TonyButcher

Why we need a fundemental review into Social Care in the UK

2011-06-20T09:13:00Z

The headlines over the last few weeks, i.e. Winterbourne, Southern Cross and, today, the delivery of Home Care, have shown that there is a crisis in how we look after the most vulnerable in society.

Unfortunately, successive Governments only appear to be concerned with how social care is paid for, with the latest review from Dilnot being due out next month. Yet the issue goes much deeper than that and because of this any funding review is redundant because it does not address the core issues which will, in turn, impact on how much we pay for caring for those who need the help of society.

One of the fundamental issues is what we, as a society, expect from social care. At present the elderly and the vulnerable are, in most instances, receiving care at the front line from low paid workers who themselves have been deemed vulnerable because of their low pay and working conditions. Is this acceptable? I am sure that if ‘ordinary’ members of the public were asked who they would prefer to look after them in their old age the answer would be well paid, dedicated professionals who could deliver the best quality care.

The majority of our care staff are dedicated and do the best of their abilities to provide good care but what incentive is there to achieve better? Incentive and motivation are key to getting the best from a workforce, in any business sector, yet these are fundamentally lacking in social care, those who achieve higher qualifications are often tempted away from the front line with the prospects of better salaries and working conditions, hardly a recipe for providing high quality care where it matters.

Care for the vulnerable also needs a comprehensive review to look at how society has changed over the last forty years. Demographics, medical advances and improved lifestyles have radically altered the shape of society, we are living longer and there is an increase in age related conditions that match that change. Society has changed therefore there needs to be a fundamental change in how we look at society and there needs to be policies and debate on that change.

Whilst much of the present focus is all on money, e.g. care costs, pensions etc., the real issues are being ignored (or rather they are just unrecognised). Our society has changed, and is rapidly changing, to one where older people outnumber the younger and there is increasing pressure on the younger people to support this older society both financially and physically.

Care is just one part of this issue that needs to be looked at, the ageing population also has a greater impact on health services and, indeed, impacts on all aspects of Government delivered services.

We need a fundamental review of social care in the UK and until we get that funding issues will not be resolved and care for the most vulnerable in society will always be inadequate.

Give the Social Care Workforce a Voice

2011-06-03T10:06:00Z

As I have mentioned, many times before, the social care workforce have been classed, by the previous Government and the TUC , as vulnerable workers because of the low pay, working hours and general conditions in the care sector. This problem has been exacerbated more recently by increased cuts in social care putting pressure on both wages and training provision and the dropping of the requirement that at least 50% of care staff in an organisation should have NVQ level 2 or above. This latter point has meant that employers do not have to spend out on training their staff to this level.

Yet it is the social care workforce that society expects to deliver quality care to the most vulnerable in society.

Despite this there is no central organisation to support and speak out for social care workers. Most Government led organisations and ‘arms-length’ bodies work through care providers and have little or no contact with the actual care workforce, for example the National Skills Academy for Social Care describes itself as an ‘employer led membership organisation’.

The diverse nature of social care, i.e. with the majority of care being provided by small or medium sized organisations, means that talking to the workforce is difficult which is one reason why unions such as Unison are unable to gain membership amongst the majority of the workforce, this is in addition for the reluctance of low paid workers to pay union fees and the view of unions as political organisations which does not interest many care workers.

There was at one point a little hope. The proposed registration of all care workers by the General Social Care Council would have created a single point of contact for all care workers and a means through which the views and opinions of care workers could have been gathered. Obviously the registration would have cost a fortune and there is the issue of paying registration fees, a problem for a low paid workforce, but it would have given a voice to the care workforce.

Undoubtedly, after this week’s Panorama programme, care workforce registration will be, quite rightly, back on the agenda but it needs to be remembered that the majority of the workforce are not abusers and that those expected to deliver care services should have a voice.

Society needs to ask itself about how it views social care, do we really want a low paid, unheard workforce delivering care service to the vulnerable or do we want an effective committed workforce, paid in relation to the responsibility of their work and who have a voice to raise their concerns about social care in the country.

Social Care - From a Different Angle

2011-03-01T11:27:00Z

Who provides care services? The answer is a complicated one but the bottom line is that most front line care is provided by independent companies, either private businesses or charities, which are dependent, as businesses, on the income provided by individual care users or by local authorities.

Putting aside the rather complicated scenario where those who receive direct payments employ personal assistants and, therefore, become social care providers themselves, Skills for Care estimate that there are 17,300 providers of care services in England and there were 18,462 care homes registered with the Care Quality Commission in 2010. Whilst some of these are Local Authority homes, this number has declined over the years and only account for around 8% of the total, this means that approximately 17,000 care homes belong to independent care providers.

Of this total it is estimated that 70% are small businesses.

Looking at social care from a business point of view, it is obvious that it is a business sector under significant strain. Increases in fees have been pegged below inflation for the last four or five years and last year there was, generally, a zero increase in fees, which also seems likely to be the case over the next couple of years.

Yet as income has declined, in relative terms, costs have increased, certainly in terms of energy costs which account for a significant part of most care home budgets. However as social care fees are squeezed there is an increasing demand to provide ever better quality care.

Social Care policy, quite rightly, focuses on the outcomes for individuals who need care services, yet there is very little in terms of policy or initiative that recognises the role played in delivering this. Under the system of social care we have at present quality care delivery needs to be commercially viable in order to succeed.

The latest idea from the Care Quality Commission puts a further strain on the commercial viability of small providers. The Excellence scheme announced yesterday will be a voluntary one, and those providers who wish to participate will have to pay for the privilege. This will place many smaller providers, especially those who provide excellent care, in a dilemma, do they divert the funds they use for providing care to the vulnerable over to a scheme which may help improve their overall business standing but could impact on the level of care they provide.

One of the possibilities this scheme creates is that larger providers, whose profitability through economies of scale is higher, will be able to afford to participate in the scheme and be able to use the excellence standard for publicity and marketing purposes. If a Local Authority commissioner has to choose between a large provider with an excellence rating and a small provider who feels they cannot afford to participate in the scheme, what choice will they make? Similarly what choices will those seeking out care services for relatives make?

The danger here is that many small providers will lose out and be forced to close and the bigger providers get even bigger leaving society with a supermarket style system of social care – do we want that?

It is essential that any social care strategy not only looks at the needs of those who use care services but also how commissioners can work with the 12,000 or so small businesses that are expected to deliver the quality care that society demands.

Daily Mail Needs To Stop Scaremongering

2011-01-31T09:48:00Z

Today's Daily Mail has an article entitled "How 600 die of thirst in care homes: Damning report exposes the rising number of elderly killed by neglect"

Read more: http://www.dailymail.co.uk/news/article-1352015/Damning-report-exposes-rising-number-elderly-killed-neglect-care-homes.html#ixzz1CbZOBZIJ

It is, of course, spectacular hype by paper. For starters what the title ignores is that the 600 applies over a 5 year period. So their table showing between 1997 and 2005-2009 actually equates to a decrease in falls and only a fractional increase in dehydration

However it is the lack of responsible research and proper journalism that is the most shameful aspect of this article.

Firstly it fails to give any comparative figures, focusing only on deaths in Care Homes they have failed to publish how many deaths have also occured in hospitals or where people have remained in their own homes.

Secondly, they have not made any effort to report on how many of those individuals were already suffering from dehydration or malnutrition before entering the care home - and the likliehood of this because people were unable to take in enough nutrition at home.

Finally they also fail to make any mention of the problems elderly people, especially dementia sufferers, have in taking in sufficient food and water.

This is totally shameful reporting and I hope other press organisation correct the facts

On Twitter @tonybutcher

Can Care Providers Be Squeezed Anymore?

2010-12-15T10:55:00Z

I think it was back in 2008 that Ivan Lewis, as Care Secretary, said, in response to a Parliamentary question that care providers should at least expect a raise in fees in line with inflation following a round of announcements from Local Authorities giving less than this for the second year running. Since then of course the raises in fees have been even less or in many cases this year non-existent.

Yet, in that time, there has been terrific inflationary pressure on care providers, particularly caused by the increases in fuel and food costs.

Now the Local Authorities are faced with a 10% cut in their budgets and, undoubtedly, this will mean another year of 0% increases in fee payments.

The unanswered question in all this how are care providers expected to provide decent levels of care in the face of ever decreasing margins and what will be the areas that care providers have to cut out in order to make ends meet. Most providers are private companies and there has to be an element of profitability to ensure that the business continues to survive, the danger in the current situation is that many smaller providers, who care about providing a decent service, will feel that they are not able to do this under the current monetary constraints. Other, less scrupulous providers will feel happy to continue to cut quality in order to maintain profit margins and the only people who lose out are those receiving the care service.

Of course the larger providers will be able to survive through economies of scale and bulk purchasing but this then creates another potential issue. Do we want a ‘supermarket’ system of care where the only cost effective choice is the big providers using purpose built complexes? Or should those who need care services be able to make choices about the type of provider they want and the way in which they wish to spend their lives.

Where providers do make cuts, these are, inevitably, in relation to staffing, which is always the biggest cost for providers. Cost cutting is most likely to hit training first, then, almost certainly the overall level of staffing, putting more pressure on existing staff to take on more domestic duties than spend quality time with individuals.

