Our social care system has reached a critical stage, marked by the government's commitment to overhaul the care system, rethink the funding model and listen to the needs of service users and the public sector. We have a once-in-a-generation opportunity to fix the fundamental flaws: lack of clarity and unfairness. That is why today Demos launches the Social Care Constitution, which seeks to define a fair settlement between social care users and society.
What are the challenges facing social care? Firstly, the care system needs to address the demographic changes afflicting it; an ageing population and growing complexity of needs. In the coming decades, the number of people aged 85 and over in England is expected to increase by two-thirds, and the number of people aged 50 and over with learning disabilities is projected to rise by 53% between 2001 and 2021. As the number of individuals needing support increases, those who find themselves in caring roles, usually the family, will also be in higher demand. These informal carers have needs too; their economic health, physical and mental wellbeing and independence is rarely even acknowledged. The future system must guarantee their wellbeing.
Secondly, the existing structure is deeply unfair. The current needs-testing model pigeonholes users into one of four bands: low, moderate, substantial and critical, with three-quarters of local authorities providing services only to those placed in the latter two categories. This leaves thousands of people with serious needs on the outskirts of public assistance. Meanwhile, means-testing too often leaves people on the bring of poverty.
The Commission for Social Care Inspection's report last week criticised this "one-size-fits-all" approach where obsession with categorisation fails to cater for social care users as individuals with complex and widely varying needs. A Constitution for Social Care rewrites the values of social care, setting out both the rights and responsibilities of the cared-for and their carers.
The constitution has already been warmly received; 95% of service users we spoke to agreed that a set of underlying principles explaining the system in its entirety would be very beneficial to their lives. The National Health Service has recognised the need for a charter of rights for healthcare users: as social care becomes an increasingly pressing concern for government, its users and providers must also enjoy and understand their rights and entitlements.
The government is ready to listen and engage with various actors on how best to transform the social care system. If a transformation fuels a uniform, basic level of care, clarifies the complexities faced by users and outlines their rights and responsibilities it will be a success now and for the future.
• A Constitution for Social Care is launched today in Westminster with the care services minister, Phil Hope, and shadow health ministers, Greg Mulholland and Stephen O'Brien. Silvia Guglielmi is a researcher at Demos
http://www.guardian.co.uk/society/joepublic/2009/feb/03/social-care-cons...
PDF version The government is to examine whether reforms are needed to the system of funding long-term care of elderly and disabled people in England.
Proposals for a Green Paper to look at the issue were contained in the Comprehensive Spending Review.
Many critics say the current system of means-testing is too complex, and often unfair on the most vulnerable people.
At present only people with assets up to £12,000 have their care paid for by the state.
Many elderly people currently have to sell their homes to pay for their care.
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 The move represents a bold first step at addressing one of the greatest social challenges facing the government  Niall Dickson
King's Fund |
The Royal Commission on Long-Term Care, which reported in 1999, called for all personal social care to be made free to the patient - but little political action followed.
The Department of Health said the review "reflects the fact that society is changing and demands a new system".
In a statement, it added: "The new system will have dignity and control at its heart for those who use services and their families."
However, officials were quick to deny reports that ministers were already planning to scrap means-testing, and replace it with a system of universal entitlements coupled with top-up payments.
Niall Dickson, King's Fund chief executive of the independent think-tank the King's Fund, said the means-testing system was much despised, and had caused distress and misery to older people and their families.
He said: "The move represents a bold first step at addressing one of the greatest social challenges facing the government.
"The government must now seize this opportunity to achieve a political consensus on how we fund long term care and deliver a fairer system for future generations."
More funds needed
The announcement follows publication of a report by former bank chief Sir Derek Wanless into the future of social care funding.
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We urgently need greater investment and a new settlement for social care Neil Hunt
Alzheimer's Society |
Sir Derek called for sharp increases in funding to meet the demand for high quality care over the next two decades, and for the means-tested funding system to be scrapped.
The report found that if the system remains as it is, its costs will rise from £10.1bn in 2002 to £24bn by 2026 as a result of demographic changes alone.
Sir Derek recommended everyone in need of social care should be entitled to state funding for 66% of their care package, after which individuals' contributions will be matched by the state up to a defined limit.
Many charities have also warned that the current system is ripe for reform.
Mr Dickson added that the level of funds given to social care over the next three years was disappointing.
The social care budget, which helps councils pay for services such as home helps which help people stay in their own homes, will rise by just £190m to £1.5bn in 2010.
Mr Dickson warned that the social care system was already struggling, with local authorities raising their eligibility criteria and only focusing on those people with the most severe needs.
He said: "Our failure to support frail and vulnerable older people has been one of the unrecognised scandals of our time.
"There are more very old people than ever and yet fewer are receiving the social care support they need."
Neil Hunt, chief executive of the Alzheimer's Society, welcomed the announcement of a Green Paper.
But he said: "The current social care system is crumbling; we urgently need greater investment and a new settlement for social care."
Sir Simon Milton, chairman of the Local Government Association, said councils had been short-changed by the spending review, which he said had provided the worst settlement for local government in a decade.
He said: "There remains a black hole in funding for the care of the elderly."
http://news.bbc
.co.uk/1/hi/health/7037059.stm
People approaching retirement can expect the cost of residential care in their old age to double in the next 20 years in Britain, research suggests.
Saga, a firm which specializes in services for the over-50s, estimates a four-year stay in a care home will soar from £112,312 to £223,476 by 2028.
Care home fees are continuing to rise well above inflation.
With life expectancy rising, Saga warns many more people need to think about how they would fund their care.
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Preparing for the future cost of care is an issue few people want to consider Andrew Goodsell
Saga |
Men in non-manual jobs can now expect to live to nearly 80 on average, and women until 83.
Andrew Goodsell, chief executive of Saga, said: "Those faced with funding care now will already know the extent of that financial burden, however preparing for the future cost of care is an issue few people want to consider.
"With the cost of funding care expected to consistently increase above inflation, it's critical that those already paying for care, or those planning for the future ensure they take advice from a fully qualified adviser."
Helping out
Saga based its calculations on care home fees continuing to rise by 3.5% above inflation.
Anyone in England who has assets over £21,500 is liable to pay for their own care, and many elderly people faced with the costs of long term care have been forced to sell their homes to fund it.
In Wales, full self-funding kicks in at £22,000, and Scotland at £20,750.
However, many are still entitled to some state benefits, and Saga said it was concerned that people were not consulting properly qualified financial advisors to find out how they could be helped.
The government is due to publish a Green Paper later this year, examining the future of care and the contributions of the individual against those of the state.
Annie Stevenson, Help the Aged's Senior Policy Advisor for Health and Social Care, said: "This comes as no surprise - Help the Aged have been warning about the consequences of inadequate planning and funding for social care for a long time.
"Introducing a fair and sustainable funding settlement for adult social care is crucial to transforming our ailing care system into one that is personalised, easy to understand and accessible .
"The promised Green Paper, expected later this year, presents a once-in-a-generation opportunity for brave and radical reform of the system."
http://news.bbc.co.uk/1/hi/health/7252323.stm
Ambitious proposals to set up a national care service, on an equal footing with the National Health Service and dedicated to providing care for our ageing population, will be unveiled in the government's green paper on care and support later today.
The aim is to address the postcode lottery that sees elderly people receiving different services in neighbouring authorities, or paying a wide range of fees for care homes depending on where they live.
The new national care service – described by a charity head who advised on the proposals as a "new frontier in the welfare state" – will try to streamline access to care, providing one port of call for people trying to find a care home for themselves or a relative.
On the issue of how to pay for care, the paper will set out four or five options, ranging from levying a care duty on people's estates after their death to the state footing the bill. Part of the green paper's aim is to stir up a debate on how the soaring costs of care for the elderly and for disabled adults are going to be funded.
