Serious Concerns and what we do about them

On Wednesday I attended Suffolk’s Health Scrutiny Committee meeting when we looked at the recent damming report by the Care Quality Commission (CQC) into the newly opened Mildenhall Lodge Care Home by Care UK. Of course if you’ve read my blog you know that the replacement for Suffolk’s very old and not fit for purpose care homes is something I led on in my time as Cabinet Member of Adult Care Services. So the report which followed an inspection 6 weeks after opening the first of 10 new Care Homes across Suffolk, in Mildenhall, was doubly disappointing given the work Suffolk put into finding them as a partner. Equally it’s bizarre given that they are investing £60 million into the new homes that they would fail to keep their eye on the ball sufficiently to deliver a quality of care in this the first, which of course should be, was promised to be and was commissioned to be commensurate with the quality of buildings they are delivering.

At the start of the agenda item, Care UK apologised unequivocally for their failing and it was welcomed, but the point was made to them in no uncertain terms that an apology without an action plan and proper implementation was…well just words.

A colleague on the committee demanded to know why the failing had taken place, I rather thought and then said the reading of the CQC report clearly indicated a common thread of low staff numbers and to be fair Care UK did seem to recognise this and were putting in place the sort of actions that were demanded of them and promised by them during the commissioning process we originally undertook. This was built on the back of the work I and my officers found during the initial thinking about the issue we had before us, namely the longitudinal study by Birmingham University as Birmingham City Council closed all of their 26 care homes and rather than re-provide into new facilities, they dispersed their residents to the existing private sector care homes in the city. The study looked at the most effective ways to help people move homes and how best to support those transitions.

The point about provider and commissioner is an important one I’ll comeback to in this blog. Across Suffolk far wider, that the small percentage of the private total market that Care UK represents and in the number of beds Suffolk provides for those who need a residential Care Home but are unable to provide for themselves. Suffolk County Council purchases (commissions) on the basis of good care and inspects to make sure good care is provided. No distinction is made and no excuses accepted.

During the course of the scrutiny a couple of things emerged. At the start of it we had a presentation from CQC about the robust nature of its new inspection regimes and I reflected on the difference between the organisation and the initial thoughts when the coalition government came in, I recall a meeting between myself and my officers with the then local CQC team announced they were moving from a full time care inspection organisation to more of a light touch registration organisation and beyond our shock as such a move, for our part we began thinking about how we needed to react to this with our own inspection regime and how we went about our working relationships with the Care Homes in Suffolk. From the presentation we saw the conclusion of a quiet transformation of that organisation into a sort of OFSTED for Care. Those of us who watch this sector closely of course know this has been happening over the past couple of years firstly with the surprise recruitment of David Behan the former Permanent Secretary to the Care Minister to tis CE role and the well-respected Andrea Sutcliffe to head up its care sector. All, I have to say, brought about by a Government that properly recognised the significance of the likes of the Panorama TV Programme’s shocking investigation into care and a concerted efforts of Local Government and other care organisations as reported in the national press, to seek to rise the issues of care standards up the national agenda.

What also emerged from the scrutiny was that this Tuesday, the second of Care UK new homes has a ‘stop to new admissions order’ instigated not by CQC but by Suffolk County Council’s own team, equally the original suspension of Mildenhall Lodge by the same team was before the CQC inspection. These are important points because despite officers informing the committee that the department was reviewing if it needs to have more people inspecting Suffolk Care Homes in addition to the CQC work, actually they did pick up the failings before CQC and the robust quality of the Suffolk County Council team working with care providers, despite the close relationship they have with Care UK as it replace the Council’s former homes, the relationship of commissioner and provider is in place and Suffolk County Council are already properly holding them to account.

Equally I was really proud to sit on the Health Scrutiny on Wednesday as it robustly did its job. Last week I was in Scunthorpe and one of the things I was tasked with doing was to meet with the Chairman of their Health Scrutiny Committee, as we considered as a part of the LGA Adult Safeguarding Peer review if we thought it was fit for purpose (which it is). Such important consideration follows on from the Francis Report into Mid-Staffordshire Hospital where one of the system failing highlighted was the lack of robustness of that County Council’s Health Scrutiny to ‘shine a light into dark corners’ and hold a provider to account, in that case, the NHS trust which failed to keep people safe in that hospital.

Of course we all want Care UK to just keep to their end of the bargain and deliver the quality care they promised. From the Health Scrutiny Committee point of view we have charged them and the department’s officers to keep us up to date on the action plan and its implementation that they have learnt their lessons and the opening of each new care home will go as we want it to and I know we all hope these actions can be of comfort to worried residents, loved ones and families as they transfer into their new home.

