Blog of Debbie Le Quesne
Chief Executive of West Midlands Care Association
She has worked in the Care Industry for over 20 years and before that was involved in fund raising and supporting several Care Homes for the Elderly and Learning Disability
Currently she is the Chief Executive of the West Midlands Care Association and the Co Chair of the Care Association Alliance
"I work with Care Homes, Supported Living and Homes Care Agencies. We all admire the work they do and we want them to feel that they are not alone in trying to provide quality care in a ridiculously complex market in such trying times.
Blog post 14 August 2017
Reimaging the future of social care: Ideals need action
Social care . . . what will become of it? I often muse on the future and what will emerge when my watch with West Midlands Care Association is over.
Technology undoubtedly must play its part, though I’m still wholly persuaded that no matter how clever robotics become it will never replace the human touch.
On a global scale the first challenge is to tap our collective intelligence. To quote a recent piece I read, “there are many tools available to involve more people in the design and implementation of social care policies.”
But central to the development of social care must be those who are its users. It is they whom must be the building blocks of any new design.
Fused with a political will to achieve ‘a sustainable solution’ our Government needs to draw on the experiences of providers and a global platform of brilliant thinkers.
But anything new – I too worry about the proposed options that may be tabled in the cross-party Green Paper – brings almost natural resentment.
There clearly needs to be a commitment to experimentation. It’s the only way to know if that which is new could work.
Key to all of our futures in the care sector is communication and a generous spirit of needing to share funds and information. Perhaps we’re getting there, but the progress is painfully slow in national terms. Health and social care need to work hand in glove, but they’re sadly two very separate entities.
Paul Burstow, a former Government care minister, wrote a fascinating article in the Guardian last month that focused on those who had embraced the future of caring.
Under the headline “Here’s what the care homes of the future should look like”, he unpacked life in a gated care village at Weesp in the Netherlands. Designed for people with dementia, it had a supermarket, streets with shops and small-scale homes.
None of the staff wore uniforms and the ethos was centred around the normal rhythm of life. Residents who were able were helped to cook, wash up, handle laundry and other domestic duties.
The development literally mimics real life and there’s even side-by-side cycles that more able residents can help pedal.
And then there was the UK care home Burstow found that formed the Wide Awake Club for residents who could not sleep at night, engaging in crafts, games and even meals.
Of course these enlightened models of care come at a cost – finance, yes, but also a willing to reimagine all of our futures and do something about it.
Ideals cannot have effect without action.
Blog post 10 August 2017
The Croft – simply 'Outstanding' and a great antidote to the gloom
I have some excellent news that proves good care is still happening and it's right on our doorstep! And it's a timely snub to those who bleat that there should be more excellence in the care sector.
How many times have I heard 'we'd expect to see more outstanding ratings' . . . ? Too many!
Indeed, the CQC pinnacle of praise is rarely found, so how appropriate it is I should be blogging about it.
Last month we saw how the vulnerable were ‘playing Russian roulette’ choosing care. Flashed across our TV screens the Care Quality Commission said drug errors, lack of staff and falls were major problems, after inspecting 24,000 services.
Nursing homes had the worst problems, with a third falling short on safety. Gloom, gloom and more gloom.
The commission added the failings across services for the elderly and disabled were "completely unacceptable".
Chief inspector Andrea Sutcliffe said funding remained an issue for the sector and a "long-term solution" needed to be found but lack of money was "no excuse".
She added: "There is still too much poor care, some providers are failing to improve, and there is even some deterioration."
It was a blow that the care sector could have done without and I responded passionately, stating that the vast majority of care – certainly on my West Midlands patch – was good.
And here's the proof: How utterly delightful it was to find one of our members, The Croft Residential Home, in Finchfield, Wolverhampton, had been rated as ‘outstanding’ in their recent CQC inspection.
Frankly, I’m not surprised. The Croft has been an excellent care home, providing both nursing and personal care, for a long time and either its manager or owner have been to the WMCA events in Wolverhampton focusing on quality in care homes.
The CQC report states: “People received care and support from staff who were knowledgeable and competent in their role.
“Staff had received training to ensure their knowledge was up to date and that they acted in accordance with current best practice. People were asked for their consent before care was provided and where decisions had to be made on people's behalf this was recorded and staff acted in people's best interests.
“People were happy with the food and drink provided and staff were responsive to changes in people's nutritional needs and sought appropriate healthcare advice when required.
“People were supported by staff to maintain their health and staff at the home had established strong working relationships with local healthcare professionals.”
It added: “People and relatives spoke positively about the kind and caring nature of the staff team. People had developed strong affectionate relationships with staff, who proactively promoted their dignity and independence. Staff recognised the importance of involving relatives and friends in the community at The Croft and visitors told us they were made extremely welcome whenever they visited.
“Staff were aware of what was important for each person living at the home and took this into consideration when supporting them, to ensure their independence was promoted and supported.
People told us they were encouraged to make their own decisions about daily life and staff supported them discreetly and with diplomacy where required.”
And the glowing praise goes on and on. It’s a timely reminder to us all that good care is still happening and can be recognised by CQC inspectors.
Well done, all of the staff at The Croft. It’s a real boost to the team at the association and a result that is thoroughly deserved.
Blog post 3August 2017
BBC beds shortage report: West Midlands bucks trend and still has capacity
As you’re probably now aware, nationally we are facing what as been described as a ‘huge shortfall’ of beds in residential care.
The BBC broke the news yesterday and we’ve posted the piece on our website.
Radio 4, which is generally measured and well-researched in its news presentations, painted a bleak picture with “up to 3,000 elderly people” facing the prospect of not being able to get by the end of next year.”
Research commissioned by Radio 4's You and Yours programme reveals a huge shortfall in the number of beds available.
Obviously increasing demand from an ageing population could see that grow to more than 70,000 beds in nine years' time, Samantha Fox reported.
Unfortunately, what the BBC didn’t say was that the shortage is NOT in every area of the country.
The West Midlands still has a surplus of capacity.
Again the response from the Department of Health was predictable, saying local authorities in England had been given an extra £2bn to help fund social care.
But we all know the cash is a drop in the ocean and is probably being diverted to health (Blog post 1 August 2017 Social care cash to go on health – LGA chair warns).
Significantly, the Beeb reported that in the past three years one in 20 UK care home beds has closed, and the research suggests not enough are being added to fill the gap.
Let me quote the online BBC report: “The research, carried out by property consultants JLL, found that since 2002 an average of 7,000 new care home beds had opened in the UK every year, but by 2026 there would be an additional 14,000 people needing residential care home places per year.
“Lead researcher James Kingdom said: ‘We're currently building half the number of care home beds every year that we need.’
‘There are more people living longer.
‘We know that over the course of the next decade there is going to be 2.5 million more over-65s, and as a result that means there is going to be demand for care home beds.
‘To fix that, we need to double the rate of delivery’,”
For the full report see out news bulletin http://www.westmidlandscare.org.uk/news/
Blog post 1 August 2017
Social care cash to go on health – LGA chair warns
The Independent announced funding intended to improve social care is being used to bail out the NHS.
We all knew this was on the cards, but seeing it in print brings home the stark reality of the financial problems the sector faces.
And we learn too from the online article “divisions between local government and the health service have widened as councils raise the prospect of a revolt over ‘completely unacceptable’ threats to withhold money unless they meet targets for reducing NHS bed-blocking.”
In the March Budget an extra £2bn was handed out to social care and was meant to be spent through the Intergration and Better Care Fund (IBCF).
It has now emerged that “most of it will go towards delayed discharges in the NHS.” says the daily newspaper.
Let me quote from the article: “Izzi Seccombe, chairman of community wellbeing at the Local Government Association, told The Independent the NHS was effectively ‘signing off’ the funding, and urged that social care workers should be treated as ‘equals’ to their health colleagues.
“She said: ‘It was very disappointing to hear that the money is only addressing the actual managing out of hospital care, not all the stuff we’re trying to do to prevent people going in, such as supporting carers and helping people in independence to keep people in their own community for as long as possible’."
Seccombe refers to the financial move on delayed discharges as “a bit of a land grab,” explaining that the NHS was to set targets for local authorities and if they cannot achieve that there’s going to be a penalty.
And this, according to the article is “is likely to be in the areas that are most financially challenged." Guess that must be my area.
Clearly social care is the sad Cinderella once again as Seccombe urges we need to be treated as equal partners.
Effectively social care monies are being spirited away by health because it has a problem. Where is the logic, I ask. Cutting funding for social care services that aim to prevent people from going into hospital will surely lead to more pressures on the NHS.
The demands for community care are at an all-time high as people are supported in their own homes with the express purpose of keeping them out of hospital.
If they are not properly supported in their own homes they are less likely to be fit and well and more likely to put pressure on A&E, bringing on more problems, Seccombe warns.
Discharge financial penalties . . . creative accounting with social care cash . . . what next?
It appears The Independent is the only newspaper carrying this story. Why? At the risk of sounding paranoid (and perhaps a little like US President Donald Trump) it does sometimes appear there is a publishing industry agenda to keep the public in the dark over certain social care news breaks and this is one of them.
Blog post 31 July 2017
Still wating to grasp the nettle of social care
Writing for Driven by Health with Care, Debbie Le Quesne review the social care landscape and offers some timely advice to struggling care providers
The political landscape is a complex one where uncertainty reigns. Theresa May did not emerge as the force to be reckoned with as many had predicted and the snap election has left social care – and many other things – in limbo.
Any hung parliament is one founded on compromises and with the recent analytics pointing to May’s radical social care proposals as key to her downfall, the proverbial nettle is still to be grasped.
Clearly the British public is reluctant to pay the price of care for an ageing population, leaving our politicians between a rock and hard place as they assemble their wisdom for the long-awaited Green Paper on a sustainable way forward.
Clues from the Queen’s Speech are few, but we do know May shredded the Conservative manifesto, abandoning pledges on social care reform – gone is ‘those that can pay, must pay’ along with energy price caps; and a new generation of grammar schools.
All we are guaranteed is a cross-party consultation – if you please, the life raft of the social care Titanic.
Reflecting on the General Election rhetoric, would it be so unrealistic to expect the public to pay for its care?
I am always surprised that no-one talks about the actual amount of funding that is already provided by the Government in benefits and state pensions . . . perhaps this could be used to offset some of the costs?
A friend of mine was worried when his ailing mum had to move into a residential home. He sold her house believing the capital wouldn’t last very long. However, he was surprised when he calculated he would have to use only a small amount of the sum each week.
Equally I was shocked when someone else explained the home care his father was receiving came at a price and was presented invoices from the local authority.
The care provider believed the local authority was footing the bill, but this man’s family were in fact paying their council for the service the artificially reduced rate for his care that has had major consequences on sustainable care in some regions.
In an ideal world (other things being equal) the natural development of economics dictating price and business success or failure, has been scuppered by this engineered lower rate. Its effect is two-fold: Providers whose core business is with local authority referrals are struggling to survive, while the already dented consumer market is at further risk of diminishing.
Worryingly, the Department of Health seems to believe it is genuinely helping social care. Ed Moses, deputy director at the Department of Health has confirmed that two thirds of the £2bn set aside for social care will go on fees, systems and assessments, and relieving late payment issues that have dogged the sector.
One third in his opinion will help relieve hospital bed-blocking pressures, particularly over winter. Really?
I suspect there are very few councils that will be brave enough to use the monies as part of an overall initiative to increase their fees for social care and pass on the increments to those from whom they buy beds.
The money is welcome, but it’s far from a solution without further forward funding, especially when it is appears to be aimed at ‘prevention, not cure’.
Recent guidelines show it must be used to keep people out of hospital, but I’m not sure how that remit is being worked out with local authorities, or CCGs.
Want to solve the hospital winter bed chaos? Invest heavily in paying realistic social care fees, thus allowing the care marketplace to function properly now and develop future growth.
Interesting, isn’t it, that my home care members and those with residential homes take more people from hospital than my nursing home members, but nationally there seems to be a CCG focus that only nursing is suitable for hospital discharge. With properly-funded care demands on doctor call-outs, district nurses and ambulance crews plummet, but CCGs desperately need to be part of this solution.
Forward-thinking with CCGs
Whatever happens, we need to work together but CCGs in some regions cannot understand why. It baffles me that the only time the private care sector is properly engaged is when there’s a need for project support – stopping falls or Infection prevention.
But there are some strident advances in our attempts to work together. Dudley is forward thinking and on board with a project to support residential and nursing providers night and day. It’s early days and not without IT issues with some care staff, but I’m hopeful this could be a national model.
No support for Home Care
Sadly, home care – essential for any plan to keep people out of hospital – remains the Cinderella of the sector. I have home care members dropping out every week as they are so stressed and they don’t earn a minimum wage rate themselves out of the £13 per hour paid by local authorities.
In an attempt to keep the service viable, WMCA is running a conference that that will zone in on business survival. Working together, pooling resources and ideas will help secure a future, but we desperately need to make it clear that those tendering for contracts at less than £13 per hour are going to struggle.
Last year we warned providers that taking a tender for three years with these figures would return a first year with a small profit, the second small loss, and the third year a big loss. Bizarrely, there is still a rush to tender.
Care quality and funded places
The quality of care is always paramount, but it’s at risk like no time before. However we dress it up: Money buys quality. There are ever-hungry council commissioners seeking beds at a knock-down price. The reality check is simple – pay more, have fewer places; pay the same and receive poorer quality.
I am concerned that in talks with West Midlands Care Association, officers apologise profusely that rates cannot be raised yet still demand increased quality, more administration and a greater reservoir of provision. It’s an impossible ask.
Surviving the challenges
In the absence of a Government lead, I believe it is we as the care collective body that must take it. That means securing a future for both supply and demand in the sector. If you run your care business as a business and not a charity that helps shore shore up local authorities there is hope, but some big lessoned need to be learned.
Be realistic with CQC rating targets
One of the things I hate advising my members in the West Midlands to do is NOT to aim for an outstanding CQC rating. Intentions are good, but business reality can be cruel and there is no local authority extra payment to recognise such achievements.
Unless there is a generous percentage of self-funders on the books, ‘outstanding’ goals can quickly diminish already meagre resources.
It is, in my opinion, far better to aim at being consistently good – no mean feat in itself. If you look at CQC’s ratings and map them with what the authorities pay, you’ll find the more authorities/self funders pay, the greater the number of good providers.
We have very few outstanding home care providers and the ones that have achieved this have additional running cost to support staff and their clients. Remember too that ‘outstanding’ does not necessarily mean your care is below standard.
Understand your area
Understanding the demography of your area and where you best service user potential is found are essential. Assessing potential clients’ ability to sustain realistic rates for care is also key. Geographically, some areas will support top-ups, while others not so.
Market your business
Don’t ignore your marketing and public relations. Get some good images – it’s worth the investment when you see what some businesses load into their websites. And ensure that everyone knows what you are trying to achieve with your care. The internet is the biggest shop window you could ever imagine and it’s seen by potential clients, social workers, commissioners and potential staff.
Have a look at the good, the bad and truly awful sites out there and learn lessons.
Work with your local care association
Ensure that you are part of a providers’ voice of reason. Help assemble data that is a true reflection of outgoings that can be part of an essential toolkit for those speaking for you.
Most regional associations will know what is happening. Several of the areas I work with are carrying out cost of care exercises. Experience tells us that the best way to secure upward shifts in fees is with credible, independent financial data on the costs of care.
We have always had the LA funded/private funded divide in the care sector, but I believe as the market shrinks because of the enduring austerity measures it will become more clearly defined.
What will remain will often be determined by geographical location alone . . . a catchment area that can support private payers should convert into a healthy business model. But it’s the businesses that are wholly reliant on council-funded placements I fear for most. I am regularly being told by local authorities that they believe there should be more outstanding providers, but are not prepared to pay the price for it with raised bed fees.
