By Debbie le Quesne

Posts Tagged ‘NHS

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.

BBC goes on the frontline of caring for our elderly

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Reality TV has a way of tugging at heartstrings and I suspect the documentary due to be screened by the BBC on Thursday evening will be no different.

Just reading the preamble on Protecting Our Parents leaves me with a lump in my throat. The programme follows cases over a year from the perspective of professionals, families and the elderly.

The film crew has been given unprecedented access to the NHS and Social Services’ older adults care teams in Birmingham and I’m not too sure how I feel about it.

We have a social care system that is at breaking point for lack of funds and a government that offers a lot of fine oratory, but little hard cash to help.

It appears this broadcast promises a ‘warts ‘n’ all’ look at how it is on the front line for all the parties involved as pressure on the care system continues to mount.

The programme blurb notes “there are more pensioners than children living in Britain.” True!

In an online teaser it adds: “Betty Williams, Jim Page and Henry Robinson, like thousands of older people in the UK each year, are in hospital following a fall. They want to return home but the challenge for the professionals is balancing their safety and independence.

“Betty has been living alone since the death of her husband four years ago. After her latest fall she lay undiscovered for 24 hours, but she is determined to return home.

“Her niece, doctors and social workers are worried that the cluttered state of her house is dangerous. They want her to accept help to put it straight, or move into respite care. But Betty fears this will compromise her independence.

“After the death of his wife of 50 years and main carer, Jim, who suffers from dementia, was admitted to hospital. Despite having to return to an empty house his family feels he’d be happier in his own surroundings and the hospital team agree it’s in his best interests.

“While Henry is recovering, plans are made for his discharge. But his condition starts to deteriorate rapidly after contracting pneumonia in hospital.”

The intimate personal crises filmed at Heartlands hospital demonstrate the myriad ways the health and social care systems attempt to treat and support people despite not being designed to cope with the rapidly increasing demand.

My worry is that these poor souls have been filmed at their most vulnerable, yet I want the public – and indeed our politicians – to know just how bad it is. It’s only way to lever change.

The pros and cons of residential care, hospital admissions, community packages and supporting person choice will continue to rumble on.

In a Guardian piece, series producer Alice Perman says that she and the team felt “pretty despondent” after finishing the project

Why? Because “there isn’t enough discussion across society as a whole about what we want to happen to us as we get older,” she says. I agree.

CQC seeking care providers’ views on new inspections

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The Care Quality Commission (CQC) is asking people who use and manage the running of adult social care services for their opinions on the regulator’s plans for inspecting and rating care services.

The general public is also being invited to pitch in with views along with health service professionals.

It all seems wonderfully inclusive as the commission heads for its new approach on inspections.

New elements include larger, more specialist and expert inspection teams led by chief inspectors, greater involvement in inspections by members of the public with personal experience of services, better use of information to identify risks and plan inspections, and ratings for all health and adult social care services.

A fresh consultation this week zones in on the detailed guidance on how CQC will regulate, inspect and rate NHS acute hospitals, mental health services, community health services, GP practices, out of hours services, care homes; home care services; and hospice services.

  • And the regulator wants to know your views on the following:
    The proposals for a rating system . . . CQC’s view of what a service looks like for any of the rating categories – outstanding, good, requires improvement, inadequate.
  • The questions inspectors need to ask to determine if a service is safe, effective, caring, responsive to people’s needs and well-led,
  • The core services always addressed during inspections.
  • The methods used to gather information about services from the public.
  • The sources of information drawn upon to help assess risk and decide when and where to inspect – the ‘Intelligent monitoring’ tool.
  • The frequency of inspections.

Three overview documents have been published that introduced detailed draft guidance for seven different types of services: · Acute hospitals; Community health services; Domiciliary care (care in the home); NHS GP and Out of Hours services; Hospice care; Mental health services; and Residential adult social care (care homes).

CQC Chief Executive David Behan says the changes are vital to care services “provide people with safe, effective, compassionate, high quality care and encourage care services to improve.”

He makes no bones about the fact that these new inspections will be on the side of service users.

Secretary of State for Health, Jeremy Hunt was reported last week as saying: “A new, independent and rigorous inspection regime will give the public vital information on health and social care performance, and the Chief Inspectors will shine a light on areas where improvement is needed.

“The CQC is seeking views on important elements of their inspection programme and I would encourage patients and all other interested parties to respond. This will help to drive up quality.”

I find myself nodding at all these proposals and agreeing with many, but it appears no secret that the bar is being set ever higher at a times when funding is in crisis with regular closures of both community and residential services.

One wonders, given the current funding dearth how my members will be rated. The jury is still out on this trial . . . will it really drive up quaility – I’d suggest some extra funding would go amiss to achieve this goal.

Care quality alert as screw tightens on the NHS

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Social care and the long-suffering providers who serve its needs are not alone when it comes to underfunding.

In a week of harrowing newsbreaks, I see that NHS acute services are to face more cuts when 2015/16 changes to funding arrangements will see £2 billion transferred to community health and social care provision.

The warning comes in a parliamentary report.

The impact for the NHS is already causing waves, while social care operators in the private sector suspect the cash injection will be far too small to plug the holes.

The House of Commons Health Committee highlighted a warning from the chief executive of health regulator Monitor, David Bennett, that the cash transfer, resulting from the introduction of the Better Care Fund from April next year, will present a “huge challenge” to NHS medical and surgical treatment mostly provided in hospitals.

The committee warned that the current model of care is “not changing quickly enough” to cope with demand and funding pressures.

