- Risk of Falling for Elderly Nursing Care Plan July 8, 2019
- Nurses in Britain are Buried by Paperwork May 1, 2019
- Pain In Dementia Is Often Not Recognised or Treated March 14, 2019
- Make Your Care Home More Dementia Friendly February 5, 2019
- Music can be an Amazing Therapy for Dementia April 1, 2018
Health and social care chiefs are demanding a crisis meeting with George Osborne and Jeremy Hunt to avert what they fear could be a wave of care home closures within months after years of spending cuts.
“What happened to the £6 billion originally earmarked for the full implementation of the Care Act?”
Care chiefs’ letter to ministers
Leaders of four separate organisations representing council and NHS bodies have written to the Chancellor and Health Secretary, warning that plans unveiled in the recent spending review fall short of what is needed to avert disaster in the care system in England.
They also question whether £6 billion originally earmarked for reform of the care system under the Coalition government has been quietly diverted into other spending areas.
Health secretary Jeremy HuntJeremy Hunt Photo: Andrew Crowley/The Telegraph
Crucially, they fear that the introduction of the new National Living Wage, being phased in from next spring, could tip care providers over the edge financially unless extra cash is forthcoming.
While spending on the NHS has been protected throughout Mr Osborne’s austerity cuts, councils which are responsible for care for elderly and disabled people have seen their budgets slashed by around 40 per cent.
The warning came in a letter jointly signed by the leaders of the Association of Directors of Adult Social Services (Adass); the NHS Confederation, which represents NHS bodies; the Care and Support Alliance, a coalition of 75 charities, and the Care Provider Alliance.
“Ultimately the package put forward for social care will not enable us to fill the current gap in funding, cover additional costs associated with the introduction of the National Living Wage, nor fully meet future growth in demand due to our ageing population,” they wrote.
“There is the potential for significant and adverse impacts … including an acceleration of the failure of domiciliary, residential and nursing home providers.”
Care chiefs’ letter to ministers
Rob Webster, chief executive of the NHS Confederation, added: “The NHS is not an island, it is part of a single system.
“Without sufficient investment in social care the sustainability of the NHS is called into question.”
The elderly deserve good quality care, regardless of age. There are fears of care homes closing Photo: Getty Images
Cllr Izzi Seccombe, of the Local Government Association, said: “We are now on the fast-track towards a care home collapse, leaving our elderly friends and family in care limbo, not knowing where they will go if a care home closes.
“It cannot be left solely to local council taxpayers to fix our chronically underfunded social care system.
“If proper funding for social care is not urgently addressed, essential services will remain increasingly at risk and the full needs of older and disabled people and their carers who require vital care and support will not be met.”
Source The Telegraph
The health regulator has warned that 40 per cent of care homes for the elderly are below standard.
Andrea Sutcliffe, the Care Quality Commission’s chief inspector for adult social care, said that a third of social care facilities require improvement, with as many as seven per cent providing “inadequate” services.
Writing for The Telegraph, Ms Sutcliffe said: “There are concerns about safety and leadership and many nursing homes are struggling.
“There is too much variation – yes, nearly 60 per cent are good or outstanding, but a third require improvement and seven per cent are inadequate.”
She added: “In this climate it is critical that responses from local services to financial pressures do not increase risks to people’s health, safety and well-being.”
Ms Sutcliffe was writing ahead of the Government’s spending review, which will set department budgets for 2016-20.
While funding for the NHS will be protected, there are fears that councils will see their grants substantially cut, putting increased pressure on funding for social care services that are paid for by local authorities.
Local authorities say £4.6bn has been cut from social care budgets in the last five years and that George Osborne’s decision to raise the minimum wage to £7.20 an hour, and £9 by 2020, will add to the crisis by increasing the cost of delivering care.
Her remarks follow a stark warning from Guy Hands, chairman of Terra Firma, the private equity firm which owns Four Seasons, Britain’s biggest chain of care homes, about the future of the sector.
• Care system ‘crumbling’ after broken promise on fees cap – inquiry chair
He warned, in an interview with The Guardian at the weekend, that care homes will start closing down or being put up for sale next spring of George Osborne does not ease the financial pressure on the sector.
