In itself it probably adds little to the ongoing debate, except to highlight that local authorities are finding it increasingly hard to fund free care for the elderly, with the overall numbers dropping by 11% over the past 2 years. The  average charge for an hour of home care has risen by 10% in the past two years – from £12.29 to £13.61, although as up to 80% of that will be made up of the employment and travel costs of the care worker involved, many of whom are often very poorly paid, this will be a reflection of wage and fuel inflation rather than any excessive profiteering by the private sector.

The need for a long term funding solution to Social Care has also been raised in two other quarters this week, firstly by the Peter Carter of the RCN. He argues that the number of Community Nursing posts has dropped by 1.700 since 2009, thereby threatening the Government’s intention of treating more people in the community. The fact that elderly care is best delivered in the community was not lost on Dr Carter,when he said that the health service…” was struggling to keep people out of hospital because of pressures on the community, and it is struggling to discharge them with support when they leave”.

Elsewhere at the RCN congress in Harrogate, Sir Keith Pearson, the Head of the NHS Confederation, argued that low pay was no excuse for poor quality care of elderly patients in the NHS. His comments reflects a growing realisation that many of today’s nursing staff are ill-equipped to deal with the particular needs of the elderly, lacking some of the common sense and sympathy that goes such a long way to making the lot of the older person on a ward so much more dignified.

The sense that many of these separate stories on elderly care are starting to coalesce was strengthened when news that the Age UK’s petition to the government to debate  Social Care funding in the House could be a reality. With 130,000 signatures already collected, the “Care in Crisis” petition calls for a new system which allows everyone to plan for their care ensure that no-one is forced to sell their home or sacrifice all their savings to pay for it. Although not a Downing Street petition, which needs over 100,000 signatures to trigger a debate, it does shows the growing awareness that the Government missed a vital opportunity to clarify the future of Social Care Funding in last week’s Queen’s Speech, and that this is an issue that cannot be ignored. Maybe, as we reach the moment the White Paper on Social Care reform is released, these various narrative strands will start to finally influence policy makers into taking action on this most important of issues, one which effects everyone sooner or later.

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Earlier in the week the Telegraph ran a story on some recent research by Engage Mutual that highlighted one of the ‘grey’ areas of care involving people in 40′s and 50′s looking after both children and parents. Such informal care has long been a feature of the health landscape, but the report now estimates that 2.4 million individuals now juggle the competing demands of older and younger generations in this way. Significantly, 15% help their parents financially whilst 25% give daily practical help to allow their parents to go on living a normal life. To anyone of a certain age reading this the previous statement will not come as too much of a shock, and it shows that the UK holds up well against its feted Continental neighbours in terms of family. However the findings do point once again to the massive stakes involved with Social Care and that in an age of austerity some families will simply not be able to support their elders financially as much as they once did.

An open letter to the Government reminding them of these stakes followed later in the week in the Daily Mail. Citing the widely acknowledged postcode lottery in the provision of care, as well as the ongoing uncertainty about social care funding, a coalition of 78 charities and industry bodies urged David Cameron to make elderly care his legacy. He doesn’t seem to have heard though, as the Queen’s Speech for the forthcoming session of Parliament made only a cursory admission about the modernisation of care in the UK, with the economy and the reform of the Lords taking centre stage. In truth the Government’s current travails mean that it probably does not feel confident enough to take on such a task as Social Care, but one can only hope that this is only a temporary rather than a permanent loss of nerve by the Coalition.

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Under the terms of the deal, if it succeeds in reversing the hospital’s fortunes then the first £2m of any yearly surplus goes to Circle. It will then keep a quarter of any profits between £2m and £6m, and of third of those between £6m and £10m. All income above that level in any year will go towards paying the hospital’s debts, but it has been calculated that it will need to make at least a £70M surplus over the 10 year period to pay off the debt under these terms. The question is whether that is too big a price to pay.

Somewhat unsurprisingly the unions and the Labour party think that it is, warning of dramatic cuts in service and staff as Circle looks to line its own pockets on the back of this deal. The calls are for all surpluses to be reinvested into the Trust so that the debt may be paid down quicker. At the same time other voices, most notably the Kings Fund, are suggesting that the real debate is whether Hinchingbrooke, which serves a population roughly 160,000, should continue to exist at all, particularly as it will have to attract additional ‘business’  from other  areas to hit the repayment targets.

There is a danger that the ability of Circle to turn around Hinchingbrooke will be seen as a test case for the involvement of the private sector in NHS service provision. The peculiarities of the situation faced by Circle, as opposed to say those faced by Virgin Care  running Surrey’s community hospitals, are quite different and the only true measure of success will be whether the objectives outlined in the original tender document have been met. In the case of Hinchingbrooke this will be about securing the long term future of the site, along with making the operation more efficient, something which Circle seem already to have started.

It seems churlish to criticise the terms of a deal that incentivises an increase in performance when the alternative was probably closure. Put another way, the hospital probably had more than enough chances to pay for itself under the NHS umbrella, but had patently failed. As Circle are also assuming the financial liability of the hospital under the deal there is an incentive for them to return the site to a more stable footing. Whatever the ownership structure in place, there is always a price to pay, it just remains to be seen whether people feel that in the case of Hinchingbrooke that price is too high.

