Report may at last spur change for care

While depressing in its conclusions, Future Imperfect, the
King’s Fund inquiry report commissioned by the health policy
think-tank nevertheless gives me hope that perhaps now, at last,
government ministers and senior health and social care managers
will sit up and begin to take notice (News, page 4, 14 June).

Those of us who have had personal experience of care services
for older and disabled people over the past few years can see
clearly how care standards are deteriorating as a result of the way
“Best Value” principles introduced by this government are being
interpreted by local authorities. In my view, local authorities are
misinterpreting government intentions and are driving down costs at
the expense of quality. This trend has been compounded by the
inadequacy of local authority contracting systems which, all too
often, are sloppily framed and inconsistently monitored.

I particularly welcome the emphasis the report places on the
appalling pay and conditions endured by care workers in the
independent sector. As the report says, without dedicated and
well-trained care staff, this government’s ambitious plans for the
NHS will founder. My recent experience bears this out.

My 92-year-old mother was recently discharged from hospital. She
is now back at her care home, in a vulnerable and dependent state.
The care she needs, and is receiving, is exceptionally good. The
combined efforts of community-based health and social care
professionals, working in partnership with relatives, are affording
her a quality of life that is as good as could be expected and, it
is to be hoped, will help her to recover at least some of her

There is no doubt that the staff in my mother’s residential care
home are the most important contributors to her quality of life and
care, and ultimately they are the people who will prevent her
readmission to hospital and the potential misuse of scarce NHS
resources. Yet these care workers endure pay and working conditions
that are abysmal. Care staff in my mother’s home have recently
suffered a deterioration of their pay and working conditions as
their employer attempts to deliver high-quality services at the
so-called competitive rate that local authorities are prepared to

I am concerned about this because securing care to meet my
mother’s needs is a constant battle. Her financial resources are
shrinking, and, although she contributes £147 towards the
costs of her care, the local authority has been unwilling to make
this up to fully cover the true cost, even though she has been one
of their ratepayers for many years.

Ministers need to act fast to avert a major crisis in social
care services which will have profound implications for the future
of the NHS. I hope the King’s Fund report will not only galvanise
them into action but also spark a campaign to ensure that care
staff are justly valued, supported and rewarded in future.

London SW2

Image uplift could help recruit carers

If we are to tackle the crisis in recruitment and retention of
residential care staff then we have to demonstrate the value and
range of work on offer (In Focus, page 10, 7 June).

Independent nursing and residential care homes do provide long
and short-term care. Staff will be required to care for and enable
residents to achieve and exercise their choices. Adding quality to
people’s later years is, and should be, a positive career decision.
It is something we should encourage. But if Glenys Jones’s
statement – “If people have a choice then they would rather not
wipe bums” – is reflective of the wider social services community,
then recruiting good staff will be a struggle.

The independent nursing and residential care home sector wants
to work with local authorities to ensure adequate funding to allow
independent sector care workers to receive the wages and training
necessary to do their vital work. If Best Value was supposed to be
about ensuring a quality, properly rewarded workforce, then this
principle should apply across all sectors and be funded

Executive director of community care
Independent Healthcare Association

Nursing homes need minimum care fee

The battle rages back and forth about to who is to blame for the
nursing home sector being in crisis (News, page 7, 7 June).

Is it the nursing home owner holding the user to ransom, or the
director of social services who treats purchasing care for service
users as just one more commodity for which he or she can drive down
the price as far as possible, or is there some other reason? Yet
again the most vulnerable in society – older people, especially
those with nursing needs – are used as pawns in an unnecessary

From an accounting viewpoint, the provision of care is not
rocket science. For example, the regulators lay down staffing
levels, and government lays down the salaries to be paid to both
care workers and nurses either by statute or by influence. The
“hotel services”, while not fixed, conform to certain averages. All
in all, the cost of providing care could be measured

How does £48 per night (the figure paid for nursing home
care) stand up to such scrutiny? Is this really the figure that
should be paid for the provision of 24-hour board and lodging,
together with the professional skills of a nurse and support from
care workers and other ancillary staff?

We saw a government committed to protecting workers introduce a
minimum wage. Is it too much to ask that the same government now
tries to protect vulnerable adults by the introduction of a minimum
fee to be paid to nursing home owners for their care?

Chief executive, Registered Nursing Homes Association

Clarify procedures for cutting services

Some sympathy could be offered to directors of social services
who find their jobs at risk if they were to publicly demand
substantial increases in social services budgets from government
(“Spend and go”, 3 May). But as matters stand, all sympathy should
be reserved for service users affected by reductions in

One director quoted talks about involving (social services)
committee members. The law provides for specific action in the
likely event of expenditure exceeding resources. sections 114 and
115 of the Local Government Act 1972 show that involvement must
include all of a local authority’s members. This would put cuts in
the public domain for discussion before they are implemented.

The sections require that where an authority’s actual
expenditure plus its proposed expenditure is likely to exceed its
resources, the chief finance officer has a duty to present a report
to all members of the authority. It will be for a full council
meeting to consider the report and take action.

The word “likely” should be noted, particularly when authorities
use reserves to fund expenditure. The test for the act’s sections
is not that expenditure will exceed resources, but only that there
is a reasonable expectation it will occur. Using reserves is a
strong indicator of how close an authority is to falling within the
sections. Should members and senior officers make cuts when the
sections apply without a report being presented to all members, the
action may be ultra vires – they don’t have the power to make that
decision. A court could quash such actions.

We need clarity on the correct procedures, and financial systems
that indicate the need for further resources at an early stage.
This would enable local authorities to secure additional funding as
opposed to enforcing unrealistic eligibility criteria by attempting
to “target resources at those most in need”, which results in
people equally in need falling through the holes in the safety net
– with potentially disastrous results.


Please tell us about your housing tool

The article “Home Truths” (3-9 May) says that the Joseph
Rowntree Foundation “reported that no frontline professional is
required to collect data on the housing circumstances of the older
people they see”.

In view of the fact that by April we should be all using a
single assessment tool, what questions does the foundation feel
frontline staff should be asking about housing circumstances? Maybe
if we know, we can include them.

Liaison social worker, Saville Medical Group Newcastle upon



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