The green paper is driven by an urgent need to address the changing needs of an ageing population, now that there are more pensioners than schoolchildren. The government expects that one in three people over the age of 65 will need long-term care at some point, and this figure is expected to expand. The number of people over 85 in the UK is going to double in the next 25 years and treble in the next 35. In 20 years' time, the Department of Health anticipates that 1.7 million more people will need care, and predicts a £6bn funding gap in the cost of care.
Currently, those who need care and have assets worth more than £23,000 may have to pay for it themselves, depending on the severity of their medical condition. But the means-tested system is widely seen as a punishment to those who have saved for their retirement; an estimated 45,000 elderly people are forced to sell their homes every year to fund their residential care costs.
Research by Age Concern and Help the Aged shows that the system is poorly understood, with many assuming that care is an entitlement, and responding with "surprise and hostility when they realise that this is not the case".
The government announcedon Monday that it would bring forward its review of the official retirement age. Currently, employers can force staff to retire at 65 but 1.3 million people choose to work beyond that. The review, due to be held in 2011, will now take place next year.
http://www.guardian.co.uk/society/2009/jul/13/older-people-longterm-care
People in England may be forced to pay as much as £20,000 on retirement to help fund the social care system under plans being put forward by ministers.
It is one of three options being proposed by the government alongside top-ups and insurance.
In return, the government said a certain amount of social care would be provided free to everyone, while accommodation costs could be deferred.
The current means-tested system is considered unfair and unsustainable.
Social care covers everything from home help with washing and dressing through to full-time residential care.
At the moment, anyone with a home or savings of £23,500 or more is not given any state funding for their care.
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SOCIAL CARE PROPOSALS
Partnership - The state guarantees certain level of care - maybe up to a third - leaving the individual to pick up tab for the rest. For some this could run into tens of thousands of pounds
Insurance - The same as partnership, except that the government would help set up insurance schemes for people to pay into to cover extra cost
Comprehensive - Payments of up to £20,000 to be paid after retirement, in return all social care, except accommodation costs, would be paid for by state
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About three quarters of people in the system fall into this category.
This means that thousands of pensioners each year have to sell their homes or use their savings to fund their long-term care.
Experts predict the situation is only going to get worse in time with the ageing population.
Health Secretary Andy Burnham said the government was trying to be bold in a bid to encourage a debate.
"For too long politicians have avoided this issue.
"We have an opportunity to grasp the nettle and confront the debate.
"If we fail to do that we face the prospect of a diminishing quality of care being provided."
Consultation
Ministers have put forward three options which will be considered during a four-month consultation.
Under the partnership model, between a quarter and a third of costs will be covered by the state, while the individual will be left to top-up the rest of their care.
The insurance option builds on this by again promising a certain level of basic care free, with the government helping to establish insurance systems for people to pay into to cover for the extra costs.
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The paper signals a welcome willingness to confront some of the hard questions about how to fix our broken care system Michelle Mitchell, of Age Concern and Help the Aged
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This would be free to opt in and opt out of.
The third - and in many ways most controversial - proposal is a comprehensive system whereby people are forced to pay up to £20,000 on retirement to fund their social care package.
This could be paid in a lump sum, through instalments or taken from an individual's pension, ministers said.
Under all three plans, the poorest will have their full care package paid for by the state.
The government argues many people will be better off under these models as the average cost of social care for a 65-year-old is £30,000 over the rest of their lifetime.
And to end the "injustice" of people losing their homes when they go into care, ministers proposed allowing people to defer the costs of residential care until their death when the bill would be taken from their estate.
Ministers said it was now up to the public and social care sector to give their feedback on the plans.
Michelle Mitchell, director of the newly-merged Age Concern and Help the Aged charity, said she had concerns about the compulsory payment option and the fact people would still have to pay for accommodation costs.
But she added: "The paper signals a welcome willingness to confront some of the hard questions about how to fix our broken care system.
"All political parties and the public must now look beyond the short-term squeeze on our national finances to agree a fairer way to pay for care."
But shadow health secretary Andrew Lansley said: "We don't need to start another debate. One debate always seems to roll into another with this government.
"We need a decision, and we need serious, costed proposals to be the basis of that decision."
It will be another five years before any changes come into effect.
The shake-up has only been proposed for England although Wales and Northern Ireland, which both use means-testing, are considering reform.
In Scotland, everyone who meets the criteria gets free social care although that threshold is set quite high to only include those with the most severe needs.
Ministers in England have put forward a revamp of the social care system.
But why is it needed and what does it mean?
What does social care cover?
The system includes everything from the support people receive with washing and dressing to stay in their own homes through to full-time residential care.
The majority is provided to the elderly who can no longer look after themselves.
But it also includes the support given to those with disabilities.
The care is provided by local authority staff as well as private care homes and agencies and charities.
In England, access to the care is means-tested.
Why does it need changing?
If there is one thing everyone is agreed on, it is that the current social care system is failing.
Councils have started tightening their eligibility criteria for those entitled to care in recent years as more and more people are asking for help.
And with the means-testing threshold set so low - the £23,500 limit effectively excludes everyone who owns a house - thousands of people each year are forced to sell their homes if they need residential care.
With the ageing population the situation is only going to get worse.
There are currently four people of working age population for every person retired.
By 2050, there will only be two.
It means that unless there is billions of pounds of extra investment, the system is likely to fall apart.
What has the government proposed?
Ministers are looking to revamp the way the £6bn social care pot is divided up.
The current system targets the poorest.
And while they will still get extra help under the plans, the government is proposing to extend the state's contribution to everyone.
But in return it wants to bring the public on board as direct contributors to the system.
Ministers ruled out raising taxes and instead put forward three options whereby the state provided a basic package and the public contributed the rest.
This could either be done through paying any costs themselves, taking out insurance or introducing a compulsory fee.
Meanwhile, they said the bill for residential accommodation, which is often cited as the reason people are forced to sell their homes, can be deferred until death when it is taken from a person's estate.
What has been the reaction to the plans?
Many of the charities and campaign groups have just expressed delight that the proposals have been put forward at all.
The green paper was nearly a year overdue and in recent weeks there has been doubts about whether it would ever see the light of day.
Saying that, many still have concerns.
Charities, in particular, are concerned about the issue of compulsory fees.
And there are still big question marks over funding.
The government's proposals did not mention money - partly because any changes would be so far away that it was impossible to say what the budget would be.
Nonetheless, unless there is a significant increase in investment the fact that everyone will receive some level of free social care could mean the poorest may see the support given to them shrink.
The new system may also lead to a tightening of the criteria used to determine whether people should get access to the system in the first place.
This has happened in Scotland since free personal care was introduced and means only those with the most severe needs get help.
What is more, the right to defer accommodation costs would require funding at least in the short-term until the state gets access to the proceeds from estates.
The Tories have been quick to jump on this, criticising ministers for not providing properly costed plans.
The Minister of State, Department of Health (Phil Hope): My right
hon. Friend the Secretary of State issued a written ministerial statement on 20 July, Official Report, column 96ws about the discovery of a backlog of conduct cases which had been identified by the General Social Care Council (GSCC). He announced that we would be asking the Council for Healthcare Regulatory Excellence (CHRE) to undertake a review of the GSCC’s conduct functions. CHRE today published the report of its review of the GSCC. The Government welcome this report.
CHRE’s report sets out a series of serious operational failings in the conduct function by the GSCC, which investigates complaints about social workers. Insufficient attention was paid to a growing backlog of conduct cases, despite additional funding being provided by the Department for three years to enable GSCC to address a growing number of complaints. Of particular concern was the decision to suspend, for a period of time, any new referrals to the GSCC’s professional conduct committee.
The Government have today broadly accepted all of the recommendations made by CHRE and a full response to its report is available at:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107882
I met with the GSCC’s Chair, Rosie Varley, on behalf of both the Department of Health and the Department for Children, Schools and Families to express Ministers’ concerns about the issues raised in the report and to set out clear expectations for the GSCC going forward.
