Government inaction on social care funding needs a radical response

Calm and careful reflection is now needed as to why such a formidable and authoritative range of opinion was so comprehensively disregarded. Simply re-stating the case for better funding is not enough. What would it take for the government to act? Where do we go from here? What do we need to do differently?

One view is that we need to make a stronger evidence-based case for social care as an investment producing wider benefits to the economy, rather than a cost. This would be rooted in a different vision of care provision that promotes independence and community resilience instead of creating dependence on formal services. But is lack of evidence the real reason for government inaction?

The need for action was recognised as long ago as 1997, when Tony Blair established a royal commission. The case for adequate funding was taken up again a decade ago by the late Derek Wanless in meticulous and compelling detail – 344 pages and 16 supporting research papers. The Dilnot Commission in 2011 added further analysis, as did the Barker Commission three years later. These three reviews were led not by professional lobbyists or provider interests but a trio of hard-nosed bankers and economists. So the proposition that the Treasury stands ready with the chequebook if only we could provide even more, or different, evidence is fanciful. There are deeper underlying reasons why this government, like its predecessors, has failed to grasp the nettle.

The most obvious is the historical legacy of means testing for social care, established in 1948, alongside a later policy shift away from long-term care provided free by the NHS. As society has grown richer, many people now have savings and assets that exceed the means test threshold of £23,250. This has allowed successive governments to stand by and watch as the costs of care fall increasingly on private individuals rather than the public purse. Over half of care home fees are now met by individuals, not the state. Persuading the Treasury to spend more when there is already a covert and convenient way of raising money through, in effect, a form of self-insurance, will always be a tough ask. Dilnot-inspired plansfor a cap on very high costs were a foot in the door, but it was firmly shut again with the postponement of those reforms until 2020 (and only ministers appear to think they will see the light of day).

Another explanation for inaction is that, unlike the NHS, social care is poorly understood by the general public and does not resonate as a significant electoral issue in MPs’ postbags and surgeries. A troubled NHS easily commands public attention through visual images of overflowing hospitals and queuing ambulances. But when the social care system is “full” few notice, the consequences scattered silently and invisibly across thousands of homes and families. It makes little noise on the radar of political and public concern.

Allied to this are 6 million other reasons that have allowed governments to get away with underfunding social care – unpaid carers, the natural shock absorberswho so far have cushioned the NHS and social care system from the full impact of inadequate services. For all the policy rhetoric about supporting carers, there is a tacit assumption that care should be undertaken by families – usually wives and daughters – and that, again unlike the NHS, it does not require highly skilled and well-resourced public provision.

So it is unlikely that more or better evidence alone will generate the necessary public support and political will for change. The case for a social movement that generates bottom-up pressure for action looks set to gather momentum. The social care sector will need to seize the opportunities offered by social media with considerably more enthusiasm than it has shown to date. It might also need to replace the nebulous and woolly term “social care” with a different vocabulary that unifies and resonates more clearly with the diverse range of individuals of all ages and circumstances with care and support needs.

Creating the conditions in which a social movement can emerge and flourish will take time. Unless the government has a change of heart, more of us will have to get used to the idea that we are responsible for paying for our own care unless we are relatively poor and have very high needs. Unpalatable a prospect though that might be, the time has come for a sensible discussion about how we should be supported to do that through better advice and information, and the use of the tax, benefits and pension systems.

In the meantime pressures on health and social care will not go away. Unpaid carers can absorb only so many bumps in the road; prospects for the NHS with winter almost upon us are grim. The possibility of large-scale provider failures that imperil the care of hundreds or even thousands of people is an ever-present possibility. The government is taking big risks on all of these fronts as a direct consequence of its indifference. How big a price, in human as well as financial terms, it is prepared to pay remains to be seen.

Sustainability and Transformation Plans for south London

Since then all health and care organisations in south east London have been working together with local councils to make plans and decisions that will ensure the sustainability of our services into the future.

The STPs aim to tackle the biggest challenges facing the NHS – money, workforce, estates and delivering high quality proactive and preventative care.