Very often Local Authorities only see their role in care provision without taking into account how their financial decisions impact on those who actually provide the care and on the impact of choice and quality on those who receive care services. Social Care needs to be raised to the top of the agenda both locally and nationally and we need a debate, not just on the best option for the elderly to pay for their care but on the fundamentals of care provision and how we expect providers to supply the quality the nation expects with less and less money to do that.

This is an issue that needs tackling NOW. After years of cutbacks already any more will put the lives of the vulnerable in our society at risk and are we really prepared to do that?

Care Education More Important Than Tuition Fees

2010-12-07T11:18:00Z

Passions are running high over the tuition fees debate but I do wonder if things are being put totally out of perspective by the well organised opposition of the NUS.

What is missing from the debate is the lack of funding for vocational education for those who do not seek a University degree but who benefit from learning about their chosen profession and, as a consequence, are able to provide better quality service to their customers.

Nowhere is this more important than in care provision.

Yet in the cuts made by the Government the Train to Gain budget taken away and there is to be no funding for anyone over the age of 24 and even for those who qualify only level 2 qualifications will be available.

Many people come into care work without formal qualifications, it is a low paid job after all, but, as a Nation, we expect care provision to be of a high standard yet, it seems, not prepared to provide those who care for the vulnerable in society the tools and knowledge with which to provide that care.

It is not enough to be a caring person. Without the knowledge that underpins care provision being a caring person can be as problematic as being an uncaring one. People who deliver front line care must have a knowledge of infection control, health and safety etc in order to be able to deliver care that is both caring and safe. Care workers need knowledge about the specific conditions of the people they are supporting, the needs of an individual with dementia will be very different from a person without and the range of conditions associated with learning disabilities need to be understood by those who are being paid to help them live as independently as possible.

The big question is how this knowledge and learning is funded. We, in the care sector, are more than aware of the issues over care funding. It is not recent phenomena, many local authorities have given lower than inflation fee increase over the past couple of years, putting pressure on private care providers. This has been somewhat mitigated by the availability of funding through Train to Gain and other initiatives to provide training for the care sector.

In any business sector, as soon as money starts looking tight, the first target of cutting back is usually training and staff development. In the care sector this has been positively encouraged by the removal of the requirement for 50% of care staff to have a level 2 or above qualification.

There are plenty who will criticise and condemn the care sector when the quality of care provision when standards fall below those expected but there seems to be a total ignorance of the need to provide, and pay for, a system of vocational education for those who provide that care and support.

I am not against a University education but I do believe that there needs to be a balance in the Further Education debate. Do we need more graduates receiving subsidised degrees or do we need to provide better educational opportunities for those who left school without qualifications but who are expected to provide a service of high standard without support from a society which values degree education over the needs of the vulnerable in our society.

Social Isolation - We Need to Work Together

2010-11-10T11:03:00Z

Today’s report on Community Care about the Relatives & Residents Association (R&RA) report on the social isolation faced by many elderly people in care homes is disturbing but not surprising (http://bit.ly/abb2pb).

Yet it does raise the question of who should be responsible for ensuring that this social isolation is avoided.

The R & RA wants local authorities to take the lead on this issue and "all adult social care departments to be legally obliged to ascertain how many potentially isolated older people are in care and develop and implement strategies for their support". Yet in these times of potentially shrinking adults social services departments should the burden fall completely on local authorities, surely the care homes themselves also have a role to play in providing support where an individual has no contact outside the care home.

It is the care homes who are most likely to know whether or not an individual is getting any contact with family and friends or have any connection with the wider community. And, therefore it should be the care home that, at the very least, reports the issue to the local authority care manager, unfortunately, in the case of privately funded individuals it is unlikely the LA will actually take any action - so what should the care home do?

Today’s report covers those living in care homes but it must be assumed that some of those receiving services at home may also be socially isolated and it is equally important for these people to be supported. Unfortunately it is more difficult to determine where social isolation occurs in these cases but much more important to find out because outside of the care hours provided isolation will be total – i.e. no other carers or residents about as in the case of a care home.

But the issue should not just be thought of as one affecting only those who are elderly, many younger people who use care services may also be suffering from social isolation.

The issue of social isolation is really where we need the ‘Big Society’ to kick in. We need Local Authorities, Care Providers and Charities, such as Age UK, to work together to identify those who are socially isolated and to find ways in which everyone can work together to provide social interaction. We are social creatures and we all need social interaction, we all need to take responsibility for ensuring no-one who receives care services is isolated from their families, friends and the wider community.

The Spending Review could Impact on Standards of Care

2010-10-20T14:15:00Z

Whilst the plight of Adult Social Care seems to have been mitigated by the announcement of £2bn to be given to councils for care provision, George Osborne's Spending Review does hold some hidden problems for the care sector.

The top of this list, from my own perspective, is the abolition of the Train to Gain Funding and the removal of the entitlement to free training for a first full level 2 qualification for those over 25.

This cut, added to the dropping of the a minimum requirement of 50% care staff to have a level 2 qualification, will inevitably lead to a drop in the numbers of care staff in the private sector who receive full level 2 training. Why should employers, who already face cuts or freezes in care fees spend money on training when it is needed just to maintain levels of care provision. Of course, those less scrupulous care home owners will rejoice in the fact they can save money this way but many home owners will be faced with the difficulty of juggling how they meet standards when they are having to face the prospects of increased costs (i.e. VAT rise), having to fully fund any training and lower (in real terms) incomes.

Another issue here is the recruitment and retention of care workers - always a thorny issue - but one of the key tools in retention is training and giving people the opportunity to develop and gain a qualification. Through full training, such as the soon to be defunct NVQ, care workers can translate their work from what appears to be merely routine into a system that recognises their abilities in care and, hopefully, although not always, rewards them in higher wages and higher self-esteem. Many of those who come to work in the care sector are over 25 and, often, have no formal qualifications. Whilst there is always a little reluctance for many new workers to take on the daunting task of achieving a qualification in the majority of cases it is a worthwhile task that people enjoy and develop the taste to go on to further learning.

A final point has to be concern for the many independent training providers who, with the losing of Train to Gain funding, will find it difficult to get business. The funding provided something of a level playing field for independents, whose costs are naturally higher than colleges, therefore it is likely those employers who will fund staff to NVQ/QCF level 2 are likely to go for the cheaper college option.

There are many issues for social care in this spending review but educating the workforce surely has to be a priority in delivering high quality care

Who will Council Care Home Closures Benefit?

2010-06-16T09:16:00Z

Kent County Council have announced a consultation about closing council operated care homes in the county in a bid to save £2m each year.

Of course the whole process is couched in spin. The cabinet member for adult social services, Councillor Graham Gibbens, told the BBC, "These proposals are about creating a legacy of dignity, quality care and a quality environment for all older people now and in the future” but of course he could not avoid the bottom line saying "They are also about saving money so that we can continue to protect services wherever possible."

What is avoided, so far, in these announcements are the impact such closures on the individuals who need care services and those who work for the homes faced with closure.

Kent is, of course, just one of the Councils with Social Services Responsibilities who will be looking at this option in the bid to cut expenditure, many have already divested themselves of their care home stock.

The jury is still out on the impact on vulnerable elderly people who are faced with being moved from one home to another but there are certainly issues in terms of the Human Rights Act, after all the Act was applied to private care homes because of an issue of trying to remove an elderly woman from a home she wanted to stay in. There will, no doubt, be plenty of legal challenges as Councils try to find a way around their responsibilities to Human Rights.

Perhaps the biggest issue is why Councils save money by contracting out care services. One reason is the amount paid to care workers, one average (going by Skills for Care NMDS figures) care workers for councils are paid 8% more than their counterparts in private companies. So aside from council care workers facing redundancy they are all facing a drop in their income if the continue to work in the care sector.

Then councils are also able to reduce their administration staff as they will be no longer needing maintenance, payroll and HR staff etc. It is, perhaps these council workers who will suffer most, whilst care workers may find alternative jobs with those private providers taking over from the councils (albeit at lower wages) the back office staff will not have such an option as the private providers will already have people in these roles.

The other way councils will save money is by having more control over what they spend on the elderly, with their own care provision the have to provide a certain level of service and pay for it. With simply paying private providers they are able to control fees. Most councils did not give providers any increases in fees this year – despite inflationary pressures and many fees have not been increased in line with inflation over the last few years. This forces private providers to find ways in which to reduce costs without impacting on basic levels of care.

The closure of council run care homes may help Local Authorities balance their books a little better but only at the expense of the levels of care provision and the lives of those who work in providing care to the vulnerable.

Fairness, Freedom and Responsibility in Social Care

2010-05-26T12:11:00Z

Fairness, Freedom and Responsibility were the buzzwords of the first Queens Speech under David Cameron’s Government.

Yet we have little detail, so far, how these ideals will be applied to social care.

We had the promise of a Commission which will look at the structure of social care but will the Commission be given the freedom and responsibility to look at all aspects of the care system and the much of the unfairness that is inherent in the system.

Yes, we know there is the question of the fairness of people having to sell their homes to pay for care but there are many other issues of unfairness to, such as the variation in services across authorities, the level at which people are able to access services, the difference in fees charged by some providers to private or publicly funded users, whether or not Local Authorities pay sufficient care fees etc. There is also the question of whether care workers are treated fairly in being asked to provide intimate services for such low remuneration, is it fair that the carers allowance for those who provide unpaid care for loved ones is just £53.90 per week?

