Posts Tagged ‘Prestige Nursing and Care’

Budget 2014 – implications for funding care

Friday, March 21st, 2014

George Osborne’s Budget announcement on reforms to pensions has huge implications for those approaching retirement yet the impact this will have for funding long term care is also significant.

His changes will increase the flexibility of pensions by easing access, lifting tax restrictions and, in essence, offering improved competition. This could play a significant role in helping people pay for care in future. Individuals will now be able to access their savings should they need to pay for care services, which may otherwise have been tied to a fixed income allowing no access for emergencies or unexpected costs. Up until now in cases such as this, those requiring residential care have been forced to sell their homes to cover the cost but now many will be prevented from having to do this.

However, there are also concerns in some quarters that these reforms could result in people having to pay more towards social care. Currently amounts tied up in pensions or annuities are not included in the means testing to assess how much one has to pay towards care while cash assets and property are. At this stage it is unclear what this could mean for people who elect to withdraw their entire pensions pot as a cash lump sum but the government has denied it will mean having to spend more. It is crucial the government makes clear the potential implications for funding care in order to avoid any confusion later on and to help people plan well in advance.

The Chancellor also announced a government guarantee to provide people with financial guidance upon reaching retirement. Prestige Nursing + Care has stressed the importance of financial advice for funding care in previous blogs so it is great to see the government is encouraging this. It should be used not just to address immediate retirement planning but also longer term suggestions for funding care, an issue that continues to worry people and will only grow in magnitude as the population gets older.

Funding long term care.

Thursday, March 6th, 2014

The issue of receiving financial advice to cover the cost of care is a topic briefly commented on in an earlier blog: it has long been the case that people use financial advisers to help with investments, savings and planning for retirement, yet seem hesitant to use it for funding long term care despite the complexities within this area and the high potential cost. The Government’s Care Bill has called for local authorities to make advice on care more accessible to the public, a positive sign that this issue is being taken note of, however, a recent article in The Daily Telegraph highlights that this is not going far enough at present.

As the issue garners publicity and people grow ever more concerned about how best to prepare for the future, elderly people are being increasingly lured into high-risk strategies in a bid to protect family homes and other assets from care home costs. Costs which, on average, cost twice the average pensioner income resulting in a shortfall of £14,568. These strategies are being displayed in roadshows and seminars that recommend options such as putting assets into trust. However, advisers have stressed that these schemes are costly and may fail to do what they claim with local authorities being able – in many cases- to seize these assets anyway.

Experts have warned that the ‘deliberate deprivation of assets’ i.e. giving away wealth or property to avoid paying for care are being increasingly challenged by local authorities so is not something that should be recommended. Instead, sound financial advice from an independent adviser, well in advance is the best way to act. Specialist-care-fees advisers are not tied to any particular provider and can therefore offer advice on products across the whole market. Furthermore increased education and knowledge is necessary as to the real cost of care, and individuals should not be lulled into a false sense of security due to the promise of a cap on costs. Research from Prestige Nursing + Carefound that the £72,000 cap on care costs puts the real cost at over £134,000 which many people underestimate.

Pushed for time

Tuesday, October 8th, 2013

Two pieces of research have been released this week, which both reach the same conclusion about the state of the UK’s thousands of care workers. In arriving at the same point, but by focusing on different symptoms of the system in doing so, both pieces of work highlight the desperate need for a long-term funding settlement for elderly care in the UK, something which the current care-cap initiative attempts but still falls far short of what is actually needed.

Leonard Cheshire Disability asked 63 local authorities which of them used care visits of 15 minutes or less. Three fifths of the respondents (38 in total) said that they used 15-minute visits, leading campaigners to brand this type of ‘conveyor-belt care’ are cruel and one which deprives people of basic dignity. The charity has called for a minimum 30 minute care visit duration when the Care Bill is debated this week and despite ministers stepping away from a statutory minimum visit time, Norman Lamb the care minister has also weighed into the debate, saying “It’s unrealistic to think that 15 minutes is enough time to help people who are older or who have a disability to do everyday things like wash, dress and get out of bed. It’s not fair on those who need support and it’s not fair on care workers.”

