At a strategic level, the last decade has seen the LTC agenda move from a backwater activity into mainstream thinking. Ample evidence has been provided, for example through national service frameworks and NICE guidance, to show that fundamental changes in the way care systems operate are needed to improve quality. More pertinently, the evidence suggests that retaining the status quo is likely to become economically unsustainable unless we can find new ways to manage demand for health care – the majority of which will come from those living with long-term chronic illness.
System redesign is long overdue. Health and social care needs to shift the balance of its business out of institutions into the community and, ultimately, into the home. If we continue with the same business model then we are creating a dangerous mix of higher taxes; reduced entitlements to care; the rationing of treatments; longer waiting lists; and the cutting back on public health initiatives. The financial crisis only adds to the problem of sustainability.
Most changes are brought about through necessity, and there is growing demand to understand what works and what value can be derived from new approaches to care integration in supporting those with LTC needs – for example, enabling people to manage their own care; offering personal health budgets; providing case management to those who need it; and in avoiding unnecessary hospitalisations and nursing home stays.
The coalition government’s plans for GP commissioning also suggest a move towards creating a more population-based focus, as GPs would become responsible for the health and welfare of communities in addition to their traditional care of enrolled patients.
However, achieving higher quality care for people with LTCs requires the evolution of multi-specialty, local clinical partnerships, a ‘shared care’ model of working with other care providers, and more effective and pro-active ways to support patients in the self-management of their conditions. Presently, those working in the system find it difficult to embrace these changes willingly.
Politicians, for example, know that votes lie in protecting the future of a local acute hospital. Arguing that care should be shifted out of hospital, and/or that patients should really take personal responsibility for managing their own care, would be considered ‘brave’. Professionals, too, primarily remain focused on traditional ways of working. While there is a momentum to change services for those with diabetes and other specific conditions, there is no professional voice or system leadership to promote the cause of those with long-term conditions – particularly those with multiple care needs. The voice of the public and patients in demanding change too often goes unheard or is undervalued.
We are beyond the tipping point where the LTC agenda can be ignored, but where will the system leadership come from in the New World of the NHS to drive it forward?
PDF version More than one in five councils in England is illegally charging service users for reablement packages of care, research by Community Care has found.
Our investigation has prompted the government to promise guidance instructing councils not to charge, while one local authority, West Sussex, has suspended its charges and is seeking legal advice from the Department of Health.
A Freedom of Information request, answered by 96 of England's 152 councils, found 22% levied a charge for reablement.
Many of the descriptions of reablement services provided by the councils surveyed met the definition of intermediate care, which must be provided free for the first six weeks under the Community Care (Delayed Discharges etc) Act (Qualifying Services) (England) Regulations 2003.
Cate Searle, community care lawyer at Martin Searle Solicitors, said: "Simply calling intermediate care by another name does not allow a local authority to charge for it."
Sector leaders were highly critical of the charges.
Louise Lakey, policy manager at Alzheimer's Society, said: "Services such as intermediate care are vital for people with dementia especially considering the current economic climate. It enables people to stay out of hospital and residential care – which are very costly – and receive care in the community instead. It should not be charged for."
Reablement has been proven to help councils contain care costs by helping people stay independent. Association of Directors of Adult Social Services president Richard Jones warned charges would blunt this effect. "We want to incentivise people to benefit from a reablement package," he said. "That's in our interest as a council, it's in our partners' interests and the interests of those people receiving the service. Charging people for it isn't sensible or sustainable."
Marije Davidson, public affairs manager for disability network Radar, said: "Local authorities are denying people living with ill-health, injury or disability the very services that enable them to take an active part in society."
Many of the councils who charged for reablement said their service did not qualify as intermediate care. One director said: "The reablement service is for people with a social care need, and is not for those with health needs."
The DH issued guidance last year, Intermediate Care – Halfway Home, which stated that social care reablement "fulfilled the intermediate care function" and reiterated that intermediate care should not be charged for. However, this guidance was "very poorly drafted" and "inconsistent in its messages", said Community Care's legal expert, Ed Mitchell and may have allowed councils to think charging for reablement was legal.