There is also, perhaps, a question of whether the Government will be fair and responsible with social care. Is it responsible to launch another Commission into the funding issue following on the double consultation process undertaken by the last Government. To waste money going over the same ground (and I am sure that many of the submission from charities and lobbying groups will be near identical to those submitted earlier in the year) seems irresponsible, surely it will be much better to focus on the wider issues of social care that impact care users and those who provide support for the vulnerable.

Whether or not the Government gives Social Care fair time in Parliament is another question. According to the 2001 census details more than 6 million people provided unpaid care, add to this the 1.2 million people working in social care in England, the 1.78 million people receiving Local Authority care packages in England (plus those in the Devolved Governments) and you find that over 15% of the population have a stake in care policy, a number that will increase with the rapidly ageing population. The Government has committed itself to a very full Parliamentary programme of the next 16 months or so and it is difficult to see where social care will find the time to have the debates in Parliament that the demographics and economics suggest it deserves.

There will, of course, be freedom for some as personal and individual budgets are pursued by the Government but the question here is how much Local Authorities will be able to make available to individuals who may not, because of financial restraints, have sufficient budgets to make real choice in their care services.

It is obvious that Social Care will be impacted by the cuts announced so far (and those yet to be announced!) so there needs to be an immediate debate on how those who depend on social care are to be protected from the cuts.

The most vulnerable in society must have fairness and freedom but it needs a responsible Government to achieve this.

Please sign my petition calling for the Government to make Social Care a High Priority: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

We need Greater Social Care Commitment from Government

2010-05-21T08:50:00Z

I would like you to see a comment left on my petition calling for the Government to make Social Care a High Priority:

“The commitment to dementia research in the Coalition Agreement is very welcome, but there needs to be a commitment to good social care for dementia as well if it is to be meaningful and the elderly are genuinely going to be supported to live at home for longer.”

I think this sums up many of the real challenges that lay ahead for social care over the coming years which have not been fully covered within the coalition document and we need to hear more from the Government who must touch on further issues.

A commission on funding is welcome but if it only focuses on the level individuals have to pay for their own care then a vast section of those who use care services is excluded, those who cannot pay for their own services. This not only includes many elderly people but also many with disabilities and mental health issues. There needs to be a comprehensive review of the real cost of care services for those with multiple and complex whose funding is wholly reliant on Local Authorities.

There was a commitment within the coalition agreement to extend personal budgets and direct payments but how can these work without a proper assessment of care costs? If a Local Authority can only pay a certain amount in Direct Payments what guarantees are there that this will be sufficient to buy the quality of service an individual may need or will lesser quality services, whose staff training etc may not be at the highest level, be the ones that care users have to use because that is all their personal budget will allow?

There needs to be a greater acknowledgement from the Government of the needs or those with Learning Disabilities, particularly those with profound and complex disabilities, who have, so often, been ignored by policy geared toward the more able.

There also needs to be greater debate around the social care workforce. Social care is about people, those who need care and support services and those who give care and support, yes there have been technological advances in providing care and support but technology cannot give reassurance to a person who is confused, technology cannot support an incontinent person with dignity, technology cannot sit and have a conversation with an individual who wants to talk about their life and needs.

Unfortunately many of those who desire to provide care and support are stifled by the system in doing so. Social Workers are often tied up by paperwork, unable to get out and talk to the people they want to help. Care Workers, themselves classified as vulnerable workers by the last Government and the TUC, are asked to carry out care tasks that many would turn their noses up at and to do so working unsociable hours but they are expected to do this for low pay and little reward from society.

Unfortunately the Department of Health seems reluctant to commit to making social care a priority but British society needs to support and care for the most vulnerable in society and the Government must make those individuals a priority in its Parliamentary work. After all, what sort of society is it that marginalizes its most needy citizens in a time of economic uncertainty when the potential spending cuts will impact directly on the services provided to them. The Government must prove that it is not one that will preside over that sort of society.

Please sign my petition calling for the Government to make Social Care a High Priority: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

Govt NOT Planning to make Social Care a Priority

2010-05-20T09:59:00Z

Apologies for hogging the blog list but I had to share this response I just got from the Department of Health on my call for making Social Care a High Priority:

"Dear Mr Butcher,

Thank you for your email of 17 May about the future of social care. I have been asked to reply.

I understand that you would like the care and support system to be a high priority for the new administration. While I appreciate your concern, I am sure that you will understand that the new Government has a large number of issues to tackle. The NHS will be backed with increased real resources but, in the light of the current financial climate, it must become progressively more efficient and cut the costs of what it does in order to meet increased demands and to improve quality and outcomes.

All of this means that the new Government will be assessing their priorities very carefully. I am sure you will appreciate that, for these reasons, I cannot outline any commitments to address your concerns at this stage.

I understand that you may find this reply disappointing, but I hope that it clarifies the position of the Department at this time."

Please sign my petition calling for the Government to make Social Care a High Priority: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

Coalition Takes the Daily Mail Option

2010-05-20T09:09:00Z

We now have fuller details of what the new coalition plans to do on social care.

http://programmeforgovernment.hmg.gov.uk/social-care-and-disability/comment-page-1/

Unfortunately they seem to have gone for the Daily Mail option and decided to focus on the needs of those who have been required to sell their properties to pay for care services. Whilst this is an important part of the social care debate it is not the whole of the debate and I would hope the proposed commission goes beyond this.

It is not just a question of how these particular people pay for their care but a question of funding social care as a whole. It is necessary to take into consideration the costs of providing social care, even for those who are unable to pay for their own care. There is a need to investigate the difference in costs between publicly funded and privately funded care, there needs to be an enquiry into the cuts in services for care users across the country, there needs to be questions asked about the variation in care costs from region to region.

Beyond the questions of finance there needs to be action on adult protection and clarification on the future of such schemes of the Independent Safeguarding Authority registration.

There also needs to be greater clarity on the roles of the various Quangos associated with social care.

Changes to the system cost in both time and money, most Care Providers are already tied up in rewriting many of their procedures to meet the change from the old National Minimum Standards to the new Care Quality Commission standards of Quality & Safety, further changes to the system need to be clarified as soon as possible.

There needs to be greater clarity in the role of social workers in delivering social care to the vulnerable in society. Will the changes proposed under the last Government still go ahead?

There are a great many issues facing social care and the delivery of care services to the most vulnerable in society, all of equal importance to that of individuals faced with selling their property to pay for care.

The new government must tackle all of these issues to ensure that those most vulnerable in society are not disadvantaged in the attempt to appease ‘Middle England’

Please sign my petition calling for the Government to make Social Care a High Priority: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

The Demonization of Care Homes

2010-05-19T11:22:00Z

A few years ago I spent 18 months or so working as a Face to Face Charity Fundraiser (or a ‘chugger’ to give it its colloquial term). Since that time there is one conversation that has always stuck with me.

I was fundraising for a dementia research charity when I had a talk with a guy who was wracked by guilt because he had had to make the decision about whether or not to continue to looking after his father, who had Alzheimer’s, at home or whether to place him in residential care. Not only was there the guilt of having to admit that he was no longer able to cope with looking after his father but also the guilt of having to place his father in a ‘care home’.

This has always made me wonder why care homes are seen as such a bad option for vulnerable people whose families are no longer able to cope with the strain of providing care at home for those they love or for those who have no family able to care for them.

This is compounded by sections of the care sector who feel that private care homes (which provide around 80% of all care home provision) are more interested in profit rather than in delivering care.

Whether it is public or private care home provision there seems to an element of demonization present. The reason for so much private care home provision is the desire to move vulnerable people away from the institutionalised long-stay hospitals and campuses etc to a better quality of care. Yet it seems that now this has been, largely, achieved, society has moved its definition of an ‘institution’ to include that of a private care home which have come to represent the 'bad' aspect of social care.

This demonization of the private care home has, of course, partly been bought about by media insistence on only publishing stories of when things go horribly wrong. But it should be remembered that, according to the care regulator, that there are more good and excellent care homes than poor and adequate ones. It is also important to remember why so much care home provision has been handed over to the private sector. Local Authorities are unable to match the lower costs that private providers can achieve in delivering care. Whether this is a good thing or not is debatable, much of saving in costs comes from the wages paid to care staff, Skills for Care figures indicate that private care homes pay around 8% less than statutory providers, but whether this leads to any decrease in the level of care provided has yet to be established and it must be remembered that the move toward private provision is Government and Local Authority lead rather than something created by the private care sector.

The flip side to the argument, put forward by care home owners and associations, is that care fees, paid by local authorities, have, over that last few years, been raised by less than the rate of inflation and this year, in many cases, no increase has been given at all and with inflation currently its highest for 17 months the lack of increased fees is bound to impact on care delivery.

Both sides have valid concerns but, unfortunately, the only aspect that has reached the national is this demonized impression of care homes that are bad and this is one reason why the Government must make social care an immediate priority.

Only Government commitment and action on social care can reassure those families who are faced with the difficult decision of having to choose residential care for someone they love that it is the right decision and that everyone in the public and private sectors are committed to providing good quality care.

Please sign my petition calling for the Government to make Social Care a High Priority: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

An Unbalanced Society

2010-05-17T08:12:00Z

Thousands of people being inconvenienced by having to change or cancel their travel plans because of the British Airways strike.

100s of 1000s of vulnerable people whose lives have been affected because local authorities were unable to increase the care fees they pay this year.

