Archive for February, 2013

CQC: Most home care good but missed visits blight some services

Late or missed calls, lack of care worker continuity and inadequate support for staff leading to poor care in minority of providers, but most are performing well, finds regulator.

Home care services are generally good but late or missed calls, inadequate support for staff and a lack of care worker continuity for clients are leading to poor care from a minority of providers.

That was the Care Quality Commission’s verdict on the sector in a thematic report today that drew on the findings of 250 inspections and feedback from over 4,600 service users or carers.

The CQC’s probe follows a series of reports that have raised concerns about the quality and safety of home care services, notably the Equality and Human Rights Commission’s 2011 report into human rights breaches in the sector.

Good services overall

However, the CQC found that 74% of the services inspected met all five of the standards CQC inspected them against: meeting care and welfare needs, respecting and involving service users, safeguarding them from abuse, monitoring service quality and supporting staff. On safeguarding and involving service users, 96% and 97% of services, respectively, were meeting standards.

Practice was good where service users had continuity of care worker, staff were trained in understanding clients’ medical conditions, care plans were regularly updated through staff accurately completing daily logs, and service users and their families were involved in decisions about care.

However, the CQC raised concerns about poor practice in a minority of services and highlighted late or missed calls by staff as the most significant problem, as it left clients feeling “vulnerable and undervalued”.

Lack of travel time

A key cause was a lack of travel time between visits for staff; inspectors found “numerous examples of rotas that did not allow time for staff to travel between visits”, and were told by staff that it wasn’t unusual for them to have to cover an additional visit during a day, meaning other visits were cut short. Late or missed calls were a particular problem at weekends.

Though it said this was an issue for commissioners and providers alike to address, it criticised some providers for failing to investigate late or missed calls and take action to reduce their occurrence, and for not informing service users where rotas were changed unexpectedly.

Service users interviewed by the CQC also expressed concerns about a lack of continuity of care workers. It said providers needed to ensure that there was a small team of staff working with each service user and ensure new staff were personally introduced to clients before their first appointment.

Lack of support for staff

While 88% of providers met the standard for supporting staff, “many staff” told inspectors that they could be better supported, while service users and carers interviewed said new staff often did not appear to be adequately trained.

The CQC found that appraisal and supervision were not being delivered in line with company policies in some agencies while others did not have a documented policy on supervision; many staff files were incomplete and did not include records of supervision.

Providers’ reaction

The United Kingdom Homecare Association welcomed the report for highlighting “the positive impact that high-quality services have on the lives of older people in England”.

Regarding the issues raised about late or missed visits, it said: “Home care providers have a duty to constantly monitor this essential requirement and act without delay. It is vital that people who use services are kept informed about delays to their expected service and know if the care worker they expect has been unavoidably replaced.”

However, the association stressed the role of councils commissioning care in slots of 30 minutes or less in causing late or missed calls.

“This inevitably creates a system lacking in flexibility, where the need to respond to urgent and unexpected events may delay a care worker’s subsequent visits during the day and threatens providers’ ability to fund training and supervision of the workforce,” it added.


The CQC made the following recommendations:

  • Commissioners and providers of home care services must work together to address the issues of timings      and length of visits and the travel times required for staff between visits, to ensure that people have the appropriate length of time needed for their care;
  • Providers should try to ensure that there is a small team of care workers for each person receiving care, to reduce the risk of them having a visit from someone they don’t know;
  • Staff caring for people with dementia should have access to relevant training and be able to develop their knowledge and expertise in this area;
  • Staff must be able to regularly see other care workers and meet with managers to discuss the needs and progress of the people they provide care for;
  • Providers must give staff  enough information to allow them to identify and record people’s preferences and choices about how they would like to receive care in their own home.

See more at: http://www.communitycare.co.uk/articles/13/02/2013/118910/cqc-most-home-care-good-but-missed-visits-blight-some-services.htm#sthash.P7AX7Zmc.dpuf

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Social worker killed herself after restructure caused workload to increase

Fear of losing the transitions co-ordinator job she had worked so hard to get put Julie Dugdale in a “highly stressful” situation, the coroner said.

A social worker committed suicide after her department was restructured and the pressures of her job reached unbearable levels, an inquest has heard.