Significant progress has already been made in handling cases on receipt of complaints and addressing any ongoing risks to the public resulting from the poor management of conduct since July. Ministers have been assured by the Chair of the GSCC that all cases are now routinely risk-assessed and allocated to a responsible manager who ensures that risk is continually reviewed as new information arises. Interim suspension orders, which suspend the registration of social workers against whom serious complaints have been made while they are investigated, are now being applied for where appropriate.
The GSCC has also begun the process of reforming its operational processes and strengthening its infrastructure to support performance management of its conduct function. A remedial plan to address the backlog of cases is now in place and Ministers have asked for monthly reports on progress to be provided to the Department.
Ministers have made it clear to the Chair of the GSCC that they expect to see significant operational improvements as a result of the implementation of the Council’s action plan by the end of March 2010, including the resolution of the oldest cases. The Chair of the GSCC has been asked to personally oversee reform of the GSCC’s procedures, to ensure effective governance and to report on progress to Ministers in March 2010.
The Department of Health will continue to work closely with the GSCC to assure and assist in the delivery of its recovery plans.
The CHRE’s report and the Government’s response have been placed in the Libraries of both Houses and copies are available for hon. Members from the Vote Office.
Gordon Brown will make social care for the elderly the centrepiece of the Queen's speech by introducing free care for some of the most needy pensioners in their own homes.
Ministers said the measures represented a staging post to help the most vulnerable before the introduction of a broader white paper on the national carers strategy, and then consensus-based legislation in the next parliament. Brown is determined to use the Queen's speech to show his commitment to free domiciliary care for the most needy. He first raised the issue during his party conference speech in October and it highlights Labour's intent on pursuing the growing grey vote.
Critics say the measures do not represent the full package on adult social care – which many say the government has failed to provide for more than a decade – but are instead seen as a stop gap before a comprehensive national care strategy.
No details have been released regarding the precise cost, or to whom it would apply, but Labour officials said it was expected to cost about £700m, representing £38 a week for each of the 350,000 beneficiaries. It is less than the more ambitious options outlined in 2007 for more expensive care for longer periods.
The free care would be introduced in October next year and paid for by the Department of Health and local authorities.
Doubts have been raised about the true cost of the scheme, and whether the introduction of a free scheme for some will complicate efforts to arrange a comprehensive scheme which will have to include an element of charging.
According to the NHS Information Centre statistics, 346,700 adults received council-arranged care in their own homes in 2007, costing £2.6bn. Those services are currently means tested, but only 12% – about £300m – of the gross cost is covered through user charges.
The shadow social care minister, Stephen O'Brien, recently challenged the health secretary, Andy Burnham, on the funding, saying: "Ministers are unable to answer our inquiry about which budgets the money will be taken from, and how the 350,000 individuals had been reached."
But figures given to the government by the Personal Social Sciences Research Unit based at the London School of Economics suggested that by 2010 there would be 933,000 elderly people in the highest "critical needs" category for social care.
Nearly 300,000 would be cared for by their friends and family, leaving 647,000 who would need care either in their own home or in residential care homes. If care home residents stay constant at around 450,000, that would leave just under 200,000 adults requiring their critical needs to be met through domiciliary care. That represents a lower figure than presented by Brown at his party's conference speech, but more free resources may need to be devoted per week.
http://www.guardian.co.uk/politics/2009/nov/17/queens-speech-social-care...
The Health Committee holds the latest evidence session in its inquiry into the future of social care services with a number of community and home care assocations. Watch live from 10am.
The witnesses are:
- National Care Association
- English Community Care Association
- UK Homecare Association
- Partnership Life Assurance Company Ltd
- William Laing
The Committee decided to inquire into the future of social care services following the publication earlier this year of the Government's Green Paper, Shaping the Future of Care Together. The inquiry is looking at options for:
- future funding of long-term residential and domiciliary care for older people and people with physical or learning disabilities
- personalisation of social care services
- more effective, consistent and user-friendly social care services
http://news.parliament.uk/2009/11/social-care-inquiry-continues/
Nearly one in 10 hospital prescriptions contain a mistake, ranging from the minor to the potentially lethal, research has found.
But the study, commissioned by the General Medical Council, found very few errors would have caused serious harm.
It also found that, contrary to belief, novice doctors were no more responsible for mistakes than the more experienced.
To eliminate one area of confusion, the GMC is calling for a UK-wide standard prescription chart as exists in Wales.
The research team led by Professor Peter Dornan of the University of Manchester, examined the issue amid rising fears inexperienced doctors were making prescription errors which could, at worst, result in a patient dying.
They examined 124,260 prescriptions across 19 hospitals - and found just under 9% contained errors.
Of these 11,077 errors, overwhelmingly intercepted and corrected before reaching the patient, about 2% contained potentially lethal instructions - such as failing to take account of a patient's allergies.
More than half involved errors in which a patient's medication was not prescribed on admission, during a rewrite of a prescription, or when the patient was sent home.
Another 40% were accounted for by prescriptions where the writing was illegible or the wording ambiguous.
Very few of these mistakes caused actual harm to a patient because on the whole they were stopped by senior doctors, nurses - and in particular pharmacists.
There were however concerns that so effective was this safety net, some doctors relied on it to pick up their mistake.
'Off the hook'
But the study did not find doctors fresh out of medical school were making the most mistakes - as has often been suggested.
Doctors in their first year of medical training in fact made slightly fewer mistakes than the average, although that rose slightly in their second year. However at 8.3% their rate was the same as registrars. Consultants made the fewest, with 5.9%.
While the curriculum at medical schools could always be improved, it was clearly not at the root of the problem, the team concluded - noting many factors - from fatigue to unfamiliarity with a prescription form - produced errors.
"The research shows the complexity of the circumstances in which errors occur and argues against education as a single quick-fix solution.
"Education can always be improved but it must be very practically oriented and include all phases of a doctor's career as well as the undergraduate stage," said Professor Dornan.
The chairman of the GMC, Professor Peter Rubin, said: "Prescribing decisions in a hospital setting often have to be made quickly, so it is important that a procedure is as simple as possible to minimise the chance of an error being made.
To avoid confusion as doctors move between hospitals with very different prescribing forms - including paper and electronic - the GMC wants to see a standardised system across the UK. Wales introduced this in 2004.
Education matters
A Department of Health spokesman said it would continue to look into the benefits of electronic prescribing systems, "taking into account the evidence gained where standardisation of the paper chart has been successfully implemented."
Dr Hamish Meldrum, of the doctors' union, the BMA, said: "It would certainly help if there was greater uniformity in the prescription forms used in the NHS and the BMA would encourage prescribing procedures to be kept as simple as possible."
Professor Simon Maxwell, of the Royal Pharmaceutical Society, said: "Like everyone else, I am extremely concerned by this error rate but I am dismayed at the suggestion that improved education and training is not a central part of the solution.
"There is plenty of evidence from around the world to show that when appropriate education and training are delivered, prescribing improves."
He said no credible observer would say this was the sole answer but that it must play a role.
http://news.bbc.co.uk/1/hi/health/8391667.stm
A quick glance at the report into social care by the Care Quality Commission regulator, may suggest that everything is rosy in the sector.
But it does not take long for the impression to unravel. While 95% of councils in England got an excellent or good rating, it is clear that this has only been achieved because they are providing services to fewer people.
In the place of the state in has stepped an army of carers.
Estimates suggest there are nearly 6m people helping loved-ones wash, dress and eat - 1.5m of whom provide more than 20 hours of care a week.
And this is why social care - for the first time in many years - is near the top of the political agenda.
At this year's Labour party conference, Prime Minister Gordon Brown unveiled a headline-grabbing policy to give the most in need free care - as happens in Scotland.
The Tories have focused on care homes, promising a one-off £8,000 payment which will guarantee no-one will have to sell their homes to go into residential care.
Meanwhile, the Lib Dems, particularly through their former health spokesman Paul Burstow, have been calling for reform of the creaking system for years.
But despite this focus, the reaction from campaigners has been lukewarm to say the least.
