Meals on wheels under threat as more councils drop service due to cuts

Just two years ago, two thirds of councils were offering a daily hot meal to help support older and disabled people in their own homes – an idea first put into practice more than 70 years ago.

The service is not protected by law, however, and is being dropped by growing numbers of authorities forced to focus only on their statutory responsibilities. Advocates for meals on wheels, however, say the trend is a false economy because it runs counter to the aim of keeping people living independently and out of hospital or costly residential care.

Neel Radia, who chairs the National Association of Care Catering (NACC), said: “This is a very worrying trend. Meals on wheels is so much more than just a meal – it’s a vital preventative service, and prevention is better than cure.”

Meals on wheels were first provided during the second world war and are thought to have been started in Welwyn Garden City, Hertfordshire, in 1943 by the Women’s Voluntary Service (now Royal Voluntary Service). The service became a fixture of the post-war welfare state, but was never made a statutory entitlement. Today, councils that do deliver a two-course meal charge a subsidised rate averaging £4.30.

Research commissioned by the NACC for National Meals on Wheels Week this week, shows that only 48% of higher-tier authorities (county councils, unitary authorities, metropolitan authorities or London boroughs) across the UK are still “actively providing” a service, whether directly or through a contractor. In 2014, the proportion was 66%.

The research, by the Association for Public Service Excellence, a network that promotes council services, found provision varied, from 100% in Northern Ireland to 59% in Scotland, 45% in Wales and as little as 17% in the north of England and the south-east outside London.

According to the Malnutrition Task Force, an independent expert group, more than 1 million people aged 65 or over are malnourished or at risk of malnourishment, the vast majority of them living in the community.

Radia said home visits by a meals on wheels service not only helped counter malnutrition, but could include regular wellbeing and safety checks on often isolated householders. “It’s about looking out for people in our communities who have contributed throughout their lives – and doing it in a human and caring way,” he said.

Although councils that have dropped their meals on wheels service say they direct people to providers offering a private service, there is no subsidy. Apetito, a leading provider, charges £6.25 for a meal, including delivery.

Radia claimed that his organisation has in the past found examples of council websites directing people to fast-food outlets, which he says is appalling.

The sharp fall in the number of councils providing meals on wheels has alarmed Age UK. The charity said malnutrition spelled misery for the individual and piled costs on to the NHS.

“Meals on wheels can be a lifeline for many older people, making sure they have a regular meal and providing social contact for those who may be isolated or living alone – a hugely valuable indirect benefit,” said Caroline Abrahams, Age UK director. “Yet in too many areas this vital service has been cut to the bone as local authorities contend with huge cuts to their social care budgets.”

The Local Government Association (LGA), representing councils in England, said the research findings reflected its deep concern at the consequences of steep cuts in government grants and a looming gap of at least £2.6bn in social care funding by the end of the decade.

Izzi Seccombe, who chairs the LGA’s community and wellbeing board, said: “Councils have long warned that the services that elderly and vulnerable people rely on, including meals on wheels, are coming under increasing threat. The government must use the autumn statement to provide councils with the funding to ensure we have a fair care system which goes beyond helping our loved ones to get washed, dressed and fed, but supports them to live dignified and independent lives.”

Councils risk ‘legal action over care cuts’

In a joint plea to ministers, the Nuffield Trust, King’s Fund and Health Foundation said the sector was facing a major funding shortage.

The think tanks said cuts were so deep, councils may no longer be meeting their duties to the elderly and disabled.

The government says it is investing in the care system with £5bn set aside for the NHS to work with the care system.

An additional £1.5bn is being added to that by 2019, while councils have been allowed to increase council tax by 2% a year to invest in care services.

The latest warning about care services comes ahead of Chancellor Philip Hammond’s Autumn Statement later this month on government spending.

Councils are complaining they have not been given enough cash. and last month, the regulator, the Care Quality Commission, said council care cuts were one of the major factors behind the growing demands on A&E units.

‘Warning sign’

The three think tanks, which are making a joint submission to ministers ahead of that announcement, highlighted figures showing how councils had started reducing the amount of support they provided to older people.