Which one did you hear about in the media?

This is one of the systemic problems faced by social care in getting the attention it deserves in today’s society. The media will no doubt argue that people are not interested in social care and it is their job to report what people want to hear through the media. Yet the flip side of this is people are not interested in social care because it is not reported about and they know very little of the social care system in the UK.

How many national newspapers covered the launch of the Social Care White Paper on 30^th March this year?

How much national media coverage was given to the Care Quality Commissions annual report which stated, back in February, “rising demand and pressure on finances make reform essential”?

The answer – very little. Yet how can society debate or make judgements on issues that affect the lives of so many people without being given the essential facts by the media we so rely on for much of our everyday information. It is not only the lives of the vulnerable people you use care services but also those who work to care for people, those who care for their loved ones and relatives, those who work behind the scenes in providing care services etc.

Whilst millions are involved in receiving or delivering care services it is, perhaps, those who have no connection with care that need to be informed and a part of the debate. The facts are plain, we have an increasing ageing population and the number of people with dementia is predicted to rise sharply. More and more people will find themselves involved in the social care system, in some way, in the coming years and it is important that everyone in the country is informed in the debates around social care.

We need greater national media coverage, involvement and balance in social care to raise the awareness of the nation of such an integral part of the British social system.

You can choose not to travel if you want but there is no choice in getting older and, perhaps, needing social care services.

I have started an online petition to call on the new Government to act on Social Care any signatures would be appreciated - Social Care Should be a Government Priority Petition: http://www.gopetition.com/petitions/social-care-should-be-a-government-priority.html

Fighting for Social Care: A Rallying Cry

2010-05-14T12:44:00Z

One of the biggest problems face by social care in achieving recognition on the national political arena and raising its profile among the general population is the great diversity found in the sector, not only in the range of people who use care service but also in the number of organisation who provide care services or support those who need services.

For starters there are the 150 or so Councils with Social Service responsibilities, each of whom provides adult social care across the spectrum of needs (this does not include provision in Scotland, Wales or Northern Ireland), then there is the innumerable number of care providers ranging from large corporate bodies to the smaller micro providers who again work across the full range of needs. Some of these providers are members of organisations set up to help providers but, again, there is at least 6 of these and many organisations choose not to join.

Then there is the vast range of charities out there who support vulnerable people, but these usually focus their efforts on specific groups of people, such as Mencap for the Learning Disabled and Age Concern for the elderly.

Then, of course, are the 1.78million social care service users and a range of organisations who support and lobby for different sections of the social care spectrum. There are also 1.2 million workers, the majority of whom do not have any national voice speaking for them.

And just to throw even more confusion in the mix, Adult Services currently come under the remit of the Department of Health, whereas Children’s services come under the Department of Education.

Whilst some of these myriad of organisations conjoin to form wider bodies, such as the Association of Directors of Adult Social Services (ADASS) for the Local Authorities and the Learning Disability Coalition, which is made up of 15 different organisations, etc. The groups tend to fight for their own corners rather than social carer as a whole. In fact such groups can often be at loggerheads, particularly over the issues of funding.

So what is needed is a single voice for social care. Not one that fights to sort out the nitty-gritty problems that individual organisations seek to address for their particular area of care but one that fights for social care to be at the top of the political agenda, one that fights to ensure social care is recognised as a national issue that cannot simply be swept aside by ‘fashionable’ topics, one the fights to bring knowledge of social care to a wider national audience so that more people can understand the complexity of the demographic challenges ahead and one that fights for social care as whole for the benefit of all the diverse components that make up the sector.

The new government has heralded a new era of partnership and cooperation, now is the time for the complete spectrum of social care organisations to come together in partnership and shout loudly for social care.

Social Care in Perspective - Why the Govt must Act

2010-05-13T14:33:00Z

Social care has, as per usual, taken a backseat during the political wrangling of the last few weeks, and any mention of social care seems to make people turn away with disinterest. So it is worthwhile pointing out just how important social care is in society and the huge part it plays right across the UK.

According to the NHS Information Centre Local Authorities in England spent £16.1bn on providing adult social care services in the year 2008-2009. High figures like that are often difficult to comprehend so it is worth putting it in perspective. Immigration, which has been a hot topic during the General Election, comes under the remit of the Home Office who had a £9.9billion (Border Control £1.6bn) in 2008/2009, devolved spending on Wales is just £15bn, the Department for Transport also only has £15bn and the Department for Energy & Climate change has a paltry £2.1bn, so social care is a major part of public expenditure in the UK.

The figure of £16.1 is considerably under estimated, it only includes the funds spent by Local Authorities in England, the figures for devolved Governments also need to be included. As to does the amount paid by the multitude of people who have to pay for their own care services and the services provided charitably nor does it include social care costs which are funded directly from the NHS (continuing care etc). On top of this are the costs of the Department of Health as well as the costs of the many ‘arms lengths’ bodies associated with social care. I’ll leave those better paid to do such research on the total cost but it does show how financially important social care is, so it should be accorded the proper respect.

But, perhaps, more important than the cost is the people. Around 1.78 million people received social care packages in 2008/2009, again this is for England only and does not include those who pay for their own care services. On top of this is the estimated 1.2 million people who work in social care (around a 5^th of the national workforce). Add in the vast number of unpaid cares and the people they care for without Local Authority support, those in care funded by the NHS, those who provide services to supply care providers and the army of civil servants employed by the arms lengths bodies and yet find that a significant number of the population is involved in social care and affected by social care policy.

Again to put this in perspective with immigration, in 2008 509,000 people entered the country (which includes Britons returning from living abroad) and 427,000 people left the UK, small figures compared to numbers of people receiving social care services. And, of course, immigration can cut across social care both in terms of care users and workforce.

Unfortunately Social care is an issue that politicians are reluctant to face up to. With other issues that can make promises to tackle, by imposing stronger border controls etc. But with social care they know that the problem is going to grow as the population ages so they seem to prefer to bury their heads in the sand (or hide behind endless inquiries and consultations).

Although putting social care into perspective in terms of money and numbers of people involved is useful, it is impossible to quantify the needs of the vulnerable people whose quality of life depends on those services and who depend on Government to ensure those services are delivered. The Government must address social care with the urgency that is demanded by a sector at the heart of British Society.

Social Care - Where Politics Must Meet Reality

2010-05-12T13:00:00Z

Now that we have the General Election finally out of the way the new Government being put into place, today it must start working on the policies that will frame its first Queen’s Speech.

Whilst we have heard much on the economy, education and political reform little has been said on one of the key issues facing the UK at present – Social Care.

No matter what areas the new government chooses to focus on, social care will not go away. The demographics of an ageing population, the serious under-funding of many social care services, the issue of how much individuals have to pay for their own care and issues affecting those who need social care services but do not fall under the category of ‘elderly’ all need to be addressed sooner rather than later.

The last Government was keen on prevaricating about the issue, endless consultations culminating in a White Paper published far to late in the Parliamentary calendar to be of any real use.

Therefore it is imperative the Andrew Lansley, in his role as Health Minister, must ensure that Social Care heads his departments agenda and that solutions to all the issues faced by social care are addressed with as much speed as possible. Many of the statements on social care during the General Election focused solely on the issue of people having to sell their properties to fund their care, whilst it is understandable that this is an issue that resonates with an important section of the electorate, it does not address the full range of issues facing social care.

It does not address the workloads and roles of social workers, it does not address the pay, conditions and recruitment issues of social care workers, it does not address the needs of other social care users, such as those with physical or learning disabilities or mental health issues. It does not address the fragmented postcode lottery of care delivery across the UK.

These are issues that need to be addressed, in addition to the funding issue, if we are to have a comprehensive plan to take social care forward and meet the demands on social care in the coming years.

In his speech outside No.10 David Cameron stated, “I want to make sure that my Government always looks after the elderly, the frail, the poorest in our country” and it is only by addressing social care immediately that he can achieve this.

Why we need dialogue in Social Care

2010-03-26T11:51:00Z

I attended a local care forum recently, made up of representatives from Local Authorities, Health, Independent Providers and University Academics.

During the course of the day one of the academics remarked that the care sector was very unusual in that there was this desire for dialogue between providers and authorities that was more intense than in any other business sector.

On reflection I realised why this is so.

Social Care is unlike any other business sector because of the complex relationship between commissioners, providers and those who actually use the service. After all, who is a care provider actually working for? The money and terms of service actually come from the Local Authority or Health PCT, the way in which the service is provided and run is dictated by central Government regulation and any service provision for an individual can only be delivered within this framework.

All of us who are actually involved in care delivery have been through, and are going through, seemingly endless changes in policy which causes both commissioners and providers problems in knowing how social care can best be delivered.

For example, Local Authorities are just entering their final year of the Transforming Social Care agenda, which, unfortunately, not all providers are aware of. This project was to ensure all Local Authorities with social services responsibilities adapt the way the deliver social care to meet the personalised needs of the people in their own areas. Yet while this project is mid-way we suddenly have the proposal of a National Care Service, with the Government touting that this will ensure that service delivery is the same no matter where you live – is it any wonder we are all a little confused!