He said a quarter of his company’s homes are making at a loss and some would “inevitably” have to close.
“For the last three years, we have assumed the Government would look at the economic effect of their policy and make a decision,” he said.
“I don’t think the effects will be felt this winter, but next April or May is when you will see care homes closing or for sale.”
Meanwhile the head of a major independent review into the social care system warned ministers will face a growing “public outcry” when the full implications of the current crisis are felt.
Dame Kate Barker, told the Telegraph, that thousands of elderly people risk being condemned to a “miserable” end to their lives following a Government u-turn capping the cost of care.
Ms Sutcliffe warned that cuts in funding, rising costs and increased demand for care from an growing elderly population have already placed a huge strain on care homes and adult care services.
“Providing good quality care needs adequate investment and funding. Adult social care should be valued by society in the same way as the NHS and other public services are,” she said, adding:
“At its very best adult social has the potential to completely transform a person’s life, but at its worst it can damage people’s lives forever.”
• Andrea Sutcliffe: My brother’s suicide spurs me on to end the care crisis
• Elderly at risk at hundreds of care homes
Ms Sutcliffe’s warnings follow a growing number of scandals about the shockingly poor standards of care endured by vulnerable elderly people in a number of nursing and residential homes.
The CQC has been criticised in recent years of acting too slowly or not coming down hard enough in cases where elderly people in care homes are being maltreated.
The commission has the power to order the closure of care homes who fall below certain standards, but only uses this power sparingly – aware that the residents in these homes would still have to be found places elsewhere, in what is already a struggling sector.
In December last year the CQC ordered the closure of two care homes in Surrey run by the same couple, businessman Soondressen Cooppen and his wife Maleenee, after it found “significant failings in safety and quality of care”.
It took the urgent action after concluding that the 27 elderly residents at Merok Park Nursing Home, in Banstead, and 19 others at Grantley Court Nursing Home, in Sutton, were at “significant risk of harm”, despite repeated warning to Mr and Mrs Cooppen.
A care home in Surrey has been shut down after inspectors found residents were “at significant risk of harm”
Residents were being washed with cold water, not given sufficient support to eat meals and the understaffed home smelt of urine, while some workers had not had any criminal records checks.
Ms Sutcliffe, who joined the Care Quality Commission (CQC) in 2013, has previously said that she draws upon personal experience when making decisions.
That has led her to use what she calls the “Mum Test” when assessing institutions, asking the question: “Would I put my own mum in here?”
She said: “As the regulator I am determined that CQC lives up to its promise of being on the side of people who use services. To do that we will continue to speak up when there are challenges for the sector and continue to provide reliable and transparent information about the quality of care we find.”
Source The Telegraph
A cash crisis facing care homes across the country could see a collapse of residential care within five years, costing the NHS an extra £3 billion annually as a result, warns a new report.
Some 37,000 beds will be lost due to care homes closing because of a growing shortfall in funding set to exceed £1 billion by 2020, claims the report by the ResPublica think tank. The problem is exacerbated by rising demand, with the number of people aged over 85 set to rise by around two million in the next 20 years.
Residential care “faces a potentially fatal crisis,” warns the report. Local authority spending on social care for older people has fallen by 17 per cent since 2009.
“If nothing in the funding regime changes within five years, there will be a projected loss of 37,000 care beds as funding fails to meet demand. This is greater in scale than the Southern Cross care homes collapse in 2011, which affected 31,000 older people,” it states. “With the sector under immense financial strain, the likelihood is this time there will be no private provider of last resort.”
The introduction of the National Living Wage will increase the burden on care homes, and at £382 million will be around a third of the £1.1bn funding gap in 2020.
“The National Living Wage is a great step forward. It is estimated it could help more than 6 million low paid workers. But for the care sector, which is heavily reliant on its labour force, it could be catastrophic,” commented Emily Crawford, co-author of the report.
This comes after the Independent revealed on 7 November that Britain’s biggest care home provider, Four Seasons Health Care, is to sell off a string of homes amid financial pressures to save millions.