The policies have been described as a "sticking plaster" or just "one-piece of the jigsaw".
In truth, campaigners believe these interventions are just an attempt to woo the electorate ahead of next year's general election.
Instead, they would have preferred to see ministers - and the opposition parties - focus their attentions on the plans published in a green paper at the start of the summer.
To almost universal acclaim, Health Secretary Andy Burnham published a set of proposals to overhaul the entire social care system.
The suggestions were controversial. The most extreme involved a £20,000 bill on retirement to help fund the system.
Of course, that is not a vote winner and many do not expect to see the next stage - a white paper - to be published this side of an election.
http://news.bbc.co.uk/1/hi/health/8391736.stm
Annual performance assessment raises concerns over performance in promoting choice and dignity for users
Councils improved their overall performance in adult social care for the seventh successive year in 2008-9 despite facing a tougher assessment process, the Care Quality Commission said today.
However, its annual performance assessment raised concerns about a lack of improvement in the promotion of choice and dignity for service users.
The APA found that 22% of authorities performed excellently and 73% well, up from 18% and 69% respectively in the 2007-8 assessment.
Big cut in authorities causing concern
Of 19 councils deemed to be a priority for improvement in 2007-8 - meaning they faced particular scrutiny from the regulator - 16 are no longer in this category having improved.
This year marked the first since the abolition of star ratings but councils were still assessed against the same seven outcomes for service users: improved health, quality of life, making a positive contribution, choice and control, freedom from discrimination, economic well-being and dignity and respect.
As last year, councils performed least well in providing choice and control and dignity and respect - despite personalisation and safeguarding being two key government priorities for adult social care.
Lack of improvement on choice and dignity
Twenty three per cent of councils performed adequately in delivering choice and control - the same proportion as last year - while two authorities (1%) were graded poor and 45 (30%) adequate for dignity and respect - similar proportions to last year.
On both outcomes there was a fall in the proportion of councils rated as excellent, from 11% to 8% on dignity and respect, and from 21% to 18% on choice and control.
The CQC said that the lack of improvement on choice and control reflected a toughening of the performance assessment in this area.
Quality ratings for providers also published
The APA was published alongside an assessment of the quality ratings achieved by social care providers, which showed that the proportion receiving an excellent or good rating rose from 69% to 77% from May 2008 to April 2009.
However, the CQC said councils needed to do more to purchase care from higher-quality providers. Forty per cent of councils purchased at least 80% of their residential services from care homes rated good or excellent, but CQC said a number of councils were commissioning a significant amount of care from homes rated poor or adequate.
CQC chief executive Cynthia Bower said: "It's good to see the steady improvements and this should be recognised. But she added: "There are also serious issues for councils to address in areas such as giving people more control over their care, treating people with dignity, and ensuring commissioning is as effective as possible. I want to see the regulator and councils working in tandem to drive poor quality care out of the market."
LGA challenges regulator over providers
However, David Rogers, chair of the Local Government Association's community well-being board, said: "No council ever chooses to deliberately place anyone in poor quality accommodation. The information routinely available to them on the standards of care homes is patchy. We expect the regulators to urgently address homes they know or find to be failing, in order to deliver the quality of accommodation that everyone expects to live in."
He added that councils deserved "great credit" for their performance this year.
Related articles
Care provider ratings on the up but CQC warns poorer services
Councils to receive adult care rating despite abolition of stars
Significance of star ratings questioned as councils improve
Star ratings: Where councils performed well and less well
http://www.communitycare.co.uk/Articles/2009/12/03/113342/CQC-Councils-improve-for-seventh-year-running-in-adult.htm
NAT calls for NHS to do more to reassure patients about confidentiality
Confidentiality a serious concern for people with HIV
A report released today by NAT (National AIDS Trust) calls for the Department of Health to clarify the rules surrounding patient confidentiality and for better staff training, particularly in relation to patients with HIV. Confidentiality in healthcare for people living with HIV finds that whilst medical professionals are generally obliged to keep personal information about a patient confidential, concerns about confidentiality are especially acute for people with HIV and breaches of confidentiality still occur.
There are now over 85,000 people living with HIV in the UK. The recently published People Living With HIV Stigma Index found that 42 per cent of survey participants were not certain that their medical records are being kept confidential.1
NAT’s report reviewed current protections within the NHS. The report also found legalisation on the sharing of confidential sexual health information is not always clear.
Yusef Azad, Director of Policy and Campaigns at NAT, comments:
“Many people with HIV have concerns over their privacy particularly within healthcare settings. Whilst in the vast majority of cases patient confidentiality is respected, breaches of confidentiality do occur. These breaches are especially serious for people living with HIV who may fear HIV-related discrimination. Not knowing how personal information will be treated also undermines efforts to encourage HIV testing.
With the electronic record systems soon to be introduced across the UK, reassuring patients that their private information will be protected is be vital to maintaining patient confidence. Clear guidance on how and when confidential information can be shared and effective training for all NHS staff, must become a priority for the Department of Health.”
Following this report, NAT will be producing a simple guide for people living with HIV, explaining their rights and what they should expect from the NHS later this year.
Notes to the editor:
1 - People Living With HIV Stigma Index is a two-year research project funded by the Department for International Development and the International Planned Parenthood Federation. http://www.ippf.org/en/News/Press-releases/HIV stigma and discrimination remain a significant challenge in the UK.htm
http://www.nat.org.uk/News-and-Media/Press-Releases/2010/January/Confide...
The increasing number of children being taken into care will have cost the taxpayer at least an additional £226 million in the current financial year and should prompt a rethink about how we fund the care system, council leaders said today, as they warned the climb could threaten the future of other council services intended to help all families. The sum is a combination of extra court costs and the increased bill for the number of children in council care.
The latest official figures on care referrals from Cafcass (the Children and Family Court Advisory and Support Service) show the number is stabilising at a higher level, following the court case into the death of Peter Connelly.
The Local Government Association estimates 2009 / 10 will see an overall rise of 32% in the number of care applications going through the courts, equivalent to an extra £39million. Those costs include the resources absorbed in preparation and support, with social workers required to dedicate significant time to the process.
There has also been a rise in the number of children in local authority care. The number entering the care system for the first time went up by 9% during 2008 / 09, and can be expected to show an even sharper increase during the current year. That rise of 9% added around £187 million to the cost of the care population.
Council leaders warn the situation is not sustainable in the long-term, and fear schemes meant to prevent family break-up and to support children from poorer backgrounds may be sacrificed in order to foot the bill for a larger care population.
The LGA is warning that if, as a nation, it is decided the state will have to intervene more often and at an earlier stage in the care of children there will have to be a detailed look at how to produce a system which can do that effectively.
Cllr Shireen Ritchie, who chairs the Local Government Association’s Children and Young People Board, said:
“The system which looks after children in care is feeling the strain – it was never designed to deal with the increase in numbers which we have experienced in the last year.
“There is no question of money being a factor in deciding how a vulnerable child is cared for. Wherever a child is identified as being in danger, councils and the courts will take them out of the family home if that is the best way of protecting them.
“It would be wrong to pretend that there is no cost involved in the changing attitudes to child protection. There is a price to be paid, particularly if it means a reduction in the help and support councils can offer to other families.
“There have been well-publicised arguments about whether social services should step in sooner and more frequently where children are thought to be at risk. If it is decided that, as a nation, we must play a bigger role in how families raise their children there will have to be a debate about how to fund and manage a system which can do this properly.”
The potential cost savings of greater use of home- and hospice based end of life care in England
National Audit Office report
http://www.nao.org.uk//idoc.ashx?docId=3BEC862C-1AED-4019-965F-3A76910CA...
The Health and Social Care Advisory Service, is an evidenced based service development organisation working in all aspects of mental health and older people’s services across the health and social care continuum.
