Take Care Before Wielding the Knife

An interesting piece of news from the National Skills Academy for Social Care (https://www.nsasocialcare.co.uk/news/whitehall-to-consider-protecting-social-care?utm_source=twitterfeed&utm_medium=twitter) which suggests that the treasury are looking at further ways of cutting the social care budget, including curbing care provider fees.

Now the reality is that care providers have, in general, had lower than inflation increases in fees since at least 2008, well before the current financial crisis really kicked and, the bottom line is, the constant reduction in real terms of care fees impacts on the quality of care that providers can deliver.

Costs have spiralled, even if social care workers pay has be held back the costs of heating premises etc has risen sharply as have food prices and other costs.

While we have to accept the implementation of austerity measures handed to us the fact is further cutting back on care provider costs affects the lives of those who need care services.

While providers focus on meeting increasing costs and maintaining the level of care they provide there are inevitably areas that have to be cut back, invariably training of staff is one of those areas and because of this it means less well trained staff are providing direct care services and because they are less well trained it means the level of service will drop.

This is, of course, exacerbated by the fact that much of the funding for care training has almost completely disappeared. Where once NVQs for workers of all ages were funded, now only under 24s generally get free training yet many of those coming into care are older, usually returning to work rather than as a first job, which means the £1000 plus cost of a formal qualification is beyond the realms of realistic costs for many and, unfortunately, because it is no longer a requirement under the current standards it means many employers will not see the point of spending that amount out.

The real issue that needs to be tackled right now is not how we can save money but how we can ensure the safety and dignity of those who need social care services, yes we need to ensure people can stay in their own home as long as possible but this should not solely be based on saving money. Those who provide care in a person’s home still need to be adequately trained and given time to sufficiently care for the individuals rather than be forced into excruciatingly tight time slots which do little for helping the individual.

There are, undoubtedly, savings that can be made yet the Government must proceed with caution to ensure the well-being of those who need care services. Cutting care provider fees could drive some providers out of business, if that happens then the Government will find themselves actually increasing social care costs as they will have to fill the gap. The reason most care is provided by private companies is because it was felt this was a cheaper option than local authority provided care by driving providers out of the market it is probable that local authority provision will have to increase.

Social care in the U.K. is increasingly complicated, with control from Whitehall being disseminated through local authorities while actual provision is delivered by private companies who receive payment for services through many different channels, i.e. local authorities, the NHS, private funding or a combination of those.

If we want to save money let’s start by reducing some of this bureaucracy rather than targeting those who provide front line care in order to minimise the impact of cuts on those who actually need care services.

The Ageing Process Does Not Stop to Wait for Politicians

Just 55 days after the publication of the Social Care White Paper, “Caring for our future: reforming care and support”, social care is once again in a situation of not really knowing what the future is.

The White paper was short on details on funding, after its publication Richard Humphries of the Kings Fund said “Despite its commitment in the “programme for government” to the urgency of reform, the government has failed to produce a clear plan for how care should be funded or a timetable for how these decisions will be considered.” (click here for full press statement).

Then in mid-august we start getting press reports that Prime Minister, David Cameron “has pledged to end the heartache of tens of thousands of elderly people who are forced to sell their homes to fund long-term care” (Daily Mail 16th Aug 2012) by introducing the Dilnot proposals and introducing a £35,000 cap on care costs.

What is unclear is the extent to which the Dilnot proposals will be implemented. The report by Andrew Dilnot applied the cap to care costs not stating that those in care homes should contribute to accommodation and food costs to the tune of £7,000 to £10,000 a year. Given that the current annual state pension is £5,587.40 pensioners in need of care home services would still need to find money from somewhere.

Because of this, as well as the increase in those who will be publicly funded and the greater overhaul of the system that will be needed if the full Dilnot proposals are introduced, the White Paper largely becomes redundant before its consultation period has even ended.

To top this all off the Ministerial architects of the White Paper and draft legislation, Andrew Lansley & Paul Burstow have been shipped out of the Department of Health, and the principle civil servant in creating the paper, David Behan, has now moved to the Care Quality Commission.

Where does this leave the thousands that need social care services, those who care for them, the thousands of workers providing care etc.

Whatever the political reasons for the change of heart about Dilnot and the reshuffling of Ministers we need, NOW, a statement from Number 10 on exactly what is happening, how things stand with the White Paper and draft legislation in order to reassure social care users and the social care sector that there will be no delay in implementing reform. Social care has become all too familiar with the prevarication of politicians and these changes in policy and the personnel delivering it must not be used as an excuse.