There are two STPs that cover the geography of our Trust – south east London and south west London. The south east London STP was published on Monday 7 November, whilst the south west STP remains under development and is due to be published later this month. The plan is that commissioners and providers will undertake further engagement and discussion with staff and local people as the detailed plans for the STPs continue to develop.

South east London STP
The STP for south east London builds on work that was already taking place via Our Healthier South East London (OHSEL), which has been a programme in development since 2013.
The south east London STP was published on Monday following a national assurance process. You can read the Full STP and Summary on the OHSEL website.

The major clinical change proposed in the south east London STP is to consult local people on plans to develop two new specialist orthopaedic centres which would bring together routine and planned surgery together from across south east London. The STP also talks about plans for a single out-of-hours service and quicker admissions to A&E. There are no proposals to close local NHS services as part of this plan.

South west London STP
It is too early to say whether there will be a reconfiguration of acute services in south west London – however the current hypothesis is that four acute sites would be the optimum number. Should any significant service changes be proposed there would be a public consultation on these.

Mental health
There are no plans in the STPs with regards to the number of mental health sites. In fact, both STPs are positively supportive of SLaM’s own planned direction of travel – which focuses on close partnership working with our neighbouring mental health trusts around specialist care and back office, and a strong local borough partnership approach.

As a trust we have been working to influence and develop the STPs in partnership with our local colleagues. The south east London STP includes a focus on integrating mental health services, to ensure that mental health as well as physical health needs are identified and addressed – including training for non-clinical workforce to recognise and support mental health needs.

The wider picture
Across the country the NHS continues to go through a period of unprecedented change and not a day goes by without there being another headline about an NHS Trust facing financial difficulties.

Over the next few months and years we are focusing our energies on improving the way we work by implementing our Quality Improvement programme and using our estate more effectively. We are also exploring working more closely with our local mental health Trusts and the potential for sharing appropriate support and back office services.

We will keep you informed of any developments and let you know about opportunities to discuss the STP further and to contribute to more detailed plans as they develop.

Carers Rights Day: Share the Burden of making an NHS Complaint

Our NHS Complaints Advocates provide clear and accessible information about the complaints process and your rights so you can decide what to do.

Advocacy ensures you have a voice.

‘You don’t have to do it all yourself’

It can often be difficult to ask for help as a carer. Advocates are there to provide one-to-one support throughout the NHS complaints process, which can often be a very difficult process to face alone.

Charlotte got in touch with the NHS Complaints Advocacy team after a lack of joined-up services meant her daughter Emmie was discharged with an undiagnosed condition and no sign of any further support.

‘Will I be heard?’

Advocacy is all about making sure you have a voice. NHS complaints advocates can help carers to draft letters of complaints, and can also attend meetings with NHS staff, to ensure your voice is being heard and you are being listened to.

An NHS Complaints Advocate helped Charlotte to understand how the complaints process worked and what to expect. The advocate worked with her to gather all the information needed to write a letter of complaint to the NHS Trust, clearly setting out what her expectations were to get the right referral and diagnosis for her daughter.

‘Will I be believed? Will I make treatment worse for my cared for?’

Many carers often feel too scared to complain, because they feel complaining will have a direct effect on future services for those that they care for.

Complaining can be a positive and uplifting process whereby your strength to speak out against poor care or treatment can lead to long-lasting benefits to future people using this service. You have the right to make a complaint against NHS services received, and this will not affect future treatment for those you care for.

Charlotte said that having an advocate there to back her up helped her to feel empowered and confident in making her complaint to a major NHS Trust. Emmie now has the referral she needs to see a specialist team.

If you want to speak confidentially to us about making a complaint about a hospital, GP, Dentist or any NHS-funded service, call our Helpline on 0300 330 5454, email us at [email protected] or visit www.nhscomplaintsadvocacy.org for more information and a range of self-help tools.

Uber-style service to book carers ‘on demand’ launched nationally

The scheme – the biggest health startup in Europe – comes in response to a growing crisis in care of the elderly, with record levels of bed-blocking in hospital, often for want of care at home.