Hear, hear. Yet anyone working in care knows all too well that local authorities are under intense pressure to manage budgets whilst struggling to cope with an increasingly aged population. Despite a somewhat disingenuous statement from ADASS that not all visits need to be more than 15 minutes (that is perfectly true) and a suitable riposte from the UKHCA pointing out that councils are buying a service from human beings for human beings and that 15 minutes is too short (also perfectly true) there is a feeling of deja vu here, and much of the debate has been recycled over the preceding months.

Elsewhere the EHRC has followed its 2011 research by calling for the national minimum wage to be paid to all care workers and an end to local authority commissioning practices that drive down pay rates to workers. The report warns that the way care is currently commissioned is unsustainable,leading to inadequate pay, poor working conditions for care workers and
increasing threats to older people’s human rights. They estimate that up to  220,000 of the 830,000 domiciliary care workers in the UK are paid less than  the minimum wage, which is £6.31 an hour. Yet the job requires “significant  compassion and skill, maturity and resilience”, the EHRC said.

Travel time is the real villain of the piece here and not zero hours contracts or electronic monitoring as some would have us believe. Much of domiciliary care is conducted in ‘runs’ – groups of visits that allow one worker to go from client to client in the most efficient way possible, minimising both travel distance and time. This works well in urban environments, but when clients are more dispersed problems can arise, particularly as demand peaks at the beginning, middle and end of the day, so not everyone can have their dinner at 7pm. It is when travel time is taken into account that a care worker’s wages will dip below the minimum wage as a large part f their day can be taken up with unpaid travel.

‘Just pay them for travelling’ is the refrain, but local authorities simply do not have the funds to do this, and nor do the various agencies that deliver care into the community either. To be able to make a meaningful profit on such care either means not paying for travel time (the status quo) or paying the bare minimum to staff, which given the quality all right-minded agencies want to deliver, would never work.

Where both pieces hit the mark is over the perception of care workers, many of whom are as compassionate, skilled and hard working as any of their peers in competing industries. The belief that care can be salami-sliced as a sort of commodity is dangerous, but until the public sector, which currently accounts for roughly 86% of all care commissioning loosens the purse strings, the strategy will have to continue to be one of ‘make do and mend’ and the morale of these workers will suffer accordingly. It is perhaps only when the people who hold these purse strings have to receive care themselves in the future that the penny will finally drop, albeit too late for this generation of elderly and infirm.

 

 

The main event?

Thursday, July 18th, 2013

Whilst Labour and the Conservatives seem intent on slugging it out over precisely who is to blame for the state of the NHS as shown in the recent report on 14 hospitals by Sir Bruce Keogh, elsewhere there have been some interesting developments in the Social and Health Care sectors which may, in the long term, make much of the political posturing we are seeing now irrelevant and not the main event.

The first of these was the publication of Camilla Cavendish’s report into care assistant training and development, initiated by the government on the back of the Francis Report into the mid-Staffs scandal. For anyone working within Social Care, Ms Cavendish’s findings are axiomatic and on a superficial level her conclusions that workers should get 2 weeks basic training to prepare for work in a variety of care settings is hardly earth shattering, whilst her advocacy of the ‘Certificate of Fundamental Care’, a qualification that would link HCA training to nurse training, making it easier for staff to progress up the career ladder should they wish to, is welcome but hardly innovative.

Where MS Cavendish does score in her report though is on attitudes towards HCAs. “Patient safety in the NHS and social care depends on recognising the contribution of support workers, valuing and training them as part of a team. For people to get the best care, there must be less complexity and duplication and a greater focus on ensuring that support staff are treated with the seriousness they deserve – for some of them are the most caring of all.” All too often HCAs are treated as second-class citizens by other healthcare professionals and the recognition of the vital part they play in healthcare delivery, combined with a more robust and universal training standard, would certainly ensure more and more come into the profession and standards would continue to rise. Recent research by Prestige Nursing has found that the UK faces a shortfall of up to 20,000 care workers by the year 2020 as the population continues to age and the demand for care inexorably increases.

