By Debbie le Quesne

Posts Tagged ‘learning disabled

The haves and have-nots: Bizarre economics of care

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The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .


Still waiting for the Care Act to deliver

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I was reminded that it’s been more than a year since the Care Act was implemented. Last month saw the milestone pass by quietly . . . except for a report by industry big-player accountants KPMG, who offer advisory analytics to the care sector.

The paper, entitled “Reimagine Local Government – Time for the Care Act to Deliver, pulls no punches and is a timely wake-up call.

KPMG Director, Andrew Webster, outlined the promise of a better future in a Guardian article. He wrote: “It is now more than 12 months since the implementation of the Care Act, a legislative success many years in the making.

“The act spoke of fair and equal access to support services, vibrant and diverse care provider markets and of people having information about how and when to access services. It was to be a fundamental change in the foundations of social care.

In the run up to its implementation, local councils focused on what the act would mean for them. Directors and professional leaders sought to ensure their colleagues understood how services would need to change and momentum built behind the changes.”

But something seems to have gone wrong. In his words there is a “real risk this momentum has stalled.”

Significantly, he writes: “Instead of surveying a diverse care market, we read headlines about providers considering an exit from the sector.

“Council websites are filled with pages about getting recycling bins or parking permits, but little about how to have a grab rail installed so you can stay in your home safely. For now, the vision of the Care Act largely feels just that: a vision rather than a reality.”

He adds: ”The idea of councils as responsive organisations, guiding people to the best care, is the correct one. It is not only right for the wellbeing of our population, it is right in today’s financially constrained public sector.

“Fewer resources are forcing councils to consider making more radical changes to care, in the same way as they have already changed other services.”

He advises: “Councils should strike a new deal with local people, making it clear both sides have a responsibility to maintain independence and wellbeing. That means everyone acting quickly when long-term care starts to be needed. People have to raise the issue before reaching the point where they need care at home, and councils need to respond with accurate advice about local services.”

With a call that councils should raise their digital game to get simple, but still put comprehensive information ‘out there’ on social care, he acknowledges “all of this costs money.”

Added into his mix is a suggestion that all major local care providers should be brought together into one room; “not to drive prices even lower but to work out how to help providers thrive, support new services coming to market and create a digital platform offering access to these new services.”

These initiatives would then be supported by councils investing in training for specific staff groups, building investment in health technology into their economic growth plan, or working with schools to develop better ways to keep young people healthy.

The possible “foundation of the new era promised by the Care Act?”

Great ideas, but I suspect currently out of reach for too many people. One of the major problems we have as an Association is persuading people outside of our membership to talk to us and each other.

What a difference that would make. Not perfect, but a start . . .

Written by debbielq

July 4, 2016 at 11:54 am

Five years on from Winterbourne: It’s so depressing

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In May an open letter addressed to the Prime Minister called for urgent action for people with a learning disability still stuck in Winterbourne View impatient units.

Families of people abused at the infamous hospital have joined with charities airing their concerns at the “painfully slow” rate of change towards improving care for people with a learning disability.

Figures from the Learning Disability Census 2015 show that there has been little change since the Panorama programme exposed the abuse at Winterbourne View, with 3,500 people with a learning disability still stuck in inpatient units, as reported by Sue Learner in the online Carehome.co.uk. magazine.

As I recall there was a pledge from Government at the time of the newsbreak to move people with a learning disability back to their communities.

Alarmingly, Learner’s report states: “Further figures from the census revealed that of the patients receiving inpatient care, 72 per cent had received antipsychotic medication, yet only 28.5 per cent were recorded as having a psychotic disorder and 1,670 had experienced one or more incidents (self-harm, accidents, physical assault, restraint or seclusion) in the three months prior to census.

“It also shows that 670 people are 100km or more from home, an increase of 17 per cent on the year before.”

Can someone please tell me why five years’ on I’m still able to read reports like this? Have we learned nothing?

The open letter says:

“We the families of people abused at Winterbourne View hospital write to express our anger at the lack of change five years on from the day that Panorama exposed what happened to our loved ones.

