Posts Tagged ‘elderly care’

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Slipping between the cracks

Wednesday, February 6th, 2013

This is a story that anyone with elderly relatives or friends will have read through their hands as they tried to take in the final shocking conclusion to the life of Gloria Foster. The fact that it involves a lady who lived only a few short miles from where I write this and an agency and County Council our company knew has also added a sense of piquancy to the story. The fact that the mid-Staffs NHS report is also due out today certainly marks this as a bad day for those involved in care, but whilst the scandal at the mid-Staffs hospital took place at an almost institutional level, the consequences of a single unintended error at Surrey County Council have had equally tragic consequences.

The case of Gloria Foster is all too familiar.  Originally cared for by an agency named CareFirst24, her care was withdrawn when the said agency was raided and six people arrested on January 15 amid allegations they had been employing illegal immigrants under the identities of former workers. Used by both Sutton Council and Surrey County Council, the agency had its care packages, of which Gloria Foster was one, transferred to other agencies. In theory. Ms Foster had been receiving 4 visits a day from the agency and when the UK Border Control raid took place they did pass over a list of all those being cared for over to the Surrey County Council, who were responsible for the care. But she never received alternative care and was subsequently left alone for 9 days before being found by chance by a district nurse. Starved, dehydrated and covered in bed sores she was admitted to hospital 2 weeks ago but died yesterday.

The inevitable enquiry into this tragedy will focus on both the agency that was using illegal workers and on the procedures employed by Surrey County Council to effectively transfer care across from one provider to another. But what about friends, neighbours, family even? The sad truth is that unless someone is paid to go and care for an elderly person, in some cases there is no other safety net available. A regular pop in visit by a friend or neighbour during those 9 days might have alerted people to the situation a lot earlier, and possibly saved a life. Before everyone starts pointing the finger of blame at the authorities here, and they undoubtedly are partially culpable, we should perhaps also ask if we ourselves have checked on an elderly neighbour or friend recently to make sure they are OK. This sense of community is sometimes sadly lacking and it easy to forget that we will all be old one day. As a friend of Gloria Foster said “She loved music, she had lots of classical music, she played bridge, golf bowls, she conversation and she liked to go to the theatre. She became ill and the quality of her life was not brilliant but she did not deserve to go out like this – in agony with a total feeling of being lost.” There but for the Grace of God…

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Courage of their convictions

Tuesday, September 25th, 2012

As he packed his bags following the recent cabinet re-shuffle, former care services minister Paul Burstow found time to lambast the Treasury over it’s perceived lack of support for the Dilnot proposals.

Accusing his coalition contemporaries, and in particular his own leader Nick Clegg and the prime minister, of lacking the political will to see through the changes proposed by Dilnot, Burstow has shone a light into the murkier aspects of inter-departmental bargaining. In the most damning part of his article for the Daily Telegraph Burstow lays the blame for lack of progress firmly at the door of No 11 Downing Street.

“So, why did Labour fail? And why, despite the signs the Prime Minister had changed his mind over the Summer, could the Coalition fail too? Answer: HM Treasury.

The Treasury’s view is simple: kick the can down the road despite our rising elderly population. There’s no sense of urgency. No recognition that left unreformed there is no incentive for families to plan and prepare.”

Pretty strong stuff, but undoubtedly correct. The Treasury responded quickly, with an admonishment that the £1.7BN needed for the Dilnot reforms would have to wait until the deficit was under control. A convenient putdown, but with  the number of people aged over 85 in England projected to double to 2.4 million over the next 20 years, Burstow’s pleas make absolute sense. The long term-reform of the care sector offers the Coalition Government the chance to leave a lasting legacy, rather than just being seen as deficit-cutters and nothing else.

David Cameron hinted as much in the Summer, when he expressed confidence that a cap on costs could be found provided that the money could be found. The fear now is that the Coalition will water down the original proposals by making scheme voluntary in an effort to make it more affordable. But that, as Burstow and his successor Norman Lamb will find, would be the worst of all worlds. For now we wait to see whether this Coalition really does have the courage of its convictions and doesn’t use the parlous state of the UK’s finances as an excuse.

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The brink of collapse?

Thursday, September 13th, 2012

The Royal College of Physicians has released a report today that underlines the tension between the number of general and emergency beds available and the increasing healthcare demands of the population, particularly the elderly. Called ‘Hospitals on the Edge’ it highlights that whilst there are fewer general and acute beds now than there were 25 years ago, the last decade alone has seen a 37% increase in emergency admissions.

