Thursday, 7 July 2011

Can trees really be more 'sexy' than people?

On Monday, just before the appalling revelations about the News of the World, hacking and Milly Dowler broke and understandably dominated headlines, the Dilnot report was published. It is the final report of the ‘Commission on Funding of Care and Support’ that has spent a year looking at how we can pay for the care of vulnerable adults over the coming years. It is a massively important and well crafted report that sets out a realistic financial model of how we can pay for the costs of an ageing society in years to come. I say that it is ‘really important’ because the status quo simply cannot continue – the system as it is is broken.

Previous Governments need to take a fair bit of responsibility here. After all they have had years to fix the system but didn’t. There have been numerous reports and commissions into social care over the years. They have reported with the conclusions being quietly buried shortly after. You can understand why. It is a brave politician indeed that stands up and says to the public ‘you know that you think that the NHS will look after you when you are unable to look after yourself, well actually it won’t and in fact it never has.’ But as research undertaken by Dilnot makes clear, the truth is that people do on the whole assume that. And it really isn’t something that you spend a lot of time worrying about when the issue doesn’t affect you.

The cold hard reality is that the costs of paying for social care are, on the whole, borne by those that need the help. So if you need hot meals delivering, help at home, a few days a week at a local day centre or to move into residential care and you have more than £23,250 in savings, then you have to pay. Once most of your savings have been spent, you will only get council funded services if your needs meet their criteria.

With local councils’ budgets being tight, you have to be pretty infirm to be able to get any help provided at all. If you think that you need help, then your local authority will first carry out an assessment to determine what your needs are. This assessment will categorise your needs as being low, moderate, substantial or critical. Generally councils will only help if your needs are assessed as being ‘substantial’ or ‘critical’. You will then be assessed financially and it will determine how much, if any, of the help you require will be paid for. And just to bring it to life, 'moderate needs', for which you are very unlikely to get any help anyway, means that you may not be able to get to the shops, use your bath or get out to meet your family or friends independently.

Suddenly finding that you or a loved one needs help either at home or residential care can be frightening, stressful, emotional and financially catastrophic. Help at home can cost between £10 and £20 per hour. The average cost of a room in a nursing home is £36,000 per year. The bills really do start to rack up quickly.

So back to Dilnot. These are not proposals for the state to pay for everything. The commission accepts that individuals should contribute something from their own assets towards the cost of their care and accommodation. Instead, there is a proposal for a partnership between the state and individuals that removes the uncertainty. Under the proposals, we will each be responsible for meeting some of the costs of our care but the extent of our exposure will be capped at £35,000. The capital limit will be raised from £23,250 to £100,000. After that the state will kick in and pay the rest although care home residents will still have to pay ‘hotel’ costs such as food and accommodation bills.

The proposal means an extra £2 billion or so in spending by the state a year, about 0.25% of public spending. And for that we get peace of mind that in our old age we won’t face the fear and uncertainty of not knowing how much or who will pay if we need it. Most people will still pay something towards their care. But for that £2 billion we can ensure that those with modest means will not be unduly penalized following a life of hard work and saving. And we can ensure that the poorest are protected.

It might not be at the sexy end of politics. But it matters. Right now the government is deciding on what to do with the recommendations. To be fair to them; it is a tough call. Like any balanced proposals, there are elements that will both appeal and repel the various strands of political opinion. And that is why we should all be helping to persuade them that this is not about party politics or point scoring. It is bigger than that.

Ed Miliband has promised to enter into all party talks and that is to be hugely welcomed. But we should all be writing and emailing our MPs to say that the government should, after considering and consulting, support and implement the commission’s findings as soon as possible. When there was a proposal to privatise a small proportion of the national forests there was uproar. Hundreds of thousands lobbied their MP. It sent a signal. Well this isn’t about trees; it’s about people. And that same uproar sadly appears lacking.

At the moment the government is promising a white paper by the spring. If the timetable slips, then it will be a sure sign of prolonged delay. Right now people are suffering, frightened and uncertain about their future because of a broken system. This is an opportunity to fix it.

