Recently in homecare Category

Happy New Year! I returned to work today to see social care at the top of the news headlines.

Social care's great and good have written an open letter to the prime minister (in the Telegraph) urging that he and his fellow party leaders deliver on social care funding reform this year to put an end to indignity and isolation for older people, dependence for disabled people and the denial of life opportunities for carers.

It's great to see social care on the front pages and at the top of news bulletins, and you cannot fault the timing: this is, of course, the year in which the government publishes a White Paper setting out how it plans to reform social care, including its funding. Moreover, cross-party talks are due to start.

Before Christmas, we predicted that the government would not deliver on social care funding reform, specifically that it would not implement the proposals of the Dilnot commission to put a £35,000 cap on lifetime care costs for all because of the £1.7bn bill.

An optimist might argue that we made the wrong call, and that the festive period showed that both government and opposition were up for making social care funding reform work.

On this line, Labour has shown how much of a priority it puts on social care by putting out research over Christmas showing how much charges for home care and other community services had risen in the past couple of years (6% for home care). Releasing the research, shadow minister for care and older people Liz Kendall urged Cameron to engage in serious cross-party talks on reform. The positive narrative would also point to action from government in the shape of a £170m injection of cash into social care services for people discharged from hospital to manage winter pressures over the coming months.

This money - one-tenth of the cost of Dilnot - was found from Department of Health savings but meeting the full cost of Dilnot is a call that only the Treasury (and Number 10) can make. Moreover, whatever the pros and cons of the Dilnot package it doesn't, in itself, purport to solve all or most of the problems outlined in today's letter to Cameron.

This is because Dilnot is about expanding the existing publicly-funded social care system to cover self-funders (who would benefit from the cap); it is not about filling the funding gap in the existing system (put at £2bn to £4bn), which manifests itself in rising charges and eligibility criteria, squeezes on providers and inadequate quality.

This £4bn-6bn black hole (Dilnot plus funding gap) is not the whole story. As the government, councils and the sector know, the way social care operates needs fundamental reform  through better integration with health and housing, more personalisation (in the widest sense) and more intelligent commissioning. This should generate efficiencies that would reduce the Dilnot plus funding gap black hole from £4-6bn a year to something less than this.

However, I very much doubt that even the reduced figure would be something the Treasury would stomach, particularly in the current economic climate.

That is why I remain a pessimist - though I would be beyond delighted to be proved wrong.

This response to today's Equality and Human Rights Commission report on human rights breaches in home care services comes from former social worker Di Galpin, senior lecturer in practice development at Bournemouth University's school of health and care and co-author of the National Competence Framework for Safeguarding Adults.

The Equality and Human Rights Commission report on the abuse of older people makes for more dismal reading on the care of older people in Britain today. Sadly this is not new to many of us who have worked in the care sector.  Yet our voices have gone unheard, leading to many, such as myself, leaving the profession in disgust. 

It is estimated up to 340,000 older people in the UK are abused each year in their own homes.  The abuse of older people now parallels that of children  with many experiencing emotional, psychological, physical, sexual and financial abuse perpetrated against them by those charged with providing care and support,  for example, partners, wider family and professional carers. Although abuse appears to pervade the lives of a substantial number of older people cries of indignation from wider society and government are strangely silent, unlike in cases of child abuse, such as Baby P and Victoria Climbie, which resulted in mass media coverage, government inquiries and the reform of childcare systems, most recently through the Munro review. 

I believe the Human Rights Act 1998 provides a framework from which we should develop care provision for those most vulnerable, a guide to practice that can help provide an ethical  and moral foundation and reframe care as compassion rather than care as a commodity to be bought ad sold in a free market. Yet the Human Rights Act 1998 is under attack with some sections of the media (Daily Mail) condemning it as a 'whingers' charter' and the Conservative Party actively seeking its removal from public life.

However, the extension of human rights is fundamental to ensuring older people are treated with dignity and respect by those charged with caring for them.

The Human Rights Act (HRA) 1998 makes it unlawful for public authorities, such as NHS hospitals and carers employed by local authorities to act in breach of the fundamental rights and freedoms set out in the European Convention on Human Rights. Problems have arisen as original definitions of  what constituted a 'public authority' were too narrow and excluded private and voluntary sector providers leaving many individuals outside of the protection offered by the Act. This loophole was partially addressed in the Health and Social Care Act 2008. Section 145 of the act provides that individuals placed in an independent care/nursing home by a local authority are covered by the Human Rights Act 1998. However, section 145 does not confer human rights obligations on other independent care providers contracted by the local authority, therefore, independent domiciliary care agencies fall outside of the Human Rights Act 1998.

This is disastrous for those most vulnerable in society, as it leaves working in a manner consistent with human rights in an individual's home to the discretion of the provider. That's why I'm delighted that the EHRC has called for human rights protections to be extended to people receiving home care arranged by councils from independent sector agencies. I think the government should also extend such protection to the increasing numbers of people purchasing care services through direct payments.

While the government suggests that the Care Quality Commission's thematic review of home care services - announced yesterday - will help, do we really have any confidence anything will change given the CQC's failures in the Winterbourne View case?