And earlier this week, Andrea Sutcliffe, chief inspector for adult social care, the Care Quality Commission, warned: “Stresses and strains in social care are impacting on quality…There are concerns about safety and leadership and many nursing homes are struggling.”
ResPublica’s new analysis of residential care in England, which draws on Government data, warns: “Given the perilous state of the industry, we believe the most likely outcome is the vast majority of care home residents flowing through to hospitals.”
It adds: “This would require the NHS to find £3 billion per year by 2020/21 to support frail and aged people who no longer have a home in the residential care sector, and who do not belong – nor wish to be – in a hospital.”
Fundamental reform of the system, designed at a time when life expectancy and duration of illness were much shorter than today, is needed, it says.
More detailed recommendations will be made in a full version of the analysis being published next January, but Philip Blond, director of ResPublica, told The Independent: “Care homes would need to be broader and become health hubs that help people manage chronic illnesses and reduce the burden on hospitals, which would need to pay them to keep people out of hospital.”
While the report focuses on England, it reflects a wider problem across Britain. In Scotland, the Task Force for the Future of Residential Care warned last year of “significant and growing financial pressures” and cited a “heightened risk of care home providers going into administration,” as being one of the implications of failing to provide adequate funding.
And in a report last November, the Older People’s Commissioner for Wales said: “The residential and nursing care market in Wales is volatile and fragile,” and added: “A current lack of forward planning means that the needs of older people in care homes will not be met in the future.”
Professor Martin Green, chief executive of Care England, which represents independent care providers, said: “The Respublica report is further evidence that the care sector is in crisis unless the government establishes proper funding that will sustain the sector into the future, the impact on the NHS will be enormous and could lead to its collapse or billions extra needed to sustain the NHS.”
Justin Bowden, National Officer for the GMB union, warned: “It is one minute to midnight for the care sector. Just as GMB warnings that Southern Cross would collapse were ignored again and again by government, history looks set to repeat itself unless George Osborne acts now.”
He added: “This time however we are not just talking about the largest care home provider collapsing, but the entire publicly funded care home and domiciliary care sectors.”
Dr Chai Patel, executive chairman at HC One, one of Britain’s biggest care providers, commented: “Southern Cross was a failing company, what we are facing now is a failing system… unless the Chancellor takes urgent action to address this looming crisis, tens of thousands of older people will lose their homes and be forced into the NHS.”
And Caroline Abrahams, charity director at Age UK, said: “All the evidence at present is that the care home sector is extremely fragile and, without significant new investment in the Spending Review, that many care homes will close their doors to all but the most affluent older people who can afford to pay premium fees.”
In a statement, a Department of Health spokesperson said: “Following the failure of Southern Cross, we empowered the Care Quality Commission to monitor the finances of key care providers and the sustainability of the market – this provides early warning of likely failures so we can better protect the vulnerable people who use their services.”
They added: “We’re making sure older and vulnerable people have a strong health and care service, having invested an extra £3.2 billion in social care over the last four years, and during this Parliament by putting £10 billion extra into the NHS.”
But Izzi Seccombe, the Local Government Association’s community wellbeing spokesperson, said: “We are heading towards a devastating care home collapse.”
She added: “Health and social care leaders widely recognise that a properly funded social care system is essential to alleviate the pressures on the NHS…it is imperative that the Government fully addresses this in the Spending Review before we see a care disaster unfold.”
Britain’s biggest care home providers include:
Barchester Healthcare – cares for more than 10,000 residents in around 200 homes. Although revenues rose to £523.4m in the 12 months to the end of December 2014, the group’s operating profits fell from £23.2m to £12.9m.
Bupa Care Services – looks after 40,000 people in 280 homes. “In aged care, public funding pressures in the UK mean that local authority fees for care services are often below the true cost of delivering care and this is compounded by the impact of inflation on operating costs,” warns its latest half year financial statement.
Care UK – runs 112 homes and 12 day centres. Its latest financial report states: “Financial pressures on the NHS and local authorities are substantial and fee rates continue to be lower than could reasonably be expected.”