• The numbers getting help from their council with care had fallen by 26% to 850,000 in the four years to 2014
• Spending on care by councils had fallen by 25% in real terms in the five years to 2015, to £5.1bn
• Additional money from the NHS and increased contributions from individuals had topped this up to £7.2bn, but that still represented a cut of 9%
• More than 40% of money paid to care homes came from people paying for themselves
• One million people with care needs now receive no formal or informal help – a rise of 10% in a year
• Once younger people with disabilities are included, the funding shortfall was likely to be in the region of £1.9bn next year

Richard Humphries, from the King’s Fund, said it was clear councils were struggling to meet their statutory duties under the Care Act, including promoting well-being and providing high quality care to elderly and disabled people.

He said while he was not aware of any legal action yet, he pointed to rising numbers of complaints about care being made to the the Local Government Ombudsman and a rise in the number being upheld as a sign that could change.

“That shows that councils are struggling. It is a warning sign. We could start seeing people taking legal action,” he added.

Councillor Izzi Seccombe, of the Local Government Association, said: “Unless social care is properly funded, there is a real risk to the quality and safety of care and being able to meet basic needs such as ensuring people are washed and dressed or helped out of bed.

“The government must use the Autumn Statement to provide councils with the funding to ensure we have a fair care system which keeps people out of hospital and living independent, dignified lives at home and in the community.”

Cycling Without Age: Southwark

Time & Talents, with the support of United St Saviours Charity and Cargobike Life CIC, is setting up a new branch of the international Cycling Without Age initiative in Rotherhithe.

Cycling Without Age is a movement started in Denmark in 2012 by Ole Kassow. Ole wanted to help the elderly get back on their bicycles, but he had to find a solution to their limited mobility. The answer was a trishaw and he started offering free bike rides to the local nursing home residents. Volunteers (pilots) sign up for bike rides with the elderly as often or as rarely as they want to. It’s a great way to stay fit and healthy in the outdoors, give something back to your community, get to know new people, and just have fun!

At T&T, we’re now looking for experienced cyclists who would like to volunteer to get involved with the scheme and help to make it a reality! Three trishaws have been delivered, and we aim to start growing a project, with some ‘pilot’ sessions in October, leading up to an exciting and fun Christmas programme to formally launch. Get in touch now and we’ll get you on board!

At present (August 2016) more than 200 chapters around the world offer Cycling Without Age from well over 1,000 trishaws – and the numbers are still growing. More than 6,000 pilots ensure that the elderly get out of their nursing homes, out on the bikes to enjoy the fresh air and the community around them. They give them the right to wind in their hair.

The bikes are speed limited and have a little power assist, so you don’t need to be a fitness freak or an Olympic cyclist!

You can find out more about the Cycling Without Age initiative here:

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Need free support during a power cut?

To give you peace of mind, if you live in London, the East or South East of England, then being on our Priority Services Register will ensure you will receive extra support if you experience a power cut.

Who can receive extra support?

• If you are of pensionable age
• If you rely on medical equipment
• If you have a disability
• If you have children under five in your household
• If you need extra support for a short time period (e.g. you are recovering from medical treatment)
• Any other case that you would like us to consider

See a full list here

What help should I expect to get?

• A priority number that you can call 24 hours a day
• A dedicated team who will contact you to keep you updated during a power cut
• Tailored support if needed such as home visits, hot meals, advice and keeping your friends and relatives updated
• In certain scenarios we may also offer a free hotel overnight and transport to the hotel

Click here to find out more about free support

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You can also call: 0800 169 9970

How do we make care personalisation cost-efficient?

As local authorities grapple with the challenges of the Care Act, it is becoming clear that significant change is required in the way that adult social care is managed and delivered. The UK needs a successful modern care system that addresses both personalisation and value for money.

While the personalisation agenda aims to allow choice and flexibility in care provision and how people manage their money, the feedback from the local authorities I spoke to at this year’s Local Government Strategy Forum is that this agenda cannot be easily fulfilled using the methods in practice today.

Some local authorities had already begun or completed strategic reviews of their social care systems with the aim of finding a better way. Many had found that personalisation created challenges – particularly in care management and financial reconciliation processes, but also in the development of diversity in care provision.

There were also widespread complaints about increasingly siloed care information – for example, between those using direct payments and authority-managed care, and between council and self-funded recipients. These silos mean there is a lack of understanding about what types of care will be needed tomorrow and by whom – and crucially whether money is being well spent. Many concluded that the only answer to these problems is radical change.