As a result it appears there is a threat to both the quality of care received by patients and the financial stability of individual providers.

Now the committee has called on both the regulator and NHS trusts to “address the need to develop different structures to meet changing needs”.

“At a time when NHS providers face an unprecedented need to change the care model, Monitor must be a facilitator of change, not an obstacle,” says the report.

The committee stated (published in the Guardian: “The model of care provided by the health and care system is not changing quickly enough, with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided;

“These pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015.”

And sadly, the committee adds that as the financial screw tightens the challenge for Monitor in supporting trusts in financial difficulty is likely to increase.

Social care has always been the poor relation in the care loop and the transfer of this funding from the NHS I fear will do littler other than to deepen the divide between the two essential disciplines.

Join me in care pledge as the NHS welcomes us in

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Yesterday was NHS Change Day – a chance for health workers to make personal but public pledges to improve and inspire patient experiences.

Similar to our Dignity Action Day event it has grown for a single day into a whole month of activity and now those who work in social care are being invited to take part – a clear recognition by the NHS that we have a key role to play.

You have until the end of the month to make a pledge.

It’s all part of working together, integration, making a difference and ultimately crafting a better care service. You can make your pledge until 31 March.

Managers, consultants, carers, doctors . . . anyone in ‘the loop’ of care is welcome to “write on the wall” http://changeday.nhs.uk/wall or go to the Face Book page http://www.facebook.com/NHSChangeDay

In 2013, more than 189,000 people made their own personal pledge to do something different to improve care. Last week, the 2014 total was already 280,000.

Reported in The Guardian online, pledges so far include someone who has committed to learn more and educate more nurses to improve patient safety and outcomes; elsewhere, someone is pledging to tidy their desk more often; a mental health expert wants to be more punctual at meetings and clinics, and a care home manager in Devon has pledged to redouble efforts to prevent avoidable admissions to hospitals for frail, older people.

It’s a new push to embrace social care, something else to do, but the psychology of commitment in a public forum can only achieve good outcomes.

Social care is key to the mapping integration of care streams and obviously, looking at the number of people already pledging, it strikes a chord.

Patients and service users are also being encouraged to take part.

So what’s my pledge? To continue to equip and support the private sector care providers I represent at WMCA to deliver care excellence and to take every opportunity to influence a national upgrading of the worth of social care.

Pioneers announced to lead the charge in care reform

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Coordinated care, integration of care packages, innovative change – the Gov.UK website, mouthpiece of the Cabinet, is full of such buzzwords regarding the future delivery of care reform.

Forgive me please if I seem a little tired of hearing the catchy phrases but transforming care is more than just words.

It does, however, seem there are positive signs of bringing care streams closer together with the announcement this month of 14 pioneering areas leading us to a glorious future of provision (maybe).

The pioneers are showcasing innovative ways of creating change in the health service, which the Government and national partners want to see spread across the country, Care and Support Minister Norman Lamb announced.

According to the government site, these pioneers have been selected by a “renowned panel of experts, including international experts drawing together global expertise and experience of how good joined up care works in practice.”

The aim? “To make health and social care services work together to provide better support at home and earlier treatment in the community to prevent people needing emergency care in hospital or care homes.”

I cannot help believe it is also aimed at saving money as the care funding crisis deepens daily.

In a statement on the website, Mr Lamb adds: “Too often care is uncoordinated, leaving too many people needlessly entering the revolving door of their local A&E again and again, because somewhere in the system their care has broken down.

“We have heard people talk about integration before, but it has never truly taken hold across the NHS. These pioneers are a starting gun for the NHS and social care to achieve a common goal – to get local health and care services working together, not separately, in the interests of the people that they all serve.”

All very laudable. It will be interesting to watch the politics of funding these services come to light as I’m sure they will.

It’s a fantastic concept to have joined up thinking in the NHS and social care and these pioneers “will test new ways of working for everyone to learn from, and drive forward genuine change for the future,” the article says.

Local to us are North Staffordshire and Worcestershire, both selected for this testbed.

It’s early days for these pioneers but WMCA will be keeping an eye on how things develop and trying to ensure that social care does not become the poor relation in these initiatives.


Fund sharing step to end the bed locking

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The Daily Mail claims that it “revealed” a problem of bed locking by elderly people is at a record level “because of a critical shortage of home helps and nursing home places.”

Tell me something new, please. I was not aware the publication had sole revelation rights on this matter, as it’s common knowledge in the care sector.

But I do note with interest the article this week telling us that “more than £2billion of Health Service cash” will be raided to give councils a chance of ending the problem.

Ask any care worker who has acted as an escort taking older people to hospital and they will readily tell you how easily their ‘charges’ can become trapped in hospitals.

The idea of the extra funding is so that hospital discharge units will be able to place such people in to residential or nursing care, or better still, their own homes once they are declared fit.

Chancellor George Osborne said he wanted to end the ‘scandal’ of frail elderly people being ‘dropped at A&E on a Friday night’ by a failing social care system, the Daily Mail reported

According to the publication, the number of bed days lost to the NHS is now the highest since the election, with pensioners who should be discharged stuck on wards for an average of 30 days because they are too frail to be sent home on their own.

In his spending review speech, the Chancellor admitted that far too often elderly people ‘fall between the cracks’ of health and social care.

That’s so true and I’m heartened that George Osborne is aware of the problem.

The Mail reported that he spoke of the elderly “being pushed from pillar to post and not getting the care they should’” . . .

“None of us here would want that for our parents or grandparents, and in a compassionate society no one should endure it.”

He hoped that shared NHS budgets would offer a join-up approach to care, and so do I.