Four Seasons Health Care – Britain’s biggest operator, with 470 homes. Has debts of £500m, and last week credit rating agency Standard & Poor’s warned the company could run out of money within six months.
HC-One – one of the firms which stepped in after the collapse of the Southern Cross group, buying up more than 200 homes. Dr Chai Patel, chairman, said last month: “If we don’t get a fee increase at all next April, literally all our surplus cash before capital expenditure, interest and rent will be wiped out.”
Source The Independent
BBC panorama exposed shocking repeated abuse of the elderly in a Care Home.
The video was clear cut graphic evidence of bullying, mental and verbal abuse and taunting and mockery of the elderly, disabled and infirm.
I have been a Care Home operator for 30 years and there are so many improvements and great things which have been introduced over those years, but seeing this abuse is devastating for any operator.
“Your service is only as good as your worst member of staff!”
My experience is that one bad staff member can cause absolute havoc.
Many years ago if a manager had any suspicion at all that a carer was not caring enough, the employment law was such it was very easy to discipline or dismiss.
Now the employment law in this country makes it extremely difficult and such a lengthy process to deal with poorly performing staff.
This is not in any way an excuse for not addressing and improving performance issues, as it is extremely important to manage staff well.
But the elderly are such a vulnerable client group.
Some people can be uncaring and have no compassion, why are they in the job?
CCTV should be allowed in all areas of Care Homes, I think this is indicative of the times we are living in.
Patients deserve excellent care and to have that care delivered in a dignified manner.
Such a move may assist managers and providers to ensure that every member of staff is delivering excellent care.
It may also help CQC staff in their inspection of hospitals and Care Homes.
Why would anyone not want to know what really happens or have an issue with this?
What do you think?
I wanted to help my own and other Care Homes achieve excellence and meet the ever increasing demands of the Care Inspectorate.
I have had so many different people inspecting my Care Home and found that each of them had slightly different opinions and ideas about what should be and comment on the content of our Care Plans and assessments, nobody could tell exactly what they were looking for and what would tick every box.
The increasing demands of the Care Inspectorate for the correct paper work means that trained nurses and carers are spending too much valuable time writing and re writing their care plans and assessments
I wanted to produce a system that would guide any nurse or carer no matter their abilities are to produce an extremely detailed person centred Nursing Care Plan.
This would enable anyone reading it to understand exactly what assistance the resident requires and what abilities and preferences they have.
In particular I wanted the nurses and carers to explore and get a real picture of who the resident is not just what issues they face.
I wanted the Care Plan to identify exactly what the resident could or would like to do themselves thereby encouraging and supporting them to maintain skills and remain as independent as possible.
I also wanted every Nursing Care Plan to be so precise and informative that any agency nurse or bank worker could deliver an excellent standard of individualised care.
Every elderly person deserves to have excellent care delivered in a dignified way.
The Nursing Care Plans produced by Planning for Care, focus on respect of choices, dignity and a persons individuality.
They ensure that no matter what the residents difficulties or issues are, whether communication, mental health or otherwise, their voice is heard and their preferences and choices are respected.
The Planning for Care system and documents have dramatically improved my Care Home service.
The paperwork is much easier to complete, is far more detailed and takes less time to complete.
That means my nurses and carers can give much more time to the actual delivery of care, which is most definitely my priority.
Two-thirds of older and disabled people in England who turn to their local councils for help with care are turned away, figures show.
Nearly 1.85 million requests for support were made last year, but just over 650,000 people received help.
Councils have been warning for a number of years that a shortage of funding is causing problems.
But the figures – the first to be compiled in this way – illustrate how difficult it is for people to get help.
Only 144,000 of the requests for help resulted in long-term care, which includes places in care homes or help in the home for tasks such as washing and dressing.
Nearly 220,000 got short-term help, such as rehabilitation after discharge from hospital, and another 300,000 got low-level support such as walking aids and telecare.
The rest either received nothing or were advised to seek help from charities, the NHS or from housing services.
Unlike the NHS, social care is not free so everybody will pay something towards the cost of their care with some covering the entire cost.