Posted by Peter Watt, Chief Executive of Counsel and Care

This blog first appeared on Labour Uncut on 07.07.11

Thursday, 23 June 2011

Abuse of vulnerable adults: Why no inquiry?

Imagine if there had been a succession of child abuse stories in the media during the last six months. There would be an outcry. Every Baby Peter story that emerges, in all its grisly detail, somehow diminishes all.

The abuse of and suffering by the vulnerable affects all decent people deeply. We find ourselves asking, “how could this happen”? And “why did no one notice”? And worst of all, “what does this say about us and society”? Parents fear for their children and their children’s future. We collectively demand that something is done. Those involved become tabloid hate figures. Ministers condemn the perpetrators as evil and establish commissions to look at lessons to be learned. Our response is horror at the pain, misery and humiliation. We have a shared feeling that this abuse shames us all. And we have an angry determination that this abuse must stop.

The result is that over the years, there has been a succession of official commissions and investigations into the abuse of children. The Maria Colwell inquiry, the Cleveland inquiry, the Broxtowe inquiry, the Victoria ClimbiƩ inquiry (the Laming report) and most recently the Baby Peter inquiry.

Each tragedy has resulted in the strengthening of the law and procedures used by those responsible for protecting children. And thank goodness that this is the case. No child should suffer and it is a primary duty of us all to protect those who are unable to protect themselves.

And yet this is not always the case: not if you are an adult and vulnerable, for instance. Over the last six months there has been a succession of stories that have involved abuse of vulnerable adults in institutional care. The patient’s association, Listen to patients, speak up for change listed 17 shocking accounts of patient care in the NHS. Just read the stories and think about their suffering and the de-humanisation of them by those involved. And then ask why the names of Anne Robson, Elsie Pague, Brigid Wainwright and the other fourteen are not linked to sea changes in practice within the NHS.

Then there was the NHS ombudsman report, Care and Compassion that detailed the failings of care of older people in the NHS.

I have written about it before but it is worth repeating some of the abuse uncovered:

» Alzheimer’s sufferer Mrs J, 82, whose husband was denied the chance to be with her when she died at Ealing hospital in west London because he had been “forgotten” in a waiting room.
» Mrs R, a dementia patient, who was not given a bath or shower during 13 weeks at Southampton University Hospitals NHS trust. She was not helped to eat, despite being unable to feed herself, and suffered nine falls, only one of which was recorded in her notes.
» “Feisty and independent” Mrs H, who had lived alone until she was 88, was taken from Heartlands hospital in Birmingham to a care home in Tyneside but, when she arrived, was bruised, soaked in urine, disheveled, and wearing someone else’s clothes, which were held up with large paper clips.
Or the Panorama investigation into the systematic abuse of adults with learning disabilities at Winterbourne View in Bristol. I watched and wept as the secret filming uncovered the horrific torture of residents in their own home. Or the Dispatches undercover report Dignity in Dying that evidenced poor care of people at the end of their lives. Or the “abuse, lack of cleanliness and poor nutrition” uncovered in some care homes by consumer group Which?. Or, indeed, any one of the countless examples of poor care and abuse that make it onto news broadcasts and into our newspapers.

Just this week, the equality and human rights commission published a report into the abuse of older people’s basic human rights when they are being “cared for” at home. They identified examples of:

» People being left in bed for 17 hours or more between care visits
» Failure to wash people regularly and provide people with the support they need to eat and drink
» People being left in soiled beds and clothes for long periods of time
» A high staff turnover, meaning that some people have a huge number of different carers performing intimate tasks such as washing and dressing. In one case a woman recorded having 32 different carers over a two week period.
Of course, on the whole most care home providers are dedicated and professional and their staff provide excellent care. I have recently visited some excellent care homes where the quality of care was incredibly moving. Patients with severe dementia, who can be pretty tough to care for, were treated with dignity and respect by some fantastic staff. And most hospital care is first class and treats vulnerable patients as sentient human beings. But the stories of abuse are too common to ignore. They are already causing fear. Imagine if you had a vulnerable relative who went into care – you’d worry. Who wouldn’t?