For those businesses that geographically straggle both the ‘have’ and have-not’ areas, it’s essential to secure a proper balance of council funded and self-funded service users. It’s common sense, but hospital discharge officers and commissions badgering for urgent beds can easily upset finely balanced margins.
Long term I foresee a smaller, leaner social care sector emerging as beds currently filled at unrealistic rates are lost with closures.
Perhaps all the answers to this long-running saga of our embattled care industry will be found in the Green Paper, but I’m not holding my breath.
The old saying ‘you get what you pay for’ is true, but educating the public that this must apply to a commodity that whom for many will not be ready to purchase for decades, is a steep curve to climb. Odd, isn’t it, many elderly needing home care will shun the service because of cost, yet have paid for a cleaner and gardener for years . . .
Debbie Le Quesne
Co Chair of Care Association Alliance and CEO of West Midlands Care Association
Blog post 30 July 2017
Another financial time bomb ticks away
The Guardian newspaper has posed an age-old question: Who looks after the carers? Unexpectedly it concluded the taxman, but the answer is true – even though it may not be the whole truth.
Earlier this year, in a case brought by Unison, an employment tribunal ruled that carers who stay overnight so that they are there if their client needs help should be paid at the minimum wage.
The decision, though clearly a moral one, has far reaching implications as providers and charities have suddenly found themselves facing ‘another bill’. Those councils – most, I suspect – with stretched finances will also have to meet the obligations.
Up until now, overnight care was covered by its own set of rules which generally meant carers were paid less for overnights.
Most of these kind of night covers would see the carers being able to sleep. Minister have delayed the rolling out of the ruling until October, but “HMRC is now demanding that employers cough up the maximum of six years’ back pay,” reports The Guardian.
Provider and councils, I’d suggest, will simply not be able to cough up the estimated £400m bill.
Inevitably, it will result in private sector contracts with local authorities being handed back, bankruptcies, and those we care for being victims of a ruling they have had no part in.
The dom-care sector will be worst hit, along with the rights of all those people who need this kind of service as their chances to live independently, or just to receive overnight care at home as part of a bigger package, become financially compromised.
The seven-year austerity measures that have squeezed social care to breaking point surely must end soon . . . which brings me to the Green Paper on the way forward. We’re still waiting.
Blog Post 11 July 2017
Safety first in Pimp Your Zimmer contest
West Midland Care Association’s Pimp Your Zimmer completion is still creating interest as providers discover its creative approach to helping residents say safe.
A great concept, the campaign has seen measureable outcomes in the safety of older people
Residents of members’ care homes were encouraged to transform their grey and uninspiring walking aids into glamorous works of art by adorning them with bespoke artwork.
The concept was initially the idea of Angela Donlevy, manager at Chalkney House care home in White Colne, near Halstead, who wondered to herself ‘Why are all walking frames grey?’
The Pimp My Zimmer seed was sown and when we learnt that it helped reduce falls in some care homes by up to 60 per cent we wanted to encourage members to take up the idea,
The ‘pimping’ plan has been particularly helpful with residents who have memory loss, the unique frames proving a reference point of ownership and a gentle reminder they need to be used for walking.
Our winner was Florence ‘Floss’ Pierce of Eversleigh Care Centre, Wolverhampton. Her frame was perhaps the most poignant of all the creations we saw.
Other finalists were: from Greenleigh Care Home, where Tracey Pearson submitted a resident’s frame with a distinctive Back Country ‘Bostin’ cup of ta’ creation; Barry Thomas (Halas House) with a cheery musical offering; and Lil of Broadway Halls Care Home with camper van art – a reminder of her camper van travels.
Blog post 10 July 2017
Good care still out there as WMCA members scoop clutch of awards
I’m not one for self-congratulation (well, maybe a little bit) but only when there are exceptional circumstances to validate praise.
So please will you indulge me as I applaud the membership of WMCA which did so well in Birmingham’s recent glittering Care Awards 2017 event.
Of the eight awards presented to celebrate excellence in care, four were scooped by association members, as well as the Lifetime Achievement Award, that recognises more than 25 years of “sustained contribution to the care sector.”
Sharon Grey, from Birmingham Jewish Community Care, was honoured with the Lifetime . . . award. Well done – an exceptional commitment.
Hosted at the Edgbaston Cricket Ground last month, the award winners were selected by an independent panel of judges and presented by Shefali Oza, the main weather presenter and news broadcaster on BBC’s Midlands Today programme.
Winners received engraved awards and certificates.
The WMCA winners were: Wayne Ching (Oakview Care Home) Excellence in Support Services to recognise integrated service development that offer a better experience for citizens; Marcia Lewis (Macc Care) Excellence in Care to recognise consistently high standards of care and exemplary all-round care skills; Stephanie Patterson (Oakview Care Homes) Exceptional Newcomer to mark outstanding development and achievement during a period of less than two years; and John McHugh from (Bourneville Village Trust) Commitment to Workforce Development Award to recognise a significant difference made to the quality of service provision.
No-one in the care industry is in it for self-gloryfication, but I believe good care needs to be honoured.
To have been part of the awards in Birmingham was a privilege and having another eight members shortlisted, it provides a good industry barometer that excellence in care can still be found.
See pictures from the night on our Facebook page.
Blog post 8 July 2017
Salvaging Home Care Together – our conference you dare not miss
So the Care Quality Commission has announced that social care is in a “precarious state.”
Indeed, it is. And we had a snapshot of its findings throughout the news bulletins of the last few days. Some pretty emotive dialogue was uttered too . . . Age UK warned the results leave elderly people and their families “playing Russian roulette” when they choose a nursing home or other care service.
One in three nursing homes failed the official inspection, with spot inspections finding medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet.
Anyone would agree that the catalogue of misery in this analysis seems endless.
Of all adult 24,000 social care services in England, the Care Quality Commission has judged 21 per cent “inadequate” or “requires improvement” in the first full checks of their kind.
A quarter of those checked have been found wanting on safety.
The list of poor practice makes uncomfortable reading and viewing. I’m furious over some of the findings, but not surprised that only 50 of all care services had managed to achieve the top rating of “outstanding”.
Despite the £2bn extra cash for social care from the government, the industry is still struggling and sadly will continue to do so until the services offered are properly funded and properly staffed.
In an ideal world money and the quality of care should never be bed partners, but they are and like never before the industry – particularly where the core client bases are local authority funded – is financially creaking.
Andrea Sutcliffe, chief inspector of adult social care at the CQC has promised to shut down homes that don’t improve or display serious failings and it’s a move I fully support (see the WMCA statement on the home page).
She also zoned in on training and recruitment – something that’s at the heart of West Midlands Care Association provision.
We cannot change this report of shame, but we’re committed to trying to help its members achieve excellent ratings . . . and perhaps more importantly – sustainable, great care standards.
Clearly we cannot align ourselves with indifferent providers, but for those who need support we’ll do our best to signpost relevant helps and to inform of training workshops run and supported by WMCA.
We believe we are relevant and earthed in the practicalities of navigating these difficult times. To that end we are planning a Rescuing Home Care conference on September 7 and the keynote speaker will be Neil Eastwood, author of the book Saving Social Care.
The book provides a practical approach to recruiting the best frontline care employees.
Recruiting and retaining a caring workforce to keep pace with the needs of an ageing society is one of the greatest challenges we face.
At the same time, Neil recognises traditional methods of finding suitable care staff are delivering diminishing returns.
All providers need new ways of finding and keeping the compassionate and loyal care workers of tomorrow.
In an approach that’s accessible and practical, Saving Social focuses on:
- Knowing exactly who your perfect care worker candidate is
- Tapping in to what are referred to be “secret sources” of new staff in Optimising your recruitment process to reduce wastage
- Spotting high potential applicants – and avoid troublemakers – much faster
- And 20 other proven retention techniques to minimise care staff loss
Get the date in your diary for the event at the Portway Lifestyle Centre, Newbury Lane, Oldbury.
More details are on our website event listings
Saving Social Care is available at Amazon
Blog Post 6 July 2017
Brexit – we need assurance for EU workers to ease the social care crisis
It was just a matter of time before someone mentioned Brexit and staff drain in social care.
Both special care providers and the NHS are losing vital staff.
I read that in 2016, 209,000 people working in the sector in the UK were EU nationals, up from 121,000 in 2009 – a rise of 72 per cent (Office for National Statistics).
But since the 2016 EU referendum figures show that the number of non-British EU nationals who said they worked in the UK public sector tumbled by 27,000.
Care England chief executive Martin Green says the problem of EU nationals now leaving is “quite significant”.
In The Guardian he’s quoted as saying: “One of the things we are seeing is that people are making decisions [to leave] when they are thinking about the next phase [of their career], or have been here two years. The other problem is that they are not being replaced.”
Clearly the future is uncertain for all of us and the message from Professor Green is one that many care providers on my patch will understand only too well.
It’s a problem which the NHS shares – England alone has a shortage of 40,000 nurses and 3,500 midwives, according to the Royal College of Nurses.
We need desperately the EU nationals who take some 90,000 jobs in England’s social care workforce (Skills for Care data).
According to NHS Digital figures for March 2017, a record number of EU nationals are also working in hospital and community health services (61,934), up from 57,604 12 months ago.
The number includes 10,668 doctors, 22,232 nurses and health visitors, 1,384 midwives, and 7,383 scientific, therapeutic and technical staff.
We need assurances NOW that those currently in the social care/NHS employment loop can remain in the UK post Brexit.
Meanwhile, staffing pressures will continue to mount with new levers of tension above and beyond what’s been ‘normal’ for years within the care sector.
My fear is that proposals by the government to allow all EU nationals living in the UK to apply for “settled status” post-Brexit will just add to the problems.
All 3 million EU citizens living here will have to apply to be included on the “settled status” register.
This may just be a day when chocolate is on the menu for breakfast.
Blog post 4 July 2017
At last – BCF lifeline for Staffordshire
Staffordhsire is to get £30m from the Better Care Fund to help with its social care programme.
I read the news in The Sentinal online this morning as I was catching up on the social care headlines of the day.
In June last year Staffordshire County Council approved cuts totaling nearly £14m to shore up social care, so doubtles this latest news will be welcome.
Delays in getting the money ‘out there’ have been partly caused by CCGs being instructed by NHS England to ‘prioritise funding’. Clearly, Staffordshire have had more than their fair share of prioritising to do (memories of the Francis inquiry report come flooding back), but at last it appears we have some traction here.
As ever, the cogs of funding help turn very slowly, but the £30m will help offset – at least for a little while – Staffordshire’s £15m shortfall that was announced last year.
The allocation will include £15m in the current year budget, and another £15m for 2018/19 and 2019/20.
And obviously this is in addition to the extra monies raised from Staffordshire taxpayers, following the authority's decision to impose the maximum three per cent social care council tax precept earlier this year.
The Better Care Fund programme spans both the NHS and local government and seeks to join-up health and care services, so that “people can manage their own health and wellbeing, and live independently in their communities for as long as possible.”
The vital thrust of such cash is to keep the frail and elderly out of hospital, something all local authorities are keen to achieve.
The intentions of the BCF are good, but long term prospects are at best foggy: The government’s extra BCF cash will cease in 2020.
Let me borrow some quotes from Staffordshire County Council’s Alan White, cabinet member for care.
In today’s report he’s quoted as saying: “This year the council will be spending a record £300 million on social care of adults, people with learning disabilities and children in our care.
“The Government has recognised the incredible funding pressures to provide social care for an increasing number of elderly people in counties like Staffordshire with the limited budgets available.
“This extra grant will help prevent some people from having to go into hospital by caring for them in their homes and communities where possible, will help towards paying increased care staff wage bills and will reduce delays in hospital discharges and assessments.
“However, while this funding is both welcome and needed to protect services, it is important to recognise that this is limited and it is more important than ever that people keep themselves as healthy and independent as possible and plan ahead for their later years."
Clearly a new way of funding social care is needed in the long-term. In the care sector, however, we have noted that all government care fixes to date have been short-term ones.
£30m is a huge sum of money, but sadly just a drop in the ocean towards resolving the national social care headache,
Blog post 3 July 2017
Social care's future: Is now the time MPs are really listensing to us?
I know the Queen’s speech was a little while ago, but it struck me this weekend nothing much was said on the future of social care funding.
I assume, therefore, that if there’s little to say, there’s no real proposal in the offing and turned to Google in the hope of discovering more information.
The speech was spectacularly non-committal regarding the care sector. My ministers will work to improve social care and bring forward proposals for consultation” was the sum total of the subject that clearly played a major part in seeing Mrs May ‘s disastrous election result.
But perhaps, with a hung parliament and lessons learnt, politicians will now have to listen to those who run and use the care services.
Emeritus professor of social policy at Brunel University London, Peter Beresford, noted that never again will sensible politicians “treat social care in such a cavalier fashion as May’s election team did.”
Does this mean then, there’s hope for us? Perhaps.
Beresford controversially challenged social care policy in his book All Our Welfare, drawing on theories that ‘user knowledge’ could remap the current model.
Greater service user involvement has been one of the pillars of modernizing care, both in residential and community settings. But In my work with West Midlands Care Association and the Care Alliance on behalf of members I seek to influence change. Indeed, we have spent many hour building relationships with ministers and backbenchers MPs in the hope of being heard.
It appears now, doesn’t it, that taking a high-minded stance on the future of social care can be costly for any government. What was it with the ‘dementia tax’ U-turn and subsequent disastrous polls outcome, I feel sure all politicians will so much more keen to hear service users’ proposals for the future.
The Institute for Fiscal Studies observed that the May plan made “no attempt to deal with the fundamental challenge of social care funding”.
Finding the way ahead doesn’t promise to be easy, but like no time before I believe there will be political appetite for ideas.
Social care policy is a massive voting issue.
If the DUP deal with the Conservatives collapses, the Prime Minister would have little choice but to propose an early election.
Smart money for a win will be on the party that embraces the care industry ‘think tank’ providers and those to whom the care is given.
Blog post 28 June 2017
Now it looks like more cuts are on the way
Chris Hopson, chief executive of NHS Providers, which represents hospitals, has warned in a BBC report that a “very difficult winter” is on the way.
The reason? Because despite of a £1bn social care cash injection in the Budget, savings still have to be made, according to Association of Directors of Adult Social Services,
And today the BBC is telling the elderly, disabled and frail to expect cuts to care services and rises in charges, following the latest ADASS survey which polled 151 council care chiefs about their plans for 2017-18.
ADASS says £20.8bn was expected to be spent on care this year, a rise of 5 per cent since last year.
I recall blogging that the Budget cash was just a drop in the ocean – it appears I was being perhaps over-generous.
Rising demands for social care services is hard to quantify, but we all know it’s a fact of life and will continue to escalate.
ADASS surveyed 151 council care chiefs about their plans for 2017-18 and the results show £14.2bn of their own council monies will be spent, rising to £20.8bn when the £1bn cash injection – money from the NHS for care projects and the fees users are asked to contribute – are taken into account.
The Beeb reports ADASS is expecting to save some of the savings through improved efficiency, but added those using services – whether in their own homes or in care homes – should still expect those services to be rationed even more.
Some 1 million people rely on council care services, two-thirds of them older people.
I dread to think that the bar of social care could be raised yet again, but I’m sure it will be the case, effectively making it harder for people to access the care they need.
Already the council chiefs have predicted user charges would also rise in some places.
Unbelievably, according to the BBC report: “Care providers – the companies that run care homes and home care services – were also told to expect their fees to be squeezed.”
Surely, with such a forecast the Government will have to intervene.
Successive cuts year on year have yielded £6bn of savings in social care since 2010.
In an interview with the BBC, ADASS president Margaret Wilcox said the system remained on a "cliff edge".
