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By Debbie le Quesne

Posts Tagged ‘cost of care

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.

Care capping delay – U-turn costing us up to £100m

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After all the spin over the capping of care costs, we now find it’s been delayed until 2020. But the hold-up on the £72,000 cap, originally due to come into force in April 2016, is set to cost up to £100m – and we, the public are footing the bill.

It was delayed after councils wrote to the Department of Health asking for the launch to be deferred, due to funding pressures faced by local authorities – and they have plenty of it.

Care England’s Prof Martin Green tweeted: “Care cap postponed. We need extra money to fund new living wage and a long term approach to funding the true cost of care NOW.”

Indeed, we do!

We could argue all day whether the delay is justifiable. Personally, with the additional costs looming driven by the Living Wage, I believe the strain on introduction would have been intolerable for the LAs.

But I’m baffled by a Government policy on social care funding that appears to be deliberately undermined by Budget legislation.

I’m all for strong, decisive leadership as we map the future of care, but with such an ambitious agenda on pay it almost appears that the real consequences of such action were just not thought through. That could never be . . .could it?

Singing from the same hymn sheet on issue of fees

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I’m not a musician, but I do know when people can hold a note, or when a choral piece is more of a discord than a pleasing harmony.

The care sector is renowned for its fragmentation, mixed messages and entrenched differences of opinion.

For those unfamiliar with my blogging, the West Midlands Care Association has campaigned long and hard for a more realistic response to fees from local authorities.

Sometimes, when the care sector is so embattled, it’s just nice to get a shot of encouragement and at the start of the month I received mine.

Professor Martin Green OBE, Chief Executive of Care England, a representative body for independent care services, has written a letter to the Directors of Adult Social services, reminding councils of the legal responsibilities regarding fees. Without collusion, Prof Green’s message is in perfect harmony with that of my association.

Acknowledging local authorities face unprecedented financial pressure – and that it is to continue – he spells out clearly the legal obligations those responsible for the caring purse.

Le me quote: “With respect to fees, these responsibilities are set out most clearly in the Care Act 2014.

“Paragraph 4.35 of this Act states clearly that: ‘Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality – for example, by setting fee levels below an amount which is not sustainable for provider in the long-term’.

“In other words, local authorities must take steps to ensure that the fee levels at which they commission state funded care enable the provider in question to offer services to that individual for however long that person requires the level of care being provided.

“We do not see how sustainability can be achieved through below inflationary fee increases, and are yet to see an assurance process that indicates this would even be remotely possible.”

Prof Green observes that Councils “cannot remain static” in this respect and the impact of providers Budget responsibilities for the Living Wage serves only to compound issues.

Let me quote some more: “In its analysis of the July Budget, the independent Office for Budget Responsibility provided four possible actions that employers could take in light of the introduction of a National Living Wage. These are:

  • Reducing the number of hours worked by their existing employees;
  • Reducing the number of people employed, either by firing existing employees or by hiring fewer people until attrition has reduced the workforce by the desired amount;
  • Changing the composition of their workforce, potentially by replacing those who are 25 years old or older with those aged 24 or less;
  • Increasing prices in order to pass on the higher wage costs to their customers.

“As the provision of care services are codified in statute, the first two of these options cannot be pursued by independent care providers.

“The fact that the average age of people working in the sector is well above 25 means that it would be impractical to pursue option 3.

Increasing prices is irrelevant in this context as the issue that this letter deals with is the setting of fees for state funded residents, not for self-funders. Therefore, option 4 is not considered, but is a measure that providers will almost certainly have to adopt for residents funding their own care.

“If self-funders have no choice but to pay higher fees, it follows that local authorities also have no option but to commission care at higher rates to reflect the increase in the minimum wage. We do not allow consideration of the possibility of self-funder fees being used to subsidise council fees, which has been happening with increasing frequency across the country. As well as being unethical, this practice is also unlawful. “

Industry annalists LaingBuisson project that care home fees must be increased by five per cent to accommodate the statutory minimum wage.