So it is time to take a stand. Piecemeal investigations are no longer enough. Vulnerable adults deserve the same protection as vulnerable children. The government should establish an inquiry into the standards of care for vulnerable adults. It should be wide ranging: looking at staff training, accountability, rights and responsibilities. The failure of multi-disciplinary cooperation to pick up abuse should be looked at. And most of all there should be a framework set in law as to how vulnerable adults should be better heard in determining their own care.

This abuse causes pain, misery and humiliation. It shames us all. It must stop.

Posted by Peter Watt, Chief Executive of Counsel and Care

This blog first appeared on Labour Uncut on 23.06.11

Thursday, 16 June 2011

Supporting carers is not just right, it's rational

This week is carers week, when the fantastic contribution and role played by the millions of carers in the UK is celebrated. It is all very big, or even good, society. The numbers of those with a caring role is on the increase. But there is one particular group of carers whose numbers are increasing fast, and that is older carers who care for very old relatives. The reasons for the increase are clear. According to the ONS, the fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. This is, of course, a fantastic success story with people living longer and living healthier for longer. But it also means that there are many older people who are themselves caring for very old and frail relatives.

The statistics are not even half the story. Behind them are hundreds of thousands of human stories of love and care that are a source of pride and inspiration. But they should also be a source of shame that as a society we are still allowing people to struggle so appallingly. Take Mrs M who is 80 and cares for her husband, Mr M, who is 87.

They have been married for forty years and until Mr M was diagnosed with dementia 6 years ago they had plans to travel in their retirement. He was once a pre-eminent science lecturer and it has been difficult for Mrs M to adjust to the changes in Mr M’s behaviour. On top of all of this, Mrs M has arthritis and has been suffering from exhaustion due to her caring role. She loves her husband but is struggling to support him – she will not give in willingly though.

She is not alone in this. It has been reported that 75% of carers have suffered with health issues as a result of their caring role. Unfortunately, reductions in the budgets in Mrs M’s London borough mean that her husband has had his needs reassessed by the local authority. Because it is not seen as a “critical” need to go to a day centre, Mr M will no longer have his one day a week outing. This break gave Mrs M three hours of time to take care of paper work, do the shop, and possibly attend GP appointments for her arthritis.

The problem is that Mrs M’s own health is deteriorating because of her arthritis and the decreasing amount of support she gets from her local council. Losing just three hours a week in respite means that pretty soon Mrs M won’t be able to take care of her own needs. This could, and in fact often does, lead to a crisis where two people end up very ill and without support.

If Mrs M couldn’t care for her husband, then the state would have to step in. And that costs. In fact, the replacement value of a carer is £18 an hour. With an estimated 6,440,713 carers in the UK, people like Mrs M, pound for pound, save the UK economy £119 billion per year by caring for a partner or family member. Even if Mrs M only cared for her husband five hours a day, instead of her usual 12 (including being woken up each night), she would have saved the economy £32,850.00 a year. That is for five hours a day. The fact is, most carers report that they care for someone for over 50 hours a week, saving the economy, on average, £52,560.00 a year per carer.

According to carers week:

» 76% of carers are worse off financially since taking on their caring responsibilities;
» 75% of carers have suffered with health issues as a result of caring;
» 49% of carers have a disability, condition or illness themselves;
» 48% have been a carer for more than 10 years;
» 78% are female.
So carers are a massive and undervalued resource. They save us all money and provide the ultimate welfare state to their loved ones. Successive governments’ track record in supporting this group is pretty poor – none of us has much to be proud of. But as we look at making savings in the public purse, we should take care that we don’t make the situation even more difficult. The long term cost to the taxpayer would be much more than the savings. The human cost would be incalculable.

Remember that in the future Mr and Mrs M could be you.

