By Debbie le Quesne

Posts Tagged ‘domcare.

Don’t miss out on our audit tool for the new CQC inspections

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The new Care Quality Commission inspection model has been rolled out and we’re all eagerly waiting for the new ratings to be announced.

At the time of writing this, nothing has been announced among our members so we don’t really know how high the bar has been set against the previous criteria.

We are, however, confident that delivering a practical guide which can easily be personalised to any care business, will be an invaluable asset for members in this time of transition.

Simply, we want to make sure everyone is well prepared for the inspection revisions, so West Midlands Care Association has produced a simple, walk-through guide that addresses the five critical pillars of the new regulations.

It’s aim is to provide an easy-access knowledge base of how to safely justify answers CQC is looking for and ensure nothing is missed.

Those using the tool and unable to resolve queries will be able to access support with a phone call.

Under the CQC initiative, inspectors will use professional judgment, objective measures and evidence to assess services against five key questions: Are they safe; are they effective; are they caring; are they responsive to people’s needs; and are they well led.

A standard set of key lines of enquiry (KLOEs) will be used to extract the information to ensure a level playing field on all inspections, a move that has been welcomed by the industry.

We all know the new approach is all about CQC asking the questions that matter to the people who are using the services, but there is a raft of critical procedures and policies that care providers need to be getting right.

Just having the knowledge where to look for supporting information required by CQC and how to present it will make a huge difference to inspection outcomes.

The inspection process aims to provide good information for the Commission for ratings and give the provider a snapshot of how they can improve.

Our CQC Audit Tool looks at ways of avoiding the pitfalls and ensuring nothing is missed in the way CQC expects the management of care to be delivered. It’s simple to use and everything is made as clear as possible

For non-members, the digital document available through email, is £70 and for member £35. Those who have previously purchased audit inspection tools

Co-operatives: Is this really the way forward?

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Not to be confused with The Co-op, Co-operatives UK is a national body that campaigns for co-operation and works to promote, develop and unite enterprises.

And it’s just possible it might have come up with a trump card in these times of care funding austerity and at the same time help restore public confidence in the sector. We’ll have to see when all the cards are on the table . . .

Published in a national newspaper, Pat Conaty, a research associate at Co-operatives UK, tables this question: “Could the active membership and co-operative ownership of workers, service users, volunteers and family members rebuild public trust in services and put an end to cruelty and neglect through a socially inclusive solution where the system of care is owned by the recipients?”

This week also saw the launch of the UK and Wales co-operatives research report Social Co-operatives, a Democratic Co-Production Agenda for Care Services in the UK.

With austerity measures aplenty, the publication identifies opportunities for co-operative approaches to deliver social care across the UK. It’s a brave agenda, but the logistics of management and accountability worry me.

So many stories of bad caring have dogged the industry and more recently the Winterbourne View scandal and the Southern Cross crisis have served to erode public confidence even further.

But what if there was a democratically accountable ownership model for health and care services, asks Conaty.

In a growing number of countries, from Europe to Canada and Japan, social care co-operative models are being rolled out.

Conaty believes these approaches can develop in the UK and would directly empower the people receiving care. Personally. I’m cautious. I have spent time studying care in Europe and there is a strong embedded culture of wives giving up work to care for elderly parents of in-laws. True, things are changing, but slowly. It’s important that people don’t think the co-operative approach is the default setting in Europe.

She adds: “We have researched social co-operative approaches extensively and the Italian co-operative movement provides a good example. The movement has been at the forefront of innovation in the provision of social and health care services.

“During the fiscal crisis of the late 1970s it pioneered a social solidarity system that enabled workers, volunteers, service users, family members and providers of co-operative capital to become member stakeholders in the governance and ownership of care services.“

Pretty radical, I think, but it’s still functioning. Most Italian social co-operatives have fewer than 30 worker-owners and less than 100 other stakeholder members.

Development in the UK has been slower but some co-operatives in the UK are now delivering home care.

Conaty says that in Wales, co-operative approaches to care delivery are specifically advocated in the Social Services and Well Being (Wales) Act which received royal assent at the beginning of May. Whatever may develop in the UK, be assured I’ll be fighting the corner for the private sector to be fully engaged. I don’t believe co-operatives can be a substitute for what we already have in place, but working alongside them seems a possible way forward. Watch this space. . .


How commissioners can play their part in social care

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In its June bulletin The Social Care Institute for Excellence offers a wealth of care information, comprehensively covering everything from commissioning of home care to whistleblowing.

At the risk of an information overload, the document is well worth a scan. With a growing number of people over 65 in the population, the new SCIE guide suggests what commissioners can do to improve how they assess, plan, contract and monitor home care services for older people with complex needs.