Concluding, Prof Green adds that the introduction of the National Living Wage in accordance with the Low Pay Commission’s own data would be “completely unsustainable for care home providers without an increase in fees from local authorities. “

I agree wholeheartedly.

Prof Green is asking adult social care to work with him, noting that many “understand the pressures that providers are facing.”

My approach is unashamedly coequal – singing from the same hymn sheet – please, help us as both directors and care providers face this enormous financial challenge that simply cannot be ignored.

Savings will have impact on care – and that’s now official

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Tell us what we already know . . . 83 per cent of Directors report that over the next two years there will be impacts as the result of savings being made.

It’s a significant hike on the 54 per cent of Directors reporting in the ADASS Budget Survey 2015 that the savings they are making to date will have an impact (the document fails to say whether such an impact would be negative or otherwise).

Surprisingly, it is noted that a number of Directors (45 per cent) are reporting that there have been no, or minimal impacts to date, but this falls to only seven per cent believing this over the next two years.

ADASS reported that its members think that the savings to date will not affect their ability to meet their essential statutory duties. However, the scene changes dramatically over the coming two years, with increasing scepticism that savings can be made (down from 81 per cent to date to 39 per cent) believing planned savings can be made met.

Sadly, this view is further confirmed with 50 per cent of Directors reporting that they believe fewer people will get access to services, and 58 percent believing personal budgets will shrink over the next two years.

Directors think that there will be more legal challenges and 17 per cent think that quality of care will worsen also over this period.

The view of Directors correlates with a recent report by Carers UK (State of Caring- May 2015) which noted of the 4,500 carers responding to survey, 55 per cent say that they are worried about the impact of cuts to care and support services over the next year. I

AgeUK last year estimated that 900,000 people in England between the age of 65 and 89 have unmet social care needs, Experts at the charity now believe the figure is closer to one million.

Quite what analysis says about society’s commitment to the sick, frail and vulnerable, I dread to think.

Cue relaxing music, light scented candles . . . soothing head massage, please.

Dementia headlines: So what about all of the good work?

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Headlines claiming that there is a national care betrayal of those suffering with dementia have invaded our living rooms once again.

A Care Quality Commission review found widespread neglect, lack of care, poor training and failings in communications. And that may well be the case.

Most of the 4,000 elderly in UK care homes suffer with degrees of dementia and the CQC found that despite the scale of the problem, professionals’ responses were not adequate. These facts too, though disappointing, don’t get my blood boiling.

But the fact the findings were presented by the media as a national scandal tarred every region with the same brush.

How could you possibly say, for instance, my home town of Dudley with its Dementia Gateway initiative is failing? Then there’s Sandwell, where a care quality drive is hugely focused on the memory-loss condition . . . or Birmingham where home-owners are being given financial incentives to build with dementia in mind?

I’ll concede that nationally there are both good and bad examples of dementia care, but the way findings have been delivered are terribly one-sided.

We cannot deny we have a lot of work still to do and my association has a huge commitment to improving this specialised kind of care.

We are constantly working closely on training models with Professor Dawn Brooker of Worcester University, who established the Association for Dementia Studies (ADS) in 200; we are wholly committed to the Dudley Dementia Gateway project and support Sandwell in its endeavours too.

There is a huge amount of exemplary work in the Midlands which appears to have been overlooked.

Across the country there are huge disparities in funding allocations for dementia that could explain the flawed delivery of care.

In the affluent south there are reports of dementia care attracting local authority funding of £1,000-plus per week, while in the Midlands the average figure is £420.

Sadly there is no common national figure. Dudley pays an extra £14 a month for dementia care on top of its normal allocation for residential care; Sandwell gets £20 and Wolverhampton £29. As monthly figures they don’t even begin to scratch the surface of the additional costs dementia care demands.

Perhaps the real scandal here is with the Government that still has not grasped the nettle on how we are supposed to finance the care of these very needy people.

King’s Fund sound alarm over shortfall in care funding

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Budget cuts of 26 percent will threaten the sustainability of social care the Association of Directors of Adult Social Service warned.

As I have previously blogged the organisation said the results of the annual budget survey show that while spending on adult services has reduced by 12 per cent since 2010, the amount of people needing support has increased by 14 per cent.

Put simply, the figures don’t stack up and councils have had to make savings equivalent to £3.53bn. David Pearson, president of ADASS, was quoted in The Guardian as saying: “As resources reduce and need increases, directors are increasingly concerned about the impact on countless vulnerable people who will fail to receive, or not be able to afford, the social care services they need and deserve.”

The warning has drawn comments from Richard Humphries, assistant director of policy at the King’s Fund: Again quoted in the Guardian online, he says: “This survey once again highlights the enormous pressure on social care budgets.

“Despite the best efforts of local authorities, this will result in further cuts to services and fewer people receiving support.

“Worryingly, half the money being transferred from the NHS budget to support better joint working between health and social care is now being spent on protecting social care services from budget cuts, rather than driving integrated care and other service changes needed to better meet the needs of patients and service-users.”

I would dearly like to bring some positive, creative solution to this ongoing debate, but frankly like so many in the care sector, my day of making savings through working smarter is nearly through. Everyone I know has cut, restructured, re-invented and re-thought the way they work to deliver more efficient care. There has to come an end – it’s an inevitable economic principle – when the wheels will finally drop off social care machine.

The King’s Fund embraces some of the finest minds in the country and the government would do well to heed the alarms.

The only real lifeline we have is the new Care Act and the Better Care Fund that focus resources to help manage their own care and hopefully save billions. Critically, however, we need monies to roll out the new working methodology – cash, it appears that is already spent on “protecting social care services from budget cuts.”

Human rights court ruling could raise the bar on dignity

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Stopping night calls to a retired, disabled ballerina was illegal, – or at least initially – according to the European court of human rights.

But the ruling allows our government “wide discretion in balancing the needs of vulnerable individuals with the economic wellbeing of the state,” the Guardian online report says.

The decision could impact significantly the level of support local authorities are required to provide.

The case was brought by stroke victim Elaine McDonald, a former prima ballerina with the Scottish Ballet, against Kensington and Chelsea Council and the UK government.

She has been left with limited mobility and at night she needs to go to the toilet regularly.

In November 2008, the council reduced the amount it was prepared to pay for her care and declined to fund a night-time assistant. They proposed she use incontinence pads.

The provision of night care would cost,

The council argued that the cost of the night service – £22,270 a year – would have to be paid out of the adult social care budget from which all other community care services for adults in the applicant’s borough were funded.

But the Strasbourg court ruled that the UK violated McDonald’s rights between November 2008 and November 2009 because the local council had failed to carry out a full assessment of her care plan.

But here comes the sting in the tail: The British government was ordered to pay €1,000 (£813) in compensation for breaches of article 8 of the European convention of human rights, which guarantees respect for family and private life. She was also awarded €9,500 for expenses and legal costs.

The court added (Guardian report): “From 4 November 2009 onward, there is no doubt that the interference [in her rights] was in accordance with the law [after the care plan was reviewed]. The court accepts that the interference pursued a legitimate aim, namely the economic wellbeing of the state and the interests of the other care users.”

McDonald submitted that if forced to use incontinence pads she would “lose all sense of dignity” and, as a consequence, she would suffer considerable distress.

The local authority said using would ensure the applicant’s safety and provide her with greater privacy and independence in her own home.

It’s a difficult one, this case . . . but undoubtedly a landmark ruling which could effect the decision-making process in many other cases.

Basically it means that if social care services are cut under social services reviews, councils will have to take into account the impact on the dignity of the individuals who will be affected.

And a final thought: How can we fix a cost on the indignity that Elaine McDonald OBE endures in processing her most personal elements of her care though the British legal system.