Julie Dugdale was found hanged at her home in Clitheroe, Lancashire, where she lived with her husband and two children, in November last year.

Dugdale joined Lancashire council’s transitions service in 2010 as a newly qualified social worker. Last summer, her department was re-organised and she was required to reapply for her job as a co-ordinator.

She was successful, but the inquest last week at Blackburn Coroner’s Court heard that, after her department was restructured, her workload intensified and became more reliant on IT systems.

Her husband told the inquest his wife became “noticeably preoccupied” with her job after retaining her post. He also said she had been having problems with a remote access IT system that had been introduced.

“She wasn’t able to get through her workload without putting in extra work at home and then, with the problems with IT, her hands were tied,” said Mr Dugdale. “She wasn’t able to sleep for the last five nights of her life.”

Dugdale went to her GP, was put on a course of medication and given two weeks off work. But the next day she was found dead by family members.

Deputy coroner Elaine Block said: “The catalyst in this case was her situation at work. Her home life was stable, but she found it very difficult to cope with the situation, her workload and the problems the workload was bringing.”

Block said the fear of losing the job she had worked so hard to get put Dugdale in a highly stressful situation. “It seems to me that Mrs Dugdale was a sensitive and conscientious person who had worked hard to get where she was and when she got there it was as though she had everything taken away from her. She took the situation she found herself in very much to heart.

“This was not a cry for help, it was an action she meant to have consequences and the only verdict I can return is that she killed herself while the balance of her mind was disturbed.”

Lancashire council, which has criticised the coroner’s office for refusing to provide a transcript of the inquest because it could be used to learn lessons, said the restructuring had not increased Dugdale’s caseload in terms of numbers, but had resulted in her having a “wider monitoring role”.

Her department had not been at full strength in the months before her death because a colleague was on maternity leave and another staff member was in the process of being recruited. It also confirmed Dugdale had problems using her laptop to access information remotely.

Mike Banks, head of active intervention and safeguarding, said: “We were all shocked and deeply saddened by Julie’s death and our thoughts remain with her family and friends at this very difficult time.

“We know social work is often a stressful job, so we keep a careful eye on our social workers via regular supervisions sessions, team meetings and through developmental work, to help them deal with the everyday pressures of what can be difficult and challenging work.”

A council spokesman said Dugdale had received appropriate supervision together with developmental support and guidance: “We follow the recommendations of the Social Work Task Force. Where appropriate, we carry out individual stress risk assessments and continue to look at other ways to help reduce pressures in response to the health check surveys we conduct with our social workers.”

– See more at: http://www.communitycare.co.uk/articles/12/02/2013/118909/social-worker-killed-herself-after-restructure-caused-workload-to-increase.htm#sthash.VUddnaRz.dpuf

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Frank Lampard signs children’s book deal

England and Chelsea footballer Frank Lampard is to write a series of children’s books, publisher Little Brown has announced.

The midfielder, whose contract expires at the end of the season, will pen five books, called Frankie’s Magic Football, for children aged five and above.

The stories will follow the adventures of a school boy, Frankie, his football-loving friends, and pet dog Max.

Lampard said the stories were “loosely based on friends and team mates”.

The 34-year-old will publish his first book, Frankie Versus The Pirate Pillagers, in June, followed by two more this year and another two in 2014.

“I first had the idea of Frankie and his Magic Football when reading stories to my own children,” he said in a statement.

“Sport and reading are two essentials for us at home, so I decided to make up my own football stories and adventures.”

‘Wacky adventures’

Lampard has two daughters, aged five and eight, with his former fiancee, Spanish model Elen Rivas. He is currently engaged to TV presenter Christine Bleakley.

The vice-captain of Chelsea FC, Lampard currently earns £150,000 per week. He started his career in 1994 at West Ham United, where his father, Frank Lampard Sr, had also played.

He has represented England more than 90 times, scoring 27 goals – but he may be best remembered for a shot he took in a 2010 World Cup match against Germany.

The ball crossed the line, and players and fans believed Lampard had scored a goal – but it was disallowed. The resulting furore prompted football’s world governing body, Fifa, to investigate the introduction of goal-line technology, which was used for the first time in a Club World Cup match last December.

