Tag Archives: Paul Burstow

End of the chemical cosh long overdue

Finally. Here is a government announcement that is years overdue: the use of anti-psychotic drugs for people with dementia must be cut by two-thirds by November 2011.

After many years of campaigning by carers, patient groups and some in the medical profession, the government has finally taken action – something the previous administration should have done years ago.

Prescribing anti-psychotic drugs to people with dementia who have behavioural problems – also known as the ‘chemical cosh’ – has long been a scandal with health and social care. Newspapers have regularly carried stories on loved parents who have been turned into “zombies” by these drugs, usually administered against the family’s wishes.

What is more surprising to me is that evidence of the harmful effects that these drugs can have on people with dementia – including shortening their lifespan – has been available for some years, yet the practice continued unabated. The simple fact that they are not licensed for long-term use by people with dementia should give a clue here – if they had benefits for the majority of people, then surely there would be recommendations to prescribe them. Seems blindingly obvious, you would think.

While anti-psychotics do benefit a minority of dementia patients – hence why there is not a complete ban – they are often prescribed for their sedative effects on people with dementia with challenging behaviour.

This is where the biggest change needs to come; in the culture of dementia care. There is still an over-reliance on drugs – from GPs and care staff – and this has to be challenged, and this directive will give much-needed focus to it.

But it is no good just cutting out anti-psychotic drug use. What also needs to happen is an increase in training for carers, care home staff etc in dementia and its effects, and in non-drug related treatments and therapies, such as reminiscence therapy, that can help people with dementia.

I know of several dementia care homes that pride themselves on being ‘drug-free’ (within reason) and there is no reason why this shouldn’t be an industry standard. As usual, best practice is out there and it needs to be disseminated better. Good practice needs to be shouted from the rooftops and demonstrated at seminars, conferences and in magazine articles and journals.

Finally, a bit of credit where credit is due: Paul Burstow has made good on the commitment he made while in opposition to tackle the anti-psychotics issue.

Indeed, while the government has come in for heavy criticism for its social care policies and proposals in recent weeks, this is one policy they should be congratulated on. Now it is up to GPs, care home staff and carers to make good on this.

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Care funding commission must consider all adults

Here we go again. Today sees the launch of the latest Commission on the Funding of Care and Support (catchy title) for adults.

We’ve been here before, most recently with last year’s Big Care Debate. That got as far as a White Paper before the election, but as soon as the government changed the proposals were swiftly dropped. So we’re back to square one. Again.

Nevertheless, the new commission has been detailed to report back within a year. Health secretary Andrew Lansley expects legislation in front of Parliament next year, and it will eventually form part of a larger White Paper that also takes in the Law Commission’s work on creating a single modern statute for social care, and the Government’s vision for social care.

The commission will focus on:

  • The best way to meet care and support costs as a partnership between individuals and the state
  • How an individual’s assets are protected against the cost of care
  • How public funding for the care and support system can be best used to meet needs
  • How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.

The politicians have, as usual, made all the right noises about this; for instance, Lansley said; “we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term.”

All regulation political guff and nothing that anybody disagrees with; it’s just that successive ministers have said this for some years, so its hard not to feel cynical.

But reading between the lines, service users should not get their hopes up that reform will improve things too much. As care services minister Paul Burstow said: “Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Trade offs? Is that a euphemism? To me, that is a subtle way of saying that to get to a solution, some existing ways of being funded may have to be axed/cut back. However, this is just speculation on my part – I may be reading too much into it.

But the commission does take place against the backdrop of swingeing budget cuts and this will form a major spoke in their thinking, hence why a leading economist, Andrew Dilnot, has been chosen to chair it.

He will be assisted by the CQC’s Dame Jo Williams and Lord Norman Warner, a Labour peer and former director of Kent social services – and also an outspoken critic of Gordon Brown’s free personal care at home policy earlier in the year – who will help to ensure that the commission does not just focus on the numbers.

As with the last commission, a range of funding options will be assessed, including a voluntary insurance scheme, as favoured by the Conservatives, and a partnership of state and individual contributions, the Liberal Democrats’ preferred option. No mentions of a compulsory levy – aka Labour’s “Death Tax” – being considered in the press release however, so we can assume that that won’t be an option.

But if this is to be successful the commission has to look at funding care for all adults. One of the criticisms of Labour’s last attempt was that it focused too much on older people – especially the voter-winning solution to people having to sell their houses to pay for care – with people with disabilities sidelined.

While older people do make up a significant proportion of those receiving care services, those with disabilities are just as important and any solution has to appreciate their needs and circumstances as well.

