Social care providers worry about maintaining service quality

These are worrying times for service users, carers and families involved in social care; with the uncertainty over service provision, eligibility criteria, benefit cuts and future policy all causing stress. Now, care providers are adding to that by saying that services may get worse.

A survey published last week by accountants PricewaterhouseCoopers (PwC), Fair care crisis? An independent survey of social care providers for the elderly,  found that many care home and domiciliary care providers are worried about the effects of cutbacks on service users, and have warned that some have ‘unrealistic expectations’ of the services they receive and ought to revise their expectations downwards.

Providers said a key challenge is maintaining the quality of services against a background of rising costs and downward pressure on fees. Indeed, 80% worry that quality of care services will suffer due to cost reduction measures.

While it has to be remembered that these are the views of care providers, who are always going to say they need more money – the majority want a fair fees policy for local authority commissioners, for instance – this survey nonetheless highlights some of the current concerns among the sector.

Respondents also fear that smaller providers may go out of business because of cost pressures, which could lead to reduced choice for service users – so much for the increased choice and control promised by the personalisation, it seems.

OK, that’s the scary part over with. The survey also had some positive messages; 97% feel they are equipped to meet current or future challenges and 94% are already taking action to address market challenges.

Of those taking action, 83% are increasing skills and capacity – meaning better-trained staff – but 78% are controlling costs, which can be a double-edged sword, depending on where the cuts come.

This survey provides an interesting snapshot of the mood of social care providers. While there is optimism about meeting the future challenges, it is worrying that some say that service users should not expect so much of them.

While this may be realistic talk from providers – if you know how to do more with less please tell me – it does not augur well for service users; it seems they will face increased eligibility criteria, fewer services, less choice and less care.

The uncertainty in the sector is also not helping. The survey notes that 79% of providers want the government to outline its vision for the future of elderly social care, but they are likely to be disappointed. While there may be some measures outlined in the plans for the NHS today, for the definitive standpoint I imagine we will have to wait until the independent commission on the future of adult social care reports back sometime in the next year.

Only when policy is confirmed, along with budgets – we’ll find out what local authorities have to spend in October when the comprehensive spending review is announced – will providers be able to plan with certainty, and therefore give service users a better picture of what services will be provided – or not, as the case may be.

While PwC’s report closes on an optimistic note from a business point of view – many expect to cope with the future challenges and see opportunities in an expanding marketplace – I can’t help feeling that the outlook for service users, their families and carers is much more pessimistic.

End of star ratings brings confusion

Amid the hubbub about the announcement of the coalition government’s plans – or lack of them – for social care last month, the Care Quality Commission’s announcement that it was scrapping its star ratings system for registered care services almost slipped under the radar – but it is an important decision and deserves more publicity than it has received so far.

But while the CQC is abandoning star ratings – 3 stars for an excellent service down to no stars for a poor one – it hasn’t got anything to replace it yet, and this has drawn criticism from some in the sector.

However, the passing of star ratings will not be much mourned. The system has been generally unpopular among care home operators ever since it was introduced 2 years ago by the then CSCI. Around the time it was introduced I was writing a lot about care homes, and to raise the subject of inspections – and the star rating the home received – to the manager often resulted in the sort of look that I’d get if I’d just sworn at them. Many objected to their rating and some were even prepared to go to court over it.

At the time, Frank Ursell, CEO of the Registered Nursing Home Association, voiced one of the major concerns – that a care home can receive a zero stars rating for being rated ‘poor’ in one of the three key areas involving safety and management, even if other areas are rated ‘excellent’.

The use of 3 stars, rather than the more common 5, was also queried as it was thought that it may confuse people trying to find care homes.

Getting rid of star ratings without having a replacement lined up has not gone down well either. Martin Green, chief executive of the English Community Care Association (ECCA) was unusually forthright on it:

“The CQC has told providers that it is interested in quality and yet… we have seen it bring forward the abolition of the star ratings system without a clearly defined timescale for its replacement,” he said. “The manner of this announcement, the lack of consultation, and the fact that CQC is not even adhering to its own published timescale gives us grave concern about its commitment to quality and its understanding and engagement with the social care sector.

“The CQC has been in existence for 13 months and it is becoming increasingly clear that it has little understanding of the social care sector, is administratively and bureaucratically shambolic, and lacks leadership and direction.”   

Harsh stuff, but if the head of the ECCA is saying it, imagine what those on the ground are.

The CQC says it is in talks with stakeholders to “discuss how a new system may work”. This can be seen as the regulator working with the sector to find a solution that suits everyone, or that it hasn’t got a clue what to replace star ratings with, depending on your view of the CQC.

But quite what they will come up with remains to be seen. In theory, star ratings should have been great to give an at-a-glance view of the quality of a home/service, but with the previously mentioned wrinkles in the system, this was not always the case.

Whatever does come from this consultation, the hope is that any new system is easy to understand, fair and remains in place for some time, rather than chopping and changing every couple of years.

This decision is crucial for the CQC, not only in terms of helping service users, carers etc navigate the system and find the right care, but for the body’s own credibility, which is seemingly on the line as well.

Paying for care still biggest concern for older people

How to pay for residential care is still the biggest worry for older people, their families and carers, according to a new report.

Older people’s charity Counsel & Care’s Care Concerns 2009 reported that 25% of calls to its advice line are about this.

Nothing new in this – it’s been a worry for years – but it shows that the issue will not go away and that reform is needed.

