will be running courses soon, but I promise we will do all we can in out bi-monthly member’s meetings so that no extra cost of taking people away from the workplace will be incurred.

Charity initiative – is this the way ahead for our cash-strapped councils?

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The future of social care services is one of the biggest questions facing all councils so we desperately need sustainable models to show the way ahead.

But a national charity just might have a solution – or at least a method of easing the financial burdens.

NESTA, the national leaders in innovation whose mission is to “bring great ideas to life” has been working with the local authority in Wigan.

People at the Heart of Scholes is one of six local authority projects selected as part of the Creative Councils programme.

The pilot project is looking at ways to address the acute challenge of how the council meets rising needs in the provision of adult social care, at a time when the population is ageing and budgets are diminishing.

The project aims to connect people with health and social-care needs with the vast under-used resource of neighbours, local people, volunteers and groups who want to give something back.

So is this what Mr Cameron meant when he famously said: “We’re all in this together”?

Project managers from the council recently staged a two-day “camp” to showcase the work currently being developed.

As well as representatives of NESTA, officers from the five other local authorities involved in the Creative Councils programme, Cornwall, Derbyshire, Monmouthshire, Rotherham and Stoke, attended.

Councillor Keith Cunliffe, Wigan Council’s cabinet member for healthier communities, was reported as saying in Wigan Today: “Over the past six months, we have been testing a number of ideas including a ‘community credits’ scheme to encourage community contributions, volunteering and local business development.

“It’s hoped that lessons learnt from this early work will be used to benefit the rest of the borough, and who knows, perhaps the entire country.”

People at the Heart of Scholes is a key part of the new arrangements for personal budgets for adult social care, which will give service users and families greater control over the way in which their personal needs are met.

Lord Peter Smith, Leader of Wigan Council, said in a Press statement: “We live in challenging times and we recognise the need for radical innovation.

“This project could potentially reap unprecedented benefits, not just for the vulnerable and isolated people who rely on social care services but also, in the long term, it could have a significant impact on the broader social care economy. We are committed to this work and have the capacity and enthusiasm to turn good ideas into real solutions.”

So far we really haven’t a clue what benefits there are to the scheme – only time will tell. But I’m encouraged some local authorities are prepared to look outside the box.

Clearly this initiative is brave and my own biggest question centres around the fears of developing a kind of Dads’ Army to tackle an issue which should be addressed by central Government professionals.

However, I applaud the initiative and wish the project well. I’ll be looking out for its first official report.

Joined-up thinking – why is it so hard to achieve the obvious?

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Forgive me if I seem radical in believing that joined-up thinking about the critical issues of social care could actually achieve an awful lot.

Currently NHS and social care budgets in England are separate and realistically there seems little movement from where I’m viewing things that this will change.

Last month shadow health secretary Andy Burnham suggested that under Labour both budgets could be put into a super pot of cash – a massive £119bn a year.

Regularly we hear that the NHS, mental health and social care sectors need more cross pollination, more exchange and a more cohesive approach to caring.

Truth is, as long as we have separate budgets that kind of goal will never be realised.

Mr Burnham said in a speech to health professionals said existing “dangerous” gaps between services put the vulnerable at risk.

Putting the funds into one pot would see councils getting much more involved in making decisions about the NHS, while the biggest hospitals may end up expanding into the community, perhaps even running care homes, Mr Burnham said.

As a way ahead, I actually think it could work. There could be huge areas of savings identified with a single overview approach and seamless interaction between different streams of caring.

Clearly changing the way the funding would be made up would see the distribution of it change too.

Mr Burnham referred to the proposal as “whole-person care”.

“As we live longer, people’s needs become a blur of physical, mental and social,” he said and how true that is.

“It is just not possible to disaggregate them and meet them through our three separate services,” he argued.

But that’s exactly what we are doing now.

I know of cases where hospital patients who are clinically fit for discharge have been bed blocking for weeks while they await a step-down physio bed, or another specialist service.

And there are other issues too . . . we end up paying what must be huge sums of cash as people fall through the social care monitoring net in the community and end up in expensive hospital beds.

What is the incentive for prevention in these cases? It should be self-evident, because it would save billions, but somehow it just isn’t.