The solution also must been seen to improve – or at the very least not cut – services, if it is to get widespread acceptance from the public. Again, this will require doing more with less – a neat trick if you can pull it off.

But what the commission must do above all is to come up with a conclusion. The Big Care Debate had 3 options, but no one option was significantly ahead of the others. This commission should look at all the options and consult widely with frontline workers and service users before making a decision – and then sticking to it.

Coming up with a solution to funding adult social care is not going to be easy – otherwise it would have been done years ago – but this time it needs to happen. However, while some tough choices will have to be made – the financial situation is inescapable – the option of doing nothing is even worse for service users.

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The future for social care programmes?

Last Friday I blogged on the government’s axing of the Caring with Confidence programme, and how on an initial reading it seemed to make little sense. But comments since then from care services minister Paul Burstow have explained more about the decision – and given a hint as to future policy direction.

Burstow, as reported in Community Care has justified the move to end Caring with Confidence by saying: “We were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly.”

Whether that is accurate or not is a moot point. But this statement may tell us more about future policy direction when it comes to social care programmes: if they can demonstrate they are providing value for money, they will be safe, if not – watch out for the axe.

Now, once upon a time I was a business journalist, and I used to regularly interview entrepreneurs who would explain that a project or an arm of a business had been closed because it wasn’t providing value for money. Their priority was the bottom line and if it wasn’t contributing to it, and showed little sign of doing so in the future, then it would be axed, more often than not.

That’s fair enough in business – they exist to make profits – but in social care, it is a whole different ball game.

In social care, investment in a project may not provide demonstrable fiscal returns; it is often a lot more subtle than that. For instance, how do you quantify the value for money for someone taking part in a mental health project? It may aid their recovery and wellbeing but does it provide value for money? How do you judge? Is it whether they are able to get a job at the end of it and therefore can come off benefits and start paying tax?

It’s not an easy call to make; social care projects often provide intangible benefits to those that use them, and in these cases it is generally more important than any financial returns.

In fairness to Burstow, he has added (again according to Community Care) that the money from Caring with Confidence will be reinvested in other carers’ projects, including a training programme to raise GPs’ awareness of their role in supporting carers. He has also said that Caring with Confidence materials will be available free to carers’ centres that want to carry on the work.

Nevertheless, Caring with Confidence will not be the last project to bite the dust in the coming months. The government is making difficult decisions and with the cuts coming – said to be 25% of local authority budgets – it is inevitable that some social care programmes will be axed.

There are projects out there that are not doing what they were set up to do well enough and need to be weeded out, but there are many more that do and should be protected. Government and council leaders will need to examine each one very carefully and assess the benefits it gives to service users before deciding which should be cut and not just make a decision based on financial data.

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Carers caring more but do the government?

An interesting juxtaposition of carers news over the past couple of days; firstly, the percentage of carers providing 50 hours or more care a week has more than doubled in the past 9 years; meanwhile, the government has axed the Caring with Confidence programme, a support package for carers worth £4.4 million a year.

New statistics from the NHS Information Centre reveal that 5 million adults in England – nearly 1 in 8 – act as a carer for a sick, elderly or disabled person, with more than a fifth providing care for more than 50 hours a week.

Today, 22% provide care for 50 hours or more, compared to 10% in 2000-01. Also, nearly half of carers (48%) provide 20 hours or more of care a week and 30% provide 35 hours or more.

These figures are based on 2 surveys of more than 37,000 carers; the Survey of Carers in households – 2009/10 England – Provisional Results, and Personal Social Services Survey of Adult Carers in England, 2009/10, so it’s fairly in-depth.

So with this in mind, it seems odd that the government has chosen to close the contract for the Caring with Confidence programme – a scheme designed to improve support for carers – in September, rather than March 2011, as was originally planned.

Care services minister Paul Burstow’s justification for cutting Caring for Confidence is that the money used in the scheme could be “spent smarter” elsewhere. He didn’t elaborate on how, other than to say that he plans to offer more support to carers’ organisations and for carers’ training.

However, given that supporting carers and giving them training is – was – Caring with Confidence’s raison d’etre, the decision makes even less sense, especially as it was coming to the end of its government funding early next year and, anecdotally, was making a positive difference to carers’ lives.

It seems like the government is trying to make quick savings to cut the financial deficit with this decision, and it flies in the face of its manifesto commitment to support carers.

Hopefully Burstow makes good on his words and this is not a sign of things to come for carers, otherwise the Personal Social Services Survey of Adult Carers survey’s statistic that 17% found their quality of life was either “bad, very bad or so bad it could not be worse”, could increase in years to come.