Indeed, the main concerns of older people are pretty much as they have been for years. Here are the top 5, according to Counsel & Care:

• Concerns about whether older relatives or friends starting to lose mental capacity are receiving the most appropriate and high quality care available in the setting of their choice
• Lack of available and meaningful information and advice for older people, their families and carers, particularly those who pay their care costs themselves
• Difficulty accessing the care and support system
• Difficulty navigating the complaints process if you experience poor quality care
• The ever-increasing costs of care and support.

Nevertheless, there are hopes that the government’s white paper on adult social care funding – promised to come out before the election – will address this.

While last summer’s green paper on the future of adult social care funding had some useful suggestions on providing better information for self funders, as well as making the care system easier to access and navigate, it still failed to address one of the most vexed points; people selling their houses to pay for care.

In addition, the government’s free personal care at home bill would go some way to addressing the concerns of older people paying for care, but it only helps those above the threshold for social care funding with high needs and who still live in their own home.

The green paper outlined several options to pay for care costs, from insurance to a mix of state and self funding, but none covered paying for the accommodation costs of residential care, which can still mount up if someone is in care for several years. In that situation, selling their house is still an option.

If nothing else, Counsel and Care’s report is a useful reminder of the main concerns of older people in the care industry and if the government does address these issues, it could leave a long-lasting positive legacy.

Keywords, however, are ‘if’ and ‘could’; if the white paper comes out before the election and if it makes it through parliament. Could, in that nobody knows yet what conclusions the government has come to.

A nation of silver gamers

Think games consoles like the Nintendo Wii are just for kids? Think again. According to a survey by online discount voucher provider MyVoucherCodes.co.uk, 18% of over 60s now regularly play games, with one in three of these identifying the Nintendo DS as their favourite console.

While these figures may surprise some, it highlights a shift in gaming culture over the past few years – it is no longer the preserve of children. For instance, in the media the ‘care home residents playing on Wii’ story has been done to death in the past couple of years.

Games makers have also twigged this; I noticed over Christmas a crossword game on the DS being heavily advertised on television. Not wishing to disparage the intellect of today’s youth, but I’m willing to bet this game wasn’t aimed at them.

But this is not just pensioners finding a new way of filling their days, there is a serious side to gaming; for older people it can help to stimulate them mentally and physically, as well as helping them to connect with the younger generation.

Older people are encouraged to keep mentally stimulated – the ‘use it or lose it’ principle – and physical activity is good at any age.

The popularity of games like Brain Training, as well as things like Sudoku, demonstrate that on the mental side, while things like Wii Sports have got older people the nation over playing sports they never thought they would again.

Most of all, its fun and, especially with consoles like the Wii, it’s social as well. For older people in care homes or attending day centres, this gets everyone involved and active, rather than sat in a chair watching TV.

Continuing care still a grey area

New Year; same old social care news stories. This one from the Daily Mail  tells the story of Phyllis Knight, a lady so badly affected by Alzheimer’s disease that she spent 4 days living with the dead body of her husband before neighbours discovered what had happened, yet has been turned down for NHS Continuing Care funding, which would ensure she gets her care home fees paid for.

Her local PCT decided that Phyllis’ needs are social care related, rather than health care, which means that the local authority assess her eligibility for services. And because Phyllis has assets of more than £23,500, she doesn’t get any state help.

It is a story that has been told many times before and sadly, dementia represents a big grey area in health and social care; the crux is whether people with dementia primarily have social care needs – such as help dressing, washing or cooking – or health care needs, like nursing care.

And it can be tricky to decide this, as people from the NHS have admitted to me. With a physical disability, it can be easier to tell what needs someone has on a day-to-day basis because their condition is (relatively) stable, but someone with dementia often has needs that can vary markedly, depending on what sort of day they are having.

Indeed, in the earlier stages of dementia, it may be social care that the person needs, and only as the condition advances, they need nursing care.

Making a decision to award continuing care or not is also difficult because it is down to a human judgement. No matter how clearly the guidelines are framed, no 2 judgements can be the same.

This issue may get addressed when (if?) the government reforms adult care funding – a White Paper is awaited with baited breath after the consultation closed late last year – with some talk of some health and social care monies being merged together. But this is only conjecture. 

But what won’t happen is the government paying for the care of all people with dementia. With about 700,000 estimated to have some form of dementia in the UK, that bill would be too much for the NHS to take.

So, for the time being, again, the newspapers will have an easy story to file every few months when the next disgruntled family decide to go to the media to complain.

Dementia care still falling short

Dementia makes the headlines again today, with news that half of all patients with dementia leave hospital in a worse state than they arrive in.

The Alzheimer’s Society says patients with dementia stay longer in hospital than those without the condition and a third have to move into a care home afterwards because they can no longer care for themselves, such has been their deterioration.

It is easy to see why people with dementia decline in hospitals – they can be noisy, disorientating and distressing places and someone with dementia is less able to cope with this than someone without.

And with 80% of nurses admitting in the Alzheimer’s Society’s survey to receiving no or not enough training in dementia, it is easy for the quality of care to vary and, in some cases, patients to not receive appropriate care for their condition – help eating and drinking, for example.

But there are already measures in place to address this; the Dementia Strategy, published in February, had an objective to ensure all health and social care staff who may be involved in caring for people with dementia have training in caring for people with the condition. This would be through basic training and continuous professional and vocational development.

This research highlights how urgently this training needs to be rolled out. With the numbers of people with dementia growing as the population ages, it shouldn’t be delayed.

But (as ever in social and health care, there is a but) it will come down to finances. Training is usually one of the first things to be shelved when cuts need to be made and with budgets already being tightened – and bigger cuts to come in 2010 and 2011 – this could well get quietly put to one side.

If it does, then little will change for people with dementia, and they will continue to cost the NHS millions by staying in hospital for longer and continue to deteriorate more rapidly than they could do. The training needs to happen.