Posted by Peter Watt, Chief Executive of Counsel and Care

This blog first appeared on Labour Uncut on 16.06.11

Monday, 2 May 2011

'Keeping Mum' and the true face of caring

During my Easter holiday break, I allowed myself to take with me just one piece of work - a book called Keeping Mum: caring for someone with dementia, which I had been asked to review. With a couple of long tube journeys down the Piccadilly Line to Heathrow, plus some time waiting to board at either end, I figured I could at least read chunks of the book to enable me to write a decent review.

But this is not that sort of book - I found myself enthralled, and read it from cover to cover. The main part of the book is a series of blogs that the author, Marianne Talbot, wrote for Saga Magazine, to record her experiences caring for her mother. Marianne uses an endearing term for the cared-for person - 'piglet' - 'Person I Give Love and Endless Therapy to' courtesy of Hugh Marriott who used it in his book about caring.

Marianne gives a no-holds-barred account of life as a carer and her struggle to navigate the system whilst holding on to her career, her social life and her sanity. The struggle of her mother to comprehend what is happening to her also comes through as Marianne imagines life through her eyes.

I can remember seeing Marianne speak at the 2009 Conservative Party conference, where she was on a panel alongside the then Shadow Health Minister at a session devoted to the care of older people, which we as exhibitors managed to get into alongside our partners, Carers UK, who had made the debate happen at conference. I remember her as an excellent speaker that in person was just as engaging as she is in her blogs.

If anyone wishes to find out what it is like to care, read this book - or if you are a carer I am sure that you will read this whilst continually nodding your head to all of the experiences described. The book is witty, hilarious at times, and finally, very moving. Alongside this, there is realistic and sensible advice for others in the same situation at the end, with practical information and a list of organisations that can help you and your 'piglet' - I was pleased to see Counsel and Care included.




Marianne's account of her experiences are inspiring on so many levels, whether or not you have experienced life as a carer. She proves that with determination, so much can be achieved for both the carer and their 'piglet', and that it IS possible to continue to work and care with the right support. Far too many people (many of them female and at the height of their careers) are lost to the workforce as they have to give up work to care full time, risking falling into poverty themselves when they reach pensionable age. We need to reduce this risk (see the previous blog on Care Concerns), and this book is a huge contribution to a solution as the proportion of older people needing care is set to grow.




Carers Week takes place every year to highlight the challenges of caring and reach hidden carers. The theme of the 2011 Week is 'The true face of carers' and the campaign will seek to discover what life is really like for carers in 2011. How much information is available? How much help do carers get from government? How hard - or how easy - is life as a carer? All of these questions will be answered during the Week that takes place from 13-19 June 2011. Counsel and Care is a partner of Carers Week, and you can find out more on what is taking place at http://www.carersweek.org/

Keeping Mum: caring for someone with dementia is authored by Marianne Talbot and is published by Hay House. Find out more at http://www.hayhouse.co.uk/ or for publicity enquiries, contact Jo Burgess on JoBurgess@hayhouse.co.uk or call 020 8962 1230.

The book can also be purchased at Amazon - www.amazon.co.uk and the Keeping Mum website can be found at www.keepingmum.org.uk

Monday, 28 March 2011

Who Will Care for Women?

Here we are in 2011: the Government has announced this year’s budget, councils are tightening their squeeze on public services, and it would seem older people will continue to lose out. But what about the progress being made by the Commission on the Funding of Care and Support? This Commission is looking into the long term funding of social care and the responses to its work are a mix of fear, hope and righteous indignation. Across the charity sector there is speculation as to its great power to create change or the possibility that it will be Dead On Arrival much like the previous efforts to sort out a coherent system. But there is a deafening silence on one topic.

Regardless of the system that is created - compulsory partnership or voluntary insurance scheme - it will fail if it does not account for women. Especially older women who could stand to gain in this system but, if forgotten, will again be relegated to the status of second class citizens as has happened in pensions. This country’s Government has long ignored the unpaid caring contributions made by women and the Commission’s Call for Evidence continues this trend by never outright mentioning gendered variations in caring.

