Meeting the challenges of supporting people with dementia

A one day conference in London organised by Community Care Magazine, featuring sessions on making personalisation work for people with dementia, safeguarding people living in the community, and improving support for carers.

Date: 23 February 2012

Venue: to be confirmed

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Free telehealth and telecare reports

Reports summarising the impact of telehealth and telecare in projects run jointly by the NHS and local authorities, are available for free from the Centre for Telehealth.

The centre brings together telehealth expertise from academia, the primary and acute care sector, local authorities, industry and third sector partners.

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Councils urged to adapt personal budgets

The Alzheimer’s Society is calling for personal budgets to be adapted to meet the needs of people with dementia. 

In its recently published report 'Getting personal? Making personal budgets work for people with dementia', the society claims dementia sufferers and their carers are more likely to be satisfied with services they receive if they are on personal budgets.

Personalised budgets allow them to buy services such as support with cleaning, gardening and for holidays, which they may otherwise not have been able to afford. 

The report highlights a number of barriers faced by individuals, including:

·       an overly complex system that is intimidating for people with dementia and their carers

·       lack of information and support for people who might take them up

·       insufficient understanding of dementia among professionals, and limited awareness about the need to offer personal budgets

·       underdeveloped local markets incapable of delivering a range of dementia services making it difficult to create a personalised package

·       strict eligibility criteria which leads to many people with dementia not receiving social care until crisis point, when personal budgets may no longer be an option.

More than three quarters of people with dementia who receive social care support at home are not using direct payments or other personal budgets, despite government plans to roll them out to everyone using social care services. 

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Countdown to Healthwatch

Countdown to HealthWatch

The new consumer watchdog HealthWatch, is busy getting ready to ensure it is fully operational before its official launch in October 2012.

HealthWatch will be the consumer champion for health and social care in England.  It will have two roles - one as local HealthWatch organisations, funded by and accountable to the public via local authorities; and also as the national HealthWatch England, enabling collective views of people who use the NHS and social care services, to influence national policy.

The HealthWatch England will be a statutory committee of the CQC but will have its own distinct identity.

The organisation will have three main functions:

·       to provide leadership, guidance and support to local HealthWatch organisations

·       to escalate concerns about health and social care services raised by local HealthWatch to the CQC, which in turn will be required to respond to advice from its HealthWatch England subcommittee

·       to provide advice to the Secretary of State, NHS Commissioning Board, Monitor and the English local authorities; they will be required to respond to that advice.

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Appeal for personalisation evidence

The Think Local Act Personal partnership is appealing for examples of innovative practice in delivering fully personalised care and support.

Initiated by the partnership’s National Market Development Forum (NMDF), the appeal is part of its work to find and share best practice.
NMDF is looking for examples of pioneering work in delivering and commissioning personalised support in:

·       residential and nursing homes

·       specialist services including dementia and autism

·       services for carers

·       homecare services

·       end of life care.

Send details to sam@groundswellpartnership.co.uk by Tuesday 20 December 2011.

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Residents asked to make a difference

A series of public meetings will be held for residents to give their views on Coventry and Warwickshire Partnership NHS Trust’s application to become a Foundation Trust. 

The partnership provides mental health and learning disabilities services across Coventry, Warwickshire and Solihull, as well as community health services in Coventry. 

It believes Foundation Trust status will lead to improvement in the quality of services and will allow service users, carers and members of the public to be more closely involved in running the organisation

The meetings will be held at various locations finishing on 21 February 2012.  Views can also be given in writing on the consultation feedback form.

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Myth busting in Walsall

Tweets and blogs were used by Walsall Council to dispel myths and show the public what social care is really about.

The week-long initiative called Who Cares? started on 21 November 2011.  During its run, regular tweets and stories were posted on the council website, including reports on a man who left care after 27 years to live independently in the community, and a mother describing how adaptations to her home changed her young son’s life.

The purpose was to give people who do not usually have contact with social services a better understanding of the work professionals do, and the difference they make to residents’ lives.

Over 800 social care staff work in Walsall and the council plans to continue with the Who Cares? theme.

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Transformation upgrade in Dudley

Dudley Borough Council is planning a change programme for adult social care services following closure of its transforming social care project.

The programme is in response to an extensive review of the council’s achievements so far in transforming social care services, and identifying issues that need to be addressed. 

Recommendations from the review include:

·       Reducing waiting lists for assessments

·       Improving processes to reduce delays in receiving services

·       Fully adopting IT systems to help staff work efficiently and improve services

·       Explore closer relationships with health colleagues to address cultural, communication and process shortcomings

·       Speeding up implementation of initiatives to develop the social care market, and independent support planning and brokerage

·       Closing the current transformation programme and develop a new change programme using findings from the review.

The new programme will be called Making it Real in Dudley, and will set the vision and ambition for adult social care locally.

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Automated pill dispensers saves thousands of pounds

A region wide pilot project measuring the impact of automated pill dispensers on reducing levels of hospital readmissions, and helping patients to take medication properly, has succeeded in freeing up beds and saving thousands of pounds.

So far, 283 people with conditions ranging from dementia and visual impairments, to mental health issues and Parkinsons, were given the dispensers as part of the trial. 

The group included 53 people who, prior to joining the pilot, had been admitted to hospital after failing to take their medication properly.  None have been readmitted since using the pill dispenser. This has resulted in:

·       Freeing up 371 bed days (1)

·       Saving the NHS £94,605 against the initial investment in pill dispensers of £10.865

·       Savings per patient NHS and social care cost of £1,810. (2)

Research shows the costs of admissions caused by patients not taking prescribed medicines was estimated to be between £36m and £197m in 2006-07. (3)

John Barber, an 84-year-old from Dudley with dementia, described the dispenser as “dead easy” in a short film about the project produced in September 2010. John, whose daily medication includes tablets for his diabetes and his heart, explains: “The bell rings, the red light shines, you lift it up and turn it forwards and it is already pre-set. Tablets in the mouth - gone!”

Head of Adult Social Care at Improvement and Efficiency West Midlands, Matt Bowsher, said: “The results of the trial are really encouraging. Failure to take medication properly puts enormous strain on the NHS and local authority budgets, not to mention ruining people’s quality of life and ability to live independently.”

The pilot began in July 2009 and ends on 31 March 2012.  Pilot areas are Coventry, Dudley, Sandwell, Staffordshire, Telford and Wrekin, Wolverhampton, and Worcestershire.

Contact: Matt Bowsher, mobile: 07500 944 766, email: mbowsher@westmidlandsiep.gov.uk

(1) Bed-day: a hospital patient is confined to bed for a day, staying overnight.

(2) Savings calculated based on the unit costs of health and social care with savings from interventions no longer required (e.g. domiciliary care calls or admission to an acute ward). The £10,865 spent on the 53 people includes a monthly £20 dispensing fee plus £85 per device. The £1,810 average saving breaks down into £753 saved from social care and £1,057 saved from NHS spend. The £205 total per patient includes £120 a month dispensing fees for six months and £85 for the device.

(3) Source: "Automatic Medication Dispensers: A review of evidence & current practice." Author Margaret McArthur- University of Birmingham 9^th September 2008.

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Telehealth and telecare set to help millions

Up to three million people could benefit from government plans to role out telehealth and telecare, following an extensive trial to assess their impact and use.

Known as the Whole System Demonstrator programme, the trial was set up by the Department of Health to examine the extent to which telehealth and  telecare can help people to live independently, take control and be responsible for their own health and care. 

Initial findings show if used properly, they can deliver:

·       a 15% reduction in Accident and Emergency visits

·       a 20% reduction in emergency admissions

·       a 14% reduction in elective admissions

·       a 14% reduction in bed days

·       an 8% reduction in tariff costs.

Findings also reveal a 45% reduction in mortality rates.

The telehealth trial involved 3,030 people with one of three conditions – diabetes, heart failure and Chronic Obstructive Pulmonary Disease.

For the telecare, people were selected using the Fair Access to Care Services criteria.

In response to the evidence, the government wants to extend the use of new and emerging healthcare technologies to three million people over the next five years. 

This will be done as part of the ‘Three Million Lives’ campaign to be developed by the Department of Health in partnership with technology industries, the NHS, social care, and other professionals.  A detailed work plan is in development and will reflect further findings to come out of the trial.  


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Speak out on social care market reform

Views are invited on the possibility of introducing additional measures to promote and protect the interests of people using adult social care services, following the demise of care home operator Southern Cross. 

Based on the discussion paper Oversight of the Social Care Market, published by the Department of Health, experts and practitioners are asked for their opinions on areas to be considered for reform, and what the overarching objective of change should be. 

Southern Cross has highlighted the risks associated with a large scale provider falling into financial difficulty, raising concerns about the continuity of service when there are no alternative providers giving the same quality of care at a similar cost. 

The remit for discussion includes the government’s wider vision for encouraging development of the social care market by creating conditions for new providers to emerge, and for the quality of services to improve.

Email for responses: caringforourfuture@dh.gsi.gov.uk, subject line – Market Oversight, deadline: 2 December 2011. 

