wmcha

By Debbie le Quesne

Posts Tagged ‘community care

GPs a gateway to social care and more

leave a comment »

The role of GPs is changing. No longer are their practices just treating medical conditions and referring patients to hospitals.

Primary care is at last being driven by an integration which seeks a greater level of collaboration across frontline services – everything from companionship advice for the isolated to social service and end of life referrals.

This is the new face of primary care service, but it’s not everywhere – not yet.

Increasingly, patients are able to access GP-led hubs offering a range of services, or are given a social prescription that provides them with access to non-medical support, such as social clubs, peer networks or arts therapy.

However, even with growing evidence that these models of care can reduce long-term demand on acute services, we have still not yet seen a major national shift in this direction.

An NHS report – the General Practice Forward View – endorses this broader remit and as well as setting out detailed plans for the recruitment of more GPs, argues for a refocus of the GP’s role on to prevention rather than cure, and the promotion of community-based care and support.

Social care is getting NHS backing. Am I dreaming?

The report calls for more areas to incorporate the multi-specialty community providers (MCPs) model of care – a programme of integrated primary, out-of-hospital and preventative care that is being piloted in 14 regions of the UK. Social prescriptions should also be more frequently used, it adds, to provide patients with access to organisations that can provide advice on employment, housing, debt and other support services.

For me, this is an exciting breakthrough, and could mean GPs become the gateway to social care.

Mmm . . . which pot of money will be used to fund this?

 

Advertisements

New PM downgrades care minister’s role

leave a comment »

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

leave a comment »

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 . . .

 

Exceptional success at the double for care workers

leave a comment »

Brum care awards

Above: Nicholas Nolan and Cherry Harvey, centre, with ITV weather presenter Emma Jesson, left, and Jag Khatkar

 

Many of us in the care sector recently attended a glittering evening to celebrate the best of caring at the Edgbaston Cricket Ground. It was a great night that celebrated excellence in care and a night I was pleased for West Midlands Care Association to be part of.

Out of that event, one story has been prominent in my mind. Two newcomers to the care sector were honoured with an industry award for their outstanding commitment to the job after judges failed to decide on a clear winner.

The selection panel was so impressed with the nominations for support worker Cherry Harvey and community carer Nicolas Nolan it decided they both deserved the Exceptional Newcomer’s Award. The couple were shortlisted from hundreds of entrant across the city for the Birmingham Care Awards.

Support worker Cherry, who is part of the Precious Homes’ Kings Heath team in Birmingham, had no idea she had been nominated and was thrilled when her name was called out.

Judges commended Cherry’s dedication, commitment, compassion and loyalty, specifically in a first-time role within the care sector.

The awards ceremony was a joint venture between Birmingham City Council, West Midlands Care Association, Skills for Care and the Care Consortium. A regional event, its aim was to celebrate and reward excellence in social care.

Joint winner Nicolas, a community worker with Trident Reach The People’s Charity, caught the judges’ attention for his “rapid learning ability and willingness to better himself.”

With no previous domiciliary care experience, he joined Trident’s Birmingham Home Care team based on Hagley Road, Edgbaston, in January.

Already he handles a customer base of varying needs, working alongside people with learning disabilities, mental health issues and the physically disabled.

His award nomination said: “Nicholas’s understanding of all his customer needs and the nature of how domiciliary care services work is highly admirable, given he started with no care experience. He is a valuable member of the service who is always willing to help customers achieve, always puts customers first and applies a personalised approach to every customer he works with.”

This pair represent everything what good care is about and I thoroughly endorse the decision that both have been declared winners. Birmingham Care Awards is about celebrating care excellence.

They are the kind of role models the industry needs and proof that quality care is out there, valued and right on our doorstep.

 

Osborne’s social care cash ‘used to balance books’

leave a comment »

 

 

In any other scenario, you’d expect legal exchanges and the Press to be shouting ‘scandal’ from front pages.

But this is the care sector – often unde-gunned and always under-funded.

It’s incredulous, but has been claimed by reliable sources, that funds being raised by Dudley Council to shore up the costs of social care are to be used to help balance the books on the previous year’s overspend.

Under Chancellor George Osborne’s plan to fund care sector needs, he sanctioned a two per cent hike in council taxes during the Spending Review last November.

But it emerged at an emergency members’ meeting of the West Midlands Care Association, which represents private and charitable care providers, the new monies will have no impact on the current industry crisis that has seen 1,000 social care beds lost across the country since January.

Neither will there be any new monies generated for social care from Mr Osborne’s 2016 Budget proposals.

Hopes that he would heed calls by the Directors of Adult Social Services (ADASS) to bring forward £700m of social care funding never materialised.

Sadly, the outlook can only get worse as care providers struggle to make ends meet.

The West Midlands Care Association understands 50 per cent of the public in Dudley agree with the Chancellor’s precept of two per cent in the belief that it will help adults requiring social care packages to continue to receive them in a sustainable way.

But the truth is that the two per cent is just not enough and is being directed towards last year’s accounts shortfall.

How can they get away with this?

There are no provision margins from such funding for the current financial year.

A packed meeting at the Quality Hotel, Dudley, delegates from across the Midlands, heard the next three to four years would be “critical to the survival of social care as we know it.”

For the last nine years fees have fallen below the viable cost of running a care home.

Figures from Industry analysts LaingBuisson reveal English councils pay on average £91 a week less than what is needed to provide fully compliant care.

I’m sure the survival rate will tumble very soon as the living wage outlays start to hit home and the number of private funders, who shore up the shortfalls on the cost of care being paid for by local authorities, remain static.

At best, I believe, we have three to four years before the landscape of care changes beyond recognition and there will be no way back to the required bed levels our ageing population needs to provide some kind of fluid service to hospital discharge managers wanting to avoid bed blocking.

In a desperate attempt to secure a funding lifeline to the industry, MPs, councillors, local authority officers and Clinical Commissioning Groups (CCGs) have been asked to meet with us to discuss ring-fenced funding for social care. It’s the only way we’ll ever see any monies decanted from Government.

The vast majority of Black Country care businesses rely on placements paid for by councils as a primary income generator. More than 26,300 people across the region are receiving residential care. A similar number have care at home.

In September last year my association revealed Dudley Social services had given rises totalling 8.9 per cent over a five year period while, the Consumer Prices Index was at 11.6 per cent, the Retail Price Index at 15 per cent and wage rises hitting 12.3 per cent.

I’m wholly persuaded our local authorities understand the dilemma, but are working under a Government that is hopelessly adrift of reality.

 

 

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

leave a comment »

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.

 

 

 

A ‘deepening crisis’ but where is the antidote?

leave a comment »

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.