There is also a need to consider the impact in the coming changes in regulation. Because the standards that are being set by the Care Quality Commission have to cover Health, Mental Health and Social Care the new standards are, in places over generalised. Does this mean that Commissioners will have to alter their contracts to ensure that certain standards, now omitted from the regulations, are maintain in care services? For example the National Minimum Standards state what furniture should be in a person’s room as a minimum, however the new ‘Essential Standards of Quality and Safety’ omit this, obviously because the same rules cannot apply to a hospital. Yet at least one LA I know of does not state this minimum requirement in their contract, so, as far as I can see, providers, from October 1^st, will not be required to provided any furniture at all!

However, what is perhaps more important right now is the public sector spending cuts we are all about to face.

Under the current Governments plans the Department of Health is planning to ‘save’ £4.35bn, but as yet we do not know how much of this is to come out of the national social care budget. Unfortunately this level of cuts is actually likely to be higher once the General Election is out of the way, and with both Labour and Conservatives promising to protect frontline NHS services it seems that the social care budget is likely to be a target for DH savings.

This is a worry for both commissioners and providers and a good reason why we need to ensure that there is a dialogue between both, if LA’s and PCT’s are having their budgets cut surely it is in the best interest of those who use services that commissioners and providers work together to minimise the impact of those cuts on service delivery.

We need to ensure there is a framework for dialogue between all parties involved in the delivery of social care to ensure that we work together in implementing policy, regulation and financial restrictions in a way that minimises the impact of care delivery for those who need our help.

Beware the CQC Registration Scare Mongers

2010-03-25T10:36:00Z

With any new system that is introduced there appears a range of organisations ready to leap onto the band-wagon and try to make a quick buck by using scare tactics to grab as much cash as they can.

The new Care Quality Commission registration seems to be no exception.

I have just received an e-mail that starts;

“Do you have £50,000.00 to spare?

I would imagine most of you have said no. Yet this is the possible penalty for not registering a regulated activity that you carry out with the Care Quality Commission. The £50k fine is only one of a number of penalties that can be applied if you fail to meet the new standards.”

It goes on to say;

“You should be receiving or already have received your invitation to re-register your service with the Care Quality Commission. This starts on 1 April, so you don’t have much time”

This is, of course, nonsense.

The CQC clearly state on their website that providers will be informed when their particular registration window opens, and providers will have four weeks from that date to register.

Yet our scaremongers will have you believe that this all has to be done immediately and for a small fee of just £225.00 you can go to one of their seminars to learn how exactly to meet the new regulations.

Now it’s my job to make sure my company know exactly what’s what in terms of regulation so I know to ignore such scare mongering e-mails but smaller care providers may feel obliged to part with their cash to find out information which is freely available to them on the CQC website.

Of course money directed to such activities has to be drawn from somewhere, especially in the current tight economic times, and more essential care provision or training could be missed.

So by way of FREE advice I would suggest that anyone concerned about the new registration system that they visit www.cqc.org.uk and check out all the details available about the new registration system. All providers should have received information on all the changes by now and been asked to call the specially set up call centre to confirm their details – if anyone has not done so it will be worth getting in touch with CQC to find out what they need to do.

Anyone who currently complies with the current National Minimum Standards are, in effect, already complying with the new “Essential Standards of Quality and Safety” but, again, these are available online for anyone to check.

There is not any major difficulty or hidden new standards that providers have to comply with in the new registration process – so think carefully about spending your money on ‘seminars’ that promise to tell you everything, when that information is available for nothing!

Challenging the Political Parties to Produce a Social Care Manifesto

2010-03-04T15:11:00Z

In terms of social care this could be the most important election choice ever so the Political Parties must set out their intentions for social care now

On BBC South East (and probably on the other regional channels to) they are asking for people to contribute to a local manifesto.

The sections they ask for contributions on are;

· Economy

· Education

· Employment

· Health

· Housing

· Immigration

Unfortunately Social Care seems, as usual, to be seen as not worthy of talking about. Yet Social Care is one of the biggest challenges facing the country in the future and is an issue that cuts across all of the above categories that are deemed more important.

Economy – Everyone who deals with social care knows the huge economic implications of the ever ageing population and increases in age related such as dementia, we also have an increasingly ageing learning disability population that depend on social care services. To meet the ever increasing demand for services a serious debate is needed on how this will be paid for. Okay we have had some tinkering around the edges so far but this has largely excluded the issues of learning disabilities and mental health focusing predominantly on elderly provision.

Parties must establish the real costs of social care and tell us who they are going meet those costs

Education – This is a subject that could be covered in two areas in regard to social care. Firstly there is the education of social workers and social care workers, the public demand a high level of competence in social care and that can only be achieved through comprehensive training for all those who deliver care services. We have just an announcement that the Department of Health are putting £500,000 into educating workers about Autism, well overdue but this equates to about £3.00 per worker (and that’s not including those working in health). However we also have the fact that the standard for NVQ requirements in care homes is to be dropped and the somewhat unclear change in qualifications due to happen in April.

The second area is the education of the public. It has been revealed that a third of people are uncomfortable around those with dementia and that 53% of people do not know enough about the dementia to help those who have it. I am sure (though have not seen anything to prove it) that similar stories would be told of learning disabilities and mental health. Public awareness of social care is always going to be low unless they understand the issues, needs of individuals and full range of social care.

Parties must set out how they are going to improve the education of the social care workforce and how they are going to tackle public ignorance of social care.

Employment – Skills for Care estimate that there are 1.5 million workers in social care, which equates to 5% of the total workforce in the UK (politicians take note that’s a sizable chunk of the electorate), yet because of the fragmented nature of social care there is little coherent policy. Both the Government and the TUC have identified care workers as ‘vulnerable workers’ because of low pay and working conditions yet nothing has been done to tackle this. Recruitment and retention has always been an issue in the care sector but with the prospect of ever more workers being needed to meet the future demographic challenges the sector is facing recruitment and retention become even more critical.

Employment is also an issue for social care service users, we have constant calls for adults with learning disabilities to have employment opportunities but these jobs have to be supported. Employers need to understand issues around learning disabilities, autism, mental health issues etc.

Parties need to set out a comprehensive workforce strategy that will meet the future needs of social care and a strategy that will meet the employment needs of care service users to ensure employment is a positive choice.

Health - The health needs of those who need social care services hardly need to be set out here but the demographic challenge means that the UK will have more people with age related conditions that they will need support with. The real question at the moment is how those health needs are to be met. Whilst this is primarily a debate for the Health sector it will impact on social care delivery, especially if social care workers are increasingly called on to provide health support.

Parties need to set out there plans for the health of social care users and how these health needs will be met

Housing - In terms of the availability of housing the key issue is that of suitable social housing for vulnerable adults who wish to live in the community. There also needs to be a comprehensive policy on those who wish to remain in their own homes but who need adaptations to enable them to do so. However one area that will be missed in regard to housing is that of care homes, there are times when care home provision will be the best option and therefore this should be recognised in housing options for vulnerable adults.

Parties should set out a comprehensive housing strategy for all vulnerable adults that covers the full range of choices available to people

Immigration – Always an emotive topic but it needs to be recognised that social care provision depends on immigrants to fill the huge gaps in the workforce. It seems to be that many native people feel that social care is not a suitable job for them but one that has to be done by someone. If we need an ever increasing workforce then it is likely we will need more people coming in to the country to work in social care. Unfortunately many of these immigrant workers are forced to work longer hours, with lower pay etc. than their natural born colleagues.

Parties must set out their policy on supporting immigrant workers in social care and recognise that more immigrant workers will be needed to support social care in the future

Just a few thoughts on what needs to be set out in a social care manifesto – any further suggestions would be welcome.

Why Gordon Brown must be Suspended and Investigated

2010-02-22T09:55:00Z

The current allegations against Gordon Brown about bullying in the workplace must be treated seriously and, as controversial as it may sound he must be suspended from his post until the allegations can be thoroughly investigated.

Bullying in the workplace has to be unacceptable but it exists – you only have to read some of the forum posts on Care Space to see the trauma and effect it can have on workers.

If the matter of Gordon Brown is just swept under the carpet then it signals that workplace bullying is acceptable and can be tolerated.

In any other situation there would be immediate calls for an investigation. Can anyone imagine a Director of Social Services being allowed to carry on working when numerous allegations of bullying had been made, or a Head Teacher being permitted to stay at work?

In such situations the Trade Unions would be fighting for those being bullied and fighting for the rights of all workers to be protected from bullying, yet the TUC have remained remarkably quiet over this issue.

In such situations those Ministers, who are currently trying to protect Gordon Brown, would be hollering for action to be taken by Local Authorities to protect the rights of workers and where attempts where made by authorities to cover up bullying threatening to impose legislation to prevent further occurrences.

Bullying is a serious social problem and everything must be done to protect people from those who believe they have a right to treat others in anyway they choose, this means that any and all allegations must be investigated no matter who is accused.

It must be shown that even those at the very top of the ladder must abide by the rules of decency and not allow bullying to become socially acceptable through setting a precedent.

For the sake of decency Gordon Brown must be suspended until an investigation can be completed.

Is Govt contravening Human Rights of Learning Disabled in Residential Settings?

2010-02-02T16:52:00Z

It is quite clear that there is a Government agenda of moving adults with learning disabilities away from residential provision to community living regardless of needs or choice. And the main instrument to push this agenda is the "Socially excluded adults Public Service Agreement" (PSA 16).

Yet the concept of social exclusion is a socially constructed one and defined by ideology, it could be argued that the Government is, in fact, increasing the exclusion of those with multiple and complex needs in residential settings and even contravening its own Human Rights legislation.