President of the Association of Directors of Adult Social Services, David Pearson, says: “This guide will help commissioners be clear that we are responsible for ensuring that a high quality and sustainable care market exists in our council areas. This is a responsibility which we share with our NHS colleagues.”

He publication highlights latest research findings on social care and offers some practice examples of good work in this area. Aimed at health and social care commissioners of home care services for older people with complex needs, the guide lists more than 20 tasks to ensure people get what they need to keep them out of more costly hospital and nursing environments.

So much of it is commonsense, with recommendations falling into the areas of assessment, planning, contracting, monitoring and further research. But is does – and very successfully – underpin what should always be fundamental criteria.

A dignified life, supported in the community, is what everyone wants to aim for. And the cost of doing so must be seen as an investment into the NHS.

My concern is that all investment monies will be viewed as overspend, but the economies of scale here are huge. Initiatives like the Vitality Partnership to assess needs in the community, particularly for the elderly, and head off costly hospital admissions.

We must drive forward flexibility, person-centred packages that marry successfully social care and the NHS, create diversity among providers and monitor outcomes against emerging needs.

The SCIE is just one of many wheels in the cogs of change. It’s heartening to see that funding issues have also been addressed, but that’s worth a blog in its own right.

Clearly apparent is a genuine commitment to partnership, something that West Midlands Care Association has been driving forward for years. I can only hope that every commissioner takes the time to read the SCIE observations, findings and advisories.

‘Make or break’ time looms for social care

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Councils in England face a funding gap of £5.8 billion between March 2014 and the end of 2015/16, new Local Government Association analysis shows.

The figures are scary and according to Care Industry News, the online magazine, local authorities will need to make huge savings equivalent to 12.5 per cent on their total budgets before next April.

Successful integration of health and social care is vital, says the LGA to stop the care system from collapsing.

The £5.8 billion shortfall in council budgets will be caused by a combination of reduced government funding and rising demand on services – particularly from the elderly.

The funding gap in adult social care alone already amounts to £1.9 billion by 2015/16 – based on council adult social care budgets in 2013/14, says the Care Industry News report.

My abiding fear is where new saving will be made. Already we have heard pledges to protect spending on adult social care next year as much as possible, but I can’t help worrying worse is to come.

Next April, will mark a critical point for adult social care in England with the pooling of £5.4 billion from councils and the health service. The Better Care Fund will aim to improve care for older people and reduce financial pressure on councils and the health system through stopping lengthy waits for discharge from hospitals and avoiding unnecessary admissions to care homes.

Initiatives like the Vitality Partnership are already under way to make a difference in the community and funding for such work has been assigned for the year.

But the scale of savings which need to be found next year illustrate the urgent need for the Better Care Fund to “quickly succeed in radically improving the way public money is spent on looking after England’s elderly,” says Care Industry News.

Indeed, 2015 I believe will be make or break for social care and council leaders are saying the same.

Quoted din the online article, LGA Chairman Sir Merrick Cockell says: ”In recent years, local government has worked tirelessly to save billions while protecting services for those who need them most. But the scale of the challenge facing local authorities next year is stark. Council finances are on a knife-edge and the old way of doing things – including the way we care for our elderly population – just won’t work anymore.

“Next year will be a make or break moment for adult social care, for local services provided by councils and for the NHS.”

Central to the rescue mission is the introduction of the Better Care Fund (BCF).

“Neither councils, the NHS or England’s elderly can afford for this not to work,” he adds.

And I have just returned from a meeting about the Better Caring Fund. Interesting – it seems the Government is still “deciding and discussing,” while local authorities and CCG’s are now too far down the line to stop in what seems a perfectly reasonable use of money. Spend the money to help people stay healthy in their own homes or care homes and spend a whole load less on acute hospital admissions.

More cuts to an already financially struggling industry or cutting back on the BCF would be catastrophic.  The challenge ahead is enormous and I for one have everything crossed that all will be well.


Care reforms in danger of ‘screening out’ needs

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People living at home with dementia could be “screened out” of the care loop, Caroline Abrahams, director of charity Age UK, has warned.

She said that those with dementia and who needed daily help to live at home could become victims of the care reforms.

In particular, she was concerned that the criteria for accessing care was “far too restrictive.”

She added that those who struggled with day-today tasks such as dressing, washing, going to the toilet or preparing food were at risk and explained that “from now on the inability to do just one of those fundamental things will not be enough to qualify for support.”

Age UK is concerned that some older people’s needs will escalate and “undermine their ability to live at home.”

The report, to which I was referred, appeared in the Western Morning News, but has not seen this story anywhere else. I find it worrying that these kinds of alerts are not getting more exposure and the fact that the historically very measured Age UK appears to becoming more political also sets alarm bells ringing.