Speaking to Community Care at this week's Liberal Democrat annual conference, care services minister Paul Burstow said: "We will issue fresh guidance to tell councils not to charge for reablement services."
He also promised extra funding for reablement services. "The best local authorities are running reablement services that ensure people no longer need care. It's about giving people back their freedom," Burstow added.
What is reablement?
Reablement is one of councils' main tools in managing the costs of an ageing population and will be important as authorities face cuts in government funding of 25% or more from 2011-15.
Providing personal care, help with daily living activities and other practical tasks, usually for up to six weeks, reablement encourages service users to develop the confidence and skills to carry out these activities themselves and continue to live at home.
It tends to be provided to people who have just been discharged from hospital or are otherwise entering the care system following a crisis.
A 2007 study for the Department of Health's care services efficiency delivery network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.
Services are often delivered by in-house council care teams, rather than the independent sector, and involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.
Almost all of England's councils are planning, implementing or running a reablement service.
How reablement saves councils money
http://www.communitycare.co.uk/Articles/2010/09/20/115393/one-in-five-co...
Liberal Democrat leader Nick Clegg has acknowledged the concern public sector workers are feeling about the impending spending cuts.
"I know these are very unsettling times for you. I will not disguise the fact that we need to take difficult decisions today to ensure there are good, affordable public services tomorrow.
"We have protected the funding for the NHS, the biggest public service of all. We will provide more, not less, money for the children in our schools. But I know you will be thinking: why should you have to make any sacrifices to deal with a recession you didn't cause?"
"Why are the bankers who helped create the mess not taking more of the blame? I agree. That's why we imposed a levy on the banks in our first budget."
Clegg called the £44bn spent a year on debt interest a "criminal waste of money". "It shouldn't be lining the pockets of bond traders. It should be paying for police, care workers and schools," he said.
On the coalition's controversial plans to cut welfare, Clegg said: "We will be tough on welfare cheats. But unlike Labour, we'll be tough on tax cheats too." He also repeated his guiding belief that "work is essential to a person's sense of self worth, their identity".
On the coalition’s controversial plans to cut welfare, Clegg said: “We will be tough on welfare cheats. But unlike Labour, we’ll be tough on tax cheats too.” He also repeated his guiding belief that “work is essential to a person’s sense of self worth, their identity”.
Speaking at a time of concern of many party members over public sector cuts, Clegg also said he wanted to make it clear that the coming spending review was “not an ideological attack on the size of the state”. “There is one reason only for these cuts. As [outgoing chief secretary to the Treasury] Liam Byrne said in that infamous letter: there isn’t any money left.”
Clegg promised to “restore power to people, families, communities, neighbourhoods and councils”, describing the coalition as “a liberating government”.
In his wide-ranging speech, Clegg also repeated his pledge to stop “Labour’s mass incarceration of children”.
http://www.communitycare.co.uk/Articles/2010/09/20/115386/clegg-claims-c...
dult social care cuts are hitting one in two English councils, a survey by charity Counsel and Care revealed today.
It found half of the 56 councils surveyed had decided to cut or reduce the range of adult care services they fund, ahead of next month's government spending review, which is expected to deliver savage cuts to councils.
Six of the councils surveyed are considering increases to home care charging and four others are already consulting on this. Of the councils surveyed, the highest hourly rate charged now sits at £19.70 an hour. Currently 20 councils charge more than £14 an hour, with 12 charging more than £15 an hour for essential home care.
The charity also raised concerns about councils increasing eligibility criteria. This follows exclusive research by Community Care that found that 80% of councils will no longer be meeting service users' moderate care needs from next year on current trends, up from 75% now.
"If these short-sighted plans are put into action, the impact will be felt first by the most vulnerable, who will have to go without vital care and support and then on acute health services as people are forced to reach crisis point before they get help," said Counsel and Care chief executive Stephen Burke.
http://www.communitycare.co.uk/Articles/2010/09/20/115356/Adult-social-c...