The technical definitions for PSA 16 treats "forms of accommodation that are more institutional, such as registered care homes, nursing homes and health facilities as representing non-settled accommodation." Aside from the argument about what constitutes "institutional" the PSA indicates states that non-settled accommodation is "accommodation arrangements that are precarious, or where the person has no or low security of tenure in their usual accommodation and so may be required to leave at very short notice." It is the issue of security of tenure that is at the heart of the Government definition of settled accommodation.

The Government regards that those renting from a private landlord, and therefore subject to the likelihood of a six-month short-hold tenancy is more 'settled' than residential accommodation, yet this surely depends on the terms of contract the provider has with the individual or commissioning authority. For example Kent County Council's Pre=Placement Agreement clearly states that contracts may only be terminated with not less than 3 months notice, given that a six-month short-hold tenancy can be terminated at the four month mark it hardly seems that the latter is more 'settled' than the former or that residential accommodation fulfils the PSA term people being required to leave at very short notice.

The more serious issue though, in terms of accommodation, is the potential infringement of human rights of those who live in residential settings.

The Health and Social Care Act 2008 was quickly amended during its Parliamentary passage to ensure that private care provision was covered by the Human Rights Act. What most people tend to forget is the reason that the issue arose in the first place. The case of YL vs Birmingham, which led to the change in law, arose because of a private care home issuing notice to terminate care and accommodation provision. Unfortunately because the care company rescinded the notice and the case focused solely on the limits of the Human Rights Act and the actual implications of tenure in residential care remain untested. However, the changes do mean that those living in residential care are, in terms of their accommodation, covered by human rights legislation whereas those who live in privately rented accommodation are not.

The case was bought under Article 8 of the Human Rights Act - the Right to Respect for Private and Family Life - and in accepting this (by changing the law) the Government has acknowledged that a residential setting is a home for the individual and that it must respect that with no interference by any public authority. Yet PSA 16 seems to suggest that Residential settings are not a home because there are defined by them as 'non-settled' and that Local Authorities should endeavour to re-settle individuals to meet this definition.

Surely a contravention of the Human Rights Act

Article 8 Right to respect for private and family life

1 Everyone has the right to respect for his private and family life, his home and his correspondence.

2 There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

Human Rights Act 1998

There also needs to be questions raised on the other issues of social inclusion, particularly paid employment.

One of the principle issues for people with learning disabilities in residential settings is the system of how care is paid, which is the same as elderly people in residential care. Under this system all monies, except the Personal Expenses Allowance, are channelled back to the care commissioners, therefore making paid work for those in residential settings a nonsense as they would still only receive the statutory £21.90 a week.

Rather than stigmatise residential settings that, generally, provide good quality person centred care perhaps it is time to re-think the funding system for residential support in a way that allows people into paid employment so than social inclusion can be a goal rather than being discriminated against by a Government who seem to but their ideological ideas above what would benefit people with learning disabilities who chose to live in residential settings.

CQC urgently need to advise Providers of correct registration procedure

2010-01-28T13:59:00Z

Last week the care provider I work for received a letter from the Care Quality Commission about the new system of registration. This letter also stated that we needed to contact a company called Teleperformance within the next 5 working days to confirm that the data held about the company was correct.

So, as these things do, the letter landed on my desk and I contacted them. After a long wait to get through I was informed that the letter was a mistake – that it should have not requested providers to call and that we would be receiving a call from them sometime in the next ten days to confirm the details they needed.

Suddenly today another letter is received – exactly the same – contact Teleperformance within the next 5 working days. So it was on the phone again.

This time there was no surprise at the phone call, although the guy on the other would not deal with the confirming the data because I was not a Chief or Senior executive of the company (does this mean the Chief Execs of Four Seasons, Craegmor, Southern Cross etc are going to have to give the details of their individual homes?), which seems strange if all they want to do is confirm company details which I am perfectly able to do.

That aside I queried whether it was okay to call now given that I was told something completely different last week. The guy had no idea what I was talking about, so I explained about the first letter etc and in response I got “oh that means they’ve sent two mail shots out” but the details were correct and a Senior Executive needed to call.

Now it was lucky I made that second call but how many other providers will do so if they were informed the first letter was a mistake?

I’ll be honest and my first instinct was to bin the letter because of the information I had been given.

Smaller companies that are run by owners may simply ignore the second letter because they are busy and because they think it is unnecessary.

Perhaps they CQC need to get something on their website to inform care providers exactly what they need to be doing and to clarify that this second letter is to be responded to.

Personal Care at Home - Policy or Prevarication

2009-11-26T11:02:00Z

With the publication of the Personal Care at Home Bill came the usual consultation process, which begs the question – Do the Government really have any intention of tackling social care funding?

This latest consultation will run to 23^rd February 2010.

Given the nature of the proposed bill and the large element of funding involved it would seem sensible to delay the response to the Green Paper consultation until the latest one is completed.

This would mean that is unlikely there will be any real proposals on the table until April 2010 at the earliest (after the Easter Recess) leaving barely 6 weeks until a General Election has to be held – therefore only 3 or 4 weeks before Parliament is dissolved. In other words we are not going to see any legislation passed by the current Government.

Way back in time, during the press briefing on the consultation process to feed in to the Green Paper consultation, some brave journalist (I can’t remember who) asked if the whole thing would end with actual policy or, given there was only 18 months to the election, was it a process to feed into the next Labour Manifesto.

It seems, despite Ministerial assurances otherwise, that the latter was correct.

So exactly how much social care money has been spent on developing the Labour Party social care manifesto rather than on legislation to help and protect the vulnerable? The army of civil servants, elaborate promotions and organised meetings have surely cost a fortune in times where money is tight and could be better spent on delivering social care rather than formulating ideas for a Government which is unlikely (given the current figures) to be returned to Government.

At that said though there is an upside to the whole endless consultation process.

Social Care is getting a higher public profile than usual and, perhaps, debate can be encouraged about other areas than financing care for older people.

GSCC Chief Exec Salary is an insult to all of us on the Front Line

2009-11-24T16:07:00Z

On one of the CareSpace Forums there is a debate on how much social workers get paid with Unison saying the average for middle-ranking social workers is £29,000 p.a., lower than many other public service workers.

Added to this many social workers will face pay freezes in the upcoming financial year.

It seems something of an insult then that the post of Chief Executive for the General Social Care Council to be advertised for “up to £150k”.

Most of us know that money in the social care budget is tight, councils are making cutbacks which are incurring the wrath of charities. Yet these councils are going to have to cut back even further to make the ‘efficiency savings’ that will be needed to fund a third of the Governments proposed free home care for the elderly.

Money is likely to be cut back for care provision on the frontline, care fees will suffer from council cutbacks and the potential withdrawal of training funds through Train to Gain etc means that care providers will have to fund training directly from care fees. This is something that will probably mean that the average pay of £6.20 per hour for frontline care workers is hardly likely to rise during the coming year.

When everyone on the frontline of care is expected to ‘tighten their belts’ and put up with pay freezes why on earth should the Chief Executive of a failed regulator have the opportunity to earn “up to £150k”.

Of course the standard answer will be that the salary is intended to compete with the private sector and designed to attract the ‘right sort of candidate’. But what does that really mean? There are very few (if any) Directors of Adult Social Services who get that much and I am sure there are many capable candidates with vast social care experience who would willingly do the job for a lot less.

If workers and users of social care are expected to put up with bad times and accept cuts in pay and services then those at the top should be as well and the GSCC should not insult the rest of us by advertising such a job with a salary like that.

Anti-Psychotics - Is Social Care Taking to much Blame?

2009-11-13T15:50:00Z

A couple of quotes to start off with;

“This report is timely in that it highlights concerns about how anti-psychotic drugs are used across the sector and we believe that specific training is urgently needed to support staff who work with people with dementia,” says Skills for Care CEO Andrea Rowe.

Stephen Burke, Chief Executive, Counsel and Care said: 'It also shows how far we still have to travel before full transformation of the social care system is achieved, and a place is reached where we can confidently state that when an older person with dementia is being supported to manage their complex care needs, their best interests and wishes, and those of their families and carers, will always remain the central focus.'

It seems that many people still do not focus on the real problem of anti-psychotic drugs used for dementia sufferers and that is the fact that it is Doctors who are prescribing them in the first place and it should be their responsibility to prescribe the correct medication for individuals. Care homes do not prescribe medication, yet the focus on the problem seems to predominantly focus on social care delivery.

Yes there have been instances where medication is given to frequently by care home staff but this could only be possible where doctors are complicit and ready to freely prescribe anti-psychotic drugs.

Somewhat ironically Skills for Health have put out no press release on this subject!

Now is the time to start thinking of ways to help dementia sufferers without sedating them with anti-psychotics but more importantly we need to fund new initiatives, perhaps we should have a commitment from the Department of Health that the money save in the cost of prescribed anti-psychotics should be ring-fenced to provide training in other methods of care for those with dementia.

It may also be time to consider the roles of organisations such as Skills for Health who should be responsible for ensuring medical professionals understand dementia and the use of anti-psychotic drugs.

The medical profession and health sector makes take responsibility for their part in over prescribing inappropriate drugs and not let the whole debacle fall on the shoulders of social care.