Home Group, one of the UK’s largest social care providers, has also called for an “urgent amendment” to the rules, so that those with moderate as well as substantial needs can access support packages.

Rachael Byrne, executive director of the operation, was reported as saying: “Many people who have relied on care from their local council will find themselves squeezed out.”

Mencap also gets a platform in the Morning News with charity chief executive Jan Tregelles saying the bar has been set too high and fears for the future wellbeing of those afflicted with mental illness.

I quote: “We know the huge difference support can make to people’s lives and how devastating the consequences when they don’t get it – needs can quickly escalate, pushing people and families to crisis point.”

I really do wonder for what this coalition government will be remembered most.

As the Care Bill progressively makes its presence felt, we wait with bated breath to see how it will standardise the criteria for care across the UK. Presently, we still have in place a postcode for care delivery.

Recently, our Worcester Care Association director Rakesh Kotecha  (left in the photo), gave a talk to a briefing at a Colliers International event in Birmingham for financial,  legal and care industry representatives.

We were all in awe of the task the Act is trying to cover. There are consultations aplenty as none of the parties really know how it can all work.

Part of the event was also an interesting presentation from Nicholas White of Colliers (right in the picture) on the key performance indicators financial institutions use to calculate what is happening in the industry – a real insight


Extra £2bn ‘needed to integrate NHS and social care’

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The chairman of the Local Government Association has warned that the NHS needs an extra £2bn to help integrate its services with social care.

Sir Merrick Cockell says the money is needed on top of Better Care Fund – the £3.8bn project to make this difficult union happen.

And, with what I believe is good insight, he’s also demanding that the fund gets five-year commitment, rather than the year it is officially scheduled to last.

He believes the money would “ease the short term disruption to residents and to patients.”

Speaking at conference organised by the King’s Fund thinktank in London, and reported in The Guardian, he does add that the Better Care Fund is “our best answer to the questions asked of us in these testing times”.

The Better Care Fund relies on pooled funding from local authorities and the NHS, with the intention of reducing pressure on hospitals by providing more care and support in people’s homes.

Not wishing to dampen enthusiasm here, but on weekly basis I seem to hear or read that local authorities have no spare cash.

The fund launches next April, and Cockell is reported as saying that the coming year is “the crunch year in all respects … we simply can’t fall apart in that year.”

I agree with Mr Cockell that we are, indeed, in “testing times” but I feel I’m missing something here. Local authorities throughout the UK have decimated social care budgets, closed care homes, day centres and libraries as central government finances have been revised downwards,

Can someone tell me please, just where is this extra money coming from? I’m fully supportive of an integrated NHS and social care system and the West Midlands Care Association has excellent working relationships with both of these care streams. I fear, however, the financial juggling is already beginning to unravel as the austerity measures deepen.

Care providers are struggling with unrealistic fees and my NHS colleagues are wincing as their budgets shrink.

Do we need a rethink, Mr Cameron, on this pressing matter? I think so.

CQC penalty notices and why we should have a measured response

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The Care Quality Commission has this year been busy issuing penalty notices over breaches in conditions of registration.

Most services have to have a registered manager as ‘part of the deal’ in being operationally compliant.

And sometimes there is good, compelling evidence why sometimes care businesses are without a registered boss.

Often, as staff move onwards and upwards, the vacancies are hard to plug. Getting the right person on deck is paramount to both the smooth running and general ambience of the service – but it all takes time

There’s some great advice in the latest edition of the Brunswicks’ Care Review, a great source of legal updates and mostly presented in a way all of us can understand.

It appears that editor Keith Lewin has had a bulging postbag relating to the penalties issue and he offers some wise words in response.

Firstly, “a penalty notice can only be applied with a care provider’s agreement.”

He advises that those with recruiting issues should be “slow to accept” them. In such circumstances and providing there is good documented evidence, a penalty notice is not an appropriate response.

He also goes on to explain the industry-wide and direct consequences of acceptance.

I quote: “There are consequences for individual care providers of meek acceptance; first, there is the beginning of a record of non-compliance which CQC will undoubtedly refer to in more formal penalty situations, for example, when before a court or tribunal.

“That said, there is a more wide-spread consequence for all care providers when many accept the penalty. It is this – that the regulator becomes convinced that in order to drive change in the sector, first change the rules, then tell people about those changes, provide a period of grace for people to become compliant, at the end of which give inspectors the stick of issuing penalty notices to send a message to all care providers by making an example of the few.”

What concerns me deeply is that the ‘stick’ approach, he says, is “expected to be deployed more in future.”

His reasoning is to be found in the CQCs board of management papers for its meeting last week.