“Despite clear commitments and plans from Government and the NHS, today, around 3,500 people, including over 160 children, are still stuck in places like Winterbourne View; often hundreds of miles from home, and at risk of abuse. Lives have even been lost.

‘The rate of change has been painfully slow, and people with a learning disability and their families continue to suffer as a result. Government and the NHS must end this outdated model of hospital care and tackle the inappropriate use of restraint, seclusion and anti-psychotic medication, which is devastating lives.”


The letter’s signatories are Steve Sollars, Ann Earley, Wendy Fiander, Claire and Emma Garrod, Dr Margaret Flynn, author of Winterbourne View Serious Case Review, Jan Tregelles, chief executive of Mencap and Vivien Cooper, chief executive of The Challenging Behaviour Foundation.


Ann Earley’s son Simon was one of the residents who faced abuse at Winterbourne View. He is now back in his local community receiving good care, according to Leaner article.


As an aside, I know the local authorities in the Midlands have worked hard to reduce the numbers of people going to placements out of the area, but it’s clear it’s not the case everywhere.


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

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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.



Care Alliance takes concerns to the DoH

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Along with other representatives of the newly-formed Care Association Alliance I have met with Department of Health officials in Westminster to discuss the pegging of fees with learning disability providers and other industry problems.

It is hoped the talks on the grass-root issues of care provision will foster a future working relationship between government and the Alliance.

With Erica Lockhart from Surrey Care Association, David Smallcombe from Avon and Roger Wharton from Somerset I met with Paul Richardson, Head of Quality and Safety and Karen Dooley, the Policy Lead for Adult and Social Care.

The Alliance was set up last November with a mandate to represent and help local care association support each other.

Key to its aim is a focus to resolve day-to-day issues of care provision and to enhance quality for those in need of it.

The meeting at the DoH headquarters targeted five main issues including the financial restrains driven by government policy and the pegging of fees for four years for those offering learning disability services.

Deprivation of liberty was also on the agenda as the Care Quality Commission has been penalising providers for not having enough DOLS in place. Many local authorities across the UK, unable to keep up with demand, have asked members to prioritise cases and “send through applications gradually” which has added to the regulatory problem.

Misuse of safeguarding orders by some local authorities; the National Skills Academy’s Registered Manager Programme for driving up care standards; and nursing shortages which continue to dog the industry were also discussed.

The Alliance already done a lot of work on the affects of nursing shortages on the care industry and need to ensure we are at the table when discussions are held so we can provide as much pertinent information to the DoH as possible.

In these most recent talks we discussed the sort of information that the associations could gather to feed into the various meetings being held by the DoH in an attempt to impact some of the sector difficulties. It was clearly apparent the DoH is aware of the challenges we face.

There are plans for specific meetings with the DoH with the most appropriate Alliance representatives in the short term and the Alliance has been assured there will be a continued working together as other matters emerge.

A lesson from the flag wavers who won an audience with a prince

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I think I like Prince Charles. He’s outspoken, has valid and strong opinions on the countryside and preserving rural life and is passionate about his beliefs.

Recently he visited the Poundbury extension to Dorchester, which is based on his planning ideals. It’s been hailed as a “sustainable model village” and it’s been going now for 20 years.

The development combines social and private housing with work and leisure facilities and is designed to put the needs of people before cars.

What’s this got to do with the care industry? Frankly, not a lot. But an unscheduled episode during that visit says an awful lot about our elderly and a prince that’s developed a heart for the people.

Poundbury, which is set to be complete by 2025, will then house about 5,000 people. As he made his way through the Duchy of Cornwall community, he was hi-jacked by more than 20 flag-waving residents at Colten Care’s Castle View.

The residents were determined to attract his attention and seize an opportunity to chat to the heir to the throne. And they were not disappointed.

The prince spent 10 minutes chatting to and quizzing these seniors. How lovely!

It was the first time the Prince had visited Castle View since he performed the home’s official opening in 2002.

The royal visit was all about the Poundbury development hitting the 20-year milestone and a visit to a block of seven self-contained flats for adults with learning disabilities, where he unveiled a plaque to mark its official opening.

