Carer’s Strategy – a step forward?

The government’s much-vaunted update of the Carer’s Strategy was launched earlier this week and, as ever, while it contains some help for those in need, it doesn’t go far enough.

The new Carer’s Strategy certainly makes some bold commitments. For example, it says that by 2018 ‘carers will be able to have a life of their own alongside their caring role’ and will be ‘respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role’.

But cut through the raft of rather woolly but well-meaning objectives and there is little concrete detail of how this will be achieved. I assume this will come later, possibly around election time, if you’ll excuse my cynicism.

Nevertheless, there are positives; the measures that have been announced, such as establishing a helpline and website for carers and launching a training programme for carers, seem to be a move in the right direction. I often hear carers saying that information is at best difficult to come by and anything that will help them cope with their responsibilities better is a good thing.

The move to double the amount of respite time available is also good news; it is now becoming acknowledged that carers – and the people they care for – need to have breaks from each other.

But the real bugbear is that the Carer’s Allowance, which currently stands at a frankly pathetic £50.55 a week – or £2,682 a year – has been left untouched.

The benefit, which is the lowest available, is often not worth the hassle and can tie carers into a poverty trap; if they earn more than £95 per week or study for more than 21 hours per week they can no longer receive it.

But rather than give any immediate increase in the benefit, the government has chosen to lump it in with the wider review of care funding and benefits, which is currently in a 6-month public consultation process and the review won’t be released until some time next year.

Until then, the new strategy will not affect many carers’ lives and no matter how many platitudes are trotted out, it will be the pound in their pocket that many carers will be most interested in and will make the most difference to them.

Social care cuts: a worrying story

Now, only 4 councils provide care for the neediest in society, according to a report on the BBC’s Politics Show.

Good news if you live in Calderdale, Sunderland, Darlington or on the Scilly Isles – but worrying for the rest of us. Over 75% of local authorities now provide social care for elderly and disabled people who meet the criteria for ‘substantial’ needs. For those with ‘moderate’ or ‘low’ needs, they are left to face the challenges on their own.

And the situation’s unlikely to improve any time soon.

An estimated £6 billion budget shortfall over the next 20 years, caused by an ageing population and more demand for services, will further restrict the opportunities for those at the lower end of the care spectrum.

The much-touted personal care budgets will do little to ease the situation and simply shift the burden away from social services and onto the families, who will struggle to fill the gaps in the care services.

But at least there’s one solution in the short-term; you could always move to Sunderland…

The future’s not bright

Ageism, neglect, poverty, isolation and deprivation; if that is all that the UK’s pensioners have to look forward to, it is no wonder that a quarter are making themselves sick with worry about it.

Help the Aged’s report ‘Spotlight 2008’ paints a grim picture for the nation’s elderly, claiming that ageism is rife, 21% of pensioners live below the poverty line and one in five do not always get treated with dignity in hospital.

As a result, nearly a million more older people are making themselves sick with worry than this time last year, the charity reports.

So much for retirement as the “golden years”.

Inevitably, Help the Aged has outlined a list of policy demands for the government to adopt, including a ban on age discrimination in the upcoming Equality Bill and establishing a targeted strategy to reduce pensioner poverty.

These are all laudable aims but whether the government will listen is another matter. There was precious little in the last Budget for older people – bar an increase in fuel payments, which will not cover the hike in prices – and it has steadfastly ignored all calls to raise the basic state pension and recently fudged the reform of the social care system.

The government’s ambivalent attitude to an increasingly large section of society seems to be percolating down to other areas, with ageism in the workplace and in general seemingly on the rise.

If this is to be addressed, the government needs to take the lead and put in place measures to ensure that pensioners do not have to struggle in poverty and are treated with the respect that anyone – regardless of age – deserves. The recent appointment of Sir Michael Parkinson as a ‘dignity ambassador’ is a step in the right direction, but more needs to be done.

After all, the power of the “grey vote” should not be underestimated. A few pensioner-friendly moves could bring Labour much-needed extra votes whenever the next election rolls around.

Social care funding: who cares?

So what is all this hogwash from the government about giving people a fairer deal on social care?

It’s the old tale of Nero fiddling while Rome burns, and all that...

Ever since New Labour stormed to power, the government has promised to review the care system with a view to reforming it. It’s a story that started in 1997 just as Tony Blair moved into 10 Downing Street.

This week, some 11 years later, Gordon Brown announced to a population weary of government obfuscation that six months of public consultation on social care is to begin in earnest. Meanwhile, a Green Paper on social care, first earmarked for publication in April, is not even on the horizon.

This is a typical government fudge designed to kick the social care agenda into touch until the run up to next general election. At that point Brown, or whoever else is running the Labour party, will issue a new social care manifesto amid much fanfare and vote catching headlines: “They care after all”. The government has probably already booked a slot in 2009 on the Andrew Marr Sunday show. Election 2010: you read it here first.

Meanwhile, back on planet earth, a brace of surveys has damned the way social care is organised in England and Wales. People are worried about how to pay for their care, worried about moving into care homes and very worried about the current means-testing system. One survey by Caring Choices found 90% of people want to see the back of it.