Let me quote some more: “Andrea Sutcliffe, Chief Inspector of Adult Social Care and Corporate Lead for Registration, reported that there was a 57% increase in the number of new registered managers in 2,439 care services which CQC targeted in a six-month period which ended in April.

“I therefore suspect that CQC management will use that statistic to drive through change in the sector at a time when care fee payments from the majority of commissioners of care, local authorities, are still exercising considerable downward pressure on care fees.

“Therefore, for the future, I expect that in matters of provider delinquency CQC will take a much less tolerant approach and that similarly, it can be expected to issue penalty notices.”

Make sure your paperwork is in order! Enjoy the weekend.

Night hospital discharge system must change

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The practice of discharging thousands of NHS patients from hospitals in the middle of the night – despite bosses ordering a crackdown to stop it – made Sky News headlines.

In a special investigation the news team found the “number of patients leaving hospital in England between 11pm and 6am has actually risen in the last two years.”

Way back in April 2012, NHS called on hospitals to cut down on overnight discharges following a series of cases where vulnerable patients had been left to make their own way home.

Some of those vulnerable patients are elderly and in care. It’s a shameful state of affairs.

Clearly the NHS needs to free up beds – but like this? No way!

Figures obtained by Sky News following Freedom of Information (FOI) requests show that despite pleas for it to end, the practice is still widespread and in many cases rising.

Figures show more than 300,000 patients have been discharged late at night since 2012 – an average of around 400 a night. Tens of thousands of those patients were over 75.

A Sky online report claims that “experts say that patients often end up in care homes in the middle of the night.”

Let me quote some more – Nadra Ahmed, chair of the National Care Association, says: “They [the residents] are going back without any relevant information about how their care might have changed, what the diagnosis might have been, their paperwork is not following because people are off duty and often without the relevant medication they need for the following day or even through the night.”

Now the National Care Association is attempting to gather information on how many residential-setting residents this has affected within its membership. The data would be useful and I would encourage a good response . . . please!

But for me there’s a more important question to address: If these patients can be discharged, why no during the day? Many service users who have emergency admissions are left waiting with their carers for hours and delays sometime result in overnight stays. It’s the economies of madness.

Frankly it’s a shambles and here are the stark facts as reported. News asked 160 NHS trusts in England how many patients had been discharged between 11pm and 6am in the past three years.

“Of those, 72 trusts provided figures for all three years. In 41 cases, the number of patients discharged overnight increased.

“In 31 cases the proportion of patients discharged between 11pm and 6am increased. In three trusts it remained the same.

“Of the 72 trusts that replied, 152,472 patients were discharged between 11pm and 6am in 2011/12, rising to 152,479 in 2013/14.

“The figures also reveal that 20,152 were aged over 75 in 2011/12; 19,728 in 2012/13 and 18,548 in 2013/14.

“The proportion of patients discharged overnight remained the same at 2.41%.”

Is this the evidence for poor social care funding?

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I’m sorry, but the whole business of the Local Government Ombudsman seeing a 130% increase in adult social care complaints since 2009 has got to me.

I read there were almost 2,500 complaints made about adult social care to the ombudsman last year alone,

And I also learn that more complaints are made about assessment and care planning than any other issue.

Well, what a surprise! As local authorities struggle to balance their books with ever-decreasing funds for social care, something must give.

And is this the evidence? Probably. Assessments are, after all, the place where monies are spent or saved.

Last year, 442 complaints included concerns in this area, a 7% increase on the previous year, the Guardian online reports.

The newspaper highlights the case of Peter, who lives at home with his mother. He has autism, epilepsy and learning disabilities. “After his NHS funding was withdrawn, the council assessed his needs but failed to comply with its legal duty to agree an aftercare plan,” the article says.

I desperately feel for social workers because many I now acting unwillingly, I believe, as frontline auditors. What a mess we are in!

The 2013 LGO review notes, according to the newspaper, that the 2,456 complaints for that year are “a small number in the context of 1.3 million users of adult social care in England. However, 40% of the total number of complaints the LGO receives are concentrated on 25 council areas.”

As for care reviews, the report shows councils “are getting this basic obligation wrong.”

Dr Jane Martin, local government ombudsman, is quoted as saying: “Over the last few years there have been a number of reviews that have looked at healthcare complaints. We must not wait for a crisis in adult care to examine more closely the way social care commissioners and providers deal with complaints.”

The LGO received 218 complaints and enquiries from private providers, just 9% of all adult social care complaints.

The review adds that while this may reflect good satisfaction, it may also mean that the public is unclear about how and where to raise concerns.

I’m sorry to keep beating the same old drum about funding, but I’ve been saying for years that if we cut, cut, cut in the way we are doing now, there are serious consequences.

Remember: The barometer of society is measured in how we treat (indeed, fund) its most vulnerable.

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.