The RCP report also demonstrates the changing nature of hospital admissions – 65% of all  admissions are from people who are 65 are over, an increasing number of whom are frail or have dementia. Perhaps the most damning section of the report comes when describing the typical experience of an elderly person in a hospital

‘It is not uncommon for patients, particularly older patients, to be moved four or five times during a hospital stay, often with incomplete notes and no formal handover. Older people are at particular risk as they account for 70% of bed days. Research shows that medical and nursing staff often feel that older patients ‘shouldn’t be there’. Being perceived as the ‘wrong patient on the wrong ward’ has been shown to reduce the quality of care, building attitudes of resentment from both medical and nursing staff.’

The RCP is also calling for a re-organisation of care so that patients can rely on care seven days a week, something made very much harder through the European Working Time Directive’s restriction on doctor’s hours. Better access to primary care and a re-design of patient services are also on their wish list, as well as better training for all hospital staff. Whilst the rather eye-catching title of the report has succeeded in raising the profile of all these important issues, the warnings have already been rebuffed by the Government, which argues that the NHS does have enough beds to cope with growing demand.

Throughout this debate the ghost of Mid Staffordshire NHS Trust still looms large, where up to 1,200 mainly elderly people died there due to substandard patient care between 2005 and 2009. If there is to be no repeat of this tragedy then an integrated solution between primary and acute care is needed, with the focus on prevention rather than cure and  less emphasis on the capacity of gleaming new hospitals but on the capacity of the local communities to care for these vulnerable people, as reducing admissions in the first place would solve a great many of the problems the RCP highlights. Only time will tell if these lessons have been learnt

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A missed opportunity

Friday, July 13th, 2012

Andrew Lansley’s long-awaited White Paper on social care has proved to be a bitter disappointment for anyone hoping for a definitive funding statement from the Government. So whilst we have aspiration (reviewing the contribution cap at the time of the next spending review in 2014), and some concrete proposals (deferred loans to individuals to help pay for long term care) elsewhere there was precious little to whet the appetite.

Elsewhere the media have been equally damning, with many rightly arguing that there is financial vacuum at the heart of the proposals and that the Treasury strangled any funding initiatives at birth. The central debate remains about who should pay for long-term care – the individual or the State? Mr Lansley seems to have engineered the worst of all worlds intop the proposals, not enough detail to allow the financial and insurance sector to develop long-term savings plans and not enough funding to allow the NHS or Local authorities to extend the eligibility criteria for care.

Looking out at the Social Care landscape this morning one can sense this is a chance lost, and that the Coalition, like their predecessors, have missed a significant opportunity to both clarify and energise the delivery of Social Care in the UK. It may yet take a tragedy like Winterborne View to shake the Government out of its complacency, but until then it is unfortunately business as usual.

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No one’s listening

Monday, July 9th, 2012

As the days countdown before the Government finally reveals its plans for Social Care funding and assessment for the years ahead, Prestige Nursing + Care releases research today that graphically illustrates that a key stakeholder in the debate, the nurses and care workers, feel they have largely been ignored in the discussion.

Up to this point the arguments above the future of Social Care have largely focused on the demand side, with the views of commissioning groups such as Local Authorities and service users taking centre stage. This is quite proper and understandable, as it is their needs that have to be met. But what of the supply side, the nurses and care workers that actually deliver the care? Ignoring for a moment the vast amounts of informal carers, typically spouses, sons or daughters, there remains a substantial amount of care and support workers in the UK who feel their views have gone unrecognised. These are the groups primarily responsible for delivering the care and for ensuring that the high standards the CQC, government and individuals expect are actually being delivered. Quite simply, without the dedication and professionalism of these nurse and care workers the care industry would quickly grind to a halt.

We talked to over 900 nurses and care workers during May and found that over a third (36%) feel that the government’s review is financially motivated and will have a damaging effect on the care industry and a quarter feel the changes will reduce the standard of care. Just 9% feel that Government changes will improve the standard of care. In light of this, just a third said they could definitely see a future for themselves in the care industry.

 When asked what they feel would be the measure most likely to improve care standards, 41% said that more Government funding would allow them to spend more time with each patient – the most popular measure. Just 6% said that the answer lies in more efficient organisation – a possible slight on the Government’s efforts to improve care.

 Despite having these strong ideas on how to improve the care system based on their experience, 43% of care staff feel their views have been overlooked. Just 9% feel their views have been well reported. If the impending Social Care reforms are to be successful, then the views of the people actually carrying out the care have to start being taken into consideration.