Mr Burnham has called for a cross-party debate and has won the backing of the NHS Confederation.

For what it’s worth Mr Burnham, you have my backing too.

Care budgets and the forecast without sunny periods

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Sending on health and social care is expected to swallow up half of all government spending in 50 years’ time.

In a study the King’s Fund said that the UK now spends around 9 per cent of its national income on health and social care, That’s more than twice as much as 50 years ago.

And the figure could more than double again to nearly 20 per cent by 2061, according to forecasts by the Office for Budget Responsibility.

A report in the Guardian online says: “Based on projections for economic growth and current levels of taxation and government expenditure, the fund’s chief economist John Appleby estimates that this would translate to around 50 of cent of public spending.”

Funding this with borrowing would be “unrealistic in the short to medium term and would be unsustainable in the longer term”.

The King’s Fund says that NHS moneys could be raised from rising taxation adding around £570 a year to the tax bill of every household in the UK.

However, Appleby warns there would be a backlash eventually. “Tax increases of the magnitude required to fund significant additional spending would, at some point, encounter public resistance  . . . difficult choices lie ahead about how much to spend and how to fund (the demands of the health service),” he is reported as saying.

And he adds something very interesting. He says that although much has been made of the demographic timebomb of an ageing population “contrary to popular perception – this is likely to drive only a small proportion of the increase”.

So what are we to believe? I really don’t know anymore, but I am certain of one thing. That I join a growing consensus that care has to be delivered within its means and government priorities ned to change dramatically.

I know we need to build for tomorrow, but we are currently outlaying £32bn to build HS2 – the high-speed rail link from London to Birmingham and into Toton near Nottingham, Sheffield, Leeds, Manchester and Manchester Airport.

Our health service is on its knees, our private social care sector is breaking, care is clearly being compromised at many levels, the disabled, marginalized and mentally ill are all targets to do what?

Balance the national debt. Hmm. Mr Cameron, why are you so willing to commit billions to a railway? Couldn’t such money be better channeled into care? Oh Debbie, how stupid of me to think in such a logical way!

Have a good weekend.

Care caterers are Guinness record champions

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I’ve always championed initiatives that raise the profile of care work no matter what that work is.

So I was thrilled when I stumbled on a story about The National Association of Care Catering (NACC) which has made history by successfully setting the first ever Guinness World Record for most community meals delivered in three hours.

It made me laugh out loud, but the record makers highlight the vital work Community Meals Service in the UK and the numbers who rely on this kind of service.

The official figures from Guinness World Records, released in January, state that the NACC delivered 526 community meals in three hours in 16 locations across England. The figure is 226 more than required to secure the title.

Community Meals providers across the UK successfully served the specifically-developed two-course menu of roast beef, potatoes and seasonal vegetables, rounded off with the Great British favourite pudding of apple crumble and custard to users of the service.

Confirmation of the NACC’s success came from Guinness some three months after the actual World Record attempt, which took place between 11am and 1pm on Monday 1 October 2012 – International Older Persons’ Day and the first day of NACC Community Meals Week, Care Industry News reported.

What is remarkable is that more than 20,000 elderly, housebound, or disabled people in the UK actually used the Community Meal lifeline between 11am and 1pm on Monday 1 October 2012.

This huge gap between official and unofficial figures is due to the very specific and detailed rules created by Guinness in order for the NACC to achieve the record.

The community mantra is heard much more frequently these days and it’s heartening that so many more people can keep their independence longer with care packages at home.

But in these austere times it’s essential that services like Community Meals continue.

As well as providing nutritious hot meals I would confidently assume that it also provides the sole source of regular human contact for an alarming number.

The old Meals on Wheels has had its day, but the need for such a service has not changed.

In sensible economics supply is usually generated by demand.

In care sector economics supply appears to be governed by auditors. I do hope this invaluable lifeline remains viable.

Welfare reform: Are the cuts really worse than what we thought?

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It becomes increasingly difficult to write about social care issues without appearing to make a political point.

I must point out that the West Midlands Care Association is not interested in scoring party points, but we will stand up and be counted if we believe care is being compromised by Government policy.

