Social care services can contribute to easing pressure on NHS

Severe pressures in hospitals this winter has seen thousands of operations cancelled, causing social care leaders to urge NHS bosses to ‘start listening’ and let care homes do more to help.

Elderly people are among those who are most at risk of illnesses such as flu during the winter months. NHS England has said hospitals, GPs, ambulances and other NHS services have been extremely challenged this winter, and have reported higher levels of respiratory illness and flu.

In the final week of 2017, the NHS 111 helpline received more than 480,000 calls.

Martin Green, chief executive of Care England, which represents independent care home providers, said: “The NHS Acute Trusts could significantly reduce winter pressures by establishing long-term relationships with independent care providers. The care sector has been saying this for years and yet again the NHS has not listened and is in yet another crisis”.

Health secretary Jeremy Hunt apologised to patients following a decision to postpone tens of thousands of operations in January because the NHS is struggling to cope with a surge in patients this winter.

Non-urgent treatments had already been cancelled until mid-January, but this has now been extended to the end of the month.

Handover delays outside A&E departments stop ambulances from getting to new emergencies. The handover of patient by ambulances at A&E departments is supposed to take no more than 15 minutes.

Almost 5,000 people were left waiting in ambulances outside A&E departments for one hour in the last week of December, as 12 hospital trusts revealed they had no beds free. These health trusts were operating at 100 per cent, well above the recommended 85 per cent.

A&E staff can’t move patients out of their department and onto hospital wards, because hospitals can’t discharge patients from their wards into the community. Shropshire County Council is working with care homes to ensure patients don’t stay in hospital any longer than necessary. The council is working to cut the number of patients delayed in hospital, known as a Delayed Transfer of Care (DToC).

At the end of December, Shropshire’s A&E departments got hospital staff from other wards to help with the volume of emergency patients it received and had already commissioned extra beds in care homes, which are block purchased to ensure they are there when needed.

The Shropshire-based care home The Uplands offers nursing and specialist dementia care. It is run by Marches Care and has been drafted in to help this winter. Mandy Thorn, the managing director of Marches Care and vice-chair of the National Care Association (NCA), which is made up of small-and medium-sized care providers says: “If care homes were more involved in local winter planning, which is actually a year-round issue, we would probably see less of a problem with DToC.”

She believes this would be possible if they are “engaged early enough and sensible and respectful contract discussions take place – around block contracts at a price that reflects the additional support that short-term admissions require.”

She says when it comes to care homes being used to address winter pressures it’s “a patchy picture across the country”.

“Smaller independent providers are not always considered when local authorities and CCGs get together to discuss their response to winter pressures. When health and care professionals get together to respond to hospital bed pressures, not every local area takes into account the residential and nursing beds that may be available.”

According to figures from the Institute of Public Care, from April 2012 and April 2017, the number of care home beds available fell by 3,769. Add to this a major staff retention and recruitment problem in the care sector and the country’s ability to respond to a winter NHS crisis gets more challenging.

Market intelligence

Responding to criticism from the care sector that some care homes’ beds are ignored in different parts of the country, Colin Noble, the leader of Suffolk council and health and social care spokesman for the County Councils Network, (made up of 27 county councils and 10 unitary councils), told “I think it comes down to market intelligence.

“Every single day we are working with every single care home. It’s a question of how much of a silo between CCGs [Clinical Commissioning Groups] and councils exists in an area. Local authorities know all of their care homes but that’s not always the case for CCGs.

“It’s a matter of CCGs using the council’s market intelligence about care homes.”

Job satisfaction

Mandy Thorne puts it simply. “Staff in my care home report increased job satisfaction because they see people admitted to us from hospital needing significant support who then leave to go home after a couple of weeks because they are well enough to return to their own homes.

“Long-term residents have also benefited because they can interact with a wider variety of people who come into the care home, and who by seeing people get better and go home they can be more motivated to do more themselves.”


Is it not time that we saw a closer working relationship between social care and the NHS to reduce the pressures of bed blocking. In Shropshire they have set a good example of forward planning, by block booking care home beds in advance. Colin Noble highlights the importance of market intelligence to alleviate the problem and Mandy Thorne suggests that more consideration needs to be given to smaller providers. Surely, making better use of what social care can offer will be of benefit to patients and hospitals and reduce the crises experienced by the NHS each winter. Come on NHS is it not time you started listening.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

It that time of year again – Looking back over 2017

Looking back over the year 2017 I have tried to bring to your attention articles and blogs that you might find interesting in the world of social care. I have covered topics ranging from the crises in social care funding to the use of yoga in care homes.

The central purpose of my blogs is to keep you informed of innovative practice that may improve the quality of life of people who use social care services. In addition, I also include new requirements placed on providers by the Care Quality Commission.

Overall the year 2017 in social care is ending as it began. Social care is still in crises because of underfunding, and has reached a tipping point. A number of care homes have decided to call it a day, and some domiciliary care providers have even handed back their contacts to local authorities because they are uneconomically viable.