"The need for a long-term solution has never been more urgent or vital.”
In the light of this, frankly, scary report, I really must now ask what is the Government plan? The so-called ‘dementia tax’ has been put to sleep and the Department of Health appears to be silent.
Oh yes . . . the Green Paper to set out perhaps ‘plan B’ for the future funding of social care: Has anyone seen such a document?
Blog post 26 June 2017
The brave new world of cooperative care – dream or reality?
I’m definitely not in the Simon Cowell wealth league, but I’d like to think I’m pretty savvy when it comes to the economics of business. Running the West Midlands Care Association, like all businesses, involves the social science of economics that essentially deals with supply, demands, profits and losses.
Overhauling the financial mechanics of the care sector is a daunting proposal, so when I read that ‘co-operatives are the way to more efficient and compassionate social care’ I was intrigued.
Politicians of all parties must come together, not only to plug the hole in social care funding, but also to think hard about how the system spends that money, the article in The Guardian says (I’m sure I’ve recently blogged something along these lines).
“No overhaul of funding will be sufficient unless there is a simultaneous shift in our approach to providing care and prioritising wellbeing,” the report’s author, Ed Mayo, adds.
But then I get a little lost with Mayo’s vision for a care industry where the financial essentials of economics are replaced with a kind of corporate ownership. “Our future care system cannot be organised around price, competition and profits. We’ve done that for 20 years and it hasn’t worked,” Mayo proposes.
Mayo is secretary general of Co-operatives UK, the national business association for co-operative and mutual enterprises.
He is co-author of the book Consumer Kids, and is involved in a range of organisations and enterprises that promote a fairer and more sustainable economy. “Our future care system cannot be organised around price, competition and profits. We’ve done that for 20 years and it hasn’t worked,” he writes, adding: “This means care has to be about people, relationships and communities. Regardless of the amount of money we have to spend, we need to organise activities and resources in ways that bring people together and give them meaningful control.”
The sentiments are honourable, but the call for a cooperative approach to the care industry for me appears to be a big ask.
And it would be a very bold government that would adopt what are referred to as “practical steps” towards such a future.
· Eencouraging commissioners todevelop a better procurement framework, one that allows and encourages commissioners to propagate real partnerships with community and user-owned mutuals.
· Learning from the groundbreaking Social Services and Wellbeing Act in Wales and use it to amend the English Care Act so that it specifically requires local authorities to promote the development of community and user-owned services.
· The need for more resources so communities have the tools and support to organise.
· Setting up of inn ovation funds that give users and communities genuine ownership and control, so social care providers can be held accountable by users and workers – because they are More public service mutuals to adopt multi-stakeholder ownership, with users and communities as members alongside staff.
Mayo declares it’s time to reimagine care. I have a fertile imagination which would even dare to believe in securing fair rates of pay for members’ care services. But even I can’t visualise this particular brave new world.
Blog post 21 June 2017
Dom care: The perils of 'alternative' introductions
There’s an ‘old guard’ out there in the care sector which often speaks of the Halcion days before regulation.
Doubtless some of those people made an awful lot of money, but we are now in more enlightened times when wealth and playing by the rules have to be bed partners.
Recently I read a story in The Independent about two brothers who are championing a new way to lock into domiciliary care.
Adam Pike and his brother Daniel were still young when their grandmother was diagnosed with dementia.
She wanted to stay at home, but she was in a different area to where the Pike family lived.
The Pikes didn’t have enough money to hire private carers and relied on a council social care package.
Eventually, a care home had to be chosen after grandma flooded the home twice.
Today there are two million people elderly people in the UK who require care, but generally it comes at a price.
The Pike brothers’ answer was their SuperCarers initiative, an online platform that provides an alternative to private home care and local authority services by linking carers and families and letting the two parties arrange the terms of care.
At this point the alarm bells stated to ring.
Yes, technology is reducing the overheads here; yes, it cuts out the middleman; and yes, as it does not manage or direct care operations dodges independent regulator the Care Quality Commission.
Agencies have higher overheads because they manage carers on behalf of families, acting as an employer.
And they also have a legal responsibility to deliver standards within the CQC framework. Training, DBS checks, and professional management all have to be addressed in an agency business.
Whilst I applaud the creative thinking of the Pike brother, I can’t help feeling this the thin end of the wedge that the ‘old guard’ would wish to drive harder into the care industry.
Halcion days? Maybe they were with some care providers having a moral conscious and delivering excellent, dignified care.
History tells us, however, that some had little care for standards. It’s a fact of life we need regulation in the industry and West Midlands Care Association works tirelessly with the CQC to help educate its members what the commission requires.
A proceed with caution, therefore, must apply to anyone seeking the SuperCarers option.
Blog post 19 June 2017
'Red top' report makes me see red (again)
I seldom read the ‘red tops’, but at the risk of raising my blood pressure braved an online dip into the Mirror. Big mistake.
Within minutes I was tense and then . . . angry. In fairness, it wasn’t the fault of the Mirror, but the facts in the report. Here we go: NHS paying private firms millions to beat bed blocking after social care cuts’.
What firms, where? Is social care getting a cut of the cake? Sorry, I have no answers and neither did the piece I read.
I had hoped for a brighter horizon post election, but the same stories emerge yet again.
The NHS Partners Network document talks of a private hospital ringfencing beds for patients from an NHS hospital, adding: “What began as an emergency arrangement is being developed into a more permanent option.”
I began to crave chocolate (bad sign) when I read there had been a 110 per cent rise in patients waiting for a care package at a nursing home since 2010.”
The NHS Partners Network, an association of private firms, insists using their services will save the NHS cash.
The report by the NHS Partners Network, the trade association for private firms providing NHS services, adds: "The independent sector has been working with the NHS to help reduce delayed discharge through providing access to community care, extra bed capacity, step down units, virtual wards and rehabilitation services for those who need it."
Am I missing something here? A Government – indeed, successive Governments – have cynically chosen to underfund social care. Net result – more pressure on those same social care providers to help ease the problem, but no extra finance to do so.
My growing concern is that the inconclusive General Election will cause social care reforms to stall. I know local authorities will be exerting pressure. but . . .
Delayed transfers of care are a growing problem across the NHS, leaving NHS patients in hospital longer than clinically necessary and also costing the NHS upwards of £820million a year.
Mrs May, Emergency arrangements appear to be the ‘permanent option.’ Is this the reform we’re seeking? Surely not.
Blog post 16 June 2017
CQC seeking our views: Now have your say
The Care Quality Commission wants our views in helping it shape the next phase of regulation in England.
For the next eight weeks our voices can be heard – so please don’t miss the opportunity.
- Changes to the regulation of primary medical services such as GPs and dentists and adult social care services such as care homes and home-care services.
- This includes the frequency and intensity of inspections and how CQC monitor, provide and gather intelligence.
- Improvements to the structure of registration and definition of ‘registered providers’.
- Further information on how the regulator will monitor, inspect and rate new models of care and large or complex providers.
‘Inadequate’ adult social care facilities would be inspected at least every six months, and those ‘requiring improvement’ would face annual inspections, as now.
However, those rated ‘good’ would have up to two-and-a-half years between planned comprehensive inspections and those with an ‘outstanding’ rating would have a gap of up to three years (up from two years in both cases).
This consultation also includes plans to register corporate providers, rather than just their individual services, so that the regulator can make those providers more accountable for the care delivered in their separate facilities.
The second in a series of three consultations aimed at simplifying and strengthening the way we regulate, I can only hope it will do just that.
The care sector is awash with regulation and in the opinion of many the current system of ratings does not necessarily reflect the quality of care, but rather the ‘exam technique’ of the provider.
‘Strengthening’ (the Commission’s term) is a big word with potentially even bigger consequences.
My understanding is that it means to give strength to. Does this mean even more powers?
I’m reminded of the statutory police charge caution: You have the right to remain silent; you do not have to say anything. But it may harm your defence if you do no mention when questioned something that you rely on . . .
Staying silent, I believe, negates our right of complaint when things are introduced we believe are unfair and unhelpful.
Have your say, be heard! Visit: www.cqc.org.uk/news/stories/tell-us-your-views-our-next-phase-regulation
The consultation runs until Tuesday, 8 August 2017.
Blog post 15 June 2017
CQC softens its approach to learning disabled bed registration
The Care Quality Commission has climbed down over a proposal to limit the number of beds for learning disabled.
In line with National Institute for Health and Care Excellence (NICE) policy on autism accommodation, the regulator appeared to want to restrict registration to facilities housing six people or less.
But an amended version of its document ‘Registering the right Support’ was published earlier this week.
The new guidance says that the CQC “will not adopt ‘six’ as a rigid rule” for providers of any service for people with a learning disability and/or autism.
And this is the critical bit . . . Smaller providers, but with more than six people in their care will be considered for registration “where providers are able to demonstrate that they follow all of the principles and values in Building the Right Support guidance, and meet the fundamental standards and other relevant regulations,” it says.
I’m heartened by this amendment as it acknowledges the need for such services and that CQC have taken on board responses to their consultation.
Martin Green, chief executive of Care England, has already commented that CQC judgments should be about quality and no size and that’s true.
My concerns principally involve the bed ceiling for such services and whether small model preferences are economically sustainable in the current marketplace.
I’m hopeful that some good will come from this announcement, but before I feel comfortable to pass any more comment, let’s see how it works out in the ‘real world’ of practice.
Blog post 14 June 2017
Celebrity chef joins dementia cake bake day
Best known for being a haute cuisine teacher on the reality television programme Ladette to Lady and as a judge on Soapstar Superchef, Rosemary Shrager is backing the Alzheimer’s Society Cupcake Day tomorrow.
The aim: To unite the public against dementia by encouraging families, friends and colleagues to bake or buy cupcakes to raise money for the charity.
The culinary whizz has not only spoken out in support for Cupcake Day, but has also shared her tips for making the perfect cupcake:
Rosemary, who also presented The Chopping Block on ITV and is a judge on BBC’s The Big Family Cooking Showdown to air later in 2017, said:
“I’m delighted to be a part of Cupcake Day because it’s an event that’s great fun for all ages to get involved with and for such an important cause. “Someone develops dementia every three minutes, and there’s currently no cure but your help can go towards changing that.
“Cupcake Day is a perfect opportunity to do a good turn and help others; dementia is little understood by many but is set to affect more and more of us.
“There’s surely no better way to do your bit for this great cause than by baking, buying and eating cakes.
“It’s not too late to take part in Cupcake Day! We’ll be making it a team effort at my cooking school; you can do the same with friends, family and colleagues.”
Okay . . . so I’m more of a chocolate person than a cake addict, but I’m almost tempted to give it a go. But my question must be: Who would be brave enough to sample such Debbie creations?
Tips from Rosemary:
- When you’re making any form of cakes, the first thing is to make sure you whisk your butter and sugar properly, that’s very important – I think it’s quite nice to make the mixture fluffy with plenty of air bubbles.
- The next step is to add your eggs and then you add your flour, folding it in.
- Make sure you add a rising agent to the mixture, ie self-raising flour or baking soda – as long as you do this the cakes will rise in the oven. The eggs are also a rising agent too.
- The fun really begins with the topping and you can actually start experimenting– you can make the toppings different colours, putting colouring in the icing.
- Try whipping a little bit of double cream into some curd cheese for a topping, or you could whisk some butter and some sugar for the top of the cakes, or simply top the cupcakes with icing fondant – anything goes!
- Just try it and if it doesn’t work try it again. The most important thing is not to be rigid, to just experiment and to have some fun!
Dementia is set to be the 21st century’s biggest killer and theses fundraising initiatives are so important.
To find out more: https://cupcakeday.alzheimers.org.uk/
Blog post 13 June 2017
A cross-partry approach to solving the care crisis
The people have spoken and here we are with a hung parliament. Depending what you read or whom you believe the reasons differ. But one theme emerges again and again: The issue of how funding is achieved for long-term social care.
A dominant issue with voters, it touched a nerve and helped change the landscape of government.
Both Labour and the Conservatives wanted to do something about the potential catastrophic costs of care in later life, both wanted to join up health and have one-pot funding, and both saw the need for a solution that was sustainable.
The sums were different, the messages confusing. We’re dropping the Dilnot capping, said the Conservatives, only to change their mind.
Labour suggested a cross-party consensus on how social care should be funded – perhaps, for me, one of the most realistic approaches to the problem that was aired in the pre-election spin.
The cross-party approach is not a new one. Last year Independent Age urged David Cameron to build a model to fund social care and in doing so to include the input of other political parties,
In an open letter, signed by 40 organisations, it said “make the Commission a reality.”
Back in January 2016 Simon Bottery, Director of Policy and External Relations at Independent Age, said:
“Without a robust health and care service that delivers for older people when they need it, the UK will never be truly prepared for ageing.
“A Commission on the future of health and social care is the vital first move towards recognising that the health and care systems cannot work in isolation – only when they work effectively together can the needs of older people be met. This is a conversation we cannot avoid if we are truly committed to ensuring older people have the quality of life they deserve. We urge the Prime Minister to back this Commission.”
Now it appears financial institutions are urging the same approach.
Old Mutual Wealth, big players in the UK and international investments markets, are calling for a cross-party approach.
Responsible Business Director, Jane Goodland has this to say in a Guardian Online article: “A cross-party parliamentary group should consider all possible options when it looks for the answer to this crisis.
“It should find a multifaceted solution that will encourage people to save for their long-term care. Current policies use a stick, threatening the public that care costs may drain their funds. An alternative is to use a carrot and incentivise people to save.
“Whatever solution is reached, it needs to be simple, sustainable and communicated in consumer friendly language. Anything else will leave the public back at square one.
“The power of simplicity has been touted by some of the great minds of history. However, when it comes to the debate around social care, it appears policymakers have yet to grasp this important concept.”
We need the best minds, inspired solutions and strategists to make them happen. To think these ‘gifts’ to society belong to just one political branding is ridiculous.
Social care needs joined up thinking; let’s have some in the House of Commons, please.
Blog post 12 June 2017
Carers Week: This unpaid army deserve so much more
Carers – where would we be without them? Interesting, isn’t it, that the UK public does not feel that unpaid carers are sufficiently valued, according to a new online poll published today (12 June) for the start of Carers Week.
More than 7 in 10 (74 per cent) of the UK public feel carers are not sufficiently valued by society for the support they provide and this figure rises to just over eight in ten (83 per cent) of those who have previous experience of caring themselves.
The unpaid care provided by the UK's carers has been estimated to be worth £132 billion a year.
The figures is staggering. I’m heartened that such a huge benefit is given out of generous hearts, but simultaneously saddened that this army of 6.5 million people in the UK is not financially rewarded in some way.
According to organisers of Carers Week, the numbers of unpaid carers is rising faster than the general population. Each day, 6000 people take on a caring role but the poll showed that many people are unaware how likely it is they would take on a caring role and would be unprepared if they did become a carer.
One in five people aged 50-64 are carers yet half of those who are not currently carers (50 per cent) thought it unlikely they would ever become a carer.
When asked their top three concerns, affordability of care and the impact on their finances is the top worry (46 per cent) for people who have never had a caring experience if they were faced with taking on a caring role. Coping with the stress of caring (43 per cent) is the second biggest worry.
Nearly a third who have never cared for someone (32 per cent) said they would worry they didn't have the skills or experience to become a carer and more than a quarter (26 per cent) said they would worry about the impact of caring on their physical health.
Carers have worse health than the general public; carers providing 50 hours or more a week of care are more than twice as likely to be in bad health as non-carers. Worryingly, almost a quarter of those polled who have never cared (23 per cent) would not know or understand what help would be available if they became a carer.
The online YouGov poll was conducted on behalf of eight major charities that are calling on the new UK Government and society to do more to recognise the important contribution that unpaid carers make and support them to care.