Simon Duffy, director of the Centre for Welfare Reform makes some interesting points in his Guardian online Professional People report.

One of the extraordinary features of the cuts programme, he observes, has been the fate of social care.

He writes: “At the same time as announcing the deepest cuts in public expenditure since the creation of the welfare state, there have been several pronouncements about extra funding for social care and how any failure to safeguard services for disabled children, adults or older people would be because of failings in local government.”

He cites the 2010 comprehensive spending review that declared that there would be “£2bn a year of additional funding by 2014-15 to support social care”.

But adds: “However, a closer examination of these figures shows it was merely a statistical manipulation, achieved by closing one small funding stream, restarting it and then publishing the cumulative figure for a five-year period. The truth is very different.


“In fact, over the past two-and-a-half years, social care has already experienced a devastating cut of over £4bn per year, about 16 per cent.

“By 2015, it will have been cut by more than £8bn per year (about 33 per cent). And there is a very simple and powerful reason for this. By 2015, local government in England needs to make an annual real term cut of £16bn (40 per cent of its central funding) and social care makes up 60 per cent of real local government spending.”

Interestingly, he points out that “most of the funding we associate with local government, such as education, is ring-fenced from the worst of the cuts. It is social care which must bear the biggest share of local cuts.”

I believe the movers and shakers of Social Services departments across the country all know they are stuck fast in this head-in-the-sand purge for savings.

There’s a whole load of spin and PR too that seems to suggest that local authorities ‘are to blame’ for the pain of cuts. Indeed, they are, but they are in reality dancing to the tune of a Whitehall piper.

Mr Duffy suggests “There are so many different cuts hidden within the so called ‘welfare reforms’ that it is a constant effort to keep up with the next attack. “

He points to The Centre for Welfare Reform’s latest report A Fair Society? How the Cuts Target Disabled People. The reading is shocking.

Mr Duffy writes: “People needing social care are hit by a double whammy of benefit cuts and social care cuts. Our analysis shows that, while most of us face cuts in services or income equivalent to £467, people in poverty face cuts totalling £2,195 per person, and disabled people face cuts totalling £4,410 per person.

“Disabled people (including children and older people) with the most severe disabilities, those entitled to social care, will face the biggest cut of all – an average cut of £8,832. This cut is 19 times greater than the cut falling on most other citizens.”

The reading is so stark, so bleak, I have to assume it really can’t be that bad. Or is it and we are being swept along, unable to grasp the full reality of the cuts we are trying to survive?

Community caring: A new voice in the chorus of change

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Domiciliary care agencies have been saying it for years, and now the NHS Confederation is adding to the chorus.

GP and community services should receive a higher proportion of NHS spend to enable more care to be carried outside hospital, says the Confederation chief.

Mike Farrar said in his New Year message that he would like to see ‘more investment in primary, community, mental health and social care services as a proportion of the total spend’.

And wouldn’t we all?

An article in PULSE online reported him as saying: ‘For instance, untreated mental illness costs the NHS over £10billion in physical healthcare costs every year. And delayed transfers in care – often a result of the right support not being in place – currently cost the NHS £545,000 per day (approximately £200 million per year).

I never realized so much money was being wasted this way.

He adds: ‘Increasing money in these areas will help keep people out of hospital and leading independent lives, accessing care in their own homes, or closer to home.’

And no doubt that some of that cash could be spent by social services commissioning on private sector community care. Like those running care home businesses, rates for the job are currently diabolically poor.

Mr Farrar also called on clinicians to ‘provide a better explanation of “safe and effective cases for change” that will improve the quality of local services’ and support ‘courageous politicians who put their population’s health above their own electoral health’.

Nicely put Mr Farrer!

He added: ‘If we want to ensure that our health service is improving in the long-term, not just running to stand still, then fundamental change is necessary. We should all be concerned about the future of the NHS and we should all be active in finding the best solutions.’

Yes, like having grown-up dialogue between all care agencies; like putting an end to an autocratic approach to ‘solutions’; like more money to furnish creative care that can be achieved and delivered; like giving us some direction; and perhaps, most of all, listening to the people who actually try to deliver care.Image

Changing the perception of a care home

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We all know that the face of care is changing radically, but residential homes with private members’ clubs – now that really is setting the bar at a new height.