Looking forward positively, we are promised a Green Paper on social care funding in the summer of 2018. On the one hand, this may be seen as a method of kicking the problem in the long grass, and further delaying tactics. Alternatively, it may at last be recognised as a problem, where the solution can only be found outside the cut and thrust of party politics and consensus on way forward is agreed by all parties.

All the best to you and yours for 2018.

Happy Christmas!

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


More funding for social care but the long term problem still needs to be addressed


Last Wednesday’s budget which saw the Chancellor of the Exchequer Philip Hammond announce an increase in social care funding in the next 3 years is to be welcomed. The constant pressure by providers of social care services, the NHS and MPs from all sides of the House has at last produced some tangible results, and the Chancellor has been forced to play his get out of jail card.

One could argue that far from the money been allocated to improve the quality of social care services or to alleviate the growing demands for social care by an ever-increasing elderly population. The main purpose of the funding was to ease the strain on the NHS by preventing bed blocking.

However, continuing with the positives. The announcement of more than £2bn of new funding for adult social care in England is welcome, and badly needed following years of funding shortfalls. Combined with measures announced in the 2015 Spending Review including the social care precept, this means that (in theory) more than £9bn of additional money has been allocated to social care in this Parliament.
The government highlights that the package announced since the election means that councils will be able to increase adult social care-specific resources in real terms in each of the final three years of the current parliament. Indeed, if (a big if) the amount councils spent on social care in 2016-17 were maintained in real terms and these new funds added on top, spending would increase by 16 per cent in 2017-18, and by almost one quarter (24 per cent) in the three years to 2019-20.

But the “big if” and “in theory” above gives concern. Largely because councils’ adult care spending isn’t ring-fenced, there’s no guarantee that current funds will be protected. There is a risk that additional earmarked funds simply displace non-ringfenced spending, with ongoing pressure on wider council budgets continuing to bear down on the social care allocation.

The second reason for concern is that even if total real care spending increases, the money the government has set aside will not be sufficient to close the social care funding gap. The immediate cash injection will go some but not all the way towards addressing an estimated funding shortfall of at least £1.3bn in 2017-18. But looking to the end of the parliament, £400m of new funding in 2019-20 means that only around 15-20 per cent of the commonly-used estimate of a £2.3-2.6bn funding gap that existed prior to this Budget has been filled (and even this might be optimistic – some organisations contend that the real value of the gap is much higher still). 

This raises the prospect of further increases in unmet need in coming years. The number of adults who say they don’t get the care they need having already doubled since 2010.

Looking to the future
While a short-term cash injection is very welcome, these concerns suggest that they are no more than a sticking plaster and the job still needs to be done. The debate must now turn to the longer-term settlement for care, so it’s welcome that the government announced in the Budget that it will publish a green paper on how the system can be put on a more secure footing. Long-term reform of social care funding therefore remains vital. Theresa May has said to be determined to find a solution to a problem that has thwarted all governments of the past 20 years, despite a series of reviews and inquiries in that time.

Any solution to this problem must face the challenge of protecting people against the risk of having their lifetime savings wiped out by care costs. The Dilnot Commission (2011) proposal of extending means-testing and capping the lifetime cost appears the right way to go. Indeed, this approach was enacted in the Care Act 2014, but then shelved in 2015. It’s now time to take it back down from the shelf and dust it off.

The other fundamental challenge is sustainable funding for an integrated NHS and care system, as set out by the Barker Commission (2014). This accepts that spending on health and care as a proportion of GDP would need to rise. To fund this, you might have to question the logic of some universal pensioner benefits, National Insurance rates for older workers and higher earners, as well as the increasing focus on taxation of income rather than wealth derived from property, inheritance and capital gains. Other ideas floating around include the suggestion of a “care Isa” to encourage people to save to meet their own costs, a guarantee of a set amount of free care for all and even retrospective payment of costs through an inheritance levy.

At long last the Chancellor in his budget has recognised the plight of social care services and the needs of an increasing elderly population. The injection of £2bn funding is to be welcomed along with the additional local authority contribution. However, some commentators believe it will hardly cover the funding gap. It must be hoped that the Green Paper promised by Theresa May comes to fruition and a realistic solution is found.

The difficulty remains that any long-term solution to social care funding will require a cross party consensus and as history has informed us this will be difficult to achieve.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Would social care be better off going it alone?

I have long held the view that health and social care services should work together in partnership and provide a seamless service. I believe that where an individual has health and social care needs they should form part of a person centred care plan. The plan would detail the health and social care input, which would be funded to take account of the person’s health needs (for example a stay in hospital) followed by care in the person’s own home or care home.

It seems to me that this approach has much to commend it. The benefits would include:

• Health and social care that is tailored to the person’s needs.
• An end to bed blocking
• More effective and appropriate use of resources
• Providing people with the services where they want them
• A single method of funding
• Clear accountability for services provided.

However, I recently found that David Brindle the Guardian’s public services editor raises the question ‘would social care be better off going it alone’? He says that this notion would be anathema to him alongside many others work in the social care industry. He has long been of the opinion that a seamless social care service where social care and the NHS work in partnership to deliver a better quality of service was the best approach.