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Push for fees agreement

Owners of private care home have been invited by ADASS president Peter Hay to discuss the fees paid by local authorities and how best to avoid judicial reviews. 

Speaking at the English Community Care Association annual conference last month, Mr Hay asked care home owners to agree on some simple guidelines for a common approach to fees, and consider mediation before rushing into judicial reviews

The invitation to reach agreement comes at a time when a series of judicial reviews of fee paid for older and vulnerable adults in residential care are under way, and when 750 Southern Cross homes have been transferred to other providers. 

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Southern Cross transfers completed

The last of the care homes formerly run by Southern Cross have been transferred to new operators.

All of the transfers were scrutinised and approved by the Care Quality Commission. The firm no longer provides care services in England. 

Care Minister Paul Burstow thanked the organisations that worked together to ensure the transfer of homes was carried out with minimal impact on the 31,000 residents and 40,000 staff. No one lost their place and everyone has continued to be looked after. 

ADASS played an instrumental role in providing up to date information by tracking and publishing online details of each home’s transfer to new owners. 

In the light of Southern Cross’s failure, the government is looking at the possibility of introducing new safeguards to oversee the care home market and protect service users. 

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Adass responds to home care human rights claims

President of ADASS, Peter Hay has called for a wider debate on looking after elderly people in need of care and support, following a damning report by the Equality and Human Rights Commission on the quality of home care in England.

Findings from the Commission’s Inquiry into the home care system (insert link), describes the treatment of many elderly as breaching human rights.  

The report highlights cases of physical abuse, theft, neglect and disregard for privacy and dignity. On many occasions support for tasks such as washing and dressing was dehumanising and left people “stripped of self-worth”.

Over half of the people giving evidence to the Inquiry were satisfied with the care they receive, but others made a number of common complaints, including:

·       insufficient support for eating and drinking

·       neglect because workers stick too rigidly to tasks

·       financial abuse, including systematic theft of money over a period of time.

The Commission says thousands of elderly people lack protection under the Human Rights Act, and is asking for the legal loophole to be closed.

Speaking on BBC Radio 4’s Today programme, Director of ADASS, Peter Hay said:

“We need to learn from what’s working well and extend that across the sector. The government is considering legal reform and placing dignity at its heart. Taking a human rights approach is key, along with giving people more choice and control to decide who comes into their home to do these tasks.”

Referring to spending cuts, Mr Hay said: 

“Resources do not excuse some of the unacceptable and intolerable practices at the very extreme end, but resources paint a context. We have to address the government’s promise to reform, by deciding what we want for older people as a society, and how we’re prepared to pay for it.  Part of that is recognising we need a modern care system with a proper resource base. We can’t just go on saying there’s a gap between needs and resources, we need to close that gap, not just with money but also with some of the new approaches that are beginning to emerge.

“It’s also something that as a society we’ve got to have a debate about, we’ve got to support politicians in making these choices and to create the proper environment for proper care of older people.”

Inquiry into homecare system

Peter Hay audio

Care home closures doubled

The number of care homes going bust, have doubled in the past year according to one of the UK’s top accountancy firms.

Figures from Wilkins Kennedy Chartered Accountants and Business Advisers show 73 care home went into administration over the 12 months up to 30 September 2011, representing a 109% increase from 35 in the previous 12 months. 

Wilkins Kennedy says a growing number of care homes are struggling with high rents and debt as income from local authorities fall due to cuts in public spending.

Some care home providers have been caught by ‘sale and leaseback’ practices whereby providers sold their homes then leased them back, guaranteeing annual increases in rent to the new leaseholder.   

In 2009/2010 the number of care homes in the UK totalled 17,500, providing 450,000 places.

Recent insolvent care homes include:

• Southern Care Group – The North Wales based care home firm went into administration in October 2010. It employed 270 people and cared for up to 300 elderly people at the time.
• Winnie Care Group – The Cheshire based group employed more than 250 people when it went into administration in April 2011. Eight care homes were put up for sale as a result.
• Grosvenor Care - A Stockport care home operator employing 150 people and operating four care homes when it went into administration in July 2011.
• Ascot Care Homes Holdings Limited - The company managed five care homes in Scotland and West Yorkshire before going into administration in December 2010.

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Home care inspections welcomed

Home care inspections welcomed

ADASS has welcomed the Care Quality Commission’s programme of themed inspections for home care services, starting in April 2012.

The inspections, which will affect some 250 providers of domiciliary care, will focus on three outcomes:

·       respecting and involving people who use services

·       care and welfare of people who use services and

·       supporting workers.