And I think I’m really warming to the concept unveiled by Carebase Ltd which will, in their own words, make the new build into a “social destination”.

The movers and shakers of top-market provider have to welcome in the local community from the outset and so membership of its private members’ club, The Riverly Club, will be open to a number of older people from Abingdon where the luxury care home is situated.

This innovative approach is one that has been championed by Baroness Greengross as she believes it is essential for care homes to become a hub for the local community and that integration is vital for overturning the negative perception that many people have about care homes.

I agree. It’s a fabulous, though brave, concept.

She said in an interview with carehome.co.uk “We have to change the image of care homes and see them as providing something positive to the community instead of as a last resort.

“If you get care homes right, care homes can be a spearhead for outreach action in the local community.”

She added: “People from the local community should be able to visit the care home and do activities there such as have their hair done or watch a film so it becomes a local hub.

“The care home should be providing services for the local community. Some care homes and a few retirement villages are already going some way towards doing this but not on the scale I mean. Years ago I wrote a book on this. It is something we need to encourage. I want the care home to be the initiator.”

All residents of Bridge House will automatically become members of The Riverly Club and will be able to access all of its facilities, including a spa, wellness centre, cinema, café, bar and library.

This, by definition, is care for the well-heeled. Bridge House will be seriously 5-star.

Set near to the river and Abbey Gardens it will provide a unique draw – for those with money to spend.

In the modernization of care treatments we now have dental practices which are uniquely boutique in design and now the trend is spreading to the care sector.

I am both heartened and saddened by this project. Heartened because it pushes the boundaries of pre-conception but saddened because I can think of no investors who would be brace enough to commit to such a build in the Midlands.

The home will house up to 71 older people when it opens in March this year.

Common sense on complex care amidst more economic gloom

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The weekend’s almost here and it’s starting to snow. Great! And just to top it all, I learn tonight on the news headlines we are in a triple-dip recession.

Quite how this latest bad news will drill down to the private sector, I’m not sure. But one thing is certain – the effect will not be good.

Earlier today I read a piece in Brunswicks Healthcare Review highlighting the need for our private sector to work hand-in-glove with the NHS,

Care homes and NHS healthcare services must work more closely together, according to a new study led by researchers at the University of Hertfordshire.  The research was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme.

Most long term care for older people is provided by independent care homes, the report said.

Many of these people have complex needs and are the oldest and frailest of the population. Yet their access to NHS services is inconsistent and determined by local custom and practice rather than the particular needs of the care home residents, the report adds.

Professor Claire Goodman, at the University of Hertfordshire’s Centre for Research in Primary and Community Care, said: “It is very clear that closer working and better integration of NHS services can promote more effective healthcare of older people living in care homes, and there are many good examples of where individual practitioners or services have tried to achieve this.  

“However, our research found that there was not a particular model of working that ensured older people received consistent care, and few systems in place to evaluate what is being achieved. “

It’s when I read material like this I have to endorse radical changes in the care for our elderly. But they need to be ‘real-world’ achievable changes.

As the economy sinks further, less and less resources are being decanted into the care for the elderly.

Just about everyone who is anyone in the care sector are driving impossible budget savings and  feel professionally compromised by unyielding cuts.

Many different NHS services visit older people in care homes, and they are very aware of the need to improve the way they work with the care homes to deliver their service. This has led to the development of a range of initiatives that range from the funding of NHS beds in care homes to the creation of specialist roles designed to promote better working between primary care and the care homes.

However, the study showed that tensions exist between the ways that the NHS services and the care homes provide care to older people. NHS services focus on diagnosis, treatment and support at specific times, whereas care homes prioritise on-going support and relationships that nurture a continuous review of the older person’s care.

Sadly the study also found that access to NHS services and identification of older peoples’ health care needs hardly ever involved joint review or discussion with care home staff, and even more rarely did it include the older person or one of their family.

Quite rightly, the study suggests that NHS services need to see care homes as partners in care and not just the solution to the problem of where to place older people who can no longer live at home.