"GSCC in Crisis" - Surely the Problem is Wider than That

2009-11-12T15:58:00Z

This weeks Community Care arrived with the headline “GSCC in Crisis” but surely the problem is much wider than just the GSCC and there needs to be a pause for thought about the way forward

Whilst the particular problems of the GSCC will mean a total reformation of that body it is unlikely to bring any immediate resolution to the question of care worker registration, the seeming lack of public support for the Green Paper proposals, pending financial constraints and overall public confidence in the system.

The issue of care worker registration is a very strange one, campaigners supporting it often site it as an important means of safeguarding yet all care workers will eventually (I use that term because the date seems to be forever being put back) have to be registered with the Independent Safeguarding Authority and only be able to get work if registered with them and are not barred from working with vulnerable adults. So in this instance there is very little difference in the conduct role of the GSCC. For those calling for the safeguarding of adults in their own home it is also worth remembering that levels of abuse by care workers are relatively low – 13% (albeit still unacceptable) compared to abuse by family members - 51% (Kings College London study2007). Further registration requirements for safeguarding purposes seem a little over the top.

The other side to the GSCC registration scheme is professional development and it is here, perhaps, some sort of rethink is necessary. The removal of a minimum NVQ requirement, the prospect of Train to Gain disappearing and pressure on costs means that staff training and development may be put to the bottom of the pile as always without any regulatory pressure on either employers or employees to force up training standards. Where registration depends on proving CPD there is an incentive for workers to demand training in order to maintain their registered status.

It should also be remember that managers of care homes and domiciliary care agencies are already registered with the Care Quality Commission and the current National Minimum Standards require an element of CPD, something also required in the draft Health and Social Care Act 2008 (Regulated Activities) Regulations, this added to the ISA registration should surely be enough registration for managers of services.

What is needed now is an open review of the way forward for care registration, why it is needed and an analysis of the benefits versus the negatives.

The current consultation on the Green Paper on Care funding seems to have become a farcical exercise with very few positive comments being posted on the website, with both Gordon Brown and David Cameron announcing funding proposals at their Party Conferences and the clear lack of any relevance to disabled people in the paper. Perhaps the time has come to end the pretence of getting an immediate solution in place and the political parties need to put forward their full proposals so that we can debate and judge these prior to voting in the next Government in 2010.

Such proposals also need to be as up front as possible on how proposed spending constraints will impact the services available to vulnerable adults and children.

It does seem that social care is on a slippery slope at present and unless something is done soon public confidence will plummet lower, impacting on recruitment and therefore on delivering better lives for those who most need it.

Pay Freezes: Assure Us All Other Measures Have Been Taken First Mr Osborne

2009-10-07T15:17:00Z

Public sector workers owning over £18,000 are being told that, under a Conservative Government, their pay will be frozen for a year in order to help bring down the huge public finance deficit created by the current Government.

Whether you agree with the proposal or not (and I am guessing most public sector workers don’t) it is unfair of George Osborne to use this cost cutting proposal without giving those workers the assurance that all other money saving measures have been put in place and that the pay freeze is a last resort not a first response.

For those of us in the real world we know that whilst inflation appears low in Government massaged figures, in reality it is costing us more to fill our cars, energy prices are still high despite falling cost and that, if we want to live the healthy lifestyle that government promotes we need to pay more for our food.

Yes we have to be realistic about the economic future, the waste, indecision and incompetency over the past couple of years means that we will have to face a re –adjustment in public finances but most of us would want to be assured that the services of vulnerable people are not cut and that means considering the recruitment and retention of the people who deliver those services.

The cost of bailing out the banking system, which in my opinion was avoidable – after all we had advance warning when Northern Rock went down and it was then the Government should have said to the other banks put your houses in order, not waiting for a year when things got worse, will somehow have to be repaid and it is the Conservatives who are likely to inherit a dire situation but we need to be sure the problem is sorted out with minimum impact on the general public who had little or nothing to do with this mess.

The British Government owns the majority (if not complete) shares in a number of banks now so how about starting to recoup that money from the banks – lets here about pay freezes for all Government controlled bank workers! Or at the very least lets here proposals on how the money spent on the banks will be recovered and how much that will ease the burden of national debt.

Personally I don’t believe that any pay freezes are effective economics – less money means less spending, so there will be less opportunity for a consumer led recovery and less or frozen pay means reduced tax income in to the Government so further cuts will need to be made to compensate for this.

These announcements from George Osborne are, if nothing else, a little bit of honesty but there needs to be assurances to all those facing a pay freeze that all other reasonable possibilities for cutting spending have been but in place and a pay freeze is the last resort.

Party Leaders Please Note - Social Care is More Important than Education

2009-10-05T15:01:00Z

As we keep being told by those who produce demographic data, there are now, or will shortly be, more people over the age of 60 than those under 18.

So, in a sense, Social Care is now more important than Education

Not to denigrate the importance of Education, the educational needs of young people today are important for their own futures and the future of society as a whole.

However, the change in demographics means there are increasing number of people worrying about their later life, what age related conditions may impact on their lives, the services they need to help them with their conditions and how they can pay for those services. We know that the numbers of people with dementia are on the rise and that adults with physical and learning disabilites need age related services as well.

Because of this politicians and policy makers need to start thinking about social care as a major policy issue not just as an add-on to health policy.

We have had some minor headline grabbing announcements over the last couple of weeks, free home care from Gordon Brown and £8000 residential care insurance from David Cameron but neither results from any real comprehensive policy on social care.

Social care is an increasingly important aspect of society that impinges on everyone’s lives not just the elderly who need social care services. The families who may have to look after elderly relatives are often faced with difficult choices and social care policy affects their lives. There are a million or so workers who deliver social care are affected by social care policy that impacts on the pay and working conditions. And even back to education where many young people are learning about social care are affected by the whims of Westminster politics.

Of course social care does is not only delivered to elderly people, something that seems to have by-passed the party leaders, the Green Paper pays scant attention to other social care users and we have had little from the Conservatives yet on social care policy for younger adults.

Ideally (and I know it aint gonna happen) we need each party to publish their own social care manifesto before the next election. We need a commitment to raising the ministerial importance of social care and we need to know that social care policy is a real commitment to all parties not just superficial headline announcements.

A National Care Service - Clarification Please

2009-10-01T11:54:00Z

The Labour Party conference has reignited talk of the National Care Service proposed in the recent Green Paper.

But I can’t help feeling I am missing something somewhere!

The proposal is that a National Care Service will exist to provide social care for those who need it but the actual delivery of that care will be done by local authorities. The Green Paper actually states that the Government proposes,

“A system that gives local authorities the space to innovate, enables services to respond to local conditions and delivers true personalisation”

Under the existing system “The Department of Health shapes the delivery of adult social care services through leadership, policy and guidance. Local councils with social services responsibilities commission public, private and voluntary sector providers to deliver services that meet the needs of their local population.” Whilst the Social Care, Local Government and Care Partnerships Directorate “provides professional leadership and advice on all aspects of social care policy in order to promote effective and equitable delivery of services, and a clear vision for the future of social care. The Department also consults with people who use services, carers and stakeholders, and actively engages those in government, to develop and improve evidence based social care policies.” (DH Website)

So what is the actual difference?

There have been plenty of comments about a National Care Service being similar to the NHS but that is certainly not something proposed in the Green Paper. From what I can see the name of the Directorate will simply be changed to the National Care Service!

One of the touted benefits of a National Care Service is that it would remove the postcode lottery that occurs with care provision yet a system that gives “local authorities the space to innovate” will surely create the same situation as now because different councils will innovate at different speeds and in different ways.

A truly national system will have to be just that with care responsibilities taken away from local authorities and delivered uniformly across the country.

Whilst the debate is ongoing the Government needs to be clearer about what it is actually proposing in terms of a National Care Service and how that service would actually be different from the current set up because for the life of me I can’t spot the difference.

Ministerial Half-Truths Undermine Social Care

2009-09-18T08:30:00Z

On the BBC Breakfast programme this morning (18^th Sep) they have been focusing on the Help the Aged/Age Concern claim that many elderly people who receive Local Authority Funding are having to have their fees topped up by relatives because, in many areas councils are not paying enough.

An old but fair claim in many cases (e.g. do all local authorities pay private care homes the same amount they spend on in-house ones?)

However in the debate Care Services Minister, Phil Hope, boldly told the nation that the Government had pumped an extra half a billion in to adult social care. Unfortunately he did not exactly explain how this money was to be spent.

He failed to inform the viewers that the money in question was not destined to be spent on front line services for the benefit of vulnerable people who use social care, but that it was a ring-fenced grant to be spent by local authorities to “help re-design and reshape their systems”.

Perhaps he also should have explained that the Transforming Social Care agenda was launched back in April 2008, a year or more before the current Green Paper therefore any reforms Local Authorities have made with the grant may have to be reformed again if the idea of a National Care Service comes into effect, thereby wasting the money spent so far.

Most people in social care actually care about the reputation of social care but it is half-truths and misconceptions bandied about by Ministers and other influential people that undermine that.

Many people will now think that the half billion has disappeared due to incompetent local authority management or greedy private care providers rather than ill thought out government policy.

Unfortunately with MP’s now more concerned with trying to impress the public in order to receive votes truth will have to take a back seat for a while.

An Inclusive Social Care System Should Include Social Care Workers

2009-09-08T14:41:00Z

According to their website “The General Social Care Council is responsible for setting standards of conduct and practice for social care workers and their employers, for regulating the workforce, and for regulating social work education and training” yet there seems to be a lack of commitment by the GSCC to those social care workers.