Elsewhere, Sir Mike Richards’s tenure as Chief Inspector of Hospitals seems to have started on a positive note, with his announcement that he wants to recruit hundreds of inspectors, including hospital
patients and their carers, so that future inspections have a wider range of perspectives, and give a voice to those who are treated by the NHS. The introduction of OFSTED-style ratings that will give a fuller perspective of a hospital’s performance, rather than focusing on one speciality or department is also welcome and stands in sharp contrast to the myopic fumblings of the previous CQC regime. Once clear and consistent ratings can be rolled out to related sectors like domiciliary and residential care, patients will have a much better understanding of what to expect when they receive care and just as importantly, make then feel that they are being put at the heart of care rather than treated as a product to be processed in the system.

It is early days for both these areas, but the signs are certainly encouraging. With the advent of a state-backed insurance scheme to help cap costs within the elderly care sector, it will be an interesting few months in the run up to the government’s official response to the Francis report later this year.

Don’t shoot the messenger

Monday, June 24th, 2013

If people thought that things couldn’t possibly get any worse with the Care Quality Commission, the UK’s NHS Inspectorate, then this week has proved them wrong. Just a few days after the CQC was accused of covering up its own internal inspection regime failings at Morecombe Bay NHS Trust, the backlash has extended to include the CQC’s political masters, past and present, as well.

The report that started the furore, by management consultants Grant Thornton, was ordered by David Behan, who became chief executive of CQC last summer after his predecessor stood down. It followed a campaign by Mr Titcombe and other families in Cumbria and Lancashire who lost mothers and babies at the hospital, where there were dysfunctional relationships between doctors and midwives and staff shortages. Problems with the maternity unit emerged in 2008, but in 2010 the CQC gave the Morecombe Bay trust a clean bill of health. However the resultant review in 2011 over the failings at the hospital was allegedly shelved, as the CQC was keen to avoid adverse criticism about its role in the affair.

The CQC initially declined to release details of who was present at the meeting where the ‘cover-up’ of the report was decided upon, citing Data Protection regulations, but perhaps sensing the public mood of outrage that was rapidly building, quickly backtracked and released the names. Jeremy Hunt then publicly warned the CQC of the serious consequences of cover ups as the names of Dineley, Bower, Finney and Jefferson all finally came into the public domain. Like lizards wriggling in a tin, all the players in the tragedy rushed to distance themselves from the accusation of a cover up, which by now had extended to include both Andy Burnham and Andrew Lansley. Mr Burnham was first accused of putting pressure on the CQC to suppress negative publicity about the NHS in the run up to the 2010 election, whilst Mr Lansley was drawn in when it was argued that his department had refused to take the warnings about the CQC’s failing seriously enough.

Amidst all the hand wringing and recriminations that have naturally followed this whole sorry affair, it is perhaps easy to forget two main points. Firstly, a number of babies died needlessly at the hospital back in 2008 and it has taken too long to identify the causes behind this and to take steps to ensure there is no repeat. Secondly, the CQC is finally, belatedly,  improving with more inspectors with better knowledge of the clinical areas they are inspecting. When it was born, the CQC was a little like a Frankenstein monster, with three different regulatory bodies coming together to become one, with all the problems that entailed. Clearly it wasn’t fit for purpose as an inspectorate, but equally it wasn’t responsible for poor care within hospitals such as Mid Staffordshire or Morecambe Bay. Ultimately the CQC can only shine a light on good and bad practice it finds within the NHS, and although wholesale reform of the body should be avoided, the debate must move on to a more transparent footing, principally around how to improve care. Constructive criticism of the NHS should be encouraged and new delivery methods discussed without fear or ridicule. As tawdry as the CQC’s role in these affairs have been, they are still only the messanger.

 

A realistic deadline?

Tuesday, June 11th, 2013

Earlier this week Jeremy Hunt addressed the NHS Confederation Conference in Liverpool and took the opportunity to set a deadline to ‘solve’ the A&E crisis that has so dominated the news agenda for the last few weeks.

The Health Secretary told the Conference that he has given NHS officials 10 months to draw up a plan to help those with chronic conditions, currently the heaviest users of the NHS. Mr Hunt told delegates: “We are putting together a strategy focusing on the group of people who if we help, we can also do the most to relieve the pressure on A&E. That is vulnerable older people, the people who are heaviest users of the NHS, people with multiple long-term conditions. We are putting together a vulnerable older people’s plan with three elements, and we would welcome your input to that plan, which we hope to conclude by the autumn and implement from April next year.”