Political Determination

Mildenhall Lodge opening

Mildenhall Lodge opening

Last Friday I attended the official opening of the New Mildenhall Care Home built by Care UK to replace the former County Council home at Wamil Court and what a splendid new facility it is.

Care UK will open, over the coming months, 10 similar new care homes across Suffolk investing some £60M in the process. As per my promise when I visited every single one of our 16 ageing care homes to meet with residents families and staff, in my former role as Cabinet Member for Community and Adult Social Services, all of those residents in Suffolk County Council’s former homes who wish to, will transfer across to a wonderful new home supported by the county council, that is now happening.

At the recent political training sessions I was involved in for both Director of Public Health and Directors of Social Services we talked a lot about what motivates a Councillor to get involved and of the ‘quality’ of Leadership.

I put forward my personal view that whilst there are many reasons people enter politics, I entered to firstly represent my community which I work hard to do and secondly to make an actual difference. It is all too easy to appear to be busy, fronting this and that decision or policy when in reality those would have been Council policy and decisions irrespective of if you or another person from your own or another party was fronting them, the council would make those decisions if you were there or not and there are many of those.

In respect of Supporting Lives, Connecting Communities, a number of great new mutuals delivering outstanding services to some of the most vulnerable in our Suffolk community, at costs lower than before (thus protecting front line services) and in respect of the replacement of all of Suffolk County Council’s care homes with something to be proud of, I was the key political decision maker. Of course I was ably supported by a great officer team who made it happen and colleagues who backed me but it was my political vision and determination often in the face of quite challenging opposition that made these things happen.

That, to my mind is the great challenge of being a Councillor, to have made an actual difference, rather than simply serve your time, to be a journey man if you will. In doing so you’re not always going to get right but at least you will have made a difference.

A heated meeting

On Friday I, along with the Trustees of the Christian Enterprise Foundation, hosted a public meeting in Lakenheath Village Hall. The meeting was essentially around the closure of the Lakenheath Village Care Home in December and I hoped to discuss how those who attended how we as a community wanted to plan for the needs of an ageing population here in our village.

I counted 90 people in all, which is a good number for a Friday night in February. At times the meeting was quite heated with a number of former staff wanting to vent their feelings, some family members who wanted to talk about their loved ones and others disappointed that the home has closed.

I spoke in support of the decision to close, which as you can imagine did not go down that well, but of course having made a very similar decision with regards Suffolk County Councils last 16 Care Homes before we brought Care UK on board to open 10 new state-of-the-art homes and invest £60 million in the process, I could do nothing else. In many ways given the level of regulation and complexity I was surprise that the Trustees continued to provide the home for so long and as we look forward to the brand new Home being built by Care UK people will hopefully see what is meant by the changing standards expected and now required by the Care Quality Commission in the provision in Care Homes. I encouraged all who attended to take advantage of the opening days when they come up and go to see for themselves.

There were quite a few specific questions and comments directed at the Trustees who did their best to answer openly and honestly. They also made a call for new Trustees and invited those attending to stay behind at the end and they would make contact how to get involved. I counted one but hopefully more will come forward over the coming weeks to help carry the important work of the Foundation forward, as they have a significant part to play in the future services we need to provide in Lakenheath, even if that no longer involves running a care home.

Towards the end of the meeting we did eventually turn to the issue of planning housing for our ageing population and I certainly took away a number of points that were made and have a determination to see Suffolk County Council continue to bring outside investment into our care homes and to strive to create a thriving Extra Care sector as well.

Worth the wait – not!

So for the past three weeks there has been an  interesting exchange on blogs and twitter as we have questioned if the Lib Dems were going to bother to produce a manifesto or not for the Suffolk County Elections and finally yesterday 22 days to go they seemed to have cobbled something together.

Was it worth the wait – I think not!

Reading through it I struggle to find an actual policy, now I know Labour and we Tories both like to take the ‘mickey’ out of the Lib Dems about not being able to decide to have a cup of tea or coffee without forming a committee but what they have put up on their web site is unimpressive even for them.

I am going to do this first blog about the area which has been my honour to have the political responsibility for over the past 4 years – Health and Adult Care.

Their document at point number 2 starts with: ‘Appropriate Care provision, for all who need it’

Yes I quite agree with that and I sort of thought that was exactly what we are doing with our policy called ‘Supporting lives, Connecting Communities’ for which we have received national interest about the way we are involving communities in the design of our care services.

Next comes: ‘’Care’ has been the Cinderella service of this Tory council.’

Does that make me the fairy godmother or one of the ugly sisters! I get called many things so that’s OK but Conservatives have and will continue to focus resources and priority to protecting and supporting the most vulnerable in our society. Adult Social Care is the biggest single spend of the County Council, there is nothing ‘Cinderella’ about the service it is a serious business staffed by professional social workers who spend literally hundreds of millions of pounds here in Suffolk looking after the most vulnerable in our society. During the course of the past 4 years I have met many very vulnerable people and I have witnesses the professionalism and care exhibited by our social workers in supporting them.