The Health and Social Care Advisory Service started out as the Health Advisory Service within the Department of Health. Throughout its 40 year history, the Health and Social Care Advisory service has made an important contribution reporting independently on good and bad practice and offering advice and support to local services, starting with the Ely Hospital scandal in 1967. In April 1997, the Department of Health transferred management responsibility for our organisation to a consortium comprising the Royal College of Psychiatry, the British Geriatric Society and the Office of Public Management. Since this time the Health Advisory Service has evolved into the Health and Social Care Advisory Service (HASCAS). We have been a registered charity and a Company Limited by Guarantee since 1997.
Since 2005 HASCAS has not been managed by its original consortium, choosing to become entirely independent.
HASCAS maintains its traditional links and functions. We are proud of the fact that our organisation very much pioneered the usage and adoption of standards and systematic methodology when conducting service reviews and inquiries. This evidence based, objective and robust way of working is central to everything that we do. Our values encompass the following:
- the experience of service users and carers is a priority for us and we aim to make a positive difference to people’s lives and their experience of the services that they use;
- we aim to be systematic, rigorous and reflective, building on the available evidence provided by research, practice and user experience;
- we aim to add value to health and social care through using our extensive experience to work alongside organisations, starting with where they are and using interventions designed to strengthen local capacity;
- we aim to be an organisation that is constantly learning from our work, and that contributes to the learning of others.
HASCAS affords a real opportunity to the service because of its independence and its ability to be reflective and raise issues that may otherwise be overlooked because of other priorities. HASCAS adds choice and diversity in service development and enhances and challenges the thinking about services and the experience of those that use them. Over every 24 month period HASCAS works with an average of 60 NHS Trusts. In addition we also work with SHAs, social services, Higher Education institutions, the Department of Health and the Ministry of Defense.
We believe that we can help your organisation in a wide variety of ways, and can ensure excellent service, value for money and an experienced team with national standing.
http://www.hascas.org.uk/
The government has "significantly underestimated" the cost of delivering free social care, council chiefs say.
A poll of 61 directors of social services suggested providing care to those most in need costs £200 a week - double the government's estimate.
The Association of Directors of Adult Social Services (ADASS) said it backed the idea - planned for England - but it wants a funding rethink.
The government said it would consider the findings.
Free personal care is likely to be one of the key planks of Labour's election strategy.
'Most in need'
The move was announced by Gordon Brown at the party's annual conference and a bill included in the Queen's Speech set out the plans.
The service - for people needing help eating, washing and dressing - is currently means-tested.
But ministers want to see English councils provide it free to an estimated 280,000 people, mostly the elderly although some have disabilities, to mirror the package available in Scotland.
They estimate that people who fall into the most critical bracket need six and a half hours of care, but the evidence provided by the survey suggests it is double that.
It means councils would have to find more than £500m a year - on top of the £420m provided by government - to fund the scheme if it comes into place in the autumn as forecast.
ADASS president Jenny Owen said the "pressures on local government will clearly be well above the sum estimated".
Consultations
She added: "We are keen to meet with the department to help clarify and resolve these outstanding issues."
A Department of Health spokesman said: "We are in the process of consulting on aspects of the bill and will feed ADASS's new contribution into this."
The concerns raised by social care chiefs come after charities said the plans may lead to councils restricting access for people who do not qualify for free care.
The plan covers only those with the most critical needs, often people who need help in the mornings, lunchtime and evenings.
But this accounts for just about half of the total people receiving home care.
In order to inform future funding and planning priorities around social care, support and information services for people with diagnosed HIV in the UK, the AIDS Funders Forum funded Sigma Research to conduct a review of commissioning and service provision in the HIV sector. The AIDS Funders Forum includes Crusaid, The Derek Butler Trust, The Elton John AIDS Foundation, The MAC AIDS Fund, The Monument Trust, and The Peter Moores Foundation.
The research had two elements.
Epidemiological review: Using the most recent published epidemiological data to 01-12-2006, we conducted a critical overview of the HIV epidemic across the United Kingdom.
The key findings of the review of epidemiological data were:
- Although there has been a recent decline in the rate of growth of numbers of people with diagnosed HIV, prevalence continues to increase by 10-15% every year.
- With the introduction of anti-retroviral treatment, the number of people with HIV dying every year radically declined ten years ago and has remained stable ever since (at about 500 deaths per year).
- Prevalence of diagnosed HIV infection is highest in England, then Scotland, Wales and Northern Ireland. Half of people with diagnosed HIV in the UK today live in London.
- In the UK, HIV disproportionately affects men rather than women and adults rather than children.
- There has been a recent decline in the number of new diagnoses among migrants with HIV, suggesting the number of people moving to the UK with HIV has stopped growing. In the UK overall, 52% of people living with diagnosed HIV are White, 43% are Black and 5% are of other ethnicities. Among the Black people with diagnosed HIV resident in the UK, 89% are African, 7% are Caribbean and 4% are from other Black groups.
- There has been no decline among the number of domestic HIV infections, suggesting the number of people living in the UK who acquire HIV (sexually) continues to grow. About 80% of all domestically acquired HIV infections occur as a consequence of sex between men.
Stakeholder survey and interviews: 1111 unique email addresses (456 in charities, 492 in the NHS, and 163 in Local Authority) were targeted with an invitation to complete an online survey which was available for five weeks in April and May 2006. After exclusions, the sample consisted of 371 responses including workers/volunteers from 111 different charities serving people with HIV; commissioners of HIV services from 60 local Health Authorities; staff from 60 different NHS providers and commissioners / staff from 37 Local Authorities. 197 survey participants volunteered for follow-up telephone interview of whom 18 (eight commissioners and ten charitable providers) were interviewed. Respondents were selected to maximise variation between urban and non-urban, high and low prevalence areas.
The key findings of the survey and interviews were:
- There are no government targets against which performance with respect to HIV prevention or care is measured.
- There are no core competencies, skills or formal training for NHS HIV commissioners.
- Constant NHS restructuring and shrinking budgets means that NHS deficits figure more prominently than need in commissioning decisions.
- HIV social care, support and information services are seen as secondary to treatment and care budgets.
- Retraction and mainstreaming of Local Authority services threatens to disrupt continuity of HIV social care.
- Social services are increasingly unable to serve the acute needs of asylum seekers with HIV. This is putting undue pressure on charitable providers.
- The majority of respondents did not think all people with HIV were equally well served by the current configuration of services. Migrants, asylum seekers and ethnic minorities were seen as particularly poorly served.
The research concluded that current service configuration in the UK is unlikely to meet the changing needs of all people with HIV because it is not needs-led. Services are funded due to historical precedent and funding tends to roll forward year-on-year. Change in population need to compete with other factors (NHS funding shortfalls, Local Authority mainstreaming and political pressures) in decisions to change service provision.
The final report was called A growing challenge: a strategic review of HIV social care, support and information services across the UK. An Executive summary is available to download.
http://www.sigmaresearch.org.uk/go.php/projects/policy/project37/
An attempt to delay a bid to provide free personal care at home for some 250,000 people in England has failed.
The House of Lords voted against a motion tabled by former health minister Lord Warner.
He had argued that the government's proposal was "unaffordable" and proper consultation had not taken place.
The proposal was originally put forward by Prime Minister Gordon Brown at Labour's conference and is expected to be a key part of its election campaign.
The plan has attracted criticism from peers, local government and campaigners because a wider review of social care is also taking place.
The free personal care plan affects only about half of the 500,000 people receiving care in their own home - most of these are elderly, although some are people with disabilities.
On top of that, more than 400,000 living in care homes would not benefit from the bill.
In contrast, during the summer, a Green Paper was published putting forward a series of proposals affecting the whole range of social services.
These include radical plans to impose charges, perhaps as much as a £20,000 bill payable on retirement. The current system is means-tested.
Lord Warner argued the free personal care plan should wait until the government knew what it was doing with the wider review.
He also highlighted claims by social services chiefs that the government had greatly underestimated the cost of introducing the service for people needing help eating, washing and dressing.
He told the House of Lords: "The more I discover about this bill the less I like it."
However, his amendment was defeated, although the legislation still will not be implemented before the election.