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The UKHCA, which represents care providers across the country, responded quickly with a few well chosen words. “It is somewhat ironic that the incoming president of the Directors of Adult Social Services (ADASS) suggests that care providers should not bid for local authority contracts at prices too low to deliver the specified service. Insufficiently funded contracts can be disastrous for people who use services, but we need to be clear that directors of social services call the tune when these contracts are offered for tender.”

They are absolutely right of course. Bidding for Social Service Contracts is never an equal partnership, with maximum price limits typically imposed on bidders, along with stringent operational targets that often fall over when faced with real world realities (fuel shortages anyone?). The fact that companies continue to bid for contracts at often suicidally low levels of profit says more about them than the local authorities, but in many cases it is born out of desperation for the smaller providers, or out of a need to demonstrate large sales volume growth for the larger providers. Although many block contracts proceed well, it worth noting that many of the recent publicised problems with care providers are related to large block contracts falling down.

At Prestige Nursing and Care we have taken a view that each local authority contract should be judged on its merits, but of the last 10 we have reviewed none seemed to be sustainable in the long term, especially given the cap on price and therefore by definition pay, that was on offer. The take up of Direct Payments of Individual Budgets is starting to increase, but this is barely making a dent in the ever increasing need for Adult Social Care in the UK.

Possible solutions? Well more money in the system for a start, so that Local Authorities can attract better quality offers for the task at hand. An ending of the uncertainty around Social Care funding in the imminent White Paper wold also be another important step forward, as would a recognition that the delivery of community care is wholly dependent on true partnership between a vast number of different providers, charities, commissioning groups and government. Achieving some consensus in this area will be the biggest challenge of all.

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Firstly we had the now infamous ‘granny tax’ as part of the budget, wherebypensioners will lose the age-related tax break they had enjoyed since it was first introduced by Winston Churchill. Although described by the Chancellor as a simplification of the system, this new measure will hit up to five million older people who will pay an extra £3.3billion in income tax over the next four years, according to Treasury figures. There was a somewhat muted response from the key stakeholders in this argument, which would indicate that the debate had hitherto generated more heat than light.

Hot on the heels of the Chancellor came the news that the Department of Health and the Treasury were considering raising Andrew Dilnot’s nominal cap on care contributions to an eye-watering £100,000. The Treasury are clearly not minded to stump up the £1.7Bn in annual funding envisaged by Andrew Dilnot’s original suggestions, but feel that the elderly population must do more to pay their own way in the future. The concept that people would need to pay £100,000 towards their own care before they received state support means that more people would lose their homes, their assets and any savings they may have. This will not hit the ‘super rich’ but ordinary hard working over-55s who have already seen punitive measures in the recent budget. The current impasse between the parties involved in the now-delayed White Paper on Social Care would indicate that they are also struggling to find a workable compromise.

Elsewhere we have had Paul Burstow decrying the practice of councils measuring out homecare in minutes, saying that the best councils focused on outcomes rather than clock watching. Well as one of the companies that is frequently asked by councils to undertake up to 15 minute packages of care, we can entirely endorse that point of view, but the question remains – how else do you measure and  pay for care given that an ‘outcome’ is such a subjective and arbitrary measure? There is an increasing use of telephone monitoring of care visits by councils the length and breadth of the land, which is symptomatic the chronic shortage of resources many local authorities face. A carer checks in and out again on the telephone and the care is billed as the difference between the two. This may not mean the care given was in any way substandard, but time as they say is money, and unless the resources are made available to fund the appropriate length of visit then nothing will change.

We then have David Cameron announcing a significant boost to Dementia funding which will rise to an annual £65M by 2015. All very worthwhile and much appreciated, but one does get the feeling that our political masters are at present giving with one hand whilst taking away with the other. At a time when clarity in policy making is essential, we are getting mixed messages, and that can be as damaging as no policy at all.

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 The report does serve a useful function in highlighting two widely identified problems within the U.K.’s home-care market. The first of these is quite clearly the quality of care that is currently being delivered to vulnerable and frail people in their own homes. The examples from the Which reports highlight a  lack of staff training, a lack of suitability or empathy for a care role and a lack of operational effectiveness, any of which an experienced and quality-led agency should be looking to improve upon incessantly. In this context Cynthia Bower’s comments about the new inspection regime the CQC is shortly to undertake are very welcome, it is just that they are about two years too late.

The other area touched upon by the report relates to how homecare is both commissioned and delivered by local authorities across the UK. Mike Padgham of the UKHCA quite rightly points out that agencies are coming under increasing pressure to cut the length of visits by local authorities wanting to save money. What  the Which report uncovered is the logical result of the relentless drive to make a dwindling supply of funding goes as far as possible. Paul Burstow’s comments concerning outcomes, training, dignity and respect are all worthy as usual, but do little to illuminate the central issue here, which is a growing funding gap for elderly care in the UK. One can have all the new training standards one likes,but if a care worker is limited to only 15 minutes to see each individual, there is a limit on what they can reasonably achieve. When you consider that only 5% of Homecare visits commissioned by local authorities last more than an hour, the opportunities to deliver meaningful, high quality care start to diminish.