Conflicting responsibilities

Local authorities’ main challenge in adult social care is delivering the demands of the Care Act. It is their responsibility to support anyone needing care in their area, to offer alternatives that are more cost effective, to give the customer precisely the amount of financial freedom they want and ultimately to personalise care. Some of these responsibilities can conflict. For instance:

• How do we keep track of what individuals are spending their money on through their personal budgets, and ensuring maximum benefit, while giving them control?
• How can you offer a broader range of (possibly cheaper) care alternatives and suppliers when your supply strategy has previously been founded on the bulk-buying of care from fewer providers?
• How do you accurately anticipate and plan when you have little information on what care-related services people are searching for and buying?
• How do you know what alternative services are required when you have no knowledge of emerging demand?
• With personalisation creating more work for frontline social care teams, how can social workers focus on giving support to those who need it most?

My calculations, based on sector data, produce interesting results. We at Younifi looked at three areas of change that could impact how much councils save on adult social care budgets. Our recommendations include:

• Diversification of the supply base to offer more, lower cost care alternatives.
• Technology integration, bringing disparate initiatives together – such as purchasing and financial control, case management, and information and advice.
• Culture change inside the authority, focusing effort where it really matters while automating resource-intensive processes.

‘Quick-win’ savings

Our estimations are that “quick win” savings of at least £186m per annum are easily possible. Over £71m could be taken off council administration costs through automated financial transaction management. Over £73m could be saved on better use of direct payments, proactively diverting people towards more cost-effective care alternatives and through retention of unspent money. Councils could then use the unspent money to support more people or invest in more preventative services.

Finally, over £40m could be saved on staffing by simplifying administrative processes in the management of care services. These savings could be made on reviews and assessments, supplier contract monitoring and arranging care for people.

The market, cultural and technological changes needed to make this happen would also provide the groundwork for a more cost-efficient and personalised care system in the future.

More than anything else, councils need to rethink their position in the care system. Instead of being care providers, they need to consider their responsibilities to themselves, their suppliers and those using care services. It was encouraging to see how many local authorities are making bold decisions, beginning to focus on enabling care, rather than seeing themselves as being the sole care owner.

Care Act risks becoming ‘unrealistic wish list’ without funding boost

The Care Act could become an “unrealistic wish list” of social care support unless the government provides more funding for the system.

That is one of the warnings from social care and health service leaders set out in a report published today by the Local Government Association on the state of social care.

The LGA said that historic underfunding of adult social care had brought the system to crisis point, with the strain on providers particularly severe. It called on the government to provide more cash for social care through the Autumn statement and said at least £1.3bn of additional funding was needed immediately to stabilise the market, with a further £1.3bn needed by 2019-20.

The association pointed to warning signs from professional bodies and frontline services that current funding levels were not sustainable. These included:

• More than half of local authorities in England saw a home care or residential care provider exit the market in the first half of 2016, according to a survey by the Association of Directors of Adult Social Services.
• Both Newcastle and Surrey councils said significant price increases for providers were becoming necessary in order to meet demand, but these were unsustainable in the face of the extensive savings the local authorities still had to make.
• Camden council has warned it will be unable to continue meeting its statutory obligations under the Care Act without an increase in social care funding. Sefton council said cuts to its adult social care budget had created challenges in meeting its Care Act duties.
• The Royal College of Psychiatrists has voiced fears that the Care Act risks becoming “an unrealistic wish list of exemplary services that no one ever receives” unless the funding situation is improved.

Nick Forbes, senior vice chair of the LGA, said: “The government must use the autumn statement to provide councils with the funding to ensure we have a fair care system where everybody can receive safe, high-quality care and support.” 

‘Lucky, not the norm’ 

Sector leaders also shared their concerns through a series of short essays in the report.

Lynda Tarpey, director of the Think Local, Act Personal safeguarding initiative, said: “We are starting to see evidence that budgets set aside for personalising services are being cut – including the amounts in people’s personal budgets. This is not a trend we want to see.”

Vicky McDermott, chair of the Care and Support Alliance, pointed to the rising numbers of people being “pushed out of the system” – an estimated one million older people in England have an unmet need for care and support. She added that people who do get the care they need were now considered “lucky, rather than the norm”.