Meanwhile, a separate survey of nearly 70,000 people who did get help revealed their experiences of care.
Some 65% said they were extremely or very satisfied with their care and 26% were quite satisfied, but one in 10 was not.
One in 20 did not feel clean or presentable and the same proportion said they did not always get enough food and drink.
The care system
- Unlike the NHS, social care provided in an individual’s home or in residential care is not free. Only the poorest get help.
- The number of older and disabled people receiving council help fell by 28% between 2009-10 and 2013-14.
- The Local Government Association predicts if extra money is not put in there will be a shortfall of more than £4bn in care services by 2020 – and that is before the implications of the national living wage are taken into account.
- An estimated 1.5 million older people with care needs rely on family and friends for help.
- One in 10 older people faces bills in excess of £100,000 over their lifetime for care.
Janet Morrison, chief executive of the charity Independent Age, said the figures painted an “alarming picture of services cut back to the bare bones”.
“This is a direct result of £4.6bn cuts to social care budgets since 2010 and comes despite an ageing population which is increasing the need for these services,” she added.
The figures come after a coalition of health and care groups wrote to the Treasury last month warning that the care sector needed to be protected as the “deepening crisis” was putting people in danger.
The government said its spending plans would be revealed in November, but pointed out that a £5.4bn fund – the Better Care Fund – had been established in April to ensure NHS money was used for services that support council-organised care.
But Izzi Seccombe, of the Local Government Association, said: “We need to see a change to the current perverse funding system which, over the last five years, has seen an increase in funding for the NHS but a decrease in funding for social care.
“This threatens to leave councils struggling to commission the essential support which keeps people out of hospital and living healthier and happier lives in their communities.”
Source BBC News
Elderly people are “trapped” in English hospitals in ever greater numbers as there is nowhere else for them to go, the charity Age UK has warned.
Its analysis shows patients spent a total of nearly 2.5 million days stuck in a hospital over the past five years.
Age UK said it was bad for patients’ health, a waste of NHS resources and a huge cost to taxpayers.
NHS England said extra funds allocated to councils would help give care and support to patients leaving hospital.
Age UK says there is a crisis in social care ranging from a shortage of care home places to a lack of district nurses to help people in their own home.
It says the situation has got worse and the number of people being kept in hospital in 2014-15 increased by 19% on the previous year.
The charity’s analysis of NHS England data for the last financial year showed the days spent stuck in hospital included:
- 174,000 waiting for a residential home place
- 216,000 waiting for a nursing home place
- 206,000 waiting for help from social care workers or district nurses to get people back into their own home
- 41,400 waiting for ramps or stairlifts to be installed into patients’ homes.
Caroline Abrahams, from Age UK, said: “These figures show that year-on-year, older people are being trapped in hospital in ever greater numbers because of a delayed assessment, care home place, home care package or home adaptation.
“Without decent social care when discharged, whether to their own home or to a care home, hospital stays are often much longer than they need to be and older people are more likely to be readmitted because their recovery stalls.”
She said this was a waste of NHS resources because it cost nearly £2,000 per week for an NHS bed in comparison to around £560 per week in residential care.
“Everyone agrees the way to go is to integrate social care and health much more effectively, but unfortunately our report shows we’ve got a long way to go before really the reality lives up to the rhetoric,” she told the BBC .
“And if we can’t get it right for such an important group of people, older people stuck in hospital waiting to get out, really we have to redouble our efforts and do much better.”
An NHS England spokesperson said: “We continue to need strong joint working between hospitals, community services, care homes and home care, which is being further helped by the extra £35 million allocated to local councils for social care so patients leaving hospital get the care and support they need.
Source BBC News
Social care has changed dramatically in the last two decades: now care homes have residents who would previously have been in nursing homes – and nursing homes look after people who would have required hospital care.
As demographics have changed, people are living for longer with more complex conditions – most notably, dementia.
“The job that we’re expecting nursing homes to do is ever more complex and ever more difficult,” says Andrea Sutcliffe, chief inspector for regulator the Care Quality Commission (CQC). Homes with nursing are expected to care for people with acute needs, while also ensuring a community aspect to the care.