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Back to the future for social care

I had a peculiar sense of déjà vu reading new care services minister Paul Burstow’s interview in the Daily Telegraph the other day. While spoke about his hopes – and the need – for reform of adult social care, I had the funniest sense I’d heard it somewhere before.

Maybe because I have; about the time the green paper on adult social care was first mooted by the old Labour government a few years back. And a various points since then, up to and including the run-up to last month’s election (Doesn’t it seem a long time ago now?).

In the Telegraph interview, Burstow – who has a decent reputation within the sector – spoke of the need to find “a sustainable funding settlement for social care” and to reform a system that will soon become “not fit for purpose”.

Nothing new there. Many commentators – as well as service users and workers in the sector – have been saying this for years, to no avail.

There is also nothing new in his outline for the funding options that will be discussed by the upcoming independent commission; a voluntary scheme, a partnership scheme where state and individuals contribute, and a compulsory levy after death – yep, Labour’s much-derided ‘Death Tax’.

This is something of a turnaround for the government, which only referred to the partnership and voluntary models in its coalition document, released just a couple of weeks ago.

But what is new is a little detail on the timescale for reform. Those of us who thought that the coalition’s plans kicked the issue into the long grass now know how far; Burstow wants the soon-to-be-formed independent commission report back on funding options within a year, with a White Paper ready by autumn 2011.

He admits this is ambitious, but necessary as the Baby Boomers hit old age.

Nevertheless, it is good to see a timescale being laid out, even if it isn’t the one most people involved in the sector would have liked – in an ideal world reform would already have been carried out.

Also, carrying on with the positives, Burstow does seem to have a good handle on what needs to be done – saying it would be wrong to fixate on the problem of older people having to sell their homes to pay for residential care, something that the last consultation seemed to, almost with an eye on the upcoming election – and is willing to consider a range of options.

But what the independent commission comes up with remains to be seen – as does how different it will be to what came out of last year’s Big Care Debate – although the rumoured presence of economists on it suggests that it may be geared towards saving money.

Again, it feels like we’ve been here before. So while this could easily be a false dawn – and there have been enough of those over the years – at the moment, it is probably best to give the benefit of the doubt to the government, while all the time reminding them of what is needed and why, and to call them to account if they let the sector down.

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Social care needs to be a priority for new government

Since the Conservative and Liberal Democrat coalition took power earlier in the week and started outlining its policies, one issue seems to have been conspicuous by its absence: social care.

As I have previously blogged, in the general election campaign social care seemed to disappear off the political radar, despite it being touted as a key issue in the run-up to it being called. Now post-election, it continues to be ignored in children’s and adults services; nowhere in the policy outline was social care mentioned.

Indeed, Michael Gove, the new head of the (swiftly renamed) Department for Education, has said in a letter to civil servants that education is the priority for the department, thus seemingly sidelining children’s services, although he added that this area will be strengthened and reformed, but didn’t elaborate on how.

Also, Andrew Lansley, the new health secretary, has spoken extensively of the plans for the NHS, while adult social care has garnered barely a mention.

This lack of attention is worrying; ask anyone within adult social care and they will say that reform – especially of the way it is funded – is urgently needed. Children’s services also need to be strengthened and supported. They can’t be left to drift as they have done for the past few years.

Leading social care organisations are also worried. Counsel & Care, a charity working with older people, their families and carers, have called for reform of social care to be made a priority by the new government.

Meanwhile, Carers UK’s director of policy and public affairs, Emily Holzhausen said; “We are deeply disappointed that the programme for Government published in the coalition agreement this week does not establish social care as a political priority.

“Clear plans must be brought forward as a matter of urgency, setting out a sustainable funding model for fair, universal, and transparent care services.”

However, despite the worries, I’m trying not to be too negative. It is still very early days for the government and we shouldn’t be too quick to judge – social care is a complicated issue and it may take more time to put together a policy.

Also, Paul Burstow, a Lib Dem MP with a history of championing issues such as social care funding, dementia and adult protection, has been appointed as a minister for state – the rung below cabinet – in the Department of Health. Having someone with in-depth knowledge of and a passion for the issues involved could ensure that they get the attention they need.

But until the government makes any policy announcements, as with everyone else blogging on this in the sector, everything is speculation and educated guesswork.

A final thought; in among all the speculation, there is one decision on social care that will have to be made soon – whether to pass Labour’s Personal Care at Home Bill. The Tories are against it, as are the Lib Dems, who would prefer to use the money for this to give carers extra short breaks, so I think we know what the result will be there.

Do you agree? Please let me know your thoughts below.

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