Tuesday, 27 November 2012

Residential Care Providers Outperform the NHS.

Residential Care providers outperform the NHS.

That is, of course, a blanket statement but backed up by the State of Care report published by the Care Quality Commission last week. The headline figure when the report was published was the fact that 15% of hospitals failed to meet the standards on making sure patients had the right food and drink and the help they needed, yet for residential care – i.e. non-nursing care - the figure was 11% of homes failing to meet these standards.

It was not just this standard that saw a difference. On meeting standards on respect and involvement 9% of NHS hospitals failed to meet this standard compared to 7% of residential care homes and on meeting standards of effective care, treatment and support 19% of NHS hospitals failed to meet the standards compared to 18% of residential care homes.

Obviously this is a very simplistic and selective view, in general, nursing homes were worse than hospitals and the complexity of health service provision is different from that of a residential care home.

Yet these figures should not be totally ignored and lessons must be learnt.

The health service must, for a start, consider what it can do to improve performance and what it can do too learn from the residential care providers which outperformed it in a number of areas. Why are residential care providers better at providing food and drink, what lessons can be learned in improving respect and involvement. There has to be a system in place where the NHS can draw on the best practice of social care to improve its performance with its patients.

There must also be a look at the significant difference in performance between nursing and non-nursing residential care where the contrast is quite startling. In nursing homes 20% failed to meet the nutrition standards, 15% failed on respect and involvement and 28% failed on effective care, treatment and support. In just about every standard nursing care fell behind residential care the most surprising of which was management of medicines where 33% of nursing homes failed to meet the standard compared to 26% of residential homes – surprising because nursing care should have trained nurses on their staff whereas this is not necessary in purely residential care.

The Care Quality Commission report gives us a snapshot of the state of care but we need now to act upon its findings and this is where we need national leadership to make improvements.

The fragmented nature of social care provision, around 25,000 different nursing and residential care homes providing services across 152 councils with social services responsibilities, means that there is little coordination over the country to draw together what lessons can be learnt from the report, how to implement the changes needed and how to engage with the vast myriad of providers to ensure ‘best practice’ becomes the social care standard.

The fragmentation of social care means that those at the top can frequently pass the buck and abrogate responsibility but with the increasing need for social care as the population ages and the increase in the complex needs of social care users we, as a nation, need those in Westminster to take full responsibility for the services provided to the vulnerable in the country.

The route to improvement is learning, learning where the failures are and learning the best way to decrease those failures. The system is never going to be perfect but we need national leadership to reassure the public that all possible action is being taken to ensure health and social care provision the best it can be and the lives of ALL those who need care services are paramount in that.

Thursday, 22 November 2012

A Few Words about Words

A word about words or maybe a brief discourse on discourse, how language is used is important in society and we have a debate now on how Dementia is referred to (see the excellent D4Dementia Blog).

Despite Shakespeare’s words, “a rose by any other name would smell as sweet”, if a rose was called a manure fed weed, chances are that you would not even bother trying to smell it in the first place!

Sometimes the changes to words we use to label something are good, we only have to look at the term learning disability, previously known as mentally handicapped, mentally retarded (mental retardation is still used in the U.S.A.), feeble mindedness etc. and we have the evolution of the label lunatic to mental health issues. In such instances re-labelling the terms we use reduce the stigma attached to the old ones and can help toward promoting a more positive image of individuality.

Many times labels are used by those in power to delineate ‘us from them’, the classic example being a terrorist in one state can easily be called a freedom fighter in another. Governments re-label in different ways constantly, usually as way of marking out their difference from the previous one – for example the Department for Children, Schools and Families was quickly relabelled the Department of Education when the current Government came to power, the functions are largely the same but the idea is to display the current ideology in the Ministerial office.

Labels also change as a form of aggrandisement, for example in job titles where those who collect our rubbish are now waste management technicians or those trying to sell us insurance become Financial Security Consultants, equally labels can be used to demonise and stigmatise where they become stereotypes in order to pit one section of society against another.

Whatever the reason for changing labels and the way we talk about things is, ultimately, about changing perceptions of how people in society view something.