With the imminent registration of domiciliary care workers you would think that the GSCC would finally begin to include social care workers in their club but, unfortunately, this year’s GSCC conference will, once again, be focused on Social Work and exclude social care.

In the blurb to the conference they suggest that the following should attend;

• Registered social workers

• Registered social work students

• Social work managers

• Directors of children’s and adults’ services

• Social care bodies and those interested in developments in the social care sector

• Social work academics

No mention of social care workers or the employers of social care workers that the GSCC is responsible for setting the standards for!

The last press release from the GSCC relating to the registration of home care workers (back in April this year) stated that 2010 as the beginning of the registration period yet any other mention of it has disappeared from the GSCC website.

Surely the conference would be an ideal opportunity to explain to the social care workforce what is happening with registration, how it will affect both workers and employers and how the whole process ties in with other elements being introduced next year – i.e. the need for all social care workers (and social workers for that matter) to register with the Independent Safeguarding Authority.

The large number of employers in the social care sector has lead to a lack of a collective knowledge base for social care workers, whilst Social Workers, generally, work for larger organisations and have representation from the BASW etc, front line care workers have little access to issues that affect their work, especially as most smaller providers also lack that knowledge.

It is up to the GSCC to fill this void and include social care workers in the debates on the social care workforce, participation has become a cornerstone of care delivery in recent times yet the social care workforce are the one sector seemingly excluded from all of this.

Training standards should not be removed but everybody needs to work together

2009-08-25T15:29:00Z

Public sector union Unison is urging the Care Quality Commission to boost standards in training for social care workers in adult care. The union say that the current requirement of 50% of care workers having NVQ level 2 or higher is to be removed with companies being able to set their own standards for training.

Helga Pile, UNISON National Officer for Social Care, said:

"Home care and care home providers are constantly squeezing margins to increase profits. If the care regulator doesn't require companies to train their staff, it is likely they will make cutbacks to save cash. Private companies already have a far worse record for training their staff than council run services.

"At a time when children's social care is moving to level 3, removing the minimum qualification level for workers in adult care services will be a huge backwards step. Also worrying is the move towards "lighter touch" regulations, including fewer inspections. We should be working towards higher standards of fully accredited training, with time off for staff to get their qualifications. People who depend on these services will pick up the bill if they end up with lower quality care."

There should be little doubt that the removal of training standards result in less care workers receiving sufficient training. Next year’s care fees are hardly likely to be increased very much, given the current financial situation, therefore many private care providers will look to cut back wherever they can and, whatever business sector you look at, training costs are inevitably the first to be trimmed.

The removal of the requirement will coincide with the demise of the current NVQ structure as the new Quality Curriculum Framework comes in to force. This will mean that many social care providers may not bother with training if they do not need to as they struggle to understand the new framework.

Whilst UNISON rant about providers squeezing out profits and the record of these providers in training (94% of council run care homes for older people met the standard in 2007-08 compared with 90% of voluntary sector and 83% of private sector homes but 83% is still a good figure considering the size of the private sector compared with council run services), the union misses one of the important elements of training.

Aside from providing knowledge and competence in delivering care services, training and development a crucial in aiding recruitment and retention in the sector. Studies have shown that firms who value and implement training and development programmes generally have lower staff turnovers, and therefore, reduced recruitment costs.

The Union membership of the private sector is low, perhaps, rather than shouting about how bad it is, UNISON should look work with providers, particularly smaller ones to develop a mutual relationship that benefits workers, providers, the union and, more importantly, care service users.

Training standards should not be removed from statutory requirements but everybody needs to work together to ensure care workers are trained, paid well and respected in their work.

If politicians want to win our votes now is the time to start talking

2009-08-25T12:46:00Z

As the summer draws to an end and the majority of us start forgetting about our holidays and start worrying about earning enough for Christmas, our nation’s politicians have one last knees up before getting back to work proper. The party conference season will soon be upon us and it is time for all three major parties to start talking about social care.

This year’s conferences will be the platforms for the next General Election and it is an opportunity for the parties to lay out their visions for social care.

With around 2.8 million users of care services and 1.6 million workers in the care sector, not forgetting the unknown numbers of those not known to social services and those who care for them, there is a sizeable chunk of the population directly affected by social care and those people have the right to know how politicians of all parties will move social care forward.

The debate needs to extend beyond the narrow confines of the Green Paper to encompass all aspects of social care, not just how older people will pay for care but how care for all users of care services will be funded and to what level. The debate need to extend to the workload and work roles of social workers, the effective recruitment and retention of care workers and how best to regulate the workforce.

In these times of tightening fiscal spending the debate needs to include how cuts in spending can be implemented with minimal impact on service delivery, outlining where cuts are likely to be made and the reasoning behind those cuts. The political parties need to say now which social care institutions are under review in the ‘Bonfire of Quango’s’ touted by all.

We need our political parties to be clear on their intentions regarding child and adult protection. Whilst recent child protection cases have had high media profiles we need to know what policies parties intend to introduce to prevent such cases happening again, after all, whilst we may do our damndest to prevent future cases Government policy ultimately decides what social workers and social care workers can or can’t do. The proposal for the full publication of serious case reviews by the Liberal Democrats and Conservatives is a knee jerk reaction which does not tackle the policy or issue of protection. Little has also been said, so far, by politicians on the issue of the GSCC backlog in conduct cases or its capability to start registering thousands of domiciliary care workers next year.

If politicians want to win our votes now is the time to start talking about social care, with around 10% of the population using or working in care plus all the carers and those being cared for without social service support those who wish to form the next government must be up front and honest about what they intend for social care.

It Seems Social Care Still Has a Way to Go

2009-08-14T11:57:00Z

The provisional data from the Social Care Indicators released by the NHS Information Centre show that there is a long way to go in providing personalised, independent living for many of those who rely on social care, particularly those with learning disabilities.

In fact the statistics reveal some worrying information.

The Civil Service spin gives a seemingly positive note by stating “65.2 per cent of adults with learning disabilities aged 18-64 and known to Councils with Adult Social Services Responsibilities (CASSRs) were in settled accommodation at the time of their assessment or latest review”. However, looked at another way this means that 1 in 3 adults with learning disabilities aged between 18-64 are not in any settled accommodation, raising questions about where they are, in fact, living. This also raises the question about those who are not known to social services, how many are in safe and settled accomodation and how many are vulnerable because of where they are having to live.

There is also disappointing news in terms of employment with those who have learning disabilities. Only 7.5% of those known to social services are in paid employment, admittedly the majority of those known to social services are more likely to have severe or complex disabilities however 7.5% still seems a very low figure despite Government incentives and policy to promote employment for those with learning disabilities.

The figures also unveil the institutional denial of older people with learning disabilities, all LD data is confined to the 18-64 age group whilst everyone over the age of 65 is lumped together regardless of whether or not they have a disability.

The use of Direct Payments is also looking somewhat grim, just 6.5% of social care users direct their own care through direct payments.

Whilst this is only provisional data it does reveal much still needs to be done in social care, unfortunately these details are unlikely to make the headlines and the focus on the care debate will be on how it is paid for rather on the needs of those who are entitled to it regardless.

GSCC - Lets Have Solutions Not Recriminations

2009-07-23T12:17:00Z

Should we really be surprised to find out that the General Social Care Council has a backlog of referrals?

At last years GSCC conference outgoing chair Sir Rodney Brooke readily admitted that the organisation would have problems this year. It has been three years since it became compulsory for social workers to be registered and, therefore, the GSCC expected to be inundated with re-registrations this year.

Added to this workload is their requirement to register all domiciliary care workers, around half a million, as soon as possible. This has been an ongoing saga with the GSCC with the initial announcement being made over 2 years ago and seemingly little progress made in that time.

With an increased number of referrals being made following the Baby P incident is it any wonder there is a problem.

The suspension of Mike Wardle solves nothing, what is needed now is solutions not recriminations.

Given the current state of the economy it is obvious that pumping extra resources in to the GSCC is not going to happen, so the need is to rationalise their workload.

Do we really need the GSCC to register social care workers at the moment? Yes, in an ideal world we need social care workers to have a commitment to professional development and a means to raise the status of social care workers but in terms of protection and the right to work in social care the Government has already put another system in place.

The Independent Safeguarding Authority will require all social care workers to be registered with them by November next year. This registration will be a means through which their fitness to work with those who are vulnerable and at risk can be checked and, where that fitness is questioned, a means to stop them working with the vulnerable. Back in April ISA Chair, Sir Roger Singleton said,

“The ability to remove or bar unsuitable and sometimes dangerous individuals from the workplace is a vital aspect of the Scheme. While the majority of individuals working with children and vulnerable adults will demonstrate the highest regard to their safeguarding, it is vital that everyone working or volunteering in this field will soon need to register and be monitored to highlight any potential risk. Our responsibility in safeguarding vulnerable groups should also enable these vulnerable groups to be taught or cared for without fear of harm.”

Surely this would also be the remit of the GSCC so why waste valuable resources in having two separate organisations chasing the same ideal, especially at a time when money is short and any major increases in funding are unlikely over the next few years.

Perhaps the remit of the GSCC should be changed, at least for the immediate future, to be an organisation purely for registering and regulating Social Workers and leave the registering of the rest of the workforce for now.