Personal care at home delay makes sense

Firstly, an apology for not updating the blog recently. This has been down to sheer volume of work – several projects all came in at once that required all my attention and didn’t allow me the time to sit and write a blog.

But these projects have been completed and normal service should now be resumed.

However, despite my little hiatus, the main debates in social care do not seemed to have moved on much. For instance, everyone is still speculating what will be in the adult social care funding white paper, nobody thinks that the government has got its sums right on the free personal care at home policy and councils are still causing controversy over cutbacks they are having to make to budgets. Plus ca change.

Taking one of those themes – free personal care – there was probably a collective sigh of relief among councils across England earlier this week when news came out that the House of Lords had voted to delay the measure until an independent review is carried out, which means that it is now unlikely to be implemented before the general election.

Many council chiefs have voiced their concerns over the costing of it (although not all, it has to be noted), with the phase ‘back of a fag packet’ used more than once.

While the bill is not yet dead – the government could still try to push it through – a delay in its implementation at least makes sense.

As Lord Best, a crossbench peer and president of the Local Government Association, said, there are worries that arrangements to help the 400,000 people it is expected to cover might not be up and running in the next few months – especially as there are local and national elections coming, with possible changes of leadership and policies – and that local authority budgets have already been set for 2010-11, so finding the funds is tough.

Pushing this bill through now could end up with services being rushed in, and just think of all the potential problems with that – getting the administration right, putting the care services in place, finding the funds – and that’s just for starters. The potential for it all going wrong is arguably high, which could end up harming service users, carers and social care staff.

If, after the election, it is still thought that free personal care at home is a viable proposition, then ministers should look at a timetable for implementation. Doing it now, with some many other things going on, is simply asking for trouble.

Money money money

Sometimes I wonder as I write these blogs if I am beginning to sound like a stuck record; the issue of funding – or more accurately, the lack of it – seems to crop up at some point in the majority of pieces I post.

But I make no apology for this. Funding is arguably the most important issue within social care at the moment.

While providing outcomes for service users should be the number one priority – and I’m willing to bet that, on the record, any politician or director of services worth their salt will argue that it is – I suspect that how social care is paid for is exercising them more.

For quite some time now, directors of adult and children’s services have accepted the fact that they will have to do more with less money in the coming years.

Now, many are starting to find out how much less they have; for example, Cambridgeshire County Council has announced that the adult social care budget for 2010/11 is being slashed by £10.3 million, as the council looks to save £88 million in total.

They are not alone; many councils across the UK are having to make similar size cuts, with the resulting risk to certain services – often those at the less critical end, such as meals on wheels.

In addition, the government’s free personal care at home plan is causing much concern within town halls. While few argue with the aim of the policy, many feel it simply cannot be paid for, especially as it is generally felt that Labour has significantly underestimated how much it will cost.

Cllr Graham Gibbens, cabinet member for Kent adult social services, as quoted on kentnews.co.uk, said: “In an ideal world, we would wish to give free personal care at home to as many elderly people as possible. However, it is simply not affordable, particularly since we are in the throes of a debt crisis.”

Gibbens’ quote neatly sums up the current reality of social care. In a recession, idealism counts for little; money influences all conversations now, and will do for some time to come, regardless of who wins the upcoming election.

Now, it is up to commissioners, providers and social care staff across the sector to accept this and work within these financial parameters to ensure the money available is used to the greatest effect.

It is a significant challenge, but one that they have no option but to rise to. It may force commissioners to be more innovative in their thinking, and providers to ensure they deliver value for money, but they have no option.

Improving dementia services will take time

When the National Dementia Strategy was launched amid much fanfare last February, the government said that dementia would become a priority and services would be improved. But nearly a year on, the rhetoric hasn’t been backed up by enough action, according to the National Audit Office.

In its interim report on improving dementia services in England the NAO was heavily critical of the implementation of the strategy – or lack of it.

Amyas Morse, head of the NAO, said; “At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s 5-year timeframe.”

However, some feel that the NAO has jumped the gun with its criticism. For instance, Martin Green, chief executive of the English Community Care Association, called the report “somewhat premature”. He believes that while there is a lot more to be done to improve services, “the development of the strategy and the achievements so far represent a significant improvement in raising the profile of dementia services and giving some clear direction for the future of care and support.”

Green does have a point; it needs to be recognised that it takes time – especially in local authorities and the NHS – for change to happen. For instance, one of the main aims of the strategy is to give basic training in dementia to every health professional that comes into contact with someone with the condition. It takes time to set a project like that up and then complete it.

It is a 5-year strategy and shouldn’t be judged too harshly yet. But nevertheless the NAO’s report should serve as a kick up the behind for government, local authorities and the NHS to ensure that they do implement measures to improve dementia services or at least start putting the mechanisms in place to do so.

This agenda is evidently not going to be forgotten about, and organisations such as the NAO won’t be afraid to criticise if they see things aren’t going as well as they should be. This should ensure that the Dementia Strategy isn’t quietly swept under the carpet by the bodies involved – possibly tempting given the swingeing public sector funding cuts coming – and do, in time, deliver the standards of services required.

More work needed to raise social care standards

While the Care Quality Commission has tried its best to get a positive spin on the findings in its review of adult social care services  published today, as ever, most people and the media have focused on the negative aspects of it. And they’re right to.

Despite the overall quality of services improving in the past year in all areas, there is still a significant minority of ‘poor’ and ‘adequate’ services being provided to adults and especially older people.

Poor services are always unacceptable and need to be rooted out or given help to improve. Reports like these highlight them, but it means nothing if it doesn’t help to bring about change.

To this end, the CQC’s chief executive, Dame Cynthia Bower, said the CQC is determined to raise standards, hence why 8 councils have been designated as ‘priority for improvement’ councils and another 16 are to have an in-depth inspection of their services.

Elsewhere, the new registration system for adult social care providers, NHS providers and independent healthcare will have a single set of safety and quality standards. Also, the CQC is to get tougher powers and will be able to respond to concerns more quickly.

But local councils also have a role to play in improving services, especially commissioners; they need to look at the services they are purchasing and, if they are failing, move elsewhere. Obvious perhaps, but still needs to be said because it seems some commissioners don’t do this.

Unfortunately, this may be easier said than done. While eligibility criteria for receiving social care remained largely constant in the past year, after the previous 2 years when the number of councils providing care for ‘moderate’ or ‘low’ needs fell markedly, the spectre of eligibility levels being raised again in the coming years because of dwindling budgets looms large.

With budgets being squeezed, commissioners may feel under pressure to look at the cost of services rather than the quality. By the same token, service providers may also be under financial pressure and be looking to make cutbacks, which could affect the quality of their services.

So, in essence, the CQC’s reports are positive – let’s not forget standards are improving – but they show how much work still needs to be done. But by acknowledging this, and laying out strategies to help, the next report should be more positive still. As long as budget considerations don’t impact too much, that is.