Heléna Herklots CBE, on behalf of Carers Week, said in a Press statement: "It is deeply concerning that three-quarters of respondents feel carers are undervalued by society for their contribution and this figure rises further for those who have caring experience themselves.
“The Carers Week charities seek to raise awareness of the huge contribution that carers are making every day to the lives of the family and friends they support and to their communities.
In Carers Week we're calling on the public, government and all parts of society to play their part in supporting carers by helping to build communities that recognise and understand the value and needs of carers.
“From hospitals that provide discounts for carers in their cafés, or workplaces that give employees paid leave for caring; to offering to shop for a friend who struggles to get out of the house, there are hundreds of small changes we can make to ensure our communities become more carer friendly.
“We urge our new Government to do more to value and recognise the contribution made by the UK's 6.5 million unpaid carers and urgently set out its plans by publishing a strategy for carers.”
I’d like to say I’m surprised that so little is in place at Government level for these wonderful people, but I’m not.
For most of my working life I have dealt with professional carers on a daily basis and just like our army of volunteers they too are undervalued.
The members of West Midlands Care Association and other representative organisations like it deliver some excellent care against all the odds.
But these are people who have been trained and chosen their working roles.
As a society we depend on their unpaid care – something that’s becoming more and more prevalent.
I campaign tirelessly for the proper funding for the social care sector and like no time before we have a voice in the corridors of power.
These remarkable souls, who are honoured in Carers Week, indeed deserve a Government action plan to recognise and support them.
Thousands of events and activities are taking place across the UK for Carers Week with hundreds of individuals and organisations pledging to play their part in building Carer Friendly Communities.
Blog post 8 June 2017
Single pot funding: Could it ever really happen?
As the nation heads to the polls today and a future government is elected, I find myself musing over what it really would be like with a single pot funding stream for the NHS and social care.
Indeed, as I’ve said often, social care really is the Cinderella sister in this partnership, but if – and it’s a huge ask – there was a proper effort to share funding, would our sector ‘go to the ball’.
Progress has stalled often; too often for me.
Integration would mean coordinated assessments on patients’ need being brought together and services commissioned with a kind of corporate agreement.
I read the other day that Governments and the NHS have been firing off integration policies since the 1970s.
In 2019 we had the announcement that £2.7bn would be transferred from the NHS to local government to promote joined-up working; in 2013 the spending review announcement of the Better Care Fund, which resulted in health and local government pooling £5.3bn to integrate services and reduce pressures on hospitals; the launch that year of the Integrated Care and Support Pioneers Programme with aims to join things up by 2018 and the Five Year Forward View in 2014.
Fascinating, isn’t it, the University of York carried out a study of 38 integration schemes and discovered no real evidence of less hospital admissions.
Le me quote something from The Guardian regarding the Better Care Fund: “The fund aimed to save £511m in its first year, by cutting demand for hospital services.
“Everybody in the NHS knows that stabilising emergency admissions would be a huge achievement, let alone cutting them, yet local Better Care Fund plans played along with the fantasy that they could deliver a rapid reversal by promising total reductions of 106,000 admissions between 2014-15 and 2015-16, saving £171m.
“Admissions went up by 87,000, costing £311m more than planned. Furthermore, delayed transfers were supposed to be cut by 293,000 days; they went up by 185,000.”
The National Audit Office throws light on not so much the infighting ‘it’s my money’ issues, but the real barriers to chance:
Misaligned financial incentives, workforce problems and poor information sharing.
Driving for togetherness is well intentioned and would ease the social care crisis. But the central fabric of the structures in which both sides work will need to change.
Duplication is a massive problem, communication breakdown is another and isolation issues are plentiful.
Could tomorrow’s new government pull it off? Judging the evidence so far, probably not on my watch.
Blog post 2 June 2017
Conference earthed in the realities of the current care climate
Earthed in reality – that’s me. And like no time before, the care sector needs just that approach.
That’s why our West Midlands Care Association Conference has a lazer-sharp focus on business.
Training, the latest in what’s happening with the Care Quality Commission in the Midlands, legal updates for the sector and the announcement of the Pimp Your Zimmer competition . . . all at the forthcoming event.
With a packed programme aimed at helping members’ avoid the sector gloom, the June 13 conference at the Portway Lifestyle Centre in Newbury Lane, Oldbury, promises to be an essential investment of time as the sector continues to struggle with underfunding issues.
Under the banner of ‘Three options – Give up, Give in, or Give it all you’ve got!’ the conference, which starts with a 9am registration, will offer responses to the harsh realities of the current industry challenges. It’s what we need.
Assessing training competence will include the latest from the Aged Care Channel (ACC-TV)) with live and online programmes that ensure compliance in demonstrating competencies have been assured. Suzy will be the speaker for the day.
Association solicitors Harrison Clark Rickerbys will take delegates through the most recent legislative changes to affect the care industry and CQC will be advising providers on what to address in care provision for good inspection outcomes.
With the issues of data protection becoming more acute as care staff are required to divulge information to agencies, CCGs, social workers, hospital staff and ambulance crews, the conference will focus on exactly what is and what’s not allowed.
From members’ feedback, the association understands the constant worry staff are facing meeting data protection standards and this session is highly recommended.
Chartered accountants, tax specialists and business advisors, Hazlewoods, will be delivering a presentation on Assessing Profitability and Sustainability in your Accounts. With a practical approach questions addressed will include what care industry accountants must consider (including tax matters).
West Midlands Fire will take a look at fires in care homes, how to avoid them and other industry-related issues.
And then on a lighter note, care supplies company Hyperama will be presenting the winning prize for the Pimp Your Zimmer competition.
The contest was inspired by a speaker from Essex Local Authority at a recent conference who addressed the matter of dementia falls, as many with the memory-loss condition just forget to use their walking aids.
By personalising walking frames, residents were able to take ownership of the aid and recognise it belonged to them.
The outcome was a reduced number of falls in homes.
The association has received pictures of some fantastic frames. Hyperama are offering a hamper to the care home/provider and a prize to the resident/client who has the best Zimmer frame.
Send your entries to firstname.lastname@example.org
Blog post 31 May 2017
Election social care proposals: Are any really credible?
The long road to social care reform appears to be getting longer. So far in the last 19 years we’ve got through 12 Green Papers, White Papers and four reviews.
Frankly, the track record on social care policy with a succession of government is . . . rubbish.
It disturbs me there seems little common ground between the three parties vying for power, though I do note both Labour and the Lib Dems appear to be moving towards a single integrated service for health and care with a pledge on a cross-party consensus for long-term funding.
My big question is where will the money come from? We have a growing problem, a sector in tailspin decline – even CQC has warned of a looming tipping point `– and more and more care providers closing.
Labour appears to favour more tax for the rich and big companies, while the Lib Dems want a 1per cent tax increase and maybe a care tax in the long term.
Okay, I understand, but there’s no indication of what will be enough money to sustain future social care, or whether, indeed, it would solve the current crisis.
That leaves me musing on the Conservative election pitch for social care. Howe things change. In 2013 a pillar of health policy was capping care costs.
Now with what the King’s Fund describes as an “inverting of the policy” are expected to spend down their own money (including the value of property) until they are left with £100,000.
Let me quote Richard Humphries, King’s Fund Senior Fellow (Policy): “The direction is clear – access to services will depend on a triple lottery of where you live, what you can afford and what is wrong with you (develop cancer or heart disease but not dementia and your house and savings will be intact).”
Such policy raises so many social questions. Undoubtedly, people will be discouraged to seek help in attempts to preserve their estates thus increasing the probability of more unplanned hospital admissions. And then what’s going to happen to the learning disabled and physically disabled who are working age and without assets?
We are, I fear, at point where the two tier system – the haves and have-nots – of both care providers and those needing their services will not change. We have focused much on care quality (a good thing), but the care of the future will zone in more on the choices we are prepared to make.
There is no socio-economic policy in place that can generate the funds needed to pay for all those who need care. What I’ve read so far from all parties does not change that.
Where are the costed proposals? Without such information are any of them remotely credible?
Blog post 30 May 2017
What the election manifestoes say on socail care
Call me cynical if you wish, but somewhere between the deceit, lies and impossible electioneering dreams lies the truth of what social care will be like under a newly elected government. Sadly, I don't possess a crystal ball.
Making a choice for the good of both the care sector and those who need it is never going to be easy without the ‘whole truth’ being available – a commodity as scare as hen’s teeth when it comes to the lessons on electioneering history. Navigating that process for General Election Day requires careful examination of what party ‘promises’ are out there.
West Midlands Care Association is non-political and would work with any party to advance the quality of care. It’s therefore important I make it clear in this blog post that is not part of an electioneering agenda.
Of the issues that have sparked interest from all political persuasions, Theresa May’s social care plans certainly seems to have ignited the blue touch paper with even the Conservatives now bickering among themselves over the implications.
Interesting, but for me hugely frustrating as it appears the immediate issues of the care crisis are now – once again – on the back burner.
Let’s have a look at what thee three major political parties have to say about their vision of social care.
It is, I believe, as one national newspaper said “the unfinished business through successive governments for at least the past 20 years.”
Both the Liberal Democrat and Labour manifestos describe social care as being in a state of crisis.
Well, that’s certainly true and with a £2bn predicted shortfall this year alone, who could possible argue is wasn’t.
The Lib Dems pledge to bring in an immediate 1 penny income tax rise ‘to rescue the NHS and social care.’
Tim Farron says money from income tax rise will go into ring-fenced £6bn annual budget to address chronic underfunding (personally, I think the budget prediction is way too low).
In the longer term, however, this would be replaced with a health and care tax.
This would bring spending on both services together in a collective budget, and be made clear on people’s pay slips what was being spent on those services.
The party said it would seek to establish a cross-party health and care convention to review longer term sustainability of the health and care finances while setting up an office of health and care funding, similar to the Office for Budget Responsibility.
The manifesto also pledges to “finish the job of implementing a cap on the cost of social care.”
So what about Labour? The party manifesto commits to “lay the foundations of National Care Service for England. It also says there would be a limit on lifetime contributions to care costs.
Labour adds it will “seek consensus on a cross-party basis about how it should be funded, with options including wealth taxes, an employer care contribution or a new social care levy”.
The Guardian notes . . . “Despite the considerable length of the Labour manifesto (128 pages, compared with 100 for the Lib Dems and 88 for the Conservatives), it has little to say on the detail of the different options.”
The Conservative political manifesto presents the costs of ageing and care as currently all “borne by working people through their taxes”.
The Conservative plans for long-term care, which talk only of elderly care and have nothing to say about others who may need care. Clearly there are West Midlands Care Association members whose care reaches younger adults with a whole raft of conditions.
Mrs May’s party states the system of care “is not working”.
“Where others have failed to lead, we will act,” the manifesto declares.
The social care changes proposed are that the value of someone's property would be included in the means test for receiving free care in their own home – currently only their income and savings are taken into account.
People will be able to defer paying for their care until after their death.
Those in residential care – whose property is already taken into account in the means test – can already do this.
There will also be an increase in the amount of wealth someone can have – savings and the value of their home – from the current £23,250 to £100,000 - before they lose the right to free care.
That means that however much is spent on social care, it becomes free once someone is down to their last £100,000.
In a nutshell the manifesto’s proposal is to raise the means-test threshold to £100,000.
Critically, however, the manifesto makes no mention of a cap on what a person may have to pay for care before this threshold and for the first time ever the value of a person’s home will also be included when means-testing for support in the home.
People will be able to remain in their homes, but will be forced to release equity or defer payment until the house can be sold after their death.
Well, that’s it . . . and I still have a load of unanswered questions. The disputed boundaries between NHS and social care funding do not appear to be addressed in any detail and that must be an essential trench of any policy that’s future-proof.
Complex, socially and economically challenging, no doubt much more will be said before I cast my vote.
Blog post 26 May 2017
Standing with Age UK on its manifesto to the emerging government
We are a civilised nation – yes. We care for the most vulnerable – yes. We provide for those who are frail and elderly – yes. We look after those with learning disabilities and ensure no-one is struggling in their homes alone – yes.
Well, maybe not; in fact certainly not.
You see I’m a hopeless liar and no matter how many times I try to encourage myself things are getting better, I’m hit with more disturbing data that reaffirms the reason I head up the West Midlands Care Association.
My rationale is simple; if we can facilitate excellence in care delivery those who need it should get it at a level that’s the envy of the world.
If good will and well-meaning sentiments were currency, my members would all be millionaires. Their stoic determination to just keep going despite the financial chaos over fees paid by local authorities inspires me.
But I find myself becoming increasingly frustrated in what feels like a perpetual uphill struggle to get traction with our cause.
Age UK recently announced that nearly one in three elderly people are struggling with essential tasks of living and called on all political parties to put social care at the heart of their manifestos as new figures reveal high numbers of over-80s going without the help they need.
Their new findings reveal that 794,000 of the ‘oldest old’, those aged 80 or older, are unable to carry out at least one activity of daily living (ADLs) and are either receiving inadequate care or no care at all.
Such simple and essential tasks include washing, eating, getting out of bed, going to the bathroom, dressing, or walking.
Shockingly, of all those aged 80 or older who are coping with at least 3 ADLs – meaning they must have really substantial difficulties – more than half (56%) are either receiving help that does not fully meet their needs, or does not meet their needs at all.
And now as we race towards the General Election, Age UK is calling on the next Government to address this situation as a matter of urgency.
It says it is another example of our social care system in freefall, where significant numbers of our ‘oldest old’ – who include some of our most vulnerable citizens – have effectively been abandoned by a system that has been chronically underfunded for too long.
Chronically underfunded too long . . . yes!
In England, there are approximately 2,622,000 individuals aged 80 or older. Age UK’s new analysis shows that:
Here are the facts that should shame our politicians:
Among people aged 80 or over with at least 3 ADLS
- 260,000 have difficulty with 3 or more ADLs (10% of the entire age group).
- Of these 260,000, around 86,000 (33% of all with 3+ADLs and 3% of the entire age group) receive no help.
- Of these 260,000, around 145,000 (56%) have unmet needs: they either do not receive any help or help that does not always meet their needs.
Among people aged 80 or over with at least 1 ADL
- 926,000 have difficulty with at least 1 ADL (35% of the entire age group).
- Nearly half a million of them (491,000) do not receive any help (53%).
- Of those who do receive help, 70% (303,000) do not receive help that fully meets their needs.
- 794,000 (equivalent to 86% of those with one or more ADLs and 30% of the entire age group) do not receive any help despite their needs, or receive support that does not always meet their needs.
In Age UK’s manifesto to the new government – Dignity in Older Age and a Later Life Worth Living – the charity focuses on ensuring that older people receive dignified care at home, in hospital and in care homes.
The Charity is urging the next Government to continue to pursue a twin track approach towards social care: being prepared to invest emergency funding in the short term to save the system from complete collapse – a real risk in some areas; while also developing an effective plan to ensure a sustainable financial future for social care in the longer term.
The current social care crisis is eclipsing and with other representative bodies we stand with Age UK to help change the inevitable miserable outcomes of historic government neglect in social care.
Blog post 22 May 2017
New report points to huge regional variations in social care spending
I’m not normally a follower of the financial Press, but I note with interest the Financial Times has seen worthy to turn its attention to social care spending by councils.
In real-terms local authority spending on social care per adult between 2009–10 and 2015–16 fell by 11 per cent.
The fact comes from a media release from the Institute for Fiscal Studies (IFS), a piece of work funded by the Health Foundation, a charitable body that aims “to bring about better health and health care for people in the UK.”
The FT reports a West Midlands reduction in social care spending by 17 per cent. Although I don’t doubt the figures and indeed, they are scary, I’m not sure whether they fully reflect just how bad thing are.