Next we have their new catchphrase ‘enough is enough’.

This in many ways does sum up their so-called manifesto’s nebulous claptrap. Enough of what? 0% Council tax increases, ever more efficient services, I could go on……

Now to the ‘meat’ or lack of it, of their manifesto commitments on Health and Adult care:

‘Liberal Democrats will: Make sure the Tory divestment of our Care Homes does not produce a worse service’

This is of course an interesting one, they are not saying it will produce a worse service but merely implying it might – so let’s look at the facts.

Our 16 not fit for purpose care homes were transferred to Care UK had 526 beds in a total market place of 5,500 beds so we were a little under 10% of that market place. Care UK will be increasing the bed capacity to 638, a little over 10% of the total market, with a £60M investment in 10 new state of the art Care Homes. Adult social services supports 2,300 people in the private sector some 40% of the total market. So the facts of the matter is that the vast majority of those we support we have been supporting in the private sector for many years, this will continue. We have a long established relationship with private Care Homes both in terms of our working relationship with their trade Association, the latest of their meetings I attended just a couple of weeks ago, and through our social workers who support people when they are making the decisions about going into a residential Care Home, this will also continue. We will continue to work with private Care Homes and the Care Quality Commission to see the highest standards of care delivered here in Suffolk just as we have been doing.

‘Liberal Democrats will: Support Family Carers with fast, targeted, assistance, recognising they are the bedrock on which the county depends!’

Simply could not agree more that’s why we Conservatives have entered into a Strategic partnership with Suffolk Family Carers which means not only do we recognise that they are one of the bedrocks on which the county depends, it means we provide them with funding and they design the services to meet our jointly agreed outcome objectives of, you guessed it, faster, more targeted, assistance.

‘Liberal Democrats will: Scrutinise the impact of the Suffolk Circle and, work with local organisations to develop new ways to help vulnerable people.’

It seems extraordinary that of all the voluntary organisations we work with in Suffolk they have decided to scrutinise and pick on one in a manifesto. Firstly surely scrutiny is the role of the scrutiny committee, which recently has scrutinised Suffolk Circle, not a manifesto pledge which is meant to be about future policies; secondly, and more importantly I would suggest anyone have a look at the Suffolk Circle website www.suffolkcircle.org.uk to see the great things this not for profit organisation get involved with. They are one of literally hundreds of voluntary organisations that through our Conservative strategy are commissioned to provide support to those in our community who need it. And on the second point in this pledge I can only refer them back to our Supporting Lives, Connecting Communities policy which is agreed, approved and being implemented working with local organisations to develop new ways to help vulnerable people. please see http://www.thesuffolkcongress.org.uk/files/health-subgroup/2012-11-15%20Suffolk%20Adult%20Care%20presentation.PDF

The next two manifesto pledges I could not agree more and that’s why we are doing those very things. We recognise the links between education, transport, nutrition and health and we are delivering on the new public health responsibility of the council. From the public health documents that have been published and the recent Health and Wellbeing Strategy document again agreed, approved and being implemented. I have to say it’s quite bizarre to see your strategies being quoted in another party’s manifesto, of course again the implication is you are not doing those things and perhaps an inconvenient truth that we are, please see http://committeeminutes.suffolkcc.gov.uk/meeting.aspx?d=29/Jan/2013&c=The%20Cabinet then click Agenda item 8 -Appendix.

All in all, I have seen some weak opposition manifestos in my time, indeed I thought the Lib Dems 2009 one lacked substance but with this one they have truly surpassed themselves.

No wonder so many lib Dems are turning away from them, no wonder they can’t find enough people to stand in each seat and no wonder so many of their supporters are leaving to join the greens, at least they have actual pledges in their manifesto, however wacky.

Suffolk Care Providers Conference

Last Wednesday I attended the 2012 Suffolk Association of Independent Care Providers Annual Conference where they invited myself and my team to speak at the end of a very successful event where over 150 people and 16 exhibitors packed the conference facilities at the Ufford Hotel, near Woodbridge.

I spoke about a number of things but principally about our relationship as we together provide Care to those who need our support.  It’s good to see that so many people have stayed to the end of a very successful event.

I said that these are difficult times for everybody involved in the care business due to the economic climate which shows no sign of easing – for social workers, providers and commissioners. These are also challenging and changing times for those older and disabled people who are being offered a different ‘deal’ that prevailed during seemingly better economic times. Of course People are living longer which is a cause for celebration but with that comes the need for more health and social care with much less money.