This report appears after many others this year, highlighting the disgraceful treatment older people experience from those supposed to be proving their care, whether at home, in hospital or residential care.  A report by the Health Service Ombudsman on the abuse of older people in hospital settings suggests there is a culture of indifference from both government and staff to the abuse of older people. The Independent commented:

"For a while we may pause to express outrage.  But we then move on to the urgent business of our daily lives.  Spot checks and hit squads may arrest the worst practice.....But they will not do much about a society that has hardened its heart against the elderly."

Doing nothing is not an option.  We as individuals who make up society all have a role to play, however, so does government. The review of adult social care law undertaken by the Law Commission this year made clear to government the law pertaining to the protection of vulnerable adults requires strengthening, the current framework is clearly not working.  I would suggest it is time to stop treating older people as drain on resources and start showing older people we value them, and to those who abuse older people that this will not be tolerated any longer.  This will require legislation that truly regulates, and punishes abusers, when required, and a society that refuses to allow this to continue.

The Care Quality Commission's review of home care services, announced today, comes five years after the report of a similar review by its predecessor organisation, the Commission for Social Care Inspection.

CSCI's report found that home care services in England were often delivered in 15-minute slots that militated against undignified care, were task-based rather than responsive to what people really needed and suffered from high turnover and shortages in staff. Much of the blame it laid at commissioners' doors.

Fast forward five years and a very similar picture was painted by a survey of members by the United Kingdom Homcare Association, which found users' safety and dignity were being put at risk by cuts and shortened visits, and the interim report of the Equality and Human Rights Commission's inquiry into home care. The EHRC's final report, due out tomorrow, is not expected to depart from this line. Moreover, the CQC itself says it shares the EHRC's concerns that people in home care are seeing their human rights being breached.

All of which begs the question of what the CSCI review achieved and what, realistically, can the CQC achieve, particularly as the CQC lacks one of the weapons that its predecessor had in its armoury, namely an overview of how well councils were commissioning services.

As of November 2010, the CQC no longer assesses councils on their commissioning, and the United Kingdom Homecare Association has already warned that this means it is "largely commenting on symptoms, without identifying the underlying cause of hurried and sometimes undignified home care".

We shall see.

We've seen a lot written about the benefits of extra-care housing and we keep on seeing the same message that we need to see more.

There was a hard-hitting message from United Kingdom Homecare Association chair Mike Padgham in his speech to the body's annual conference yesterday.

A recent UKHCA found that councils cuts to home care were:-

• Putting users' dignity and safety at risk.
• Damaging the viability of providers' businesses, particularly in rural areas.
• Leading to worsening terms and conditions for staff.

Needless to say, cuts loomed large in Padgham's message to the troops:

"What do we have to do to get people to listen to the plight of social care in this country? Thousands of people are being denied care because local authorities are commissioning less and less care. Some care businesses are in danger of going to the wall, thus reducing capacity, many are facing imposed changes in contracting arrangements, unfair competition from local authority in house provision and the challenges of personalisation .....not to mention all the cost pressures and safeguarding....... the list goes on."

But there was also a tough message for providers, particularly the majority who operate in the independent sector, in the wake of the Winterbourne View and Southern Cross cases:

"In my view the Southern Cross and the Winterbourne issues have set us back several years in terms of perception and trust...and we have to regain that trust and work hard to develop a much more positive image of the independent sector."

It will be interesting to see how providers act on that message.

As we all know the Department of Health is not always famed for its use of accessible language and it's met expectations with its consultation document "Caring for our future".

This is the engagement document launched by the government to inform its future social care white paper, in which it asked for the sector's views.

However as one of our forum members has pointed out, the language is hardly friendly for front-line workers.

Big Red Dog says: "I've been trying to think of a way to describe it and my addled brain keeps producing the word 'gobble'. The language isn't exactly obtuse but the layout isn't user-friendly either. What do you think? Is this really an accessible document for front line workers, carers and service users?"

Her four-point plan for improvements is this:

1) Less jargon: Integrated Services and Practice-based Evidence are not phrases I hear workers, carers, and service users using (although personalisation seems to have filtered down now). This does not mean that they would not understand the concept if described another way, eg. How could carers, GPs and District Nurses work better together? Give examples of when xyz has happened.

2) Ask the contributor directly: What, if any, barriers to integration  should be removed, and how can we incentivise better integration of service at all levels? (3d) should read something like, Have you ever experienced any problems trying to get social workers, nurses, carers etc to work together? Why do you think it was difficult to get them to work together?

3) Ask one question at a time. Question, space for answer, question, space for answer. Six vague questions followed by a blank space looks really uninviting. You may as well put: Public spending should be focused on prevention, not intervention. Discuss. (1000 words, marks will be lost for grammar and spelling mistakes).

4) Ask open questions. None of the questions under section four (prevention) invite any ideas for preventative action. Our ideas might not be particularly sophisticated, but I reckon service users, carers and workers could point out some things that would have managers kicking themselves.

I presume the government does want to hear the voice of the frontline professional, but you'd be hard-pushed to believe it.

What do you think? Have your say on CareSpace

Community Care has just launched a website for domiciliary and residential care workers. The idea of You Care is to help promote good practice across the sector and to raise its profile.
I've already been out and about meeting and speaking with care home managers and domiciliary care workers to get a feel for the issues and it's clear to me already that there's a lot of fantastic work being done in a very pressured funding climate.

Use it and enjoy it.