Plenty has been written on the state of social care and doubles with the launch of the Conservative manifesto on radical socal care funding, much more will be.
For decades I’ve said geographical differences in the delivery and funding of care are diverse and it’s a point the FT has brought to our attention.
Here we go – and this is from the PR put out by the Institute:
- There remains significant variation in councils’ social care spending across the country: spending was less than about £325 per adult resident in a tenth of council areas, while it was more than about £445 per adult resident in another tenth of council areas in 2015–16. That’s a difference of more than a third.
- Councils where there are relatively more people over pension age (particularly those entitled to means-tested benefits), and where levels of disability benefit claims and deprivation are higher, tended to spend more on social care. Higher local earnings levels are also associated with higher levels of social care spending.
- Even so, these ‘spending needs factors’ explain only a small proportion of the variation in spending across councils. Indeed, councils’ ‘scores’ in the last official needs assessment in 2013–14 can only explain around 13 per cent of the variation in what they actually spent on social care per person in 2015–16.
- In part, this may reflect inaccuracies in that needs assessment, and the fact that by 2015–16, the assessment was two years out of date. But it will also reflect that given similar needs, different councils are likely to make different trade-offs between spending on adult social care and spending on other services. And they have different overall budgets (from council tax, business rates, and grants) from which to fund their service spending.
- In addition to council spending, care recipients often contribute towards the cost of their care through fees and charges. These raise an average of £63 per adult resident, but the amount varies widely: one-in-ten councils raise less than £35 per adult resident, while a further one-in-ten raise £95 or more.
- However, there is no clear relationship between local authorities’ own spending and fee income. It is not the case that all high spenders charge lower fees, nor that all low spenders rely on high income from co-payments to meet costs.
I’m reminded of a quote from George Orwell’s Animal Farm, essential reading for English lessons of my generation: “All animals are equal, but some animals are more equal than others.”
Orwell’s comment was on the hypocrisy of governments that proclaim equality of their citizens but give power and privileges to a small elite. Not quite the same premis, but the facts state that in varying degrees, some have, some don't.
Devolved power allows local authorities to spend budgets mostly as they see fit – a good thing, I believe.
But the figures presented clearly show big differences in spending per adult on social care among councils assessed to have very similar spending needs by the government. Some, indeed are ‘more equal’ and are worthy of better funding.
Our media guy knows of a West Midlands family who are moving to Wales because they fear massive care cuts in local authority provision for their severely disabled daughter would make life unbearable.
Wales, they say, is “a safe refuge because social care is being preserved.”
An extra £10 million a year of new funding will help ensure the social care sector is strong and sustainable for the future, Welsh Government Minister for Social Services and Public Health Rebecca Evans announced in January.
As supporters of the providers of social care, my West Midlands Care Association, it would be fascinating to know how the IFFS spending cuts map translates to business wellbeing (or the lack of it).
Such a study would be fraught with regional demography complexities and it’s not one I’d wish to undertake.
The data does, however, provide another raft of evidence that social care has at best been financially neglected, or (depending on my levels of paranoia) positively persecuted.
2009–10 and 2015–16 (both in 2016–17 prices), and changes between these years by region
and council type
Blog post 19 May 2017
Stand with us as we stand togther against dementia
Tomorrow (Saturday) will mark the end of Dementia Awareness Week – the annual event that highlights the memory-loss condition and how we all can contribute to finding a cure.
Our televisions are regularly invaded with the clever advertising campaign by the Alzheimer’s Society encouraging to put differences aside and “unite against dementia.”
It’s a powerful promotion . . . dementia does not care who you are. It will affect us all and is set to be the 21st century’s biggest killer.
The ad campaign reflects some of the realities of society, tapping into uncomfortable truths and challenges assumptions by showing that everyone can – and needs – to come together in the face of this invasive health problem.
I can only hope that this week has created a talking platform where new cases can be recognised earlier because someone has been brave enough to seek help.
The hurdle of acknowledging someone close may have the disease is a huge one and very often partners of those diagnosed make excuses for their behavior early in the dementia journey.
Truth is we all bury our heads in the sand from time to time. But if you’re seriously concerned, and the problem continues, it’s important to talk to someone about it. The sooner you know what you’re dealing with, the sooner you can get on with your life and feel in control again.
Earlier this year it was revealed that dementia is now the leading cause of death in England and Wales. For the first time, more people are dying of dementia than heart disease – in 2015, 1 in 9 people died of dementia.
The number of people who die from dementia each year is increasing and while there is progress in treating many major health conditions, there’s still no cure for dementia.
It doesn’t seem that long ago where diagnosis was hit and miss, where care home staff would recognise symptoms, but the resident would be ‘undiagnosed.’
Thankfully that is now changing with more people receiving a diagnosis of dementia than ever before. Some two-thirds of people now get a formal diagnosis
Changes in the way cause of death is recorded have also meant more people have dementia recorded on their death certificate
But, the figures also reflect that there are more people living with dementia and that, sadly, there is still no cure.
I read that of the top ten causes of death, dementia is the only one we can’t prevent, cure or even slow down.
The care sector needs to make sure that there’s the best possible care for people with dementia today. As a representative body, my West Midlands Care Association is regularly working with training providers and other companies to ensure members keep abreast of best practice.
We’re standing together. Please make sure you join us in this cause.
Blog post 17 May 2017
Public warming to tax levy for social care survival . . . but . . .
A tax rise to fund social care may not be such a bitter pill, according to a new survey where 57 per cent of those polled supported the idea.
The findings in The Observer were published earlier this month – just days before the Conservatives outlined their manifesto for the snap General Election.
As the article points out “funding care has become a key domestic political challenge after years of falling town hall budgets led to cuts in home services for older people.”
Pollsters ComRes found that 33 per cent of the 2,029 adults it interviewed would pay up to £50 a year more in council tax to rescue social care.
Another 17 per cent said they would happily see their bills rise by between £50 and £100 and others were prepared to pay between £100 and £150 (4 per cent), £150 to £200 (1 per cent) and more than £200 (1%) for social care.
In the breakdown, some 27 per cent of males were more disposed than women (20 per cent) to say they’d cough up more than £50 a year extra.
Across all social classes the survey revealed 23 per cent were happy to pay at least £50 or more.
I should be heartened by the response as it appears the general public (whoever they are) seem to be getting the message that social care needs money to survive.
For me, this is much more heartening feedback that was received on proposals for private social care insurance policies.
Former shadow health minister Norman Lamb was reported as saying people had “the clear appetite for paying a bit more to ensure that our loved ones get the care they need.”
It would be unfair not to mention that unwillingness to pay was highest in the northwest of England (40 per cent) and Wales (39 per cent), with men (35 per cent) more opposed than women (31 per cent).
Okay . . . so the care sector has gained some traction it appears in educating those who do not yet need its services, but, and it’s a big one . . . any tax-driven system needs to be a fair one.
Philip Hammond, the chancellor, allowed councils across England to levy an increased 3 per cent precept, on council tax this year, a drop in the ocean to fix the problem.
But these council tax hikes hit those on lower incomes disproportionately harder.
A more proportionate arrangement is needed here.
In what is essentially is a two-horse race, the election polls show a comfortable majority for the Conservatives with a 94 per cent chance of the party securing a Commons majority. Labour, I read, is gaining ground, but a win seems unlikely.
Do I believe such radical tax proposals would be announced by either party before voting in June? Never! Far too risky.
Ah well, I was heartened for a little while . . . Chocolate beckons.
The survey was carried out for Incisive Health, global healthcare policy and communication experts.
ComRes interviewed 2,029 British adults.
Blog post 15 May 2017
Common sense and when togetherness is better than being 'rescued'
It was hard to miss last week the news that Britain’s most senior family judge has warned that separating elderly couples in care homes can lead to deaths from broken hearts.
Just about every news stream picked up on Sir James Munby’s comments made during a conference speech to local authority care leaders.
Although such instances were rare, Sir James said no-one should ever be uprooted from their home and other family members against their will.
His call was passionate and would have struck a chord in the heart of most seasoned care workers. I once heard of a case where, in a Midlands nursing home, a devoted husband came and sat all day, every day with his ailing wife and it went on for years.
His devotion touched the hearts of staff. By the time he needed residential care, he didn’t qualify under the nursing criteria and the inevitable sad saga played out its course.
The bottom line in all of theses cases is money, and yes, in these circumstances I too believe it has been the cause of deaths from “broken hearts.” Mammon can be a cruel master, but social work in our care sector is more and more these days a branch of accountancy.
Sir James suggests professionals should take a "common sense" approach and think carefully about recommending that an older person should be separated from their beloved family, home and possessions.
Common sense is what we all need, but it’s in short supply.
For me it would be common sense for the Government to dig the care sector out of the black hole with some serious financial rescue deal; common sense would focus on realistic fees paid for beds by local authorities; common sense would rein in spending on vanity projects such as HS2 (the time’s just not right); common sense would have heeded the warnings of care sector providers that NHS chaos was imminent; and a common sense response would have headed off the rash discharge delays, operation cancellations and the winter beds crisis.
The judge, who has been president of the High Court's family division since 2013, added that some professionals want to "rescue" patients from "unsatisfactory, unsuitable, rather squalid" surroundings which in some cases they have "literally been born in and lived the whole of their lives".
Indeed, I believe these kind of cases, as Sir James puts it, foster "personal outrage", but its will be funding criteria and medical need that are the drivers that eclipse, it seems, compassion.
The greater financial implications of keeping couples together in old age has an obvious moral response, but in the real world – and particularly in the arena of social care – hearts seldom rule heads when deciding care criteria.
I wish Sir James well with his campaign for compassion and totally support him in preserving people’s longevity and relationships.
I’d bet any money that this hot potato is NOT included in the political ‘spin’ as we approach the General Election.
Broken heart syndrome, or stress cardiomyopathy, is a real condition caused by shock such as bereavement or separation in which the left ventricle changes shape, weakening the heart muscle. It is normally survivable but can be fatal in elderly people or those with a pre-existing heart condition.
Blog post 10 May 2017
A message to Mrs May (and any other politician who has ears to listen)
The electioneering has begun as we trundle towards a premature General Election.
Promises will be made and no doubt and for ‘good reason’ fail to materialise. It’s just the way it is as the parties contend for votes.
Perhaps the spin doctors, advisers, strategists and wordsmiths involved in the election machine could take counsel from my jottings of what needs to be addressed with social care policy. But first let me make it clear that West Midlands Care Association is non-political and would work with any party to advance the care of our most vulnerable and those who deliver this valuable service.
It would be foolish for anyone to claim something has not gone wrong over the last decade; the problem being so complex successive Budgets and Government policies have failed to secure a resolve.
Mrs May has pledged fairness and serious consideration of the social care issues.
Perhaps in her musings she could consider the following, though I suspect former Government health minister Paul Burstow, who inspired this piece, will have already delivered a comprehensive document on this matter to No 10.
· Spending on social care by local authorities and Government has effectively stopped.
Recent tax levies are a drop in the ocean and a massive injection of finance is required to stabilise the sector as businesses close almost weekly – especially in the geographically less wealthy regions.
Mrs May’s ‘fairness’ pledge is well placed as some social care expressions are affected more than others. Social care covers everything from children's social workers and fostering through to services for disabled adults and the care provided to people in their old age.
- Spending by care providers continues to escalate and the demand is ever increasing.
Growth in the population, people living longer and those with long-term medical conditions living longer add to the challenges.
Swaging cuts in recent times from central Government to local authorities have meant smart thinking on the part of providers as they struggle to survive. But the financial headaches can effectively be raced back to 2008 and the final crash. From that point the economic brakes were being applied and social care very much became the Cinderella service while the NHS continued to get funding.
BBC analysis of social care spending suggests that more than half of council budgets are swallowed up by these services.
- Spare a thought for the local authorities.
The majority of oouncils have tried to protect social care as cuts have been made to other services – libraries, leisure centres and refuse collection etc. But for many with whom I work, their ‘smart thinking’ is at an end. They need funding and need it now.
- The health of social care has a direct impact on the NHS as patients get stranded.
According the to Beeb, in 2015/16 some £900m less was handed to the NHS than in 2009/10. In itself that’s a massive problem, but add to it those 150,000 days of discharge delays in 2016 and the bed blocking earlier this year we continue to write all the wrong things into our history.
There’s cycle that’s emerged: Discharge officers can’t find care packages quick enough as the social care supply diminishes. Investment in care provision is only for the brave – and then in areas where self-funders are in the majority. When beds are occupied by patients who cannot leave, it gets more difficult to admit new patients.
The number of delays of this sort has nearly doubled in five years and we’ve all seen the news on worsening waiting times in accident and emergency departments.
- Like it or not, care is on ration.
Fewer people aged 65 or over in England are receiving social care as councils try to prioritise who gets what. That also means fewer old people are getting council funding for care home placements. And when they are funded, the funding is unrealistic – not fair, Mrs May.
- Spare a thought for the elderly and frail who are left to fend for themselves.
Figures from Age UK, Laing Buisson, NHS Digital and Carers UK estimate 30 per cent of older people get no help, 12.5 percent pay for help, 37.5 per cent get help from family and friends, and 21 per cent get council funding for care. Age UK estimates there are 1.2 million with substantial needs who are left to fend for themselves.
- Self-funders subsidising councils and Government.
There’s an argument that self-funded care subsides local authorities and the Government. Prices councils are paying are squeezed so much that many care providers are now making a loss in areas devoid of private payers.
Is this fair, Mrs May? I really don’t think so. It has been called a "hidden care tax" but sadly, unless funds are forthcoming from Government it looks like it will remain.
- The bigger picture
As the care market is pressured the inevitable will emerge . . . In areas where self-funders can be found the sector will survive, but in regions like mine (the West Midlands) where there is a shortage of council-funded places, market forces will dictate a decline of a crucial service that relies principally on council-funded clients.
My concern is the destabilising effect on the care industry for both those needing care and the care providers, an issue that has been raised by the Care Quality Commission.
I simply don’t believe the sticking plaster council tax precept will fix the problem.
Finally, a note to our politicians regarding social care: Please, please don’t make promises you cannot keep.
Blog post 8 May 2017
May's pledge on care: Election ear-tickling?
Call me a cynic, but I’ve heard yesterday’s big social care news somewhere before . . . Theresa May is allegedly giving 'serious consideration' to introducing a cap on social care costs so the elderly do not have to lose their homes.
Hmm . . . According to credible national newspapers, the Prime Minister is said to be considering bringing forward plans to introduce the £72,000 cap so those receiving care do not lose everything.
I’d like to see this interest in social care funding a step forward, but I sense an old political ploy afoot here.
The term ‘giving serious consideration to’ for me is get-out-of-jail speak for policies that are nice, but perhaps unachievable.
David Cameron pushed back any action on social care capping to June 2020 as I suspect the Government’s books would not balance on the plan.
Doubtless the electioneering will get more interesting as we near Polling Day, but May’s comment has successfully ignited the imagination of headline writers and social care is again in the media arena.
May, I read in the Mail online is “expected to move it forward to 2019 as she makes tackling the social care crisis a central theme of her party's manifesto ahead of the General Election.”
And a ‘source’ we read told the Sunday Express: “What she wants from the manifesto is to address not just immediate issues but long-term and complex policy areas such as social care, which covers everything from the problems now to generational fairness.”
Reality dictates that the care industry needs massive reform in the way it is funded, but I’m not sure if this second phase of the Care Act is the right move. What’s more, it smacks of election ear tickling.
There’s a lot of business insecurity and we’ve already proven, I think, that the British public is not yet ready to shoulder the burden of social care costs. Surely we need a more stable foundation for the care sector before we start considering reintroducing shelved plans.
It’s not that I’m against capping, but monies need to found somewhere to fund the new living wage and the long-term approach to caring, NOW and 2019 polices light years away.