And as the government procrastinates, the malaise in the social care system intensifies making reforms more difficult to implement. Local authorities become more cash-strapped, cutting off vital services and politicians continue to obfuscate where possible because they have no answers –and because they can.

And while Nero fiddles and all that… real statistics on social care relating to real people’s lives will continue to do the rounds. Some facts to date: by 2028 there will be a £6 billion shortfall in care funding; at the same time a quarter of the UK’s population will be over 65 years old and those over 85 years old will have doubled. Meanwhile more than 1 million will have dementia. Who will be caring for all these people and how is that going to be paid?

Remember, we’re not talking here about your mums, dads or grandparents – the next generation is you and me.

By Andrew Chilvers

All stars?

This week, the Commission for Social Care Inspection has launched its much-vaunted star ratings system for care homes. But are they a useful guide for the public or just a waste of time?

The theory is that the system of awarding care homes stars gives the public an at-a-glance guide to how good a home is; 3 stars means it’s an excellent home for you or your mum, 0 stars means it should be avoided and possibly be closed down.

So far, so good – after all, it works in the hotels industry, among others. But moving into a care home is a much more complicated business than looking for a hotel and should not be viewed in the same way – it is more like buying a house and should be treated with the same thorough research.

So for this reason, I wonder whether the star ratings will really make a difference. People looking for care homes are increasingly savvy and many already know of and use the freely available CSCI reports on care homes. These go into much more depth about the conditions there, judging it over 7 categories and listing what the home does well and does badly, rather than just an overall star rating.

For me, the star ratings will only be useful at the outset of a search for a care home. If someone is skimming a list of homes in an area, it will most likely mean that homes with poorer ratings will instantly be discounted.

But this will not save that much time because about 70% of care homes have received a 2 or 3-star rating so far and only 3% given a zero rating. While this is good news – it shows that the vast majority of care homes do provide a good service – it will not narrow the field down much for many people. So they will still have to complete the time-consuming legwork to find the right home for themselves or their loved one.

Dementia drug appeal victory gives hope

It seems odd that while potential treatments or cures for Alzheimer’s disease are heralded in the media virtually every week, access to a readily-available drug that is proven to help people with the condition is restricted.

Yet this is the case with Aricept, a drug that many people with early-stage dementia say has changed their lives – although hardly anyone can now get it on the NHS.

But this could be about to change, thanks to a Court of Appeal ruling.

The ruling relates back to November 2006 when the NHS advisory body, the National Institute for Health and Clinical Excellence (ironically referred to as NICE), decided it was not cost-effective to give Aricept to people with early-stage dementia and reversed its earlier guidance to issue it as standard.

The decision came as a shock to many people with the condition. Anecdotally, many have sung the praises of Aricept and the way it has given them their life back – few can fathom NICE’s decision.

Moreover, nobody understood the decision because few if any details of how NICE reached that verdict were made public.

As a result, Eisai, the manufacturer of Aricept, challenged the process that NICE went through to arrive at its decision to restrict access to the drug. The case went all the way to the Court of Appeal – after the High Court rejected Eisai’s case – which sided with the manufacturer. Giving NICE a rap on the knuckles, the Court of Appeal insists that in the future it should be more transparent in the way it makes decisions.

Eisai will now be able to see how NICE came to its decision and comment on it. NICE will then have to go away and consider those comments carefully, which could lead to another review of Aricept’s availability.

So what’s in it for all those people with dementia? Some 100,000 or so people denied Aricept and other such drugs will hopefully get the review they’ve been pushing for and a positive decision will be made for them sooner rather than later.

Stop talking start acting

I’m getting a sense of déjà vu.

In the news today MPs have urged the government to clamp down on the “dangerous over-prescribing” of antipsychotic drugs to people with dementia in care homes.

MPs say about 105,000 people with dementia are given prescriptions they do not need because antipsychotic drugs have no benefits and could even worsen residents’ conditions.

These drugs have been associated with an increased risk of stroke, social withdrawal, accelerated cognitive decline – especially verbal skills – and severe sensitivity reactions. Essentially, they can leave a person with dementia in a zombified state.

Haven’t we heard all this before? This story seems to keep coming back into the headlines about once every couple of months – indeed, I blogged about it back in February [http://bettercaringblog.blogspot.com/2008_02_01_archive.html]. Panorama also had a programme on it late last year.

Last time I wrote about this, I said it was good that the issue was being revisited because it should prompt something to be done. But it seems that – still – nothing is being done, except a lot of hand-wringing and points-scoring soundbites about how “the government must end this needless abuse”.

Various people in parliament and beyond have been saying this for months. Surely the time for talking has ended, there needs to be action to stop this drugging of care home residents now. Even if it is a directive to care homes and doctors telling them to stop prescribing antipsychotics unless they are a last resort, it would be something.

But this is not going to happen. While it seems that action will be coming, it will only be once the government’s much-vaunted National Dementia Strategy is published sometime later this year.

For some people, you can’t help feeling that it will be too late by then. For the 100,000 or so people still stuck in a zombified state – or even ushered to a quicker grave by needlessly prescribed antipsychotic drugs – time is something they do not have.