The founders of the business said it would mean families could take more control over the help given to elderly relatives, and find the right carer to meet their needs.

Those behind the idea include an NHS advisor, with £1.3m investment in the scheme coming from investors, including the head of food delivery giant Just Eat.

Once rolled out, the new venture will guarantee a carer to a patient’s front door or hospital bed within four hours, they said, helping to reduce delays currently suffered by those in need of care.

It comes amid a growing crisis in social care, and fears the NHS is facing its toughest winter yet, because of record levels of hospital occupancy and bed blocking.

Dr Ben Maruthappu, a junior doctor and recent advisor to NHS chief executive Simon Stevens, said  he experienced issues with the sector first hand, when he struggled to find the right care for his own mother, after she suffered a fracture.

“It can be a real struggle, and sometimes a total nightmare to navigate the system and to find the right care for relatives, “ he said.

“Digital technology has changed so many aspects of our lives – how we order food, books, hail a cab or even dating – yet when it comes to the really important aspect of our lives, we often don’t get the help we need,” Dr Maruthappu said.

The company, called Cera, is also trialling artificial intelligence, with alerts raised when patients show early signs of illness or failure to eat properly, and links to gadgets in the home which can help to monitor pensioners.

The junior doctor said technology was needed to help families cope with the complexity of organising care for loved ones, on top of busy working lives.

“Often elderly people can suffer from multiple conditions, and end up needing carers three or four times a day. No carer works seven days a week so you need a system which responds flexibly to what people want, and to the hours people can work,” he said.

The service aims to become increasingly personalised, so that at first clients can book according to the type of care needs, such as dementia, or request particular languages, while in time it will develop personality matching.

“We don’t want care to become a commodity,” Dr Maruthappu said.“This kind of work is very personal and intimate, and it’s really important to find the right person.”

The service will allow relatives to log on and check the records of their loved one’s care, and receive text alerts letting them know that visits have been completed.

Don’t be home alone this Christmas Day 2016

Dinner will be served at 1pm

Bacon’s College is at Timber Pond Road, Rotherhithe, SE16 6AT

(Go down the LHS of the Rotherhithe Tunnel entrance)

Just phone Les Alden 0203 355 2619 / 07710 179 400 to book your place  –  closing date 16th December.

We regret we are unable to cater for children. Ethnic and Diet Meals available – Please notify in advance

We also need volunteer helpers and drivers!

This Party is for residents of the London Borough of Southwark

We acknowledge the generous assistance of Southwark Council and local Business and Charities

People Care Association Ltd. is Registered Charity No. 1077651

Powers of attorney rocket as dementia becomes Britain’s biggest killer

Power of attorney arrangements allow an individual’s financial and health affairs to be looked after by someone else, the attorney, if they lose mental capacity in the future.

Information released under a Freedom of Information request show that in 2015, 441,500 power of attorney arrangements were set-up, compared to just 36,000 during 2008. Up to August this year, there have already been 300,000 registrations.

In total just under two million “lasting” agreements have been registered since 2008, when they replaced “enduring” power of attorneys, amid concerns that the rules were too easy to abuse.

There are two types of agreement – one covering finances and property, and another for health and welfare. Finance and property is far more popular, in 2015 there were 134,311 more of these arrangements established.

The sharp rise in new agreements  – which are set up on average when the donor is 75 – comes as the Office for National Statistics reveals deaths from dementia and Alzheimer’s jumped by a fifth last year.

They accounted for almost one in eight deaths in 2015 – a total of 61,686 people – overtaking heart disease as Britain’s biggest killer.

Rachael Griffin, of Old Mutual Wealth, a pension company that filed the Freedom of Information request to get the data from the Ministry of Justice, warned many people were still exposed.

“There are still many more people who don’t appoint a power of attorney,” she said.

“Although it is possible for someone to take control of your financial or welfare decisions after an individual becomes mentally incapable, this can be a lengthy and complicated process with extra cost, which can cause distress at an already difficult time.”