There is an intolerable strain on care providers and surely the Government needs to ensure they are paid a fair price for the care they deliver. After all, the Government has actively promoted private sector hive-offs, and local authority care homes have been part of that initiative. I’d submit that addressing the underfunding of social care is a more urgent priority than a cap.
Blog post 8 May 2017
Another pice of music to help keep memories alive
Maybe it’s because I’m generally in need of a lift after the weekend, or perhaps our media guy’s timing is just perfect for Mondays, but on the heels of my last blog about the Lost Chord Lottery windfall he’s pointed me to another piece of news that’s music to my ears.
Dementia is an issue that’s close to my heart, having seen first hand how it can impact lives and families. Engaging those who are diagnosed with this memory-loss condition is sometimes not easy, but music is a fabulous way to do it.
Making a few headlines recently – and doubles some melody too – is the Rossendale Memory Choir for those living with dementia, their carers and families.
Online magazine Care Industry News turned the spotlight on the project and its connection with the local community in Lancashire after an activity coordinator at Haslingden Hall & Lodge took a number of residents to the choir’s weekly meeting.
The “ trial “ proved a huge success, with high engagement from both the dementia and residential members of the home.
Now it appears the new Haslingden Memory Choir will meet on the first Monday of each month, inviting friends and relatives into the home for an afternoon of song. Great!
Activity coordinator Tracey Booth said: “Our new choir will bring everyone together to sing a variety of new and classic songs, which will be particularly beneficial to our residents with dementia. We have some fantastic voices in the home and now we have our own choir, everyone can get involved.”
We can all forget things. We’re human. It happens. But with dementia, it can be constant. Memories from long ago are vivid, but today is a blur, a battle to cope.
Singing has many benefits – social, psychological, and medical. For example it is good for the lungs (and therefore increases oxygen levels in the blood), it reduces blood pressure and boosts the production of endorphins (happy hormones) and has been found to be one of the most enduring functions that a person living with dementia will be able to use.
The power of music, especially singing, to unlock memories and kickstart the old grey matter is an increasingly key feature of dementia care. It seems to reach parts of the damaged brain in ways other forms of communication cannot.
In a study of music and dementia, Professor Paul Robertson, a concert violinist and academic, said: “We know that the auditory system of the brain is the first to fully function at 16 weeks, which means that you are musically receptive long before anything else. So it’s a case of first in, last out when it comes to a dementia-type breakdown of memory.”
Of course there are a number of oranisations that focus on music for dementia; Singing for the Brain, Music for Life, Golden Oldies and Live Music Now all add to the growing chorus of melody that’s ‘out there’.
To know that the initiative is growing may even get me singing (but only in the shower).
Blog post 5 May 2017
This really is something to sing about
Dementia – one of the biggest challenges our country is facing and yet, given its overwhelming impact on society, rarely is it the headlines.
So I was delighted to read find out singing charity Lost Chord, which provides vital interactive musical experiences for people living with dementia in care homes and day centres, has been awarded £50,000 from Lottery funding,
The Big Lottery Fund, ITV and The National Lottery teamed up to give the UK public the chance to decide how £3 million of National Lottery funding could make a difference in their local area and this wonderful work won the cash.
For me it’s a ‘happy Friday’ story that cheers me into the weekend. I’m obviously pleased Lost Chord has the cash, but for me this success marks perhaps a more important issue.
Helena Muller, Lost Chord’s founder and chief executive said: “I can only thank the many people across our region who understood how important our work is and how much this funding will mean to us and took the time out to go on line or fill in the postcard to vote for us – the victory is TRULY YOURS!”
And that’s spot on. The awareness of what this South Yorkshire project brings to people with the memory-loss condition truly means the message is getting to the public.
Helena added: “It has made us realise just how important Lost Chord is to you all and it is also fantastic recognition of the work we do, with the support of our talented musicians and dedicated trustees and volunteers.
“At a time where social care is in crisis, people with dementia in residential homes and day centres need the support of Lost Chord more than ever.”
Clinical evidence points to a need to keep the brain stimulated for as long as possible and the power of live music has a significant impact on this.
Mysteriously, just like the lager in that famous advertising campaign, music reaches the parts that nothing else seems can do.
The money means that over the next year the choir will be able to provide 50 musical sessions per month, touching the lives of so many people living with dementia.
This is absolutely great news and hopefully an inspiration to others who are able to make melody. Early morning chocolate celebration now called for.
Blog post 4 May 2017
Care home residents deserve a vote this General Election
In the columns of The Guardian, Sara Livadeas, a consultant with Social Care Works, writes: “Care homes are communities within communities, and have a vital role to play for people who would otherwise face isolation and declining health.”
And the writer adds that understanding the role of the care sector in enhancing lives is “too often neglected in favour of bad news stories and funding crisis discussions.”
I agree. The point she goes on to make is that those who live in residential homes still should have a voice – particularly when it comes to the coming General Election. I like it.
Not all care home residents are intellectually compromised and many do hold strong opinions, believe me.
Livadeas suggests: “With a government and media obsessed by Brexit, social care is not going to get much of a look in during this election campaign.
“We can do something about this. People living in care homes are lucky enough to have some time on their hands. Older people have been around the block a few times, know their own minds and generally don’t suffer fools. The most obvious thing to do is to bring them face to face with politicians.”
Can you imagine it?
With social care in peril, those who are supported by it really should have the loudest of voices, but it just doesn’t happen.
Let me quote a little more from Livadeas’ work regarding the way she sees extra leverage can be brought to the Government door: “It shouldn’t be too difficult to arrange [media visits to care homes].
“Politicians want to get elected and are not going to miss a photo opportunity – so invite all your local candidates into care homes and hold hustings. If you can invite the local media at the same time, all the better.
“Local people will see that care home residents still have opinions, are still part of society and their votes count. And it will force candidates to address the issue of social care, even if it’s just to discuss some of the most basic questions: who pays for care and what’s available locally?”
In the General Election of May 2015, the Orders of St John Care Trust their residents were encouraged to vote. At the time the OSJCT invited candidates to visit with a remarkable consequence.
Before the candidates arrived residents “did not seem interested”, but afterwards 70 per cent decided to vote.
The "Your Vote Counts" campaign involved appointing Voting Champions – staff or volunteers – who ensured there were plenty of activities and debates to engage the campaign policies of the day.
And in Wiltshire, Oxford and Lincoln election candidates made visits to have their say and face the residents’ questions.
The OSJCT was not a political campaign, but one that actively honoured the voting rights of our elderly.
Livadeas adds: “We need to get people in care homes voting . . .
“By creating voting champions we also raised the profile of our residents as citizens and reminded people of their rights. Deciding who to vote for is a very personal decision and a fundamental expression of your individuality – it really brings out who you are, what you value and what you want for your future, and that of your family.”
To support a voting campaign in a care home, you first need to make sure residents are registered to vote and then sort postal voting – logistically much easier.
Legally, only those in prison can be deprived of their voting rights.
Blog post 3 May 2017
Join our protest over social care spending plan in Birmingham
Here’s the dilemma: Birmingham City Council is to receive a total of £81million over the next three years to address its social care crisis.
But none – yes, none – of that money is going on front-line social care services.
Yes, I reacted the same way . . . stunned disbelief and frustrated that this funding is for back office functions for internal staff.
Social care is ripping at the seams, we have crisis like I’ve never known in a lifetime of social care work . . . and the money is not going where every care provider expects it to be spent.
That’s why we are running an online campaign for change.
Online 38 Degrees (People, Power, Change) is hosting a petition aimed at Birmingham City Council.
It asks visitors to “support vulnerable and older citizens who use existing frontline social care services” to add their voice to the cause.
Let me quote from 38 Degrees why this petition is so important . . . It says: “We now know that in addition to the normal budget for social care Birmingham City Council will receive in excess of £51m over the next three years plus in addition to that funding Birmingham Council has charged households the additional three per cent precept that will bring in an additional £10m each year.
“That is over £81m additional funding specifically to address the social care crisis up to 2020.
“Birmingham City Council is not planning on spending any of that additional money on existing front line social care services. Instead, it will fund back office functions for their internal staff.
“Please give your support so that vulnerable adults and older citizens in our city can benefit from this additional funding from Government.”
One of the most telling reasons for signing the petition was left just a few hours ago. It says: “Birmingham was mentioned at a national conference, for not having raised payments to care homes for 9 years.”
There are plenty of other reasons to sign, but do we really need them? I think not.
As the petition blurb adds: “Real change happens when everyday people like you and I come together and stand up for what we believe in. Together we can reach heaps of people and help create change around this important issue.”
Feeling compelled to sign? When you do please take a moment to share it with others via email or social media.
Blog post 2 May 2017
Grass root lessons in survival at Care Association Alliance conference
Looking to get an insight into the current market trends of the care sector? Wanting to catch up on the national scene and hear some informative speakers who’ll tell is how it is? Need to network with the movers and shakers?
The Care Association Alliance is holding it’s fifth annual Health+Care conference at Excel London June 28-29 and our West Midlands Care Association will by there in the providers’ area where you can network and share best practice.
Being billed as “the largest and most important event dedicated to securing the future of care in the UK,” it promises a range of business workshops with a networking zone that represents a collaboration for the entire care industry.
Health+Care is the leading event for both residential and home care businesses.
My co-chair Erica Lockhart, says: “The Alliance will be hosting sessions at Health+Care in addition to a sponsored lunch and networking event. This provides a great opportunity to learn from our peers within health and care.”
And we all know knowledge is power. Like at no time ever before, I’m driven to know what is on the horizon for care and how care providers and those who buy in care are responding to the current unstable marketplace.
Owners, directors and managers from local care home businesses will get the unparalleled opportunity to attend Health+Care at no charge.
It’s been our experience that delegates attend year-on-year to find real solutions to safeguarding the future on their businesses and to dramatically improve the services they provide.
There are already 20 associations on board and will be attending with their teams.
These include: Bedfordshire Care Association, Berkshire Care Association, Care and Support West, Cornwall Partners in Care, Bournemouth, Dorset & Poole Care Providers Federation, East Midlands CARE, Essex Independent Care Association, Gloucestershire Care Providers Association, Hampshire Care Association, Isle of Wight Care Association, Kent Integrated Care Alliance, Lincolnshire Care Associations, London Care and Support Forum, Northamptonshire Care Association of Registered Care Homes, Norfolk Independent Care, Oxfordshire Association of Care Providers, Somerset Care Association, Surrey Care Association and, of course, West Midlands Care Association.
Michael Corbett, event manager at Health+Care adds: “The partnership between the conference and Care Association Alliance comes at a pivotal time for the care sector.
“The pressure to keep care businesses open during a financially challenging time has meant the sharing of best practice has been put on the back burner.
“Delegates won’t waste time in long laborious seminars hearing from those who have no idea what it’s like in the real world. Instead, delegates can combine short inspiring talks from those who have already changed the way their care businesses run and have improved their outcomes. Managers, directors and owners of care businesses will gain valuable insights into how to perform their roles better and run more effective operations.”
Any members of the associations listed above can secure a complimentary pass to attend Health+Care on the 28-29 June 2017, Excel London via: www.healthpluscare.co.uk/caa
If you are looking to engage with any of these care associations to help grow your business, get in contact with Michael Corbett to discuss the opportunities available – 0207 348 1855 or email email@example.com.
Blog Post 2 May 2017
UK's £1.3bn aid to help China's social care
How would you feel if I told you British money is being spent on improving social care in China?
And this foreign aid – some £1.3 billion of it – is being spent as an investment into future trading partners,
I have always felt fairly liberal minded over helping poorer countries, but my compassion is being challenged by this latest news that broke in The Telegraph.
We have a social care system on its knees and we’re crying out for money to be spent at home. Am I so wrong at raising even a murmur of disquiet?
I read the Foreign Office has outlined a series of “policy objectives” for the funding in China with “suggested projects” including improving “care in the community for elderly people in China” and the “sustainability of the health system”.
The money will go into the aptly named Prosperity Fund, which according to the report is “at risk”.
Other projects targeted for aid spending include supporting China’s fashion and film industries and providing “policy and regulations for football”.
I just don’t get it.
A government response claimed “sustained economic growth is the only long-term solution to poverty and the Prosperity Fund supports the vital economic development needed to help middle-income countries, where more than 60 per cent of the world’s poorest live, to stand on their own two feet and become our trading partners of the future.”
I often muse over what history will declare on the generation that has overseen the most chaotic dismantling of social care.
I’m not a political animal and my association will work with any party for the betterment of care for the elderly, frail, learning disabled and sick. I like to think I’m reasonably selfless and well rounded in my response on care matters. This news, however, appears to be bringing out a darker side of me.
Blog Post 1 May 2017
Fees – response and resposibility
I’ve recently completed an article for hard copy/online magazine/multi-media platform Driven by Health, addressing the care sector’s response to fees – those paid, and those charged.
Fees. Often a dirty word in the Press and something some people want as their own secret. Truth is, however, there needs to be a growing cooperation among all care operators if we are to get any real traction on the money paid to us by local authorities. That means a frank exchange of information.
It’s a ‘given’ that such fees do not anywhere near represent the cost of caring and for the record, the majority of the West Midlands Care Association time spent researching, negotiation and learning is centred on fees.
It’s taken a long time for the industry to heed Lord Digby Jones’ message that to be heard the sector needed to stand together with one corporate voice.
More than a decade ago I attended a WMCA conference where he was the keynote speaker and he said: “We stand at five to midnight without a voice in the corridors of power.” He was speaking about the fragmentation within the industry.
Need – the urgency to survive such difficult times – is driving change and like no time before the corporate voice of the care sector is finally being heard. Headlines in the media on the plight of social care are common and the issue is regularly on the lips of politicians.
How things change.
If you want to read the whole article it can be found online, but there are few extracts worth highlighting.
We are in a progressively polarised industry of the ‘haves’ and ‘have-nots’. Essentially the difference is geographic – richer areas, as opposed to those poorer regions. My colleagues in Surrey rarely have businesses built with their prime income driver being a local authority; they are blessed with private payers aplenty. On my patch, however, the Midlands relay a very different story – but even within this area there are still rich/poor divides.
Currently the association is collating information on what authorities across the UK are paying for care packages, but whatever funding streams there are, essential to any business is sound economic policy. Knowing the cost of care in a unit division is essential to survival and the first lesson is the ability to dismiss sentiment, but keep the compassion.
As Winston Churchill said: "It is not enough that we do our best; sometimes we have to do what's required." There are practical steps that we can take that will make a real, sustainable difference to the people we serve.
I don’t doubt that the majority of care operators who are struggling are doing their best in hugely difficult circumstances. Best, however, can often mean a reimagining on the way things work.
There is a place for being sentimental, but sustaining failing models requires clear thinking – something that sentiment can easily cloud.
What needs to be done is a proper costing exercise that delivers a creative and, yes, compassionate response.
In the article, I major on hope – I believe the engine that can drive the difference. Check it out – the psychology of it makes interesting reading.
And then there’s the need for cute marketing – again worth digesting – that capitalises on attributes some don’t even know they have.
Our patch – the Midlands – has a unique story hidden inside the common headlines of NHS bed blocking, families or local authorities refusing to sign off the finances of care and the chaos of over-full hospitals.
Our region’s diverse demography with extremes of ‘haves’ and ‘have-nots’ has seen even moderately well to do businesses bow out of local authority contracts as they are unable to survive on the local authority rates paid.
You’d expect the marketplace to be rich with opportunity as demand outstrips supply, but the economies to scale only stack up if additional charges are levied. More of this and the problems of dome-care, learning disability specialisms and a static sales market can be found in my article.
Blog Post 30 April 2017
Getting the bigger picture and forging change
With a hunger for reform on the issue of fees paid to service providers by local authorities, the matter is top of the agenda at the next meeting of the Care Association Alliance.