But this royal visitor, who broke off for an unscheduled call, also brought a very special day into the lives of 20 or so elderly people, a priceless gift.

Activities organiser Sue Goodwin was reported as saying: “He stopped and spoke to everyone and asked about the home, how many residents we have and what sort of activities we get involved in. The residents were absolutely thrilled to be in the limelight. It created a lovely buzz.”

This bunch of sparky elders were determined to be heard and the prince gave them an audience. I’m thinking we may well be missing a trick here. We consistently battle to get our voice heard by government ministers . . . just maybe, we’re lobbying the wrong people.

For years I’ve been saying we need an advocate, a high-profile, respected individual who will fight our corner. I feel a letter coming on . . .

When trust is broken we all feel the pain

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Trust is essential to any element of caring. And when that trust is broken the damage done is immeasurable. It not only affects victims but also bruises the already-battered image of the care industry.

The joys of the internet give ready access to the news no matter where we are.

So playing golf in Portugal, my phone is storing up the latest misery for when I catch up with a coffee. I wanted to know what has happening with the floods in the south, but the BBC were carrying the story of a deputy manager in a care home who defrauded residents out of almost £15,000,

Thank goodness he’s been jailed for two years.

Denise Nichols, aged 55, of Kiveton Lane, Rotherham, took the money from the bank accounts of 23 residents at Wensley Street Care Home, in Sheffield.

He then tried to cover his fraud by creating false records, but was found out after an audit,  Sheffield Crown Court was told.

This is what Judge Peter Kelson QC said: “The real mischief of what you [ Nichols] have done is your gross breach of trust.

“The system relies upon honesty on the part of people in your position and, for five years and eight months, you were dishonest.”

Nichols pleaded guilty to one count of fraud by abuse of position at Sheffield Magistrates’ Court in January.

Oddly, the defence counsel said Nichols t had “no real explanation” for the fraud, but had been going through an “extremely difficult time”.

You bet he didn’t have a real defence! These cases make me so very angry because we all pick up the tab of the wrongdoing.

One of the most special groups of people are those with learning disabilities and Wensley Street Care Home looks after to up to 30 of them.

I am relieved that Nichols has got a proper sentence and his liberty taken from him. As Det Con Jenny Elsley, of South Yorkshire Police, said, according to the Beeb, the fraud was “a calculated and sustained crime”.

While my ager burns over the perpetrator of this crime, my heart goes out to the residents and the staff, who are left to pick up the pieces. I would love to go through just a couple of months without news like this breaking. What it is with people who wish to take advantage of those who are challenged?

Sadly we will never be without them and although we all dislike these kind of stories, be must readily expose all wrongdoing.

I can only hope Nichols has a reflective and educational time in jail.

Fitness to work assessment not fair on some candidates, rules court

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I am aware that some of our West Midlands Care Association members run sheltered housing schemes for those suffering from an array of mental health problems and learning disabilities.

Some of those residents will undoubtedly been faced with a fitness-for-work assessment. I confess to having little specialist knowledge in this difficult field of work but on the grapevine I have head some assessment outcomes that have left me speechless.

Many have been deprived of benefits because of this assessment and a number of high-profile charities have taken up their cases.

A colleague pointed me to a Guardian piece last Thursday, but have only just found time to catch up.

 “The test used to determine whether hundreds of thousands of disabled people are eligible to claim sickness benefits puts people with learning difficulties, mental health problems and autism at a disadvantage, the court of appeal has found, upholding an earlier ruling that had been challenged by the Department for Work and Pensions (DWP),” the newspaper reports.

Three charities – Rethink Mental Illness, Mind and the National Autistic Society – all welcome the ruling.

Reported in the Guardian, a statement from the three organisations, said: “The judges in the original ruling independently confirmed what our members and supporters have been saying for years – the system is unfair for some of the most vulnerable people in our society and is failing the very people it is meant to be supporting.

“It’s fantastic that the court of appeal has upheld this judgment … It would be irresponsible for the DWP to carry on using these flawed assessments as they are. They must halt the mass reassessment of people receiving incapacity benefit immediately, until the process is fixed.”