I also said a few words about the reform of the Country’s care and support systems including an overhaul of the current social care legislation which is very welcome and that I still remain very optimistic about government action to the Dilnot recommendations and I do believe that a cap will eventually be set on an individual’s liability for care costs and the insurance market will develop new care insurance products.

I also shared my impression at the recent National Children’s and Adult’s conference in Bournemouth and Norman Lamb MP the new Care Minister’s recommitment to significant change and I said that for those in the room who delivered Residential Care that they needed to make sure their accounting procedures make that distinction between care costs and pricing and the hotel element of the accommodation provision.

One of the exhibitors was Care Aware our SCC funded service to provide people with financial advice as they consider Care services; this is our response to how we are going to cope with people increasingly failing out of being able to pay for their Care homes costs; this model of funded advice is now being adapted by other councils across the County.

I then spoke about the very positive and collaborative partnership between SAICP and SCC. Of course its not without its tensions especially around money but I was very pleased that we were able to agree a 2 year pricing deal which provided some certainty and stability going forward.

The care market across the Country is in a relatively fragile state although I did note from a national report for 2011 that care home profit margins increased marginally during 2011 to stand at 30.5% of total income and care homes occupancy rates rebounded to stand at 87.8% for the UK as a whole.

Another recent report published by the Association of Directors of Adult Social Services and the Lead Government Association for 2011/12, told us that the rate of permanent council funded admissions to care homes of all ages has began to rise, reversing the trend of previous years.

While the number of people aged 65 and over receiving home care fell by 2% between 2010/11 and 2011/12. However the number of people receiving direct payments increased by 20% which could account in part for the decline in home care.

So year on year there are the market trends but looking at our demographics there will be a growing number of people using care services and we will continue to work with Suffolk providers to see their businesses grow supporting people across Suffolk.

Next I tackled the subject of the new relationship we are forging in Suffolk with Care UK taking over the running of our 16 residential homes for older people and eventually replacing them with 10 new Care Homes and bringing a £60Million investment with it. Not to mention that SCC will save money over the period of the contract (£11.5m), we will avoid a backlog of maintenance of £7.5m and future maintenance costs of £25m not to improve but to maintain. And importantly it will increase much needed capacity in specialist care and the provision of nursing care is an aspiration I have for the sector.

In closing I said I recognise that we are partners, in fact we are the biggest partnership in Suffolk, together we look after the most vulnerable people in Suffolk and in this respect ours is perhaps the gravest responsibility in Suffolk, as indeed it is and long may it remain so.

Suffolk planning for future care needs

It’s been a busy couple of days, on Tuesday I announced the preferred bidder to take over the 16 Suffolk County Council Care Homes in the SCC cabinet meeting and have done quite a lot of media interviews since.

The key as we navigate the incredibly complex procurement process has always been to make sure that we discuss our thoughts with Residents, their families and carers and staff first and everyone else second, yet at the same time there is a legal framework that has to be worked through.

As was to be expected following the announcement the press were keen to know the answer not to the question where will the preferred bidder be investing and building new homes but where might be closing.  A reasonable question but one that simply can’t be answered yet, but I did make the point somewhat repeatedly that when that is fully worked through the very first to know will be residents, their families and carers and staff.

Throughout this process uppermost in my mind has been the fact that whilst they might be SCC’s Residential Care Homes, to those who live there it is their home and I have at times been dismayed at the lack of sensitivity to that, in some of the comments others have made. No one is more aware of the cocners of residents and their families and carers than myself and our officer team, that is entriely naturally and right and proper but in the visits I undertook to each and every home to discuss our thoughts, we explained why we need to change the way we provide and over the next few months I shall be keeping a promise I made to go back and to explain, in person, what we are doing.

Personally I thing this is great news, the Preferred Bidder – Care UK is an extremely well respected provider and the level of investment I will be able to confirm in the coming months is a good leap along the path we as a county need to take to make sure over the coming years we are providing the sort of facilities we would all want for our loved ones and ourselves.

Since we started this process, over the past couple of years I have heard a lot of words spoken by those opposed to SCC us no longer being a provider, much of it lacking rigour and I think some of that nonsense has been extremely worrying for residents and families.

This change will bring about delivery of new homes and an increase in the capacity particularly the higher needs end of residential care; something that we most definitely will need here inSuffolk. We simply do not have the capital needed to do this as a Council ourselves.

Above all else it seems to me that the role of the Council must always be to make sure we plan for our ageing population, deliver services as cost efficiently as we can so that we can help the maximum number of people and how we can be there to make sure standards are upheld, maintained and improved.

As the council stops being a direct provider it will be able to focus its attention on making sure that if you or I need help and support as we all grow older the County Council is there to protect us now and in the future. Along side the coming announcements we will be talking about the councils future role to help shape the quality we would all want for our loved one, ourselves included!

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