Without power of attorney, friends and family have to retrospectively apply to the Court of Protection and prove why they should assume responsibility. This process incurs court fees and can take up to 16 weeks, leaving money locked into accounts until a decision is made.

To set up a power of attorney, the donor needs to fill in a set of forms from the Office of the Public Attorney. Each document – one of each type of arrangement – costs £110 to register, so a couple who want both types would pay £440.

The forms must be signed by the donor, the attorney and a “certificate provider” – someone the donor has known for two years or a professional, such as a doctor or lawyer.

You can apply yourself online, or a solicitor will typically charge around £1,000 to help you. Those on incomes below £12,000 a year or on some benefits may qualify for a discount.

Last year the average turnaround time for applications was 39 days.

Volunteer opportunity – patient and public voice for the Our Healthier South East London programme

They have places available on several working groups seeking to make improvements in the following areas;

1. Cancer
2. Children and Young People
3. Community Based Care
4. Information Management and Technology
5. Maternity
6. Mental Health
7. Planned care (treatment that are planned in advance, for example hip replacements)
8. Urgent and emergency care (e.g. A&E)

Places are also available in the groups that oversee the strategy.

These groups meet regularly at central London venues and usually during daytime working hours.

They are particularly keen to hear from people who can bring the perspective from south east London’s communities whose voices are seldom heard in healthcare planning, and people who can contribute to their strong commitment to equalities and diversity.

If you are interested in applying or knowing more about any of these roles, please contact Fiona Gaylor by email: [email protected] or by calling: 02075252216 or 07500 835266.

The deadline for returning completed applications, to Fiona, is noon on Friday 9^th of December 2016.

Background information

Role description

Application form

Lords defeat government on plan for exemptions from social care law

Peers voted 245-213 in favour of amendment to delete the proposals, set out in clause 29, from the Children and Social Work Bill.

The so-called ‘exemption’ clause handed the education secretary the power to grant councils exemptions from statutory duties under children’s social care for an initial period of three years, subject to parliamentary approval.

Legal protections

The government said the powers would enable services to cut red tape for social workers and safely trial new ways of working.

But opponents, including Labour and a coalition of more than 30 organisations including the British Association of Social Workers (BASW), claimed the measures threatened legal protections for vulnerable children that had been built up over decades.

The growing backlash against the clause led the government to offer concessions in a bid to win over critics, with an amendment to the bill building in extra safeguards before exemptions were approved and ruling out the powers being used to change rules prohibiting profit-making in child protection.

It wasn’t enough to convince peers, who said ministers had failed to make a convincing case for why the powers were needed.

The government must now decide whether to re-insert the clause when the bill moves to the House of Commons. However, the final bill would have to be agreed by the Lords. By convention peers are expected to agree measures that were in the governing party’s manifesto but the exemption proposals were not.

Fundamentally flawed

Carolyne Willow, director of Article 39, a charity that campaigns for children’s rights that opposed the plans, urged ministers to scrap the plans entirely.

“The fundamental flaw with clause 29 was that it allowed highly vulnerable children to have different legal protections on the arbitrary basis of where they happen to live. Peers have determined this to be unacceptable,” she said.

“We hope the government will now listen and respond to the huge opposition its plans have provoked. The very worst response to this defeat would be for ministers to simply reinsert the clause when the bill enters the Commons.”

Ruth Allen, chief executive of the British Association Social Workers, welcomed the vote result.

Lack of evidence

“I think what runs through is the lack of evidence that this was the right way to make improvement in children’s social care,” she said.

“The DfE couldn’t substantiate their approach in a strong, credible way. It was poorly drafted legislation with lots of holes. The case for it undermining children’s rights and leaving the door open for fragmentation and privatisation of services was strong and wasn’t disproved.

“Our position was always ‘show us the evidence’. Probably the fundamental problem around this is the government didn’t talk to the sector, didn’t consult, didn’t work up something that would enable us to have really beneficial flexibility while protecting children’s rights.”