The DWP, however, seem determined to push a hard line stating that the court’s decision would not trigger a pause in assessments. It added that the judgment would have not effect on day-today business. I bet some bright lawyers somewhere disagree. Watch this space.

The cuts: Good PR or desperation?

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The Eastern Daily Press web pages tell us that “the most vulnerable” people in Norfolk will be hit because of proposals to save £56m in what the county council spends on social care.

It seems to be a story that’s emerging all over the country and like those local authorities in the Midlands with which we work closest, the books have to balance.

Some 15,000 people who get care from the Norfolk county council have to see changes to services.

Shake-ups proposed in the county council’s consultation equate to a £140m saving over the next four years.

And here’s the thing that caught my eye. Among controversial proposals are suggestions that £12m could be saved over the next three years by limiting what people can spend personal budgets on. Okay!

Personal budgets were introduced in a blaze of publicity in 2008. Like the latest buzz phrase ‘smart working’, personalization agendas could be found everywhere.

It meant that sums of money allocated after assessment for personal care could be spent by the service user on whatever they believed enhanced their quality of living.

It was, quite simply, a way to give people more choice on the sort of care they got.

People were encouraged to use the budgets on things which improved their wellbeing – theatre trips, cinema, concerts – as well as essential care needs.

But in Norfolk the council is now proposing to allocate less money for those sort of activities, thus reducing budget allocation.

Harold Bodmer, director of community services, is reported as saying there needed to be a debate over the most appropriate use of personal budgets. Too true. Bottom line: under the current government administration there’s precious little money for social care.

Another contentious cut is to save £6m over three years by reorganising how the council provides care for people with learning or physical disabilities. It seems no-one is escaping.

The council is planning to write to everyone who gets social care from the authority, while the public is being asked to have a say on the proposals.

This is the second kind of public debate plan on the cuts I have heard of in two days. Is this good PR or a genuine sign of desperation?

Report on learning disability standards heartening

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I am passionate about the delivery of good care, but there’s one particular area of caring that always tugs at my heartstrings.

Delivering good packages to the learning disabled I know is hugely rewarding, but equally demanding work.

Very often those who need such care are hugely responsive and often it appears there’s a kind of inherent goodness to be found within their characters.

The range of care too is as vast as it is creative – from personal care to farm employment project, from teaching domestic living skills to encouraging social integration. I’m no expert and confess that my insight into care for the learning disabled is not comprehensive. But I’m thrilled when I hear of success stories in this needy sector, just like the students from Staffordshire who took a trip to Bulgaria to help with building work on an orphanage.

How we need to embrace the worth of these special people!

I note in the last week or two, The Local Government Ombudsman (LGO) has welcomed an update report by the DH on its progress towards improving care for people with learning disabilities.

Dr Jane Martin, Local Government Ombudsman, said in a statement on the Local Government Ombudsman website: “We welcome the report and the progress made in recent years to improve health and social care for people with learning disabilities, especially the positive attitude of care staff and the increased involvement of the people themselves, and their families and carers, in decision making.

“However, any instance of a person being disadvantaged because of their disability is one too many, and we are still finding these in our casework.

“For example, we recently reported that Essex County Council failed to safeguard the welfare of a young man with learning disabilities who suffered serious injuries at a care home it funded to look after him.”

All of this is positive, but a telling quote that adds:”It is also clear in the report that people are still finding the complaints process difficult” concerns me.

Dr Martin adds: “It can be confusing for the public to know where to turn to when services go wrong, and we have been actively arguing for a simplification of the current system.”

Of all people groups, the learning disabled do need an easy access to complaints procedures. Let’s hope there’s quick fix for this problem.

DH’s Six Lives Progress Report, is published in response to the LGO and Parliamentary and Health Service Ombudsman’s (PHSO) joint report from 2009 entitled Six Lives: The provision of public services to people with learning disabilities. This report told the story of six people with learning disabilities who were failed by health and social care services, resulting in prolonged suffering and inappropriate care.