What it rarely does is change the reality of what happens. Waste management technicians still collect our rubbish on a regular basis, the violent actions of an individual whether they are a freedom fighter or a terrorist remain the same and Ministers still sit in comfortable offices whatever the name of their department at the time.

So those with dementia or neurocognitive disorder, will suffer the same symptoms, require the same level of care and support and families will live through the same fears no matter what the condition is labelled with. Yet what about further up the social care ladder?

As the cases of dementia continue to grow as the population ages what difference will the label ‘disorder’, rather than disease, make to those holding the purse strings of care and support. It would be interesting to test public perception of the two words and see which is considered more worthy of tax payer money and how politicians in power would change their policies dependent on the word used. Many have campaigned to have dementia recognised as a disease in order to receive proper health funding for those who suffered from it, where does the word disorder leave their efforts?

It is also important to consider the people who actually suffer from it. Throwing new terminology at a person with cognitive decline and probable short term memory problems does seem foolish. One of the keys to personalised care and support is using language which is familiar to the individual and be changing terminology in can confuse and bewilder, especially when the new terminology is particularly vague, after all neurocognitive disorder could easily be interpreted as the result of a head injury, or more connected with mental health issues, something in the realm of psychiatry rather than the physiological needs that can be associated with dementia. In the wider world the public are more aware of dementia than ever before, throwing in new terminology muddies the waters at a time when increasing awareness is needed.

Words are important and the way we use language has an impact on how society as a whole perceives something yet the most vulnerable in society, those with dementia or those with learning disabilities will always have some difficulty in grasping new labels attached to conditions they may have which in turn can further confuse and bewilder them.

Although the possible changing name of dementia has sparked this debate it does not just apply to that, anything we re-label, any terminology we use can cause confusion amongst those who need clear, precise and understandable language to support them in their day to day lives. Whatever the reason for wanting to re-label dementia those who wish to do so should consider how their new terminology will improve lives for individuals and if it does not, why bother?

Thursday, 15 November 2012

Social Care Users are Not All Elderly

Half a million people under the age of 65 receive council funded social care services. That is around a third of all those receiving services and there is a danger they become excluded in the wider social care debate.

We have seen some excellent initiatives in dementia recently, albeit maybe not going quite far enough, but we need the social care debate to encompass all those who need societies support in life. The funding debate in social care has almost exclusive focused on the Dilnot proposals and how elderly care is paid for. How much should older people contribute to care they receive, what should be the threshold for capital etc. This debate has little to with those under the age of 65.

Similarly we have seen the debate of health and social care integration. There is no doubt that the two are related but more so in relation to elderly care than the support needed for those under 65. Those with physical or learning disabilities and those with mental health issues do need support in health but they need support in daily life, support with housing needs and support with employment and welfare in order to live as independently as possible.

The number of those under 65 receiving council funded services has, in line with the general trend, declined slightly but this does not mean there are less people needing societies support, simply that the eligibility criteria for receiving support has tightened and the fact that support centres have closed because of the budgetary constraints on local authorities meaning less support being available to many.

As with all areas of social care there are many who do not appear on the statistics but that does not mean they are any less deserving of societies support. In addition there are many families who provide support for individuals who also need our help. The changes in demographics and the ageing nation applies to those with physical and learning disabilities as it does to the general population and there are an increasing number of elderly parents still caring for a child without the support of society.

Social care is wider than just health and should be treated as equally as any other area of social policy.

The health and social care integration debate and the focus on elderly care detracts from this wider function of social care and marginalises those who are under 65 and who need more than just health support in social care settings.

We need to raise ALL social care into the spotlight and social care needs to have the same Government input as Education, Welfare, Health and Employment therefore it needs a cabinet minister for social care as this will put it on an equal footing with these other areas of social policy.

Please take the time to sign my e-petition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

Tuesday, 13 November 2012

YOU are getting older ACT NOW

One in three people over the age of 65 will die with some form of dementia (Alzheimer Research UK).

Given the latest statistics suggest that there are over 10 million currently over that age in the UK we are looking at around 3 million people having dementia, as the population grows and ages this means dementia will impact on even more people in the future.

Big numbers generally make our minds switch of, the bystander effect kicks in and we just assume it is someone else’s problem, not our responsibility and best left to ‘professionals’ to deal with. Yet we need to put the issue into perspective.