Would social care be better off going it alone? While logic and principle suggest that the care and health system should be seen as an inseparable whole, and reviewed as such, he claims realpolitik may dictate otherwise.

He argues that social care should also show willingness to look at its own performance. Prime Minister Teresa May has always been convinced that there remains money to be found in the system by making better use of existing resources. Although this does not obviate the need for funding reform, it is true that better value is being found in some places more than others.

Research by the Social Care Institute for Excellence (SCIE) in Birmingham shows that significant savings could be made if the city adopted three models of care reform pioneered elsewhere: the Living Well scheme of support for older people in the community, developed in Cornwall; Kent county council’s hospital discharge programme; and the Shared Lives concept of family-based accommodation for people with disabilities.

Using data supplied by Birmingham council, SCIE estimates that applying the three approaches could save the council £6.6m a year and the NHS £1.4m. To put that into perspective, the council has to make cuts of £78m in its overall budget in 2017-18 and the care and health economy across Birmingham and Solihull faces a £720m shortfall by 2020. But £8m is not to be sniffed at. Equally important, the kind of community support fostered in SCIE’s models plays perfectly to May’s vision of a “shared society”. If that’s the flow, Brindle suggests that social care needs to go with it.

While giving cognisance to his arguments, I do not share in Brindles view. I accept social care services should be open to new practice and make cost savings, but these approaches in themselves will do little to alleviate the social care funding crises and indeed may deflect attention from the central issue of funding reform.

In summary, the new research by the Social Care Institute in Birmingham should be applauded in that it provides evidence of cost savings in three models of care reform. Although these are worthy of exploration by other local authorities and along with other initiatives of reform that may come along in the future. I hardly think they add up to giving consideration as to whether or not social care services should go it alone.

I would maintain that we should follow the example of Scotland and Northern Ireland and recognize that the way forward is a seamless Health and Social Care Service.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Care Quality Commission Registration Requirements



Statement of purpose

Further to my last article on the understanding of the requirements of CQC Registration. You will recall that I suggested that potential providers may have some difficulties with understanding the requirements of the Statement of purpose.

What is the statement of purpose?

The Statement of Purpose is a document that describes the purpose and function of the service that you wish to provide. It should be designed to ensure that people who use the service, families and all stakeholders have a common understanding of the nature of the service, and anyone reading it should be easily able to understand and identify the service provided.

CQC says “A statement of purpose for a business describes what you do, where you do it and who you do it for.”

Every service provider is required by law to have a statement of purpose for each of the regulated activities they carry on. If you carry on more than one regulated activity you can either have separate statements or combine them into one.

By law, in accordance with Regulation 12 and Schedule 3 of the Care Quality Commission (Registration) Regulations 2009 (as amended), the statement of purpose must include:

•    The aims and objectives of the service provider in carrying on the regulated activity.
•    The kinds of services provided for the purposes of the carrying on of the regulated activity and the range of service users’ needs which those services are intended to meet.

Aims and Objectives

The aims and Objectives of your service may depend on the kinds of service you choose to operate. However, they should concur with the CQC Fundamental Standards. You may wish to include in your aims and objectives some of the following:

Our service objectives are:
1    Describe your philosophy of care (A short summary that outlines your values and ethos that underpins your service)
2    A commitment to high quality services
3    A commitment to person centered care
4    Involvement of service users in the service
5    To ensure the privacy and dignity of service users
6    To safeguard service users from abuse
7    To ensure that all information received or held on behalf of service users is treated confidentially.
8    To recognize the service user’s diversity, ensuring religious, cultural, racial and gender identities are respected, and the adoption of a non-discriminatory approach.
9    To ensure service users are provided with information concerning the services provided, and any changes to those services which may affect their well-being.
10  To ensure that service users heath and care needs are met by competent trained staff.

We aim to achieve our service objectives through:
•    Management and staff commitment to high quality services
•    Putting person centered care at the forefront of the services we deliver.
•    The provision of appropriate resources to meet the needs of service users.
•    The employment of competent, well trained management and staff.
•    Following policies and procedures that comply to Fundamental standards and CQC requirements.
•    Providing accessible and updated information to staff and service users.
•    Encouraging service users to be as independent as possible in line with their risk assessments, and our responsibilities for their care.
•    Listening to service users through person centered plan reviews and satisfaction surveys.
•    Planned monitoring and auditing of our services.

Kinds of service
You will need to state here the kind of service you are going to provide:
•    Adults over 65+
•    Younger adults
•    Domiciliary care
•    Supported living
•    Learning disabilities
•    Mental Health

Range of service users’ needs

You will need to state who the service is to be provided for. For example:
Frail and vulnerable adults
•    People with dementia
•    Mental health problems
•    Physical disabilities
•    Sensory impairment
•    Illness (including end of life care)
•    Adults who are recovering from illness
•    Adults with Learning Difficulties (excluding those assessed with specific challenging behaviour)

These lists are not intended to cover all aspects of the registration process but rather an attempt to improve understanding of what the Care Quality Commission are looking for.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy