End in sight for postcode lottery?

Finally.

After years of grumbling by people in the care system, the government has finally announced that the eligibility criteria governing older and disabled people’s right to receive care services is to be reviewed.

In theory, this review could see the end of the unacceptable ‘postcode lottery’ of care services. But we should not get too excited – the credit crunch could see any reform stymied.

One of the most common gripes I hear is the unfairness of the care services system, where someone in one area is denied – in some cases life-saving – drugs, while elsewhere they’re available.

The Commission for Social Care Inspection has been asked to undertake the review and report back to Care Services Minister Ivan Lewis in the autumn. CSCI’s brief is to focus on national definitions of need and the application at a local level.

At least the review is focusing on the right area. A set of national guidelines for eligibility, which are not open to interpretation at a local level, is crucial. All too often local officials have their own take on the rules and this needs to be stopped. Access to care services should not rely on the luck of where you happen to live.

But much of the postcode lottery is borne out of a lack of adequate funding for social care services. Many councils have ramped up their eligibility criteria in recent years to save money and plug huge holes in their budgets.

And with the credit crunch and resulting economic downturn, it is unlikely the government will start pouring extra cash into council budgets to fill those holes.

So while this review is to be welcomed, how much effect will it really have? If any major reforms happen, they will be down to the economic situation and the prospects for the moment are looking grim.

Do you feel lucky?

Continuing care should be given to everyone when they need it. But the current system is hampered by a postcode lottery, depriving many because of where they live – and this is only going to get worse.

New government guidelines have increased the eligibility for access to ‘Continuing NHS Healthcare’ by more than 5,000, Age Concern says. Yet in many areas of the UK vulnerable people are seeing reductions in the services offered.

If you live in Mid Essex, Sandwell and Wandsworth, the situation can’t get much worse.

All three authorities have reduced the continuing care services offered by more than 80%. East Riding, meanwhile, halved the number of people receiving continuing care – some achievement considering they had the second-lowest number of service users in the first place.

The gap between the worst Primary Care Trusts and the best is one that deserves much consternation and head-scratching, and is evidence of the postcode lottery facing people who access healthcare.

If you live in Coventry and Plymouth you’re in luck – both have reported a growth in the number of people using the service. Better still, Derby, which had the lowest number of people accessing continuing care in 2007 – 1.5 people per 50,000 – has grown to 25 people per 50,000.

How some PCTs can offer such extensive continuing healthcare while others fail is a mystery, but by naming and shaming Age Concern has successfully highlighted the inequalities found throughout the UK.

In the case of some – particularly Derby – it’s great to see moves being made in the right direction, and the PCTs should be praised for raising the standards. But this still remains a postcode lottery that needs cracking.

Where has all the money gone?

That was the question asked by Age Concern recently when it reported that an estimated 2.2 million pensioners had not claimed council tax benefits. Elsewhere, 1.7 million were not claiming Pension Credit, and 310,000 were not receiving Housing Benefit. Total all this up and it amounts to some £2,000 a year per household in unclaimed benefits.

There may be a stigma attached to claiming benefits, but £2,000 is a lot of money – especially for pensioners who may be funding care, may still have a mortgage to pay, or may be caring for somebody else.

But, above all, can government do more?

In a sophisticated modern state like Britain, it’s disquieting to think there’s not a central database that contains all this information. Government is eager to catch tax dodgers, but seldom eager to pay out when it should.

Moves are being made in the right direction with the initiative on self directed support, a buzzword that means people will be given the freedom to choose their own kind of care out their own personal budget, supplied by the local authorities. This will also give people the right to question the benefits system – and hopefully encourage them to take the benefits that are on offer.

Nevertheless, self directed support will take years to roll out across the country and each local authority will have its own idiosyncrasies regarding services. It’s certainly not a quick-fix panacea and, meanwhile, older people will continue to lose out on essential benefits.

So what’s the answer?

If you can, go to your local social services, speak to your social worker and demand to know what benefits you are eligible for. This really is essential; it could be the difference between a cosy, heated home or days spent under covers in the bedroom during the latest cold snap.

Care home attitudes need to change

When many newspapers recently carried stories about hundreds of illegal immigrants working in care homes, one question was left unasked: why are so managers willing to employ them?

The answer, it seems, is that most British people don’t want to work in care homes.

Recently I attended a conference where I was told that the available social care workforce in one English town dropped by 10,000 after a Morrison’s superstore opened up nearby. To put it bluntly: most British people would rather work in a hypermarket stacking shelves than help to care for the elderly and disabled.

Unfortunately, it’s a scenario that has been repeated across the country and should surprise no one in the caring industry.

Working in social care requires dedication, but it’s low paid, the hours are long and the media publicity is almost wholly negative. It’s hardly an incentive to want to join the industry.

To state the obvious: a sea change in the perception of care homes and care home workers is needed. But the question is how to achieve it.

A good start would be to emphasise the positive work that goes on in many residential homes. For example, schemes such as Art for Age, in Kidlington in Oxfordshire, a joint project between the Glebe House care home and Beckley Primary School, showed what can be achieved. The public display of artwork late last year was a great success. See www.bettercaring.com/editorial/channel3.aspx?id=370 for the full story.

Highlighting the tireless work that many care home workers and managers put in to the job would also help the industry. This could help restore a sense of pride in their work.

As well as this, pay rises for care home workers would help to retain the best staff and provide an incentive for others to progress.

Many care homes, especially those run by the local council, operate on tight budgets, with little in the pot for pay increases. With the government showing little sign of increasing funding for social care, staffing concerns and adverse media publicity are probably set to continue.

Benefits system needs continuing reform

With a benefit called ‘continuing health care’, you would expect it to be paid out to all those with long-term serious healthcare needs. But apparently not.

Currently, more than 400 people are suing various health authorities after they or a family member were refused continuing health care. They allege they were not given proper assessments and had to pay out hundreds of thousands of pounds in some cases for nursing care as a result.

While the plaintiffs are seeking compensation, it highlights the confusion around what constitutes social care – which is means-tested and carries a charge – and health care, which is provided free by the NHS.

The distinction between the two has been muddled for years, and has often come down to the local Primary Care Trust’s interpretation of government guidelines.

Unsurprisingly, it has led to some frankly baffling decisions. I have heard anecdotally of a man with the later stages of dementia – he could not walk, barely talk, was doubly incontinent and needed help for the most basic of tasks – refused continuing health care.

How a man with such care needs, and who’s health clearly won’t improve, does not warrant continuing health care funding is beyond me.

This provides another example of the urgent need to reform care funding. The guidelines for awarding benefits such as continuing health care need to be clearly set out and the distinctions between the various benefits need to be made clear to all.

If this happens, it could stop people being wrongly forced to pay for their care. Estimates in the press speculate that if the judge were to rule in favour of the 400, thousands of pensioners could be in line to claim refunds from the government – a bill that could run into hundreds of millions.

It is a bill the government could ill afford, but may help galvanise ministers into action to ensure that such cases do not occur again and that the care funding system is finally made simpler and, for many people, fairer.

Bogus nurses: a care home conundrum

If fighting against perceived poor standards and public perception weren’t enough, care home managers now have to contend with fake nurses.

This goes far beyond poorly qualified staff and involves people pretending to be registered nurses to work in a care home.

The story of 49-year-old Carol Dabbs is one that should alarm every care home manager – and the families of anybody who lives in a care home.

Dabbs is alleged to have lied about being a nurse, and worked at a couple of care homes in Wales between 1992 and 2006. She was allowed to administer drugs and care for vulnerable frail people with no qualifications or training.

She now faces criminal charges of deception, supplying class A and class C drugs and wounding. A helpline has been set up for people who may have been treated by her.

At Bettercaring we hear of numerous cases of people unqualified to do the job, but few are as serious as this.

That Dabbs got away with it for almost 15 years is frightening and astonishing, and part of the blame must lie at the doors of Neath Port Talbot Social Services and the two care homes in question for not vetting the staff appropriately. Even the Care and Social Services Inspectorate Wales (CSSIW) should face an inquiry for such an enormous lapse.

But it begs the question – how easy is it for someone to get a job in a care home without the right qualifications?

I recently spoke to Diane Smith, the manager at Cantelowes House in Barnet, and was impressed with the standards of recruitment in the home. She refuses to use agency staff and ensures there is a paper trail associated with every member of staff.

New members of staff don’t start work until all of the checks have been carried out, and this paper trail makes it impossible to falsify records – training and experience. It’s an almost foolproof system.

Diane admits it’s a long process, but it means there are no false nurses on the books – and she can sleep easy when CSCI come to visit.

A little perspective

When allegations surfaced of dementia sufferers being neglected at Bamburgh Court Care Centre in South Shields, the ‘Fourth Estate’ went on high-alert.

With reports of residents being forced to sleep on filthy mattresses on the floor, mouldy food left rotting in the cupboards and faeces smeared on the walls, it’s no wonder many older people fear going into a care home.

These shocking allegations about Bamburgh Court Care Centre appeared last week in the Daily Mail and this story will no doubt heighten fears about the standards of care in residential homes.

But from what we have seen at Bettercaring, these cases are few and far between and the vast majority of people in care are well treated and lead happy lives.

In truth, nobody knows how prevalent abuse is in care homes, which is why the announcement of a £2 million study by the Department of Health and Comic Relief into the risk of abuse in care homes and the infringement of dignity on NHS wards is timely.

The research, which, crucially, will take in the views of older people, should finally show how widespread – or not – abuse is in care situations.

The results of this research – slated to come out in 2011 – will hopefully demonstrate that abuse in care is rare and that cases such as Bamburgh Court are the exception rather than the rule.

But more importantly, it should help to change perceptions about the industry.

In the meantime, the government has announced plans to strengthen protection for vulnerable elderly people in care homes and ensure those that do suffer abuse can bring the perpetrators to book.

The government plans to make people who have publicly-funded care in private homes subject to the Human Rights Act, which should safeguard them from such things as unfair eviction. Also, self-funders will be able to refer complaints to an independent adjudicator from later this year.

These are all positive steps and should, in time, help to rebuild the industry’s reputation, which has been consistently tarnished in recent years by stories such as Bamburgh Court. It will take a long time to change the public’s perception, but these are steps in the right direction.