They will help the regulator ensure services meet the standards people have a right to expect, including being treated with dignity and respect.

The programme will be supported by an advisory group with members from a range of organisations, including the Equality and Human Rights Commission, Age UK, the United Kingdom Homecare Association and ADASS.

ADASS president Peter Hay said: “I am glad that the Commission has taken on this important task at a time when every penny in the inspection pot has to count, and when a number of recent reports indicate its urgency.  ADASS wishes the Commission well in this significant and timely enterprise.”

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ADs pivotal to social care development

Assistant directors of adult social service are well placed to ensure councils remain sensitive to the needs of service users while delivering changes in social care, according to the founders of the ADASS Assistant Directors (ADs) Network.

Set up earlier this year, the network will offer practical support to ADs in the day to day running of services, and provide a forum for developing new ways of thinking and operating.

Network founders, assistant directors Peter Davies of Walsall Borough Council , Tony Ivko from Wolverhampton City Council, and Brendan Clifford from Dudley Borough Council, give their views on managing demands, expectations and reforming services in the rapidly changing world of health and social care.  

Peter Davies:

“Our responsibility is to know the business of adult social care well, and to fully understand the needs of our customers, patients, carers and partners. It’s important that we remain on top of current issues and be innovative in how we deal with them, particularly in the existing economic climate. 

We need to share experiences as well as our knowledge of the customer journey, and how to achieve specific results; for instance, I recently phoned a colleague in Wolverhampton to exchange views on working more effectively with external consultants.

The focus on improving the quality of services with ever decreasing resources means the network has a role in defining what ‘quality’ means for the different areas and authorities in the region, and supporting ways of working together.  I’ve a particular interest in the quality of nursing in care homes and have been involved in improving standards locally.  An issue arose when neighbouring boroughs began placing their residents in our up-graded homes; the challenge for us was to ensure equitable financial contributions from our neighbours to the improvements and up keep of our homes.

I think adult social care is one of the pivotal areas of service provision in councils. The depth of our experience built up over the last few years in transforming services, makes us well placed to ensure that reform in any area of council services remains sensitive to the needs of service users.”

Tony Ivko:

“I think the silos between different public sector organisations will have to break down as we won’t have anything near the amount of resources needed to meet increasing demands, or for us to deliver services on our own effectively. 

We will need to pool resources, knowledge and expertise, and focus on early intervention.  To do this, it’s important for us to understand the path taken by individuals before they became dependent on services. If we take for example, someone who is overweight, has limited mobility and receives health and care service, a discussion with their GP might reveal that life changed for the individual when they stopped walking in the park and getting exercise after their dog had died.  This simple explanation opens up new possibilities for helping the service user in a different way.

If we keep on doing what we’ve done in the past, we’ll end up with the same results, which in this day and age are no longer adequate.

We also have to consider how we’ll be judged and how we prove we’re making a difference to people’s lives.  We’ve been freed from the national drivers that we used to comply with, opening up new opportunities for a different type of dialogue with local people; our role is to help members engage with their electorate in a new way.

I think the network could learn from some interesting work carried out in Chicago USA on setting performance indicators that are shareholder driven.  Their starting point is to look at the advantages and resources that already exist in a locality by asking citizens “what have you got?” and “what does a good community look like?”; rejecting the traditional approach to providing services based on what communities don’t have.”

Brendan Clifford:

“It’s all about a new type of leadership and understanding that people don’t live their lives in accordance with the way public sector organisations are set up.  We need to make sure our services reflect the way people want to live, not the way we think they should. 

The network will help us to become a new type of leader who can work across the different boundaries and work with each other.  With less money available the trick is to make sure we operate at a level that allows people to make their own decisions, in a supportive environment.  Of course, we have to take risk into account, but what we need is a society where people can get the information they need to help themselves and stay out of the health and care system for as long as possible. 

There’s work to be done in further stimulating the health and social care market to ensure there are sufficient and appropriate services for people to buy. Social services never provided everything for people; friends, relatives, neighbours and support groups often provide care.  The shape of the market will depend primarily on the needs and decisions made by people seeking support.  Our role is to make sure community based solutions are available and easy to get hold of. The health and care system will be there to help people when they really need it.

We need to get the message of self-help across more effectively, as a way of managing expectations and explaining why health and social care services have to change.”

The network’s next meeting will take place on 16 December when the group’s priorities will be refined and work will start on an AD development programme.

For more details contact Matt Bowsher, Head of Adult Social Care, Communications & Strategy, Improvement and Efficiency West Midlands, mobile: 07500 944 766, email: mbowsher@westmidlandsiep.gov.uk .