 

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The clock is ticking

Monday, June 25th, 2012

What many commentators feared after last year’s Winterbourne View scandal now seems to have become a reality. Today the CQC released the findings of recent inspections into the UK’s residential care sector. In it they found that less than half of the homes  complied with essential standards on the care and welfare of people with learning difficulties or were properly safeguarding them from abuse.

The fact the CQC ordered the inspections of at leat 150 homes in the wake of Winterbourne View event does at least show that there is at least an admission of how far standards had dropped, but given that they were and indeed remain the body charged with ensuring standrds are met, this is a classic case of being asleep at the wheel. It will make very uncomfortable reading for the new Chief Executive of the CQC, David Behan, who has publicly pledged to act on poor services. As any captain of industry or football manager will testify, new arrivals are allowed some latitide for the mistakes of others whilst they settle into a new role, but the extent which the CQC seems to have neglected its regulatory role during Cynthia Bower’s tenure is shocking, and many people will asking quite rightly how it came to this. The clock is ticking for the CQC.

 

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Same problem; 2 different approaches

Tuesday, May 29th, 2012

The world of Social Care has been unremittingly bleak for as long as anyone can remember, or at least since Andrew Dilnot finally put a price tag on what it would cost to resolve the funding crisis in the sector. Despite initial positive noises eminating from the Government about the funding issue, it was virtually ignored in the recent Queens speech and no one really believes that the long-awaited White Paper will truly meet the problem head on. So what is there to be positive about?

The Nuffield Trust has declared that the £1.7BN funding gap identified by Dilnot can be filled using a combination of the NHS surplus and better means testing for winter fuel allowances and other such tax raising measures. it quire rightly points out that about £140bn a year is spent on elderly people across the NHS, welfare and social care sectors, but just 6% of this currently goes on social care. The report’s author, Anita Charlesworth, has also called upon the government to have an open debate with the public about what its priorities are for this sector rather than seeking to spread finite resources across too many sectors. Although the Treasury would no doubt have something to say about the re-distribution of the NHS surplus into other areas, this report marks a welcome attempt to fill the funding gap with practical solutions rather than the hand wringing that has typcally accompanied any discussion about the size and seriousness of social care funding.

Elsewhere, afficianodos of the TV classic The Great Egg Race will probably be somewhat surprised at Heinz Wolff’s latest innovation, Care4Care. This aims to solve the problem of Social Care from a different perspective by enlisting volunteers to care for local people then ‘claim back’ the help when they need it. Currently it is being piloted on the Isle of Wight, where the scheme went live in March, with volunteers banking care hours by helping older people with a whole range of tasks to help them maintain their independence at home, from trips to the shops to changing a lightbulb.

The fusion of both self interest and community spirit makes this a very interesting project, although it does rely on a degree of self awareness amongst the volunteers that someday they too will require care, and because of this it may limit the recruitment of new volunteers going forward, but it is this kind of lateral thinking, allied to more funding, that gives the Social Care sector some cause for hope. Even if the debate is moving forward, as both these pieces show, the main currencies within the care sector remain time and money, as Wolff  himself admits “I see Care4Care as a form of mobilisation where the community makes up its mind to do something the country desperately needs. If you put in a few hours every week over the years, lo and behold when you get to 78 and are a bit creaky yourself you might have 5,000 hours and can get those back. That’s worth a lot of money – even on the minimum wage you are talking about £30,000 of care.” Plus ca change.

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A growing narrative

Wednesday, May 16th, 2012

Another week, another story about funding for elderly care. Following on from research by Prestige Nursing + Care at the back end of 2011 into the wide vagaries in care funding across the UK, another survey, this time sponsored by Labour, has hit the headlines today.

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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Mixed Messages

Monday, March 26th, 2012

Trying to divine the Government’s direction of travel with regards to Social Care can be a tricky business, especially if the last week is anything to go by. Just when clarity, purpose and resolve are needed we have a series of announcements that reflect confusion and obfuscation at the heart of the Coalition.

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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Who do we blame?

Friday, March 16th, 2012

The state of elderly care in the UK hit the headlines again this morning as the Which consumer group reported its findings from the diaries of 30 people or their carers who currently receive homecare. The term ‘disgraceful’ is being used to describe the quality of Homecare these 30 people received. The anecdotal evidence that Which has uncovered certainly makes for distressing, if unfortunately quite common reading, although one must guard against inferring too much from what remains a very small sample size.

 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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