Martha Spurrier, director of human rights organisation Liberty, said: “Our child protection laws are the result of a century of learning, public debate and parliamentary scrutiny – but, with no research or proper consultation, this government has decided they are dispensable.

“Well done to the Lords for doing the government’s job, listening to the concerns of social workers and campaigners, and standing up for children’s rights.

Latest setback for DfE

“If the prime minister really wants a country that works for everyone, she must now prove it by scrapping this dangerous and undemocratic plan once and for all.”

The defeat marks the latest setback for the government’s children’s social care reform programme just a week after ministers performed a U-turn on proposals to bring social worker regulation into a Department for Education agency.

A Department for Education spokesperson said: “Our bill aims to give every child the best possible start in life, and to suggest it would place them at risk, or open services up to privatisation is simply wrong.

“Local authorities should have the freedom to work with social workers so they can  develop new and effective ways of supporting the vulnerable children in their care and we are committed to giving them that freedom.

“We are disappointed that peers have not accepted these clauses but there was a good debate about the issues and we will carefully consider next steps in the light of the ‎concerns raised.”

Bedroom tax appeal ruling: Supreme Court says Government acted unlawfully towards disabled campaigners

Following the decisions one of the victors called on Prime Minister Theresa May to scrap the ‘bedroom tax’ completely.

Since 2013 people in the social rented sector deemed to have a spare bedroom had housing benefit reduced 14 per cent, while those with two or more spare, had it reduced 25 per cent.

Ministers said it would encourage people to move into smaller properties, freeing up larger ones for families, but many disabled people claimed their needs were not accounted for.

Today’s decision saw Supreme Court justices rule in favour of Jacqueline Carmichael, who lives with her husband in a two-bedroom  flat in Merseyside and Paul and Sue Rutherford, from Pembrokeshire.

In a joint statement Mr and Ms Carmichael said they were “overjoyed”, adding: “We have been through almost four years of the sheer hell of the ‘bedroom tax’ policy, and this decision vindicates our long and difficult fight.

“Out of this human rights victory over the bedroom tax we ask Theresa May to now reconsider the whole policy for everyone.”

Judges also ruled in favour of Mr and Ms Rutherford, from Pembrokeshire, who care for teenage grandson Warren.

But the justices had been asked to decide on other individual cases relating to disabled people or their carers, in which they ruled for the Government.

A spokesman for the Department for Work and pensions said: “It is welcome that the court found in our favour in five out of the seven cases.

“The court also agreed with our view that Discretionary Housing Payments are generally an appropriate and lawful way to provide assistance to those who need extra help.

“In the two specific cases where the Court did not find in our favour, we will take steps to ensure we comply with the judgement in due course.”

The spokesman said the Government will have provided over £1 billion to councils by the end of this parliament for discretionary payments to ensure people in difficult situations had help.

Age Exchange- new Day Care Services and 1-1 for people with dementia and their family carers

With over 30 years’ experience Age Exchange is recognised internationally as the leading practitioners, consultants and sources of information about reminiscence. Age Exchange has been awarded £468,000 by the Big Lottery Fund as part of the Reaching Communities Programme. This award will enable us to provide support for older people with dementia and their carers through innovative Reminiscence Arts Intervention. Age Exchange with the support of partners and funders aims to extend its expertise from residential care into preventative care, working to maintain the health and well-being of people with dementia and their carers living in the community, in the boroughs of Lewisham, Greenwich and Southwark.

They have launched a new project to provide day care services and one to one support for people with dementia and their family carers.

What do they Offer? 

•  Weekly day care services held at two locations: Age Exchange and Conrad Court
•  One-to-one sessions for those who have difficulty leaving their homes
•  Programme of reminiscence arts activity based on successful evidence based Reminiscence Arts (RADIQL) method of working with people with dementia and their carers, designed to maintain the health and well-being of participants
•  Support of Reminiscence Arts Practitioners and volunteers
•  Nutritional lunch in day care centres with respect of your dietary needs

Venue

Age Exchange

11 Blackheath Village

London SE3 9LA

020 8318 9105

www.age-exchange.org.uk