As people start looking around for someone to blame for the poor quality of homecare currently endured by too many people, one is reminded of the old saying “Success has many fathers, failure is an orphan”. In this case, yes – agencies must accept responsibility that their staff are up to the task and be prepared to be penalised when they are clearly not, and yes – local authorities must ensure care is commissioned and delivered in such a way that prioritises quality above quantity, but at the end of the day there needs to be funding, and significantly more of it than present, to ensure no more people have to endure what these 30 did.

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So far, so good and no one would ever argue against the need to develop a clear and coherent strategy for dealing with the delivery of high quality care to elderly people, especially as they now account for 60% of current hospital admissions. Yet the analysis delivered yesterday by the Commission seems so breathtakingly anodyne as to be almost worthless. Take first the observation that recruiting staff with compassion should be a priority when considering elderly care. Really? One would hope that was always uppermost in a recruiter’s mind when interviewing nurses or care workers. Equally the insight that ward managers should have the responsibility of changing things around if standards are slipping for elderly people will prompt the question, ‘Well what are we paying them for then?’

The report gets onto slightly stronger ground over the subject of training, particularly with regard to the scourge of the elderly – Dementia. Insisting that staff in regular contact with people who suffer from Dementia receive the requisite training is a concrete aim and one that should be followed through on. Equally, the often – quoted aim of reducing hospital admissions for the elderly by treating more conditions in the community is also reiterated, but without concerted effort and funding, one fears that this will remain a pipe dream.

There can be no doubt that the momentum towards achieving long term changes in how we care for the elderly in the UK is building ahead of the Government’s response to the Dilnot report in the spring, but however laudable the Commission’s efforts are in changing perceptions they are ultimately doomed to failure unless a long term funding solution can be found.

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The straw that broke the camel’s back came in the form of a damning review by the Department of Health which revealed that board members had repeatedly complained about sloppy management and an inability to measure it’s sole raison d’être – the quality of care in the UK.

It would be all too easy to ascribe the blame to poor management, and there is compelling evidence to suggest that the CQC under Ms Bower’s leadership failed to make its mark in any area and seemed more interested in registering providers than actually checking what they were doing. However you have to set this against this the enormously wide remit the CQC was given in the first place and the funding cuts that accompanied it’s inception. It might be that as the government surveys the wreckage of this failed quango it looks at other regulators that have now embarked upon a different course, OFSTED being one of these.

Last week saw the launch of a Trip Advisor style website to collate care reviews from patients across a number of different sectors. Although we welcome any attempt to increase transparency and uncover bad practice in the sector, there is no substitute for a well-funded, impartial regulator that is prepared to talk to people rather than tick boxes. Lifting up a few more stones at hospitals, care homes and agencies to see what crawls out is the only way to ensure you are getting an accurate picture of care. At Prestige Nursingn+ Care we are arguing that registration should be put back with another body that can handle it more effectively and and that the CQC should get back to increasing the number of inspections. Only performing 2,000 inspections during a 6 month period last year shows where the CQC’s weak spot was, and it may well be that splitting the inspection regime back out into residential, acute and domiciliary care is the best way to ensuring real rigour and pertinence in future inspections. We await the new direction of the CQC with interest.

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Quality of care is, of course, entirely subjective and even the previous star rating system relied heavily on feedback from clients along with the normal box-ticking procedures. The government’s stated objective of raising the quality and cost effectiveness of care through its NHS reforms are predicated not just on the private sector’s ability to deliver such change but also on a true measure of care quality that allows effective comparisons across regions and specialities. Take away the current waiting times analysis so favoured by politicians and hospital managers and there is little else of substance that can effectively measure care quality. This of course was the original role of the CQC, but it became one that it abdicated so publicly with the care home scandals back in 2011.

 At Prestige Nursing + Care we have long campaigned for a return to a meaningful way of comparing the quality of care so that individuals, many of whom are in receipt of both Direct Payments or Individual Budgets, can make an informed choice about their care. Anyone who has shopped at Amazon or on EBay can testify to the latent power of a rating system to subtly influence buying decisions based on other’s experiences. Yet the travails of  TripAdvisor which has come under increasing scrutiny for its inability to properly police the veracity of feedback sounds a cautionary tale. The Good Care Guide’s plans to provide real, honest feedback on what is available is laudable, but policing it will be another matter. Unless there are stringent procedures in place to prevent the sort of malicious feedback that TripAdvisor sometimes attracts, both care providers and the consumers themselves will suffer as they will stop believing what they read. There is compelling evidence that beneficial reviews do create a virtuous circle of even better care, as was the case with some hospitals under the NHS Choices scheme. Transparency and accountability in care are what everyone should be striving for, but this comes with a cost – the diligent and often painstaking accrual of information by bodies such as the CQC was once the gold standard, and should still be the primary method of measuring quality. Offering a vast notice board for people to add their own comments on care will certainly add to the debate, but it cannot and should not replace what has gone before.

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