This is no small point. Women make up the majority of people aged over 65 at 129 women to every 100 men. Women of all ages are the bulk of unpaid carers for children, the disabled and older people. They also are disproportionately represented in social care work, a notoriously poorly remunerated field. Women are, quite literally, the majority of inputs to and outputs from the social care economy that has been undervalued and devalued.

Let us not forget that women are still well behind men in terms of cumulative life time earnings because of time taken out to care, the gender pay gap, and over-representation in low paid, flexible and part-time work. This is not changing. If women struggle to accumulate pensions at a par with men, even the most sophisticated of partnership systems based on compulsory top-ups by the public will not account for a life time’s worth of low wages and time out of work. If social care is an area predominantly made up of one gender, where are the indications that economic modeling takes into account women’s working patterns and that their needs will be supported in this new world?

The ‘Sandwich Generation’ (the increasing amount of women who are caring for young children and parents at the same time) may be left feeling a triple burden as men continue to have higher earnings, higher pensions savings, and now greater social care assurances while women still bear the bulk of caring responsibilities. What will happen to women if the largest ever inquiry into economic reform of social care forgets to include women?

Posted by Lili Hoag, Senior Policy and Communications Officer

Thursday, 14 October 2010

MORE FAMILIES PAYING OUT FROM SAVINGS SO LOVED ONE CAN STAY IN CARE HOME

Helping a relative or loved one to move into a care home is always a traumatic and emotional experience. So an unwelcome addition to this stress is when the local council social services inform you that you will have to sign a third party top-up agreement to keep your relative in the care home that you have chosen.

Our advice line has been getting more and more calls from families who have been routinely requested to pay more money for their relative’s care home fees in addition to the contribution made by social services. This is a worrying trend that is one of the main topics of concern to reach our advice line. In fact, it is not unusual for us to receive calls from distressed family members who are being given wrong information about third party top-ups or who feel bullied and threatened into signing a top up agreement with the council or the care home.

Recently, I was contacted by the wife of an elderly gentleman who had been in a care home for a number of years because of dementia and other serious health problems. He had been assessed as needing residential care because his wife, who had looked after for him for years, was not longer able to manage his care at home. Now that his savings had reduced to the capital threshold of £23,250, the local council had become involved in contributing towards his care home fees. The wife, whose own income was supplemented by Pension Guarantee Credit, was told by a social worker that if she did not agree to pay a substantial monthly top up to the care home fees, her husband could be returned home.

I was able to advise her that this was incorrect because firstly, her husband had been assessed as needing 24 hour care and the council had a duty to provide this, and secondly, guidance suggested that councils should not make third party agreements with relatives who were unable to financially sustain the arrangement. Our enquirer contacted me again to tell me that the advice and guidelines I had given her enabled her to challenge the council’s stance on this matter and it had now agreed to pay the care home fees in full.

Third party top-up agreements should only be requested by councils in certain circumstances, not as a matter of course. Only where a care home that is more expensive than the usual council rate has been chosen by an older person on the basis of preference rather than on the basis of their assessed care needs and where a cheaper, but still appropriate care home vacancy is available, can councils ask families to pay more. There are clear government guidelines on this issue for councils to follow and it is important to seek expert advice from organisations like Counsel and Care before signing a third party top-up agreement.

However, I do remain concerned how many people remain unaware of this and continue to pay out often from their own retirement savings to ensure that their loved one remains living where they want to be. The forthcoming cuts to council budgets has the potential only to make this situation worse, unless we do more to highlight people’s rights and entitlements in this area.


Posted by Pat Lacroix, Counsel and Care Second Tier Advice Worker

Wednesday, 28 July 2010

TURNING UP THE HEAT ON BRITISH GAS

While everyone else is tightening their belts, British Gas today announced a 98% rise in its profits, making £585 million profit in just the first six months of 2010.

Clearly British Gas profited from the very cold winter because older people and others had to use more gas to stay warm.

Rather than further price rises, surely British Gas should be looking at how to help older people with their gas bills in this coming winter and beyond.


Posted by: Stephen Burke, Chief Executive, Counsel and Care