But if you stop and break it down a bit can we afford to be bystanders?

How many brothers or sisters do you have? I have three, so the chances are that between the four of us at least one will develop dementia. A daunting thought and enough to make me think that action needs to be taken now so if I, or anyone else in my family, develops dementia the best possible care and support is available. Although many would like to deny it we all age and as we age we creep closer to being the one in three who will develop dementia and if we do not have the infrastructure in place what sort of care and support we will receive.

Think about your future as you age. You may develop dementia or you may find someone you love develops it and you have to be their primary carer. The issue may not even be dementia, other conditions such as Parkinson’s disease or long term heart conditions etc. Imagine being in a situation where you are unable to fully engage with your family or friends because you are physically unable to make even a simple cup of tea or having issues with continence that leaves feeling embarrassed or ashamed.

Stop, and start to ask yourself how well prepared in the country to provide YOU with the support and care you need later in your life.

As you think about your future also think about those who are in that situation now. There are millions caring for someone they love but without real support from society because they ‘fail’ to meet the eligibility criteria set by bureaucrats. Local authorities, who supply most social care funding are facing ever tightening budgets and services are declining because of this. Take time to think about the pressures on elderly people in the current economic climate where the costs of heating and food are climbing but help from the state is declining.

You are getting older, and as you get older there is an increasing likelihood that you will need social care support either for yourself or for someone you love. We are an ageing population and it is important for us to act now to secure our future and also those who need support services today.

We cannot be bystanders in the ageing process and the need to ensure society provides its best for those who need our help.

Monday, 12 November 2012

We shouldn't gag the BBC

Newsnight had two stories of child abuse, one they suppressed and one they failed to verify the facts. The result has been a total breakdown in the BBC news department with resignations aplenty and the entire news agenda dominated by the BBC.

Yet we must be careful.

Firstly the fallout at the BBC has obscured the very important issue of systematic and institutional abuse of young people in care, as well as the abuse by celebrities who held a position of trust. And, while the horrendous events reported by Newsnight are described as ‘historic’, the fact remains that abuse can scar people for life, impacting on their lifelong mental health, ability to form relationships etc.

There are still unanswered questions about the events at the homes in North Wales but these questions have been eclipsed by the frenzied call for heads at the BBC. The real story revolves around the original investigation in the early 1990’s yet, it seems, the truth will be buried beneath the bodies of those falling on their swords at the BBC.

In the second instance we need to be careful about this fevered attack on BBC News. After all, what percentage of news output at the BBC do these two Newsnight programmes amount to? Probably very little and we must not frighten BBC News into ‘playing safe’ with such stories in the future.

Without BBC reporting the Winterbourne View abuse could still be going on, elderly people could still be abused in certain care homes etc. Although these were Panorama investigations they still come under the BBC News banner.

We have more to commend BBC News for than we have to dismiss it with the fervour shown by many in high places and we need it to continue to investigate the wrong doings in society and expose abuse wherever it happens. The danger is BBC News producers will become too afraid of the ramifications of being too controversial and facing the wrath of those who disagree.

Newsnight cocked-up yet, if you read the circumstances, they were GIVEN the high profile name, further reading tells us that the victim in question was told that name twenty odd years ago. Reporters should have gone further in verifying the name and that is the only failure causing the BBC frenzy while the real story goes unreported and, possibly, uninvestigated.

The majority of the BBC News output is good, their exposure of injustices must continue and we must not allow this current mistake to stop this.

Tuesday, 6 November 2012

Cabinet Minister for Social Care: Business Focus

Yesterday the Daily Telegraph revealed that the big care companies have a total debt of £5 billion (http://www.telegraph.co.uk/health/elderhealth/9655229/Britains-biggest-care-home-owners-have-5-billion-debts.html), also yesterday Ed Miliband declared support for the ‘Living Wage’ saying “there are almost five million people in Britain who aren’t earning the living wage” (http://www.labour.org.uk/ed-miliband-speech-on-the-living-wage).

It is probably fair to say that at least one in five of these people are frontline social care workers who are on, or just above, the national minimum wage.