We have an ageing population with increasing need for social care services, the ageing process does not stop to wait for politicians so those politicians need to act now for the benefit of people who need care services now.

Why Care Can't Wait

Panorama has discovered a series of cases in which elderly people have been unsafe and unprotected in nursing homes. Instead of being looked after, vulnerable, elderly people were insulted, neglected, roughly handled or physically assaulted.

Sound familiar?

Yet it is not the episode aired on 23^rd April this year where Fiona Phillips exposed the treatment of Maria Worroll at Ash Court. It is an episode that was aired on 12^th February 2007. So, in five years, why has nothing been done to prevent these things occurring?

We have had other exposés in between most notably the abuse of people with Learning Disabilities at Winterbourne view but none of these seem to be able to make politicians care enough about social care to take real action on improving the lives of the most vulnerable.

We cannot solely blame the politicians, the national media must take some responsibility. Such events soon disappear from the news agenda and while Panorama will provide us with regular exposés they seem to lack the inclination to ask WHY is this still happening?

I was reminded of that Panorama episode when I was flicking through my copies of the magazine I used to write for. Ironically my column in that same edition focused on the success in care training that had been achieved as had been highlighted in that years “State of Social Care” report from the CSCI. At that point the National Minimum Standards required all care providers to have at least 50% of their staff with NVQ level 2 and real progress was being made on that. Unfortunately that requirement was dropped in 2010 and, in fact, there are no specific requirements at all for care providers to have qualified staff.

In that same column I also raise concerns about whether the level of success in training care workers can be sustained because of diminishing fee increase from Local Authorities and question the effect that proposed registration of care workers may have on the sector. Five years later those fees have continued to be lower than inflation (in the last few years there have been no increases at all) and the registration of care workers has evaporated into thin air.

My reason for looking through those back copies was to try and find when it was that Ivan Lewis faced a question from a backbencher on the practice of local authorities not raising fees to care providers or, if they were, at a rate below inflation. This was in March 2008 and he condemned the practice stating that care providers should, at the very least, expect an increase in fees that kept pace with inflation. Of course this has not happened and the amount being paid to provide care and support has fallen behind in real terms.

So, in essence, nothing has happened to tackle the issues facing social care over the past five years, now we face another delay to action on care.

In five years we still have Panorama exposes on care, we still have no actions on care worker registration and the amount paid to provide care and support to the vulnerable continues to fall behind and while we have had tinkering around the edges with changes in regulator etc no substantive political act has been taken in that time. 


We have had a consultation in 2008/2009 which led to a Green Paper in July 2009 followed but another consultation and a White Paper in March 2010. Then, with the change in Government, we had the Dilnot Commission launched in July 2010 and the Dilnot Report published in July 2011.


Surely we have had enough talking. 

This is why care can’t wait and we need action NOW not later

Cut Out the Middle Man: Do we need Local Councils in Social Care?

So there isn’t a pot of gold for social care (http://www.bbc.co.uk/news/health-17740832)

So we need to find new ways of making certain that the money that is available goes directly to those who need care services.

I am not an economist and I do not have the figures to hand but it seems to me that  the best way forward  is to take a radical look at the social care system and make wholesale changes that increase the funds at the front line.

We all know the way the current system works, money from central government filtered through Local Authorities to front line care provision.

So how about cutting out the middle man?

There are 152 Councils with Social Services Responsibilities (CSSRs) and, therefore, 152 directors of Adult Social Services (or whichever name they currently go by!), similarly there are 152 different administration systems that have to be paid for and 152 systems of line management.

It is said that this system creates a postcode lottery it which where you live can be important in the level of care you receive.

What if we eliminate that?

Have just one Director of Adult Social Services (there is one already in situ at the Department of Health), have one administration and assessment system that provides the same level of care across England and a system that allows more money to be directed at front line services.

Such a system will, of course, still have localism at its heart. Obviously social work remains in local offices and local services will meet the needs of local people but does such a thing really need director level involvement local level and does localism need variation when it comes to who is entitled to what service?

This would not necessarily mean that Local Authorities have no impact on local social care services. The Health & Well-Being boards could exist as a monitor to services and are still important in providing an oversight to ensure integration between services.

I have admitted I don’t have the figures for what the savings actually would be but I think it is an exercise that needs to be undertaken. Money is tight and we need what money is available to provide support and care for the people who need it and if that means 152 Directors of Adult Social Services losing their jobs isn’t that worth it in the long run?