Co-chaired by myself and Erica Lockhart of the Surrey Care Association, it will provide a platform to essential data sharing as it continues to lobby national organisationa and politicians on social care matters.
For me it's hugely important for us at this time to know what other local authorities are doing in their response to the latest Budget monies that have been made available . . . and not least, the General Election news.
Playing an active part in the Alliance helps us to see a bigger picture and assess what’s happening in the current ever-changing circumstances within the sector.
Any nuggets of news from the London meeting, we’ll get out to members via the website and newsletter.
Blog Post 30 April 2017
Social care lessons from our colleagues in Wales
If I’m truthful, I reckon the Welsh know a thing or two. All that rich heritage – castles with their towering fortifications, graceful abbeys, ancient monuments . . . I could go on and on.
They are the practical examples of history and in my opinion no history lesson can be complete without a field trip to study those Norman, Edwardian and indigenous Welsh-build structures.
Which leaves me wandering: Could we get a lesson from the social care reform model in the land of the red dragon?
I read with interest on the Care Management Matters website the Welsh Government has made social care a priority and has been backing this up with funding and targeted initiatives. Am I dreaming?
As central government is gearing up for a Green Paper on the future of social care, the article asks is there anything that can be learnt from Wales?
Let me quote: “Since devolution in Wales, the Welsh Government has had policy responsibility for health and social care, amongst other areas.
“Under this responsibility, it aims ‘to promote, protect and improve the health and wellbeing of everyone in Wales, by delivering high-quality health and social care services, including funding NHS Wales and setting a strategic framework for adult and children’s social care services.”
Social Services and Well-Being Act
In April 2016, its first big social care policy change came into force with the Social Services and Well-Being Act 2014. It aimed to transform the way social services are delivered in Wales, to meet the needs of the individual and ensure services are sustainable for the future.
Critically, the Social Services and Well-Being Act set out to ensure services are available to provide the right support at the right time and people have a stronger voice and real control over the support they need to remove barriers to their wellbeing.
As the CMM article says: “It focuses on earlier intervention, increasing preventative services within the community and helping people maintain their independence. It provides a framework to enable people to get the help they need before their situation becomes critical. The Act also promotes health and social care integration to achieve improved wellbeing outcomes and provides for a strengthened approach to safeguarding.”
There’s an embarrassingly basic question going around my head . . . How the Welsh achieve this and we can’t.
The act also:
- Introduced new eligibility criteria focused on individual need, replacing the current threshold system
- Gave carers an equal right to assessment for support to those they care for
- Ensured easy access to information and advice is available to all
- Kept children and vulnerable adults safer by making powers to safeguard people stronger
- Required local authorities and health boards to come together in new statutory partnerships to drive integration, innovation and service change.
At the time, Health and Social Services Minister, Mark Drakeford called it, ‘A radical, made-in-Wales system for the care and support of our most vulnerable citizens, which is fairer and more sustainable.’
Currently, seven Regional Partnership Boards are spearheading the changes – undertaking their own area population assessments to enable them to plan tailored solutions based on firm evidence of what the people in that region want and need.
What a great idea! As well as multi-agency representation, the citizen voice is increasingly present in the decision-making process ensuring solutions are being co-produced with input from all of those involved.
To support the Act, £60m was invested over 2016/17 to ensure children, adults and older people in Wales receive joined-up health and social care services.
Some £50m came from the Intermediate Care Fund, now known as the Integrated Care Fund, with an additional £10m of capital funding. Sadly, this is stuff we can only dream of.
£30m of the Fund was invested in services to support older people to maintain their independence and remain at home; £20m was allocated to establish new integrated services for children and adults with autism; and the final £10m to assist all groups, especially those with long-term conditions, through reablement or step-down beds in the community.
The primary aim of these investments? To avoid unnecessary hospital or care home admissions and prevent delayed discharge.
Based on independent research on the cost of these policies, says CMM, “the Welsh Government has made £4.8m available in total to support implementation of the higher capital limit and the full disregard of the War Disablement Pension.”
In addition to this £4.8m, an extra £55m has been made available for social services in 2017-18. This includes an additional £10m for social care to help meet the costs associated with the introduction of the National Living Wage, and £25m extra for local authorities in recognition of the growing pressures that social services face.
The CMM piece concludes with a raft of questions. Has Wales got it right with its social care reform? Is the situation in England too complex to solve in this way? Is there too little money available? Is it more straightforward in Wales? Or does the political direction of the Government have more of an impact? What can or should England take away from the Welsh social care policy?
Interesting, isn’t it, that CMM deliver no answers or opinions. For me, however I think there’s a lot we can learn – not least one of priorities on Government funding. Over to you Mrs May, but I suspect you’re distracted by the looming General Election.
Blog Post 25 April 2017
The Assoication is part of the Care Assoication Alliance which is made up of all the other Assoication from other Counties in the Country. We help each other run succesful Associations so that we can support Care Providers who want to give good care, as well as ensuring the National voice includes the local implications.
I went to London yesterday to catch up with the other Associations to discuss what is happening, particularly with fees for Care Homes, Home Care and LD. We also talked about what other areas are doing with the precept and the £2 Billion.
A Couple of the areas have said they are going to use the £2 Billion to increase the fees to Care Providers to safeguard the future of the Care Industry. However the majority feel they have already addressed that with the small increase they have given. These areas are looking for other options to spend the money. Nationally we are going to collate all these ideas and feed them to the National Bodies to ensure the Government see the piece meal way in which their money id being spent
we are putting information on the blog if you want to keep up to date there.
One of the other people that we talked to was Neil Eastwood from Sticky People who is just about to publish a readable book called 'saving soical care'. The book will be about chosing and keeping the staff. Neil has been to a number od our conferecne and talks a lot of sense. The book is being launched in June and will be £1.99 if you have a Kindle and their will be 20 ways you can use to help. I am hoping to get a sneaky peak before then.
Blog post March 22, 2017
Panorama: Historic underfunding, recritment ills and more chaos
Everyone in the social care sector is aware that care firms are cancelling contracts with local councils because they cannot deliver the services required for the fees paid.
Now viewers of last night’s Panorama also have an insight to the care crisis gripping our nation. A new audience, I hope, which might help forge change for the better.
The BBC investigation highlighted that care businesses could not recruit or retain staff – wages elsewhere were much more enticing, problems “historic underfunding” and an ageing population were not being effectively addressed and a Freedom of Information request which was responded to by 197 of 212 UK councils showed 95 had experienced care provider contract cancellations.
According to the research, carried out for Panorama by Opus Restructuring and Company Watch, 69 home care companies have closed in the last three months and one in four of the UK's 2,500 home care companies is at risk of insolvency.
The figures are shocking – and yet they’re just a snapshot of what’s happening.
In the Midlands, which did not feature in the programme, things are just about as bad as anywhere else in the country not precluded by a wealth-laden demography.
On average, dom-care providers are getting £13 per hour and there’s no sign of an increase this year.
Dudley, which pays slightly more, but still under £14, is pressuring providers to accept 15-minute calls. And there lies madness, with travel time having to be paid.
Desperation is the only word I can think of for Birmingham, with some contracts secured at a ridiculous £10 per hour, The figures just don’t stack up.
Some are with new companies which simply don’t understand the full implications of the business, but ultimately it will leave those in need of caring
without the wellbeing guarantee of continuity.
On the DP (direct payments) front, again there’s no increase for those who manage their own budgets.
I am immensely proud to be part of a regional care sector that still maintains standards, but the time is now here where some of the best are being forced into debating whether their businesses can any longer survive the squeeze.
Councillor Izzi Seccombe from the Local Government Association, which represents councils across England and Wales, said on the Panorama programme: "We have warned that the combination of the historic under-funding of adult social care, and the significant pressures of an ageing population and the national living wage, are pushing the care provider market to the brink of collapse.
"These figures show the enormous strain providers are under, and emphasises the urgent need for a long-term, sustainable solution to the social care funding crisis."
Last October, the regulator for England, the Care Quality Commission, warned the council care system had reached "tipping point" and was in the worst state he could remember during his 38-year career in the system.
In an unprecedented step for the regulator, CQC chief executive Sir David Behan called on ministers to pump more money into the council care system.
One home care company featured in the report, Cymorth Llaw, which had contracts with three councils in north Wales, told Panorama it had recently stopped working with one - Conwy, which had initially paid £14.20 an hour for care.
It offered to raise that to £15, but the company decided that still wasn't enough and handed back the contract.
Ken Hogg, at Cymorth Llaw, said: "We didn't think we could do it for the money - it was as simple as that.
"We pay as much [in wages] as we possibly can and we've always paid above what was the national minimum wage and the national living wage.
"[Carers] get a mileage allowance, they get paid travelling time between their clients."
Mr Hogg said the company was legally obliged to pay 1% pension and 13.8% national insurance contributions, along with training and other staff-associated costs, which "doesn't leave a great deal".
Conwy Council said it was committed to supporting vulnerable people in communities, despite the financial challenges.
Home care company Mears used to have a contract with Liverpool City Council but cancelled it in July, saying £13.10 an hour was not enough to cover costs.
Mears said it needed at least £15 an hour, and like other companies across the UK, argued its costs are often greater than what councils pay.
And far from being hostile towards care providers, the tone of the programme was stereotypically old school BBC: The facts and no ‘spin’.
Alan Long, executive director at Mears, said: "That was a terrible thing to do for both service users and for care staff.
"We absolutely did not take that lightly, but frankly what choice did we have?
"We just cannot do the two most basic things that you need to do in home care - pay staff the absolute minimum of a living wage and be able to recruit enough people to deliver the service that Liverpool Council actually expected from us."
It’s an all too-familiar response I’ve heard from care companies all over the UK.
Policy and campaigns director of United Kingdom Homecare Association, Colin Angel, said some care providers are "really desperate" and "really do not know whether they're going to be able to continue in business, beyond the next year."
He added: "That means they're really having to make some hard commercial decisions, whether they might need to cease trading or indeed just hand back work to local councils."
Mike Furlong, manager of the Granby Rehabilitation Unit in Liverpool, told Panorama that while on average people spend 28 days at the care facility, "some patients have been with us 12 and 14 weeks because all the therapy is complete, but unfortunately there's no care package available at the end of it".
Liverpool City Council said that, over the last seven years, its budget had been cut by £330m and it now needed to find a further £90m over the next three years.
As for the £2bn Budget handout – it’s just not enough to keep up with demand.
I’d love to believe such a powerful presentation would furnish the sector with real results, but I’m convinced the intransigence of Government will remain; well at least until the promised Green Paper.
Blog post March 22, 2017
Don't miss an opportunity to celebrate care
Celebrating excellence in social care, our west Midlands Care Association will again be involved in the Great British Care Awards that come to the city’s ICC at the end of the month.
A glittering national finals awards ceremony on March 31 will be the culmination of taxing selection processes that will honour a whole raft of care qualities shown by individuals, business and teams.
There are 21 award sections which represent all areas of the social care sector, whether it be older people or specialist services, residential or home care. From frontline staff such as care workers and care managers to people who have made an impact in other ways such as training and innovation – they will all get their moment of glory in a very public display of marking quality caring.
The awards will bring together the statutory, independent and voluntary sectors, as well as unpaid carers.
And on the selection panel our Debbie has been busy interviewing some of the nominees. As you’d expect, despite all of the industry gloom, the standards are exceptionally high.
Awards include – see http://www.care-awards.co.uk/categories/
The Care Employer Award
The Care Home Worker Award
The Home Care Worker Award
The Care Newcomer Award
The Care Home Registered Manager Award
The Care Home Cook/Chef Award
The Dignity in Care Award
The Dementia Carer Award
The Care Team Award
The Care Home Activity Organiser Award
The Ancillary Worker
The Home Care Registered Manager
The Care Trainer Award
The Care Innovator Award
The Frontline Leaders Award
The Home Care Coordinator Award
The Putting People First/Personalisation Award
The Housing With Care Award
The Good Nurse Award
The Palliative Care/End of Life Award
The Care Assessor/Care Planner
The Unpaid Carers Award
The Outstanding Contribution to Social Care
Our care association message is clear: Get involved and help us ‘big up’ the great care our sector delivers as it helps change lives for the better. The past, the present and what’s to come will be represented in the gathering of people who’ll attend. Go on – book a table – http://www.care-awards.co.uk/product/table-booking/
Blog post March 16, 2017
A valuable insight into safeguarding
There’s play I should catch in London which has its last showing on Friday (18th) at the New Diorama theatre.
According to The Guardian it’s “a wonderful, funny and absurd play” with a message that explores risk and the implications of its mismanagement.
The plot centres around a bunch of character trying to put on a play. But their endeavours are thwarted by people intent on keeping them “nice and safe”.
A health and safety officer says prop umbrellas are potentially lethal, a local councillor worries about slips, trips and falls and a care assistant just wants them to sit down and drink tea.
By the end the production and its characters are indeed safe, but the play . . . well, I guess it could be viewed as collateral damage.
I’ve blogged before that risk is an element of all our lives and without it life can lose its spontaneity and thrill.
As The Guardian says, it may well be an absurd production, but “the frustration on stage echoes frustration in life.”
The cast comprises older people (most actors are aged 65 and over) and those with learning disabilities. Each has been told at sometime not to attempt something because of the risk involved.
There is a tricky balance between protection from harm and support and in the mix comes a whole raft of legal what-ifs.
The play’s strapline – “Take risk away, and what’s left?” – is something the social care community continues to debate.
Admirably put, let me quote from the article: “The obvious challenge in terms of safeguarding is that despite the legislative and policy frameworks we have – the Care Act, safeguarding boards and reams of organisational guidance – so much of it comes down to individual professional judgment. The decisions that are weighed up and taken day after day, in partnership with the people being cared for, will inevitably need regular revision as circumstances change.”
WMCA recent Press Releases
April 13, 2016
Osborne’s social care cash ‘used to balance books’
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, it has been claimed.
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.
Association chief executive Debbie Le Quesne (correct) has warned “the outlook can only get worse” as care providers struggle to make ends meet.
Ms Le Quesne said: “We understand 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. There are no provision margins from such funding for the current financial year.”
At 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, members claim fees have fallen below the viable cost of running a care home.
Latest figures from Industry analysts LaingBuisson (cor) reveal English councils pay on average £91 a week less than what is needed to provide fully compliant care.
Ms Le Quesne added some homes were being kept operational only by private funders who shore up the shortfalls on the cost of care being paid for by local authorities.
“At best 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.” she said.
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 the organisation to discuss 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. More than 26,300 people across the region are receiving residential care. A similar number have care at home.
In September last year the 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.
Added Ms Le Quesne: “The rises don’t track cost, and what increases have been offered are still well adrift of reality.”
April 1, 2016
Living wage threatens future of care to most vulnerable
West Midland businesses providing social care for thousands of people across the region are now facing a “monumental struggle” to survive as George Osborne Living Wage legislation comes into force today.
At a recent emergency meeting of West Midlands Care Association – the representative body of the private and charity care sector – delegates heard it would be the final straw for many operators who rely on local authority referrals as their main source of income.
Chief Executive Debbie Le Quesne (correct) said: ‘I cannot think of one member who does not wish to pay their staff better wages, but there simply isn’t enough cash in the business models so many have been forced to adopt under the current austerity measures.”
In an impact analysis survey carried out by the association, 50 per cent of providers reported there was no long-term sustainability for their businesses paying the living wage.