Stephen Dorrell, chair of the NHS confederation, said politicians persisted “in believing that the NHS is a special case”, despite the evidence that cuts to social care services increased pressure on the health service, with GP visits, A&E attendance and admissions all on the rise.

He said acute hospitals were increasingly being used as “unbelievably expensive care homes”, which was a “grotesque” waste of resources and failed to ensure people’s needs, whether they be for social care support or high-cost NHS services, were met.

The Mental Health Five Year Forward View Dashboard

It includes a suite of metrics based on the proposals in the Implementation Plan and is structured around the core elements of the mental health programme:

• children and young people’s mental health
• perinatal mental health
• adult mental health: common mental health problems
• adult mental health: community, acute and crisis care
• secure care pathway
• health and justice
• suicide prevention.

In line with the recommendation in the review, the dashboard also includes metrics on employment and settled housing outcomes for people with mental health problems.

A key purpose of the dashboard is for NHS England and the Five Year Forward View Programme Board to be able to monitor progress on its commitments to transform mental health services. Additionally, by making the data publically available, we are ensuring that commissioners can use it as a tool to inform their work and that services users and their families and carers can see how local services are performing and understand where to look to make informed choices about their care.

The starting point for development has been the 25 high-level recommendations for NHS England from the Mental Health Taskforce, with independent advice from the Five Year Forward View Independent Advisory and Oversight Group, chaired by Paul Farmer.

Where possible, data is drawn from published datasets and is available at the national level, with scope for regional breakdown. The content will be developed in waves as defined by data availability and updated in line with developments in the mental health programme.

Due to the lack of robust data in mental health, the first iteration of the dashboard contains several ‘placeholder’ indicators which will be populated as changes to the Mental Health Minimum Dataset and supplementary data collections in priority areas come on line over the course of the coming year. In addition, there are a number of areas where we have identified a requirement to include a measure of performance and progress, but the exact measures to be used for this are yet to be fully defined. These are listed in the dashboard under ‘indicators in development’. This list could be added to over time in response to the work being developed and emerging priorities. The dashboard will be updated quarterly.

Access the Mental Health Five Year Forward View Dashboard.

Southwark Carers Celebrates Living Wage Commitment

The Living Wage commitment will see everyone working at Southwark Carers, regardless of whether they are permanent employees or third-party contractors; receive a minimum hourly wage of £9.40 – significantly higher than the national minimum wage of £6.95 and the new minimum wage premium for over 25s of £7.20 per hour introduced this April.

The Living Wage is an hourly rate set independently and updated annually. The Living Wage is calculated according to the basic cost of living using the ‘Minimum Income Standard’ for the UK. Decisions about what to include in this standard are set by the public; it is a social consensus about what people need to make ends meet.

“Southwark Carers recognise implementing the Living Wage was the right thing to do for us as a business and for our employees.”

Employers choose to pay the Living Wage on a voluntary basis. The Living Wage enjoys cross party support, with public backing from the Prime Minister and the Leader of the Opposition.

Living Wage Foundation Director, Katherine Chapman said: “We are delighted to welcome Southwark Carers to the Living Wage movement as an accredited employer.

“The best employers are voluntarily signing up to pay the Living Wage now. The Living Wage is a robust calculation that reflects the real cost of living, rewarding a hard day’s work with a fair day’s pay.

“We have accredited over 2,600 leading employers, including Southwark Carers, ranging from independent printers, bookshops and breweries, to well-known companies such as Nationwide, Aviva and SSE. These businesses recognise that clinging to the national minimum wage is not good for business. Customers expect better than that.”

Study offers potential breakthrough in care of children with autism

A new form of therapy has for the first time been shown to improve the symptoms and behaviour of autistic children, offering a potential breakthrough in care for millions of families.

Six years after parents were trained to better understand and interact with their preschool children, researchers found that the therapy had moderated the behaviour of those who had been severely autistic, unresponsive or unable to speak.

A child who might have run around a supermarket squealing, heedless of their parent, putting objects in their mouth and pushing past shoppers to try to press the buttons at checkout, might instead wait in the queue and even help load the trolley, the research found.

The success of the preschool autism communication trial (Pact) has surprised even the researchers who designed it. There are no drugs to treat the condition, which typically sets in around the age of two, and many families have tried intensive training of their children by therapists, with mixed results. Pact instead trained the parents to help their children.