Before the debate, Health Secretary Andy Burnham said it had been properly costed and was about "making the system fairer".
Twenty Members of the House of Lords, with wide-ranging experience of and expertise in health and social care issues, contributed to the main debate on the Personal Care at Home Bill on 1 February.
The Bill would implement free personal care at home for those in most need and Members of the Lords discussed subjects including healthcare reform, current charges for personal care at home and reablement support (physiotherapy and personal support) to help people after a fall, when their health deteriorates, or following a period in hospital.
- Video & Audio: watch the second reading debate on the Personal Care at Home Bill
- Lords Hansard: read the second reading debate on the Personal Care at Home Bill
- Lords Divisions Analysis: view the results of the vote on the Personal Care at Home Bill
A vote took place on a motion to delay the next stage of the Bill - committee stage - until the Government had provided more information on how the Bill would be implemented.
The motion was defeated and the committee stage - line by line examination of the Bill - is scheduled for 22 February.
Further information
- Personal Care at Home Bill
- Passage of a Bill: Second reading (Lords)
- Parliament News: Personal Care at Home Bill passes final Commons stages
http://news.parliament.uk/2010/02/personal-care-at-home-bill-lords-secon...
There is an unacceptable variation between GP out-of-hours services, the government admits.
But health minister Mike O'Brien said care had still improved since doctors gave up providing cover in 2004.
He was speaking after a report suggested marked differences in levels of cover and home visits.
He said the government would publish its own review of night and weekend care following the conclusion of a high-profile inquest later this week.
A Cambridgeshire coroner is due to give his verdict on Thursday into the deaths of David Gray and Iris Edwards, who had been seen by out-of-hours doctor Dr Daniel Ubani.
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There is a problem with consistency. It is down in part to the investment by PCTs. Out-of-hours has been subject to cost-cutting Dr Richard Vautrey, of the British Medical Association
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Dr Ubani, who is a cosmetic surgeon in Germany, was doing shifts for Take Care Now, the company which was running the NHS out-of-hours service in Cambridgeshire. The contract was terminated at the end of last year.
In April 2009, the German authorities gave Dr Ubani a nine-month prison sentence, suspended for two years, and he was ordered to pay a £4,500 fine for causing death by negligence.
A subsequent report by the Care Quality Commission last year then raised further concerns about out-of-hours care.
The regulator looked at five trusts which used Take Care Now and warned they were failing to properly monitor services.
It said the variations in performance suggested it could be a nationwide problem.
Most GPs opted out of providing out-of-hours care in 2004.
Since then local health managers working for primary care trusts (PCTs) have been responsible for providing cover at nights and weekends and have often relied on private firms working under NHS contracts.
Responding to questioning about differences in services, Mr O'Brien told GMTV the service was not a shambles as services had actually improved over the past six years.
But he added: "There is an unacceptable variation between primary care trusts."
Performance
His comments come as figures from the Primary Care Foundation, a research group which compares performance for PCTs, illustrated the scale of the differences.
For example, the number of patients receiving home visits varied from one in four to one in 50.
It also showed that some areas were using one GP to cover a population of 300,000.
But Henry Clay, director of the foundation, agreed it would be wrong to assume the system was in chaos, pointing out services were only receiving a small number of calls on average.
"There are still areas that need addressing, but in many ways it has improved."
Dr Richard Vautrey, chairman of the British Medical Association's GPs committee, said: "There is a problem with consistency. It is down in part to the investment by PCTs. Out-of-hours has been subject to cost-cutting."
But he added: "We can look back with rose-tinted spectacles. Before 2004 GPs were tired because they were working day and night and that was not good for patient safety."
London as a region has specific social care needs, costs and pressures and therefore requires social care funding that reflects all of these factors. Any extra social care burdens that are created for a new social care system must ensure London as a region is adequately funded so it is able to continue to deliver high quality social care services for Londoners.
London boroughs in recent years have been able to contend with the huge financial pressures in social care funding placed upon them because they have striven for excellence in efficiencies and balance in social care placements for residential and home care.
We are concerned about the future funding of social care in London because of the combination of the future financial climate and increased social care demands. We ask the government to consider London boroughs' situation carefully so that extra social care burdens have adequate and appropriate funding to avoid London boroughs facing extreme financial risks.
Personal Care at Home Bill - Response from London Councils Opens in a new window
related documents
Personal Care at Home Bill - Response from London Councils (PDF, 67.55Kb)
http://www.londoncouncils.gov.uk/healthandadultservices/consultationsand...
Councils will struggle to cope with the financial challenge posed by England's ageing population, a watchdog says.
The Audit Commission said the £9bn a year social care bill will double by 2026 if current practices continue.
http://www.audit-commission.gov.uk/SiteCollectionDocuments/Downloads/201...
The warning comes as ministers are considering a revamp of the funding system for social care.
But the Commission said councils needed to look at new and innovative ways to provide services, particularly by embracing technology.
It highlighted a number of examples of how "telecare" was being used to provide electronic links between services and people living in their own homes.
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The variation between local authorities is unacceptable Stephen Burke, Counsel and Care
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It cited examples where councils had fitted exit sensors, fall detectors and flood alerts - in case people left taps running - to monitor vulnerable people in their own homes.
The watchdog also said an increased involvement of neighbours was another solution to the growing demands.
And it raised concerns about the variation in spending levels on services such as meals, care at home, assessment systems and nursing support. In some areas, these cost three times more than in others.
Highest needs
Audit Commission chairman Michael O'Higgins said: "There are huge financial pressures on councils in the years ahead, but redesigning services and exploiting technology can make them better, more efficient and more personal."
Stephen Burke, chief executive of the Counsel and Care charity, added: "The variation between local authorities is unacceptable."
But David Rogers, of the Local Government Association, said local authorities were well aware of the issues.
"We are acutely aware that the future will mean doing things differently to cope with an ageing population, developing new technology with less funding from the public purse and are already making huge strides to adapt to the future."
The report comes as the government prepares to publish detailed plans in the coming months into how social care should be funded.
The current system is means-tested, but campaigners and the political parties all agree the arrangements are unfair, as more and more people are being excluded from services by greater restrictions on eligibility which are being imposed by councils.
Labour has pledged to introduce free personal care so people with the "highest needs" can stay at home.
The party has put forward several proposals, including a compulsory levy on people's estates which the Conservatives have dubbed a "death tax".
http://news.bbc.co.uk/1/hi/health/8520800.stm
There must be a "decisive shift" in the NHS to provide more care in people's homes, the health secretary has said.
Andy Burnham said the health service must be more "confident" in being able to offer services, such as kidney dialysis, outside hospitals.
This could improve patient experiences as well as save billions, he added.
The Tories have pledged to put patients in the "driving seat", with people able to receive treatment for more minor ailments in their local communities.
'Patient convenience'
The Lib Dems say high-street pharmacists and the voluntary sector should play a role in supporting patients with long-term conditions and those with one-off medical queries or issues.
In a speech, Mr Burnham said: "The time has come for the NHS to make a decisive shift in providing more care out of hospitals and in the patient's community and home."
Integrating health services into the local community could save the NHS £2.7bn a year, he argued.
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What we know now is that we can safely do far more in the patient's home Health Secretary Andy Burnham
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Last month, Gordon Brown unveiled plans to offer cancer sufferers free home care from specialist nurses, including access to chemotherapy.
And on Thursday, Mr Burnham told the BBC he wanted "to make the convenience of the patient the most important thing".
"It's about a personal NHS, a patient-centred NHS. For the individual, it's about bringing the services to them rather than vice versa," he said.
"Perhaps, in the past, the NHS has been a bit too much of a 'take it or leave it, like it or lump it' service.
"What we know now is that we can safely do far more in the patient's home, and at a local level, than we could before."
Taking the example of dialysis, he said it could have "a massive effect" on a patient's quality of life to be treated at home.
"It really can give them control back of their life, to balance work with treating their condition."