Findings also included:
· Currently care providers in the West Midlands have not agreed the figures proposed by any of the local authorities for the purchase of care services
· Care for the learning disabled could be the hardest hit with no fee increases being paid since 2008 and none currently on the table
· Those with direct payment contracts – where budgets are self-managed – will not get any extra local authority funding to pay potential living wage increases
· Local authority fees paid for domiciliary care, residential and nursing home services have not tracked the real cost of care for nearly a decade
“While none reported imminent closures, more than half said they would actively be looking to increase fees, sell up, or cease trading in the future. It is a desperate day for the care industry and threatens not only the region’s businesses, but also the stability of care for the elderly, frail and learning disabled,” added Ms Le Quesne.
More than 26,300 people across the region are currently receiving residential care. A similar number received care in their homes.
The National Living Wage applies to people over 25 and is set at £7.20 per hour, a 50 pence per hour rise. It will increase to £9 by 2020.
“We recognise fully that carers are worth the extra money. However, Mr Osborne has chosen to be blind to the implications to the care sector where council fees for beds have failed to track real costs for some nine years.
“To put things into context, the annual increase in wages for one provider with 100 full-time workers would be £96,000.”
“With profit margins already squeezed, this is stretching the economies of many of our homes and domiciliary care businesses to breaking and they face a monumental struggle to survive,” added Ms Le Quesne.
In the West Midlands there are 410 residential homes, 446 learning disabled homes, 97 nursing homes, 49 mental health homes, 12 physical disability homes and 80 homes specialising in dementia care.
“That represents 27,000 beds and the take-up is almost full capacity. From today onwards there is no knowing how long those beds will be available. Additionally, there are 500 community care business across the West Midlands serving another 27,000 people with operators collapsing every week. In this environment there is little continuity of care,” Ms Le Quesne said.
“The industry is at a point of meltdown. If a major employer were to make this kind of warning there would be huge political interest over the potential loss to the economy. What we have here is a bunch of businesses across the region that create about 125,000 carer jobs for adult social 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.
“Hard choices need to be made where government could find the monies needed by the sector. As more homes inevitably close, domiciliary care becomes increasingly unstable and the care of our vulnerable is uncomfortably exposed, I suspect only a public outcry would dictate a revised political agenda,” added Ms Le Quesne.
In 2013 Birmingham City Council and other Midland local authorities 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 that to meet escalating costs, care commissioners would need to pay £460 per week. Currently, the average fee across the West `Midlands is £400.
Three years on, and not including the financial implications of the living wage, Ms Le Quesne said It would take an increase of six per cent to bring homes in line with the minimum figures used by the Association of Directors of Adult Social Care (ADASS) as its threshold for safe care.
1st September 2015
Care crisis: Time to work together
Currently across the West Midlands some 26,300 people are looked after in residential care settings and a similar number receive care packages in their homes.
The majority of that care is from private providers, who, according to regional figures released by Skills for Care – the development body for adult social care in England – employ a staggering 125,00 carers.
It’s an immense workforce and sadly, like no time ever before, is under threat.
Unlike more economically privileged regions, care businesses in this part of the country rely heavily on local authorities purchasing beds as a primary income generator.
Revised regulatory governance, government austerity measures, the Chancellor’s living wage legislation and councils paying fees for the last nine years that have not tracked the real cost of care, now result in homes on the verge of closure.
Occupancy across the region is running at 97 per cent. When our homes fail, where will we put those who are displaced?
We have been creative and made savings to the point where there are none left to make without compromising Commission regulation and desperately need ring-fenced financial intervention.
We are at five to midnight and are appealing for MPs, councillors, local authority officers and Clinical Commissioning Groups to join with us to find a way ahead. Our individual responses will, I believe, be all the more fruitful if we can work together.
September 1, 2015
Fees lifeline plea as care homes crisis deepens
Care providers throughout the West Midlands are calling on councils to stop hiding behind government austerity measures and pay a “viable rate” for care beds purchased from the private, charity and voluntary sectors.
In a bleak warning they said closures were imminent and there was little regional capacity to take up those frail and needy residents who may be displaced.
At an emergency meeting of West Midlands Care Association (WMCA), which represents private and non-for-profit providers, members heard George Osborne’s living wage directives could “be the final nail in the coffin for care as we know it.”
In a desperate attempt to secure a funding lifeline to the industry, MPs, councillors, local authority officers and Clinical Commissioning Groups (CCGs) were now being asked to meet with the organisation to discuss 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. More than 26,300 people across the region receiving 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.
Debbie Le Quesne, chief executive of WMCA, said: “The national picture is gloomy, but in our region it’s much, much worse and Osborne’s announcement could be the final nail in the coffin for care as we know it.
“Our members were in crisis before his landmark legislation on wages.
“I cannot stress how desperate the national warning is, but for the Midlands it’s not just care and nursing homes at risk; it impacts massively on those offering learning disabled and community care packages.
“Our 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?”
Ms Le Quesne added that the care business community feared the promised autumn Government Spending Review would be too little, too late.
Residential care occupancy levels throughout the Midlands are averaging 97 per cent. “There’s not a member in the association who is not anxious about the future wellbeing of those requiring care.
“Of course providers deserve to make a living and have successful businesses, but the most vulnerable across the whole social care spectrum are our raison d'etre and we owe it to them to be diligent in securing a viable rate that will safeguard futures for provider and client.
“What’s more, 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.
“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 hitting 12.3 per cent.”
Sandwell Council’s cabinet meets on Wednesday (September 2) 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.
Latest figures from Industry analysts LaingBuisson (cor) 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, Ms Le Quesne said 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.
Ms Le Quesne added: “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.
“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.
“Council do have choices what to do with funds, they need to stop hiding behind government austerity and the care sector must now become a priority.
“Because of the regulatory body [Care Quality Commission] there is a legal limit to which we can cut staff and all our small care homes have already made those economies. There is nowhere left for them to go.
“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.”
On CCGs . . .
The hospitals bed blocking crisis in the West Midlands can only get worse, care industry chief Debbie Le Quesne has warned.
In June, figures released suggested that 11,000 days were lost in the region because step-down beds and community care package were not immediately available, or there were delays on securing funding.
Ms Le Quesne said: “Clinical Commissioning Groups need to understand the crisis we’re in and the impact it will continue to have on delayed hospital discharges. We need to see some of the £5.3bn from The Better Caring Fund aimed at integrating social care and health. So far, I have no evidence of it being spent on our sector in this region.”
She added the delayed days run into thousands and a fundamental reform was needed which in the future “must involve ring-fenced monies for social care.”
Ms Le Quesne said she had already received reports that hospitals had been unable to find social care beds because local authority fees being offered were too low.
“CCGs can no longer tell us it’s not their problem and they need to engage on the issues of finance with the local authorities and with us,” she said.
On wages . . .
A WMCA impact survey suggests any benefits found with reductions in Corporation tax – a fall to 19 per cent in 2017 and 18 per cent in 2002 – will not plug an ever-widening chasm between realistic operational care costs and fees paid by local authority commissioners.
The study also notes that such advantages would clearly apply only if businesses were in profit.
Under the Chancellor’s plans, workers aged over 25 will get a minimum of £7.20 an hour from April next year, rising to £9 by 2020.
The government says this will mean a direct pay rise for 2.5 million workers of an average of £5,000 by 2020.
The last major care company collapse was Southern Cross, in 2011, Britain’s biggest care home operator with 750 homes.
2nd September 2015
Care Under Threat in Sandwell
At the Cabinet meeting on 2nd September you will be asked to make a decision about the Care industry in Sandwell.
Sandwell Care Providers have worked on very small margins for many years and the recession has hit Care Homes and Home Care Providers as much as the Council. Fees have not kept pace with increases in costs, particularly in Minimum Wages increases. Providers have hit the point where they can’t absorb the wage rises.
We sent information to the Council Officers illustrating the dire situation that Care Providers are in on June 2015
We have not received a response and we have been advised that a report is going to cabinet on 2nd September for a decision. Here is the link to the letter.
Since the information was sent the Chancellor has announced the new living wage which will mean Providers having to have a good luck at their business.
Unlike other business care provider have to provider a certain number of Care hours per person which cannot be reduced and this makes up approx 60% of their costs. With the Chancellors living wage that put the salary bill up by 10%. However Sandwell Providers were already unable to absorb the increase from Oct 2014.
We are not clear whether the minimum wage increase for April 2016 has been included in the report going to cabinet.
At an emergency meeting on 26th August with Directors and Association Members it was decided reluctantly that legal advice must be sort in order if a realistic response is not forthcoming.
We would urge you to take responsibility over the funding of care to sustain services for the most vulnerable people in Sandwell. Please would you make decision that would not only impact on business sustainability but the welling being of the people you represent.
August 25, 2015
Survival talks plea after big five warn of care home closures
News that a national care homes chain could fail within a year because of George Osborne’s radical living wage reforms has prompted fresh calls for speedy action on resolving chronic funding shortfalls in the sector.
Five care home companies with 1,200 properties between them have written to the Chancellor warning of impending disaster.
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 throws a financial lifeline.
Struggling West Midlands care providers last month warned that the industry was at “breaking point” with the unexpected wage increases creating a financial meltdown.
Debbie Le Quesne (corr), chief executive of West Midlands Care Association (WMCA), which represents private and voluntary sector care providers, said: “I cannot stress how critical last week’s (Aug 20) warning is and for us it’s not just care and nursing homes at risk. It also impacts massively on learning disabled packages and community care operators.
“Our calculations suggest the Osborne legislation will add £23 per week to the care cost of every Midlands person in a residential care setting.
“If the corporates – HC-One is in our membership – are predicting at best only a two-year survival rate under the current economies, what chance have my other members, who have much smaller homes and much-depleted resources?
“Many of them have mortgages on their businesses and are personally financially entrapped by the costs of the care they deliver. It’s heart-rending to hear what’s happening and sadly the only way some will survive is to cut corners.
“No-one wants to, but it will happen if the Government doesn’t intervene by releasing extra funding that will enable local authorities buying beds to pay a figure that realistically reflects the price of care.”
The Association’s directors have called an emergency meeting next Wednesday (Aug 26) to discuss the “desperate situation and to formulate an action plan,” added Ms Le Quesne.
A WMCA impact survey suggests any benefits found with reductions in Corporation tax – a fall to 19 per cent in 2017 and 18 per cent in 2002 – will not plug an ever-widening chasm between realistic operational costs and fees paid by local authority commissioners. The study notes too that such advantages would clearly apply only if businesses were in profit.
Under the Chancellor’s plans, workers aged over 25 will get a minimum of £7.20 an hour from April next year, rising to £9 by 2020.
The government says this will mean a direct pay rise for 2.5 million workers of an average of £5,000 by 2020.
Ms Le Quesne added: “How many times do we have to say there are no savings left to make? We are people of integrity and telling the truth. To be fair, the response from out local authorities has been heartening, with councilors and officers recognising we all in this mess together.
“But this latest warning really does hit home just how close to impending disaster we all are and I fear the promised Government Spending Review will be too little, too late.
“We are now literally begging council decision-makers and representatives, Clinical Commissioning Groups and MPs to come alongside and talk with us.
“Not one single body, I believe, has the answer. We must work together to survive in our businesses and, not least, for the benefit of the 26,300 West Midlands care home population and a similar number receiving community care packages.”
The last major care company collapse was Southern Cross, in 2011, Britain’s biggest care home operator with 750 homes.
July 14, 2015
Budget reforms put care homes at ‘breaking point’
Struggling West Midlands care home owners face a bleak and uncertain future following living wage Budget reforms announced by George Osborne.
Debbie Le Quesne (corr), chief executive of West Midlands Care Association (WMCA), which represents private sector care providers, warned the industry was at “breaking point.”
An impact survey by the association suggests any benefits found with reductions in Corporation tax – a fall to 19 per cent in 2017 and 18 per cent in 2002 – will not plug an ever-widening chasm between realistic operational costs and fees paid for care by local authorities.
Under the Chancellor’s plans, workers aged over 25 will get a minimum of £7.20 an hour from April next year, rising to £9 by 2020.
The government says this will mean a direct pay rise for 2.5 million workers of an average of £5,000 by 2020.
But although Ms Le Quesne and her members welcome initiatives to bring in better pay rates for carers, they estimate it will add £23 per week to the care cost of every Midlands person in a residential care setting.
“It will also mean there will be no pay differential between domestic staff will little responsibility and experienced NVQ Level 2 carers,” said Ms Le Quesne.
For those businesses offering community care, the association concludes there will be an additional £1.50 per hour cost for each member of staff. This figure does not include the additional expenses of travel time, which is not funded in the local authority rate.
“Mr Osborne’s Budget has done no favours to the care industry in the Midlands. Most domiciliary providers are on set local authority contracts which have seen next to nothing in increases over the past five years.
“They are still trying to work out how to find funds to pay travel time and now a second increase in outgoings looms.
“Calculations do not include external price rises we expect to see from our suppliers, who will also need to pass on their increased production costs,“ she added.
Along with other representative bodies, WMCA is calling on government for a financial lifeline to keep the industry afloat.
Ms Le Quesne said: “It’s a hugely complex situation with most of my members having local authorities as primary income generators in their businesses. Under the terms of which they work they are allowed to return profit margins on council contracts of between only five and seven per cent.
“There simply isn’t anywhere for extra savings to be made. Years of austerity have taken their toll and the creative thinking is through.
“Addressing living wage increases for council workers, the Local Government Association, which represents more than 400 authorities in England and Wales, said the cost of implementing the policy should be taken into account when council funding levels are set in future.”
West Midlands Care Association is making the same plea to government.
“Our calculations regarding the timing of and potential savings on Corporation tax just don’t stack up as an offset to this extra expenditure, over which members have no control.
“We’re in deep financial trouble and we know local councils are too. Central government must now heed the care industry plight if it wishes to see a diverse sector survive the next two years. We are at breaking point,” added Ms Le Quesne.
Picked Up by The Guardian and the Times
2nd July 2015
Latest calculations – the Budget impact on social care
I knew the Budget was bad news, but I’ve just read a piece from yesterday’s Guardian and I think I feel sick.
I’m trying to console myself with the fact that this publication does not align itself with the Conservative government, but I know some of the figures presented are credible.
The piece suggests that the care sector has been “invisible” to George Osborne. I agree. I cannot image any politician setting in stone anything like the national living wage knowing the impact it could have.
Let me quote: “Let’s suppose Osborne had done all his sums, however. In that case, the logical conclusion can only be good news for social care because he must have realised he would have to factor in a hefty bung of taxpayers’ money to meet the sharply rising costs of paying the NLW from next April. Any other way lies disaster.”
As the article says “there simply isn’t the money in the system to meet the costs without it.”
According to initial calculations by the Local Government Association, indemnifying care contractors against the new minimum would cost councils in England an extra £330m next year, rising to £1bn extra by 2020 (Guardian).
But rightly, as stated “at a time when, the association says, the funding gap in adult social care is widening by £700m annually.”
The article goes on: “The Resolution Foundation thinktank, which has carried out previous detailed analysis of the implications of ending the low-pay scandal in social care, puts the UK-wide extra costs to the public purse of Osborne’s plan at £1.3bn by 2020 – on top of another £1bn already pencilled in for increases in the original national minimum wage.
“In net terms, deducting savings to the exchequer after tax and benefits, the foundation reckons the additional costs to be £675m by 2020, or just over £1.2bn
Already we have seen hospital admissions soaring since the austerity measures began and a strong argument presented that social care funding cuts are to blame. I fear sores is to come, though there will be regional differences.
My Members and I in the West Midlands are particularly concerned over the issue and we are busy putting together figures to ensure that Councilors Local MPS and the Authorities are aware of the impact. The West Midlands is more dependent than other areas as the Local Authorities are the main funders and there is limited Self funders. The Authorities fees are calculated to give a very small profit margin which these wage increases will easily wipe out and there is no money in the pot of the West Midlands Local Authorities
I wonder how we will remember Mr Osborne: Will he be the one who has managed to unstick the whole fabric of social care in the UK, despite his government’s pledge that “social care is a priority.”