The current minimum wage is £6.19 per hour and the touted living wage is £7.20 per hour, the average pay for a care worker sits neatly in between at £6.65 an hour. So to reach the living wage employers need to find 55p per hour per employee working, on average 40 hours a week for 52 weeks (inc holiday pay) a year. With this applying to over a million people the cost will be around £1.1 billion a year, add into this employers NI contribution etc. and the cost gets higher.

I totally and whole-heartedly agree with the living wage and the benefits of it to social care will be enormous, particularly in terms of recruitment and retention but the real issue is where will the money come from. Most agree that social care funding is in crisis and without promises of extra money to fund the living wage the only place it can come from is existing care services and as noted earlier the debt situation of the bigger care providers hardly suggests that they can afford the living wage whilst maintaining care standards.

Many people easily and comfortably slip in to the idea that social care is a Government run and funded thing yet the reality is, of course quite different. There is no homogenous entity such as the NHS as social care is provided by, according to Skills for Care, approximately 22,100 organisations over 49,700 establishments. Just to put this number in some sort of perspective, the total number of high street bank branches across the UK is just 11,000. This vast, complex myriad of care providers range from the smallest micro-providers to the huge debt-ridden big companies, from not-for-profit voluntary organisations to those owned by offshore parent.

Social care is big business, around 20% of local authority spending in England goes on social care equating to around £21billion per year, so it is no wonder some offshore companies feel there is money to be made, and, of course, this does not include the money paid by those not entitled to local authority support or those who have to pay ‘top-up’ fees to providers.

Yet, despite this seemingly high amount, the payments by local authorities have declined in real terms over the past few years, with eligibility criteria also tightening, and many professionals agreeing that social care needs an urgent injection of real cash to prevent and halt the constant cut back in services.

The business of social care can be as complex as meeting the needs of many individuals who need care services yet everything is the responsibility of a junior minister within the Department of Health.

I truly and honestly believe this needs to change and I would ask you to support my epetition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

Friday, 2 November 2012

The World is Changing, Let's Prepare for the Future

Not strictly a social care blog I will admit, but social care is intrinsically linked hence the reason for putting it here.

The world is changing and, unfortunately, the politicians are failing to acknowledge and address the change that has a huge impact on all levels of society.

We are living longer.

As a result there is a change in the dynamics of society which are only partially addressed by Westminster and, as a result, preparation for the future is woefully short.

Take, for instance, working and the State pension. The age at which the pension can be claimed has risen and will continue to rise over the coming years to mitigate the ever increasing state pension bill. But what notice has been taken of the implications of this? Much is made of the current economic climate, unemployment figures especially among younger people. What we do not here about is the effect of people working longer on the unemployment figures.

It does not take an economist to work out that if people are working longer there are going to be less entry positions available to younger people and where people are working longer the size of the available workforce grows, meaning there is also a need to ensure growth in the number of jobs available otherwise the employment benefit bill will continue to rise.

Ironically, given the current Government approach, one of the areas of employment growth will be needed is in the public sector. As the population ages so will the age related conditions that need to be dealt with by the NHS and its staff, the number of those with dementia will increase dramatically as will other conditions that effect people as they grow older. As the population of the country continues to grow, because of ageing, other public services will need to meet the increasing demand.  It is all very well cutting services to reduce the deficit today but where will that leave us tomorrow?

It is not just politicians that need to adjust to the change in social dynamics. Businesses to need to be aware their customer base is getting older and adjust accordingly. As we age our needs change and it is folly to simply appeal to the younger market (personal bug bear – I do not want skinny jeans but why is it only them available in most shops!), with the high rate of youth unemployment and the fact that people are working longer in life businesses have to consider where the disposable income is!

Institutional ageism has to be halted, older people are now the majority rather than a minority to be sat in the corner and ignored. Some organisations (such as the BBC) have often been accused of ageism (especially with female employees) yet, increasingly their audience have become older people who deserve to be represented.

We are living in an ageing world and as the life expectancy rate continues to grow society will change. Those in charge of policy etc in the country, and, indeed, around the world, need to start changing too, in order to meet the challenges this changing society will bring.

The world is changing, let’s prepare for the future.