'Knock-about'
The health secretary restated Labour aims to provide more social care for the elderly at home and said he hoped a cross-party consensus could be reached.
He has called a conference on the issue on Friday, but the Conservatives have refused to attend unless Labour drops proposals for a £20,000 "death tax".
"These issues are too important to be the stuff of normal knock-about," Mr Burnham said. "I think we do need to work across the political divide to find a sustainable solution for the long-term."
He also confirmed the government's intention to outline proposals on giving patients the right to die at home in future.
The Communities Secretary has advised council leaders not to overlook the third sector when improving public service delivery.
John Denham was addressing a meeting of council leaders when he urged them to consider the skills and expertise of third sector organisations to deliver local services.
Third sector organisations bidding to deliver local services are feared to lack the expertise and size to win council contracts.
Mr Denham said:
“We know services are best when they are delivered locally because they really reach into the community and it is often third sector that is closest to the community. I have a real concern that the third sector is not getting the opportunity to play its full part. They must have an equal chance to show what extra they can do differently.
“Councils and companies are short changing their communities socially if they don’t look beyond the price tag to deliver the current services at then lowest possible cost and consider the many additional benefits third sector providers can bring such as jobs for the workless that can save even more money in the long run.”
The Government has also revealed a new community enterprise strategic framework helping groups to launch new social enterprises.
The framework will offer support and skills training to strengthen community enterprises, helping them build their capacity to bid for public sector contracts.
To view the framework click here (opens in new window)
Source: Department of Communities and Local Government, 11/02/2010
http://www.fundingcentral.org.uk/newsview.aspx?WCU=DSCODE%3dOTSSCMLIVE%2cNEWSITEMID%3d248-N7811
Services have steadily improved overall but rising demand and pressure on finances make reform essential, says new regulator
The Care Quality Commission today (Wednesday) applauded overall improvements over recent years, as it published its first annual report to parliament on the state of health care and adult social care in England.
But it cautioned that some services were lagging behind the pack and that there were areas of common concern across health and social care, notably keeping people safe and staff training.
CQC pointed out that services would be operating in a different environment in future, with pressure on finances adding to continuing increases in demand and rising expectations. It said that the next big challenge for health and social care is to accelerate efforts to make services more joined up and centred around people's needs.
Its report argues that joining up health and social care can deliver both better care and greater efficiency.
It calls for investment in services that maintain people's independence, by reducing the need for expensive hospital and residential care. For example, up to £2 billion could be saved annually from hospital budgets if each area were able to reduce the number of older people admitted repeatedly to hospital in an emergency, and the number of days these people spend in hospital, to the levels seen in the best performing areas of the country.
Drawing on the richest sources of information available, this is the first time that an independent regulator has looked simultaneously across both the health and social care sectors.
CQC also published a five-year strategic plan today, which sets out what it wants to achieve for people using health and social care services, and how it will go about it.
CQC's interim chair, Dame Jo Williams, said: "Overall, there have been steady improvements and it is really important to celebrate that. Successes have come in areas that really matter to people such as reducing hospital infection rates and helping people live independently at home. But we are mindful of the fact that pockets of poor practice remain. This must be addressed.
Turning to the future, Williams said: "We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.
"This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."
She added: "We hope providers and commissioners of services will seize on the information we are making available and use it to improve care for the people using their services."
The report's main conclusions are:
Overall there has been major improvement, including in areas that really matter to people. Sixty-three percent of NHS trusts, 77% of adult social care providers and 95% of councils were rated ‘good' or ‘excellent' last year. Hospital waiting times in A&E and waits for non-emergency care have been driven down, rates of MRSA and C.difficile have reduced by 34% and 35% respectively compared with the previous year, and reporting of serious incidents to the National Patient Safety Agency has improved greatly from 922,552 incidents in 2007/08 to 1,061,934 in 2008/09. These figures show that organisations have made progress in routinely reporting serious incidents in order to learn and put things right. From 1 April it will be mandatory for all organisations to do so.
More people had access to services that: help prevent unnecessary emergency admissions to hospital (148,000 in 2009, up from 80,000 in 2004); and services that help them return home quickly from hospital (157,000 in 2009 up from 112,000 in 2004). More people are supported to live independently at home, with 2.1% of people aged 65 and over living in care homes in 2009, compared to 2.5% in 2005.
But some organisations lag behind the pack and there are areas in which services frequently struggle to meet standards. The three key areas of concern highlighted by CQC are:
Safety - It is crucial that organisations report their mistakes or near misses (called ‘incidents') so that they can learn and put things right. Despite national progress, the reporting rate of incidents varies significantly across organisations. Although 90% of patient contact takes place at GP practices, only 3,417 incidents were reported in the year to July 2009, compared to 693,700 from hospitals.
Safeguarding (protecting people from harm) - Nine percent of NHS trusts did not comply with the minimum standard on child safeguarding (up from 4%). The vast majority of social care providers fully met standards relating to safeguarding procedures. There were major lapses in only 2% of services but this equates to 383 services.
Workforce training - All types of organisations find minimum training standards hardest to meet, which includes things like basic training on safeguarding, life support and fire safety. In 2009, the standard requiring NHS staff to participate in mandatory training programmes had the lowest overall compliance rate of all standards, varying from 73% in ambulance trusts to 90% in mental health trusts. Eighty-six percent or less of adult social care services (such as care homes and home care agencies), meet minimum standards on training.
Rising demand and pressure on finances make reform essential. A predicted 1.7 million more adults will need care and support in 20 years' time. This comes at a time where public finances will be stretched further. CQC says services must speed up progress in providing joined up care centred around people's individual needs to tackle these pressures. It says this will improve people's experiences, maintain their independence and make care more cost-effective.
It is even more crucial to accelerate efforts to join up care and give people more choice and control by making care person-centred.
- Joined-up care - Access to intermediate services that prevent emergency admissions and delayed discharges has improved. But there is an over 30-fold variation in the proportion of people whose discharge from hospital is delayed. Some older people are admitted to hospital as emergencies twice or more each year, which could be prevented if they were cared for better in the community. If each area were able to reduce the number of repeated admissions and length of time these people spend in hospital to that seen in the best performing areas, it would result in an annual saving of up to £2 billion to hospital budgets.
- Person-centred care - Person-centred care is more effective because the focus is on the individual's needs and maintaining their independence and health. The government has calculated that up to £2.7 billion per year could be saved by enabling people with long-term conditions, such as diabetes, to manage their conditions better, treating them closer to home and avoiding unnecessary hospital visits. There is some cross-over between this figure of £2.7 billion and the £2 billion saving from reducing hospital admissions highlighted above. This is because the £2.7 billion figure here also incorporates potential savings from avoiding unnecessary hospital visits, and instead helping people with long-term conditions to keep healthy. Therefore the two figures cannot not be added together.
An important part of centring care on people's individual needs and protecting their rights is giving people choice and control to make decisions. To do this people need adequate access to information about their conditions and treatment options. Nearly 99% of NHS trusts and over 80% of social care providers meet minimum standards on making information available. But, 21% of hospital inpatients said they were not given enough information about their condition or treatment, and 29% of people with disabilities using social care services said they were not communicated with in a way that helped them understand everything properly.
In 2008/09, 86,000 adults used Direct Payments from councils, allowing them full control to choose and purchase their own social care. But this accounts for only 4% of the overall gross expenditure on care. In 53 councils fewer than 5% of people receiving care use Direct Payments.
CQC will play its part in driving improvements to make care joined-up and person-centred, but providers should use these findings to drive change. CQC says from 1 April the new set of standards will help to form the foundations for the shift towards joined-up, person-centred care. The new standards are focused on outcomes and put people at the core of how services are regulated. CQC says it will identify serious issues by responsive and vigilant assessment and where it finds shortfalls in performance, it will act swiftly, using its enforcement powers where needed. This is alongside driving improvements through performance assessment and through special reviews and studies.