Public Service & Private Profit: The BIGGEST Elephant in the Social Care Room

“There were a number of respondents who raised concerns over the business ethic of the care homes they worked for. These respondents felt the organisation and/or general management were driven by profit, rather than providing high-quality care” RCN – Persistent Challenges to Providing Quality Care 2012

If there is to be any resolution of the current care crisis and to ensure the provision of quality care for the most vulnerable adults in our society then the BIGGEST elephant in the room has to be tackled or, at the very least, talked about openly.

The majority of social care provision is delivered by private sector companies who do so in order to make a profit. Direct public sector provision has dwindled and continues to do so as more local authorities look to close or sell care homes.

The reason for this is relatively simply – it’s cheaper. By outsourcing care services local authorities save on administration costs yet more specifically the save on wage costs. Private companies are less bound by conditions that local authority employers have to abide by, particularly in terms of pensions and the myriad of different companies delivering social care means the workforce is fragmented, largely un-unionised which has allowed care worker wages to remain low at a national average of £6.71 per hour (Skills for Care NDMS Data). 

Undoubtedly the poor pay and conditions associated with working in social care contribute to the continual recruitment and retention problems which, in themselves, have an impact on the quality of care provision.

Now there is no doubt that what local authorities have paid in fees for social care provision has dropped, in real terms, over the last few years firstly by lower than inflation increases and more recently by totally freezing fee increases and there is equally no doubt that social care needs greater investment.

There is also the additional fact that many of those who have to pay for their own care provision are forced to pay a higher amount in order to ‘make up’ for the low fees paid by local authorities despite receiving exactly the same quality of care by the provider.

Yet the issue that has to be addressed is what guarantees are there that increasing fees will drive improvement in the quality of care or workers’ pay rather than line the pockets of those who run their companies for profit?

One solution by a respondent to the RCN survey was to suggest a cap on the amount of profit that could be made ensuring the rest was reinvested into the care of residents.

But to flip the argument a little, most people go into business to make money and any threat to the profitability of the care sector would discourage people entering it. With the demographics indicating increasing amounts of social care provision being needed there will be a demand for more suppliers. So what happens if the suppliers are not there? There will then be pressure for local authorities to take responsibility for providing care at the higher costs associated with the public sector.

There is no obvious or easy solution to the dilemma but it is one that has to be recognised as a major part of the debate on social care. 

Why I Am Supporting #Twobby - End the Care Crisis

Back in 2008 I sat in the press conference where then Health Minister, Alan Johnson, announced that the Labour Government was launching a consultation on a social care Green Paper. Now a Green Paper is, in itself, a consultation document – so it was the announcement of a consultation on a consultation! This, effectively, meant that the then Labour Government would not have to tackle the issue of social care before a General Election, something that was raised by numerous journalists at the time.

Since May 2010 we have had a Conservative/LibDem  Government whose only action, so far, has been to launch yet another consultation – Dilnot – with the promise of a White Paper which appears to be delayed yet again, although reports last week suggested we will get a draft version which will be open for consultation!

Apart from the blatant prevarication by all parties there is also the issue of what the constant consultations involve and that is the issue of who pays what for social care.

Yet the issues go deeper than that, social care has been facing cuts since well before the recession actually kicked in with issues over less than inflation fee increases by local authorities going back to at least 2007.

So it is not only a case of who pays but also is enough actually being paid?

Principle in this question of how much is being paid is what we are paying social care staff. At the end of last year the BBC revealed that many care workers are actually getting less than the minimum wage http://news.bbc.co.uk/panorama/hi/front_page/newsid_9604000/9604221.stm

If we want to provide the best possible quality of care for the most vulnerable in society then we need the best possible workers to provide that care and support. Yet care workers have been described as ‘vulnerable workers’ by the TUC and there seems to be little political action on improving the image of care work to encourage more people into the sector.

In 2010/2011 there were around 1.5 million adults accessing Local Authority funded social care services and this does not include those ineligible for funding and who are having to pay for their own care. And the issue of social care will only become more pressing over time, more people will need care and support services as the population continues to live longer and WE WILL NEED more workers to provide that support.

Government should be about leadership yet ALL political parties seem to prefer to run and hide when it comes to dealing with social care.

I am supporting #Twobby because those who sit in Westminster need to STAND UP and take action on social care NOW rather than endlessly prevaricate in the hope that it will go away