The distinction between care homes and nursing homes is simply that the latter offer nursing care, with nurses on site who provide this, while both are residential facilities for older or disabled people.
But findings from the 2014 CQC State of Care report suggest that there is also a quality distinction to be made between the two and that nursing homes provide poorer care than care homes.
Less that 80% of nursing homes inspected met CQC standards for safety, compared to 85% of residential care homes.
The increased complexity of care is one explanation for the problems faced by nursing homes. Another is the difficulties recruiting nurses.
The State of Care report found that 20% of nursing homes do not have enough staff on duty to ensure that residents received good and safe care and their turnover and vacancy rates are among the highest in social care.
This affects the nurses already working in social care.
Claire Phillips, a registered nurse in a Cumbrian nursing home, says: “We’ve been begged to do extra [work] because there’s not enough nurses to cover all the shifts. So there’s been periods where we all work more than our contracted hours and that can be hard … It’s a lot of pressure, I’ve got a young family.”
Frank Ursell, chief executive of the Registered Nursing Homes Association (RNHA), says that one reason for the shortage is that the NHS has been hiring many more nurses since the Mid Staffs scandal and “sucking them out of our sector”.
Phillips echoes this, saying that nurses leaving “seems to come in waves, especially with the NHS recruiting so heavily – that’s been an issue certainly in the last year”.
The Conservative party’s manifesto promised 6,900 more nurses for the NHS, suggesting that homes will be further mined for their nurses.
In a recent Guardian interview, the head of Health Education England, Ian Cumming, said: “We’ve got a significant problem with nursing, and the inability to recruit nurses.” Nurses are not just in short supply in social care.
Nursing homes have limited control over the number of nurses trained each year and as a registered profession, this is in the hands of the government. “The Department of Health is not good enough at determining how many nurses we need,” says Ursell.
In April, the Royal College of Nursing revealed that there are fewer nurses now than in 2010, because of a cut in student nursing commissions. While 50,000 people applied to be nurses in 2014, there were only 21,000 places available.
The poor reputation of the social care sector compared to the NHS is often cited as a reason for the shortage of nurses in social care.
Care and nursing homes are not seen as attractive places to work, despite the fact that nursing in a residential home can be much more relationship-based.
“I like going in and knowing the faces I’m going to see,” says Phillips. “My strengths lie in communication, the building up of the relationship.” The continuity of patients in a nursing home gives nurses the chance to get to know the residents and their families.
“There’s a difference between nursing inside the NHS, which is prominently episodic, as opposed to working in our sector where it’s more relationship based”, says Ursell. This is a key strength of social care and is what so many people working in the sector love about it. But it can be overshadowed by the harsh media criticism and poor public image of the sector.
The RNHA is making strides to try and improve the recruitment situation and is exploring partnering with universities to offer nurse training courses.
Students would have to pay for these themselves, rather than being covered by an NHS bursary, but would be guaranteed a job in a nursing home at the end of it.
While many students may not be overly keen to pay for a degree they could get for free, the over-subscription for places on current nursing degrees may nevertheless lead to demand for this course.
And there are steps that nursing homes could take themselves, such as paying a higher rate for night shifts and improving their pension offering in line with the NHS.
A problem that affects the whole of social care, and one that the sector skills agency Skills for Care is attempting to address, is the actual or perceived lack of a career pathway.
Care assistants can feel that there is no way to progress unless they take time out to get a nursing degree, and registered nurses find that they cannot move up the career ladder without going into management and losing the hands-on nature of their role.
Making it easier for care assistants to get a nursing degree while staying in their job could be a longer term solution, as would enabling registered nurses to specialise in particular areas of care within the nursing home.
Tracy Paine, registered nurse and operations director at care provider Belong, says: “I think we need to really sell the great news stories, the opportunities available in adult social care, the training and investment.” Nursing in social care does have some advantages over the NHS, but the sector needs to shout loudly about them. Phillips, who has worked in a nursing home for two years, says: “I can’t imagine now working in a hospital even though I did my training there. I think this job gives me what I need.”
Source The Guardian