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For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143
Notes to editors:
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. We inspect all health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We make sure that essential common standards of quality are met everywhere care is provided, from hospitals to private care homes, and we work towards their improvement. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.
Our work brings together (for the first time) independent regulation of health, mental health and adult social care. Before 1 April 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.
Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people's own homes, or anywhere else that care is provided.
Registration: The Health and Social Care Act 2008 introduced a new, single registration system that applies to both health and adult social care. The new system will make sure that people can expect services to meet new essential standards of quality and safety that respect their dignity and protect their rights. The new system is focused on outcomes, rather than systems and processes, and places the views and experiences of people who use services at its centre.
From April 2010, all health and adult social care providers will be required by law to be registered with CQC and must show that they are meeting the essential standards. Registration isn't just about initial application for registration. We will continuously monitor compliance with the essential standards as part of a new, more dynamic, responsive and robust system of regulation.
http://www.cqc.org.uk//newsandevents/pressreleases.cfm?cit_id=35862&FAAr...
Report of the Royal Commission on Long Term Care, established on 4 December 1997 by the Secretary of State for Health, the Rt Hon Frank Dobson MP.
- With respect to old age: long term care - rights and responsibilities - Report of the Royal Commission (opens new window)
- The NHS Plan: The Government's response to the Royal Commission on Long Term Care
- Long term care: the Government's response to the Health Committee's report on long term care
- Royal Commission on Long Term Care for the Elderly (opens new window)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
The Conservatives are refusing to take part in a conference about the future of social care in England, as they say the summit is a "political ploy".
Labour and the Lib Dems will join care providers and charities in talks over options for a national care service.
Many are likely to tell ministers a compulsory fee would be the best funding option, the BBC understands.
Government "age champion" Dame Joan Bakewell attacked politicians for "political point scoring" on the issue.
The Tories have dubbed the idea a "death tax".
'Silent heroes'
Last year, Labour set out a range of options in a Green Paper on how the means-tested system could be overhauled.
One of the suggestions was a compulsory fee, possibly up to £20,000, which could be taken from an individual's estate after death.
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It is time for a serious debate. We believe a system that involves everyone is the only way to properly fund care Stephen Burke, of Counsel and Care
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The Conservatives vehemently oppose this idea, claiming it would penalise families who want to look after elderly relatives themselves. They favour a voluntary scheme.
The issue has proved a major sticking point and caused secret talks between the three main parties to break down.
Health Secretary Andy Burnham called Friday's conference, but Conservative health spokesman Andrew Lansley has said he will not be there.
Mr Lansley told GMTV that the talks were "a Labour Party political ploy".
He added: "I will talk to anybody, anytime, anywhere, but I won't take part in a Labour party political smokescreen that stops people making progress and covers up the fact that they are pursuing the option of a compulsory death tax."
'Most in need'
In a letter to those taking part in the conference, Mr Burnham acknowledged that there were "pros and cons" to each funding proposal.
"A voluntary option gives people more choice and control but will not cover everyone," he wrote.
"A compulsory option provides peace of mind and care free at the point of use when needed, but restricts choice."
Dame Joan Bakewell, the government-appointed Voice of Older People, said no-one should expect to have a new policy "written in stone within a few weeks".
She added: "I think it's a very, very big issue indeed and it's going to take time to arrive at a consensus.
"And this flurry of political point scoring is just getting in the way of it, because really the politicians need to listen more and do less sparring with each other."
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We don't need a political bun fight because then it will be put into the 'too difficult box' Association of Directors of Adult Social Services
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Mr Burnham will be told at the conference that he needs to be clearer about how a national care service would be funded.
David Rogers, of the Local Government Association, said: "We need much greater clarity over this. We don't want to see councils left to pick up the bill."
He said local authorities had already had to start restricting access to services because of a lack of funding to cope with the ageing population - three-quarters of councils now only provide help to the most in need.
His concerns were backed by an Audit Commission report this week, which said councils were facing a struggle as the £9bn-a-year bill for older people could double by 2026.
Mr Rogers said the LGA did not have a position on which of the models for reform it preferred - this reflects the fact the group has cross-party membership.
But others at the conference, being held at the Department of Health's London HQ, are expected to ask Mr Burnham to be bold and go for the compulsory charge.
'Bun fight'
Stephen Burke, of Counsel and Care, a charity for the elderly, said: "It is time for a serious debate. We believe a system that involves everyone is the only way to properly fund care."
The Association of Directors of Adult Social Services said a compulsory charge was the best way to get the most funding.
Its president, Jenny Owen, said: "The problem with a voluntary scheme is that too many people opt out.
"We now need to get consensus. We don't need a political bun fight because then it will be put into the 'too difficult box'."
Liberal Democrat health spokesman Norman Lamb is expected to attend the meeting and his office said he was open to backing a compulsory charge.
The government had hoped to achieve cross-party support for a specific plan, which will be published in a White Paper in March.
The Conservatives have already published proposals for an £8,000 voluntary insurance fee to cover care home charges and is now in the process of drawing up similar plans for support at home for things such as washing, dressing and eating.
http://news.bbc.co.uk/1/hi/health/8522734.stm
Thousands of people in England are likely to receive more help towards their care costs, a minister has said.
Ivan Lewis, the care services minister, was unveiling a national framework for funding NHS continuing healthcare.
The aim is to standardise decisions on who is eligible for continuing care, making the process faster, fairer and more simple to understand.
However, campaigners said the measures did not go far enough, and many people could still be unfairly treated.
They also stressed it would not cover social or personal care, which includes help with washing, feeding and dressing.
It does not go far enough to convince us that it will achieve the basic changes that are so badly needed
Jean Gould
Help the Aged
Continuing nursing care - a package of nursing and social care - is needed mostly by elderly people to help them cope with illness, or an on-going medical condition.
At present, decisions on who is eligible vary around the country, often leading to people with identical needs being treated differently.
The new guidance - which will affect thousands of people living in care homes, and in their own homes - is an attempt to end this "postcode lottery" by introducing nationwide rules.
The charity Age Concern estimates 100,000 people should qualify for funded continuing care, but at present around 31,000 actually do. Under the new rules an extra 5,000 to 10,000 people should qualify.
Difficult decisions
Mr Lewis, said: "We understand that families do have to make difficult and emotional decisions when someone has to go into residential care and this can be made worse by having to consider how this will be funded."
STREAMLINED CHARGES
Under the new system, the banded charging system for the amount a primary care trust must pay to a home for providing nursing care will be scrapped
The three bands - £40, £87 and £139 - will be replaced by a single £101 flat rate charge
He said the new system would not solve all the problems immediately, but would lead to real improvements over time.
He said: "It will lead to fair and consistent access to NHS funding across England, irrespective of location, diagnosis or personal circumstances.
"This will make the system faster and more convenient for both patients and professionals.
"In particular, it will be of help to those who previously have been excluded, such as younger adults with long term neurological conditions and older people with dementia or other mental health needs."
Jean Gould, of the charity Help the Aged, said: "This is a helpful step towards resolving the horrific unfairness and inconsistencies which have so far blighted the lives of many older people and their families trying to grapple their way through a complex funding system.
"However, it does not go far enough to convince us that it will achieve the basic changes that are so badly needed.
"There is still no clarity about where social services responsibilities end and the NHS begins, leaving many potential gaps where no one picks up responsibility."
Complete overhaul
Neil Hunt, chief executive of the Alzheimer's Society, said the new guidance was an improvement on the current system, which he called a "public scandal" which discriminated against thousands of people with Alzheimer's disease.
But he added: "Despite this, there is no escaping that the current care system is broken and needs a complete overhaul.
"Thousands of families will still be left struggling with astronomical care bills. We need a national debate on who pays for care."
Conservative health spokesman Stephen O'Brien said: "It has taken Labour years to produce these new guidelines, yet they will do nothing to stop the scandal of elderly people having to sell their homes to fund their care."
The guidance comes into operation in October, and is expected to cost £220million in its first year.
http://news.bbc.co.uk/1/hi/health/6240408.stm