So far so good, and the fact that it coincides with the current review of emergency and urgent care being carried out by Professor Sir Bruce Keogh is helpful in that it shows more joined-up thinking than had previously been the case. It remains to be seen however whether many of the key stakeholders in such a plan will be able  or willing to implement it in the timescale specified. GPs are still furious with Mr Hunt for his suggestion that their 2004 pay settlement and relaxation of out of hours requirements were to blame for much of the crisis affecting A&E departments, whilst Labour has recently broken the fragile cross-party consensus on the Dilnot care cap and argued that cuts to the primary care budgets initiated by the Coalition have effectively triggered the A&E crisis by reducing the community care capacity.

Most commentators would suggest that the travails of the NHS are not solely due to one thing or another, but a combination of many things, including the botched introduction of the 111 service but even more importantly the remorseless ageing of the UK’s population and the proportion of people living longer but in ill-health. 10 months will probably not be enough time to start making real change to the volumes at A&E and when 100 year-old pensioners like Lydia Spilner are left to die from dehydration in our hospitals, you realise that there is still such a long way to go to get even the basis of care right, let alone a complete re-organisation of health and social care integration.

For change to be effective, there has first to be an acceptance that change is needed. Some have argued that the NHS should act more like a business whose customer base has changed, and reconfigure services accordingly. Certainly the traditional models of delivery are starting to break down, and if Mr Hunt can unite the disparate groups that make up our modern health and social care system and somehow get them to agree there is a problem, and that there is a common ownership of the problem, then he will have made significant progress. Plans are all well and good, but to be realistic they need to involve people and there are still too many siren voices opposing this latest initiative. The axiom, ‘Success has many fathers, Failure is an orphan’ was never more true than when looking at healthcare.

Joining the dots

Wednesday, May 15th, 2013

One could argue that government announcements are just like buses, and if so then the recent surge of seemingly disparate initiatives is most welcome. Firstly we had Care Minister Norman Lamb pledging to close the health and care gap, by moving towards closer integration of health and social care by 2018. Whilst undoubtedly trying to steal a march on Labour’s earlier announcement over health and social care integration, this move towards better co-ordination is most welcome. Apparently a series of pioneer projects will be launched at the end of the summer, which will explore new ways of pooling budgets, speeding up discharge from hospitals and streamlining assessments. The commitment has been signed up to by the Department of Health, NHS England, the Local Government Association and the umbrella bodies for directors of child and adult social care. Prestige has had first hand experience of how well the enhanced co-ordination can work when we were part of a pilot scheme up in Leeds to streamline the process of delivering care for vulnerable adults. The wife of one of our service users appeared on the news yesterday explaining how the better working practices helped her enormously.

This commitment to improve the co-ordination of care comes in the context of rising concern over the appropriateness of the UK’s hospitals for the elderly population. Research by Age UK found that patients now wait an average of 30.3 days before finding a place in a residential care home, a rise of three days per patient since 2010. In financial terms it costs  the Health Service at least £1750 a week to maintain one bed compared to almost £530 weekly charge for care home room. Adding up the figures for the NHS as a whole means that ‘delayed discharge’ costs the NHS up to £260M a year. An issue that is very germane to delayed discharge is the increasing ineffectiveness of the A&E Service that hospitals run. Only today the rather dystopian vision of a complete collapse of the country’s A&E services was offered up, but for anyone misfortunate enough to have been in an A&E department recently this warning will not sound like a hollow threat. Whilst staffing levels, GP surgery opening hours and overall funding also have their part to play in limiting the effectiveness of A&E departments, it is delayed discharge and the inability to move elderly patients on from wards that does gum up the system. Now that £7 our of every £10 funding goes on treating long-term conditions such as dementia and heart disease, the need to treat these even more effectively in the community will not only result in better patient outcomes biut will also create much-needed slack in the rest of the health system.

With this in mind, Jeremy Hunt’s eye-catching pronouncements about one-to-one care for all elderly people may certainly appeal to some voters, as does his ideas about paying hospitals on patient wellbeing rather than results, but as his colleague Norman Hunt opined “People don’t want health care or social care, they just want the best care.” As you join the dots up from better integrated health and social care, to a requirement within the new Care Bill about better information on local care in the community and finally on to a need to shift resources away from acute trusts into the community, this aphorism starts having a fighting chance of becoming reality.