Prof Jonathan Green at the University of Manchester, who led the study published in the Lancet medical journal, said they had not found the cure for autism, but he and his team believed it had great potential and hoped it would be widely adopted.

“The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child,” he said. “Our findings are encouraging, as they represent an improvement in the core symptoms of autismpreviously thought very resistant to change.

“This is not a cure, in the sense that the children who demonstrated improvements will still show remaining symptoms to a variable extent, but it does suggest that working with parents to interact with their children in this way can lead to improvements in symptoms over the long term.”

The trial involved 152 children aged two to four. The families visited a clinic twice a week for six months, where parents were videoed with their children and a box of toys. Autistic children might not interact with their parents at all, but when eventually a child did offer a toy or made a noise that could be interpreted as a request, the incident was rerun on video and the parent encouraged to respond. If the child offered a toy, the parent reciprocated. If the child said a word, the parent repeated it and added something. The practice was repeated at home every day.

The therapy continued with the parents for the next six months with less intensity. At the end of the first year, the researchers could see the children had improved, but the most dramatic development was seen at the follow-up six years later. At the start of the trial, 50% of those in the control group who did not get the therapy and 55% of those who did were assessed as severely autistic. The children in the intervention group, though, got better. The proportion assessed as severe in the control group was 63% by the end of six years, compared with 46% in the intervention group.

Other experts applauded the work. “I can see why these researchers are excited,” said Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford. “These results at follow-up are pretty consistent in showing the benefit of this early intervention for autism across a range of measures. My impression is that this is an intervention that reduces the severity of autistic symptoms, rather than curing autism. Nevertheless, for parents of children with autism, even a modest reduction would be worthwhile.”

Dr Max Davie, of the Royal College of Paediatrics and Child Health, said it offered “a hugely cheering message for families”, while Uta Frith, emeritus professor of cognitive development at University College London, called it “a remarkably positive story, because the intervention itself was neither intensive nor invasive”.

The absence of any hope, as well as the very sudden regression in children’s behaviour, led many parents to believe in the discredited theory of Andrew Wakefield that the MMR (measles, mumps and rubella) vaccine was the cause of autism.

“Parents commonly tell us that they fight for a diagnosis but when they finally get it the cupboard is bare, with little information or tailored support available to them,” said Dr James Cusack, director of science at the charity Autistica.“Too often, parents fall victim to the false claims of charlatans who prey on desperate families. These results look promising for the many thousands of parents who want to find early interventions for their children based on solid science.”

The researchers said children’s communication with their parents was improved at the end of the six years. The parents said there were also improvements in relations with other children, in social communication and in repetitive behaviours. But there was no change in child anxiety, challenging behaviours or depression in the autistic children and they would still need a lot of support while growing up.

About 1% of children and young people are affected by autistic spectrum disorder, which ranges from mild to severe. The lifetime costs to the UK, which include health, social care and education costs as well as productivity losses, are estimated at £1m to £1.5m per child and between $1.4m and $2.4m in the United States.

CAMHS bulimia service wins Guy’s & St Thomas’ Charity grant award

The charity has provided a grant of £118,495 to our CAMHS to raise awareness of the symptoms of bulimia. Through the new service, a full time mental health outreach practitioner will build relationships with GPs, schools, community groups, youth clubs and other local services across the boroughs, and provide accessible information to young people and professionals in contact with them via lessons, posters, assemblies and more.

The service will make referrals and self-referrals easier and promote access to existing treatment pathways, with a special focus on young people from ethnic minority groups. It will test new practices which, if successful, could be applied across the country.

By the end of the project, we expect to treat 35-45 young people who have symptoms of bulimia per year. By strengthening prevention and improving access to treatment, the new service also hopes to benefit over 470 local teenagers who may otherwise have developed the condition to chronic levels.

Dr Catherine Stewart, who leads the project, said: “Young people have very clearly told us that we need to be more visible and provide more information for those experiencing symptoms of bulimia nervosa so they can seek treatment earlier. Discussions with teachers from local schools has revealed that staff have great concern about anorexia, which can be a very visible problem, but that they are largely unaware of the difficulties experienced by an equal number of young people with bulimia. This project will ease access for young people with symptoms of bulimia nervosa to existing but currently under-utilised pathways, before the disorder becomes chronic and harder to treat.”