 

One step forward, two steps back

Thursday, March 28th, 2013

Earlier this week we saw Jeremy Hunt’s response to February’s Francis report on the Mid Staff’s outrage. Many of the measures proposed by the Secretary of State were well trailed in advance, principle of which was the NHS now having a legal duty to be honest about its mistakes, with sport also being given to making individual doctors and nurses criminally responsible for covering up errors. All well and good but these measures still only really tackle the symptoms and not the root cause of what happened at Mid Staffs.

 

One of the more eye-catching initiatives was the requirement, albeit on a pilot basis initially, that trainee nurses are to spend up to a year working as a healthcare assistant so they can experience providing basic care such as washing and dressing patients. Undoubtedly nurses of a certain generation and experience will roll their eyes at such a purportedly new initiative, arguing that this has always been a key part of the nurses role, but such practical experience will hopefully weed out those that choose this vocation without considering the real-life implications of such a choice. Equally, although the government stopped short of introducing a full registration scheme for health care assistants, the new code of conduct and minimum trading standards for this critically important group of staff are to be welcomed and will surely raise standards.

 

Whilst Andy Burnham’s observations that staffing issues are a major reason for some of the quality issues in the NHS rings true in one sense, it is the quality and not just the quantity of staff that has to be addressed if the NHS is to offer a better service to patients. In this sense Jeremy Hunts other recommendations which centred around holding NHS managers much more accountable for their decisions and introducing a new rating system for hospitals and care homes are nothing that any company operating in a competitive marketplace would not already be subject to and as such seem too little too late.

 

This seems particularly true following Kay Sheldon’s comments on the BBC on Wednesday where she alleged that the CQC deliberately passed failing hospitals as compliant for fear of having another mid-Staffs disaster on their hands. An ex-director of the CQC, her questions concern the registration of University Hospitals NHS Trust for Morecambe Bay in 2010, which is now in the middle of litigation with more than 30 families over the poor standards of care at it’s maternity unit during that time. The results of the independent audit into Ms Sheldon’s allegations will be known by the end of April and it will be interesting to see whether the CQC survives this latest scandal. There has to be something wrong though when it is the regulator, rather than those being regulated, is making all the headlines and one has to question the organisation’s place in Jeremy Hunt’s brave new world.

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…

Food for thought

Tuesday, January 29th, 2013

Last week saw a speech by Andy Burnham, the shadow Health Secretary, that put forward the view that health and social care budgets should be pooled in the UK to help ensure more joined up care for the individual. The figures involved are certainly eye-watering – £119Bn is the pot of money available should the idea ever take off, but the idea that councils would get more involved in NHS care and that NHS hospitals might expand further into the community, whilst making good theoretical sense do come up against the cold reality of practicalities.

Joint commissioning is nothing new and as a company Prestige Nursing + Care has often worked with such teams to deliver integrated care into the community, offering patients a seamless journey on their road to recovery. Mr Burnham quite rightly identifies the gaps in the system at present and by characterising hospitals as working on a production -line model, particularly in the care of the elderly, he is undoubtedly correct. However it is still unclear how the imminent settlement on Social Care funding would fit into Mr Burnham’s plans, or indeed the Clinical Commissioning Groups which are due to arrive later this year. Jeremy Hunt, the current Health Secretary has pointed out that a re-organisation of the NHS along the lines of Mr Burnham’s proposals would take away power form doctors and nurses, one of the supposed benefits of the new CCGs. Equally the admission that Labour would consider abolishing means-testing of care services if it wins the next general election would open it up to accusations of another ‘death-tax’, used by the Tories against them so successfully at the last election.

 

Chris Ham, chief executive of the King’s Fund health thinktank, said Burnham had the right diagnosis of why change was needed if the NHS and social care systems were to continue to meet the needs of the ageing population. But he said the plans “leave many questions unanswered”. However it seems that Burnham’s musings on whole person care reflect a phlegmatic approach to the thorny issue of Social Care, with the party seemingly happy to put forward ideas without worrying too much the details of the implementation as yet. Such is the luxury of opposition politics, but without doubt Mr Burnham’s ideas are on the right track and represent food for thought as the Social Care debate continues to evolve before our eyes.