Lampard’s book deal was brokered by Neil Blair and Zoe King, who also represent JK Rowling. They said the books were “full of loveable characters on wacky adventures” and destined for “great things”.

He is not the first footballer to write fiction – Arsenal star Theo Walcott has written a series of children’s books and former England manager Terry Venables co-wrote a series of crime novels.


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The Independent Police Complaints Commission (IPCC) has launched an investigation into a complaint that Sussex Police restrained an 11-year-old girl with Smith-Magenis Syndrome on several occasions.

The girl’s mother has made the complaint about how the girl appeared to have been restrained with handcuffs and leg restraints on 5 occasions by Sussex Police officers between February 2 and March 2 2012 in Horsham and the surrounding area. On all but one of these occasions she was arrested and taken to police stations, and twice she was held overnight.

The complaint about the police management of the incidents, the methods of restraint used on her daughter and the decisions to hold her in police station cells overnight was made to the IPCC in July 2012.

Sussex Police then referred the matter to the IPCC on December 12, 2012 and an independent investigation commenced.

IPCC Commissioner Mike Franklin said: “The IPCC investigation is examining the nature and circumstances of the officers’ interaction with the girl on five separate occasions in February and March 2012 to determine whether the degree of force and method of restraint used by officers was appropriate and in accordance with the law, the officers’ training and force policy and procedure.

“The investigation is also looking at the appropriateness of the decision to place the girl in police cells on four occasions and to refer her to the Crown Prosecution Service for charging on one occasion.

“These are very serious complaints about the treatment of an 11-year-old girl suffering from Smith-Magenis Syndrome and I will ensure that they are investigated thoroughly.”

A Sussex Police spokesman said: “We take our responsibility for any use of force very seriously particularly when it involves young people or those who are disabled.

“Given the unusual circumstances of the case and that is it being independently investigated we cannot go into full detail until the conclusion of the investigation. We welcome the IPCC’s scrutiny and we fully support its investigation.”

Smith-Magenis Syndrome is a genetic disability due to a microdeletion or abnormality of chromosome 17. The major features of the condition include mild to moderate intellectual disability, delayed speech and language skills, distinctive facial features, sleep disturbances, and behavioural problems, according to the Smith-Magenis Syndrome Foundation UK.


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Social care: Jeremy Hunt hails ‘fully-funded solution’

Health Secretary Jeremy Hunt says people must feel confident their homes are not at risk

The government says it will announce a “fully-funded solution” on Monday to the problem of elderly people in England who cannot afford social care.

It is expected to include a £75,000 cap on the costs people pay for care and a rise in the threshold for means-tested support from £23,250 to £123,000.

Health secretary Jeremy Hunt said the “scandal” of many people selling homes to pay care bills must be tackled.

Labour said the country needed “a far bigger and bolder response”.

At present, up to 40.000 people every year are forced into selling their homes because they face unlimited care bills, says Mr Hunt – who will set out the plan in a statement to the Commons.

He told the BBC’s Andrew Marr show the aim was “to be one of the first countries in the world which creates a system where people don’t have to sell their own house”.

Deputy Prime Minister Nick Clegg, writing in the Sunday Telegraph, meanwhile, said: “We will make sure no-one is forced to sell their home to pay for care in their lifetime, and no-one sees their life savings disappear just because they developed the wrong kind of illness.”

The cost of accommodation in residential care homes averages about £7,000-£10,000 a year.

Ministers may be giving themselves a big pat on the back for their changes to the social care system.

But for many involved in the sector this is just the start of the process.

Firstly, the £75,000 cap is more than double the figure recommended by Andrew Dilnot, the independent expert asked to look at the issue by government two years ago.

While publicly it is being welcomed – campaigners have been promised reform ever since Tony Blair came to power – there is a nagging fear that it is too high to really get people engaged with planning for their old age.

And, secondly, this reform does nothing to improve the quality of services currently on offer. It is purely aimed at preventing people having to sell their own homes to pay for care.

Local government has long argued the system is dramatically under-funded and services are suffering as a result. For many, this is just the start of the solution.

While the cap is a sizeable sum the hope is that, by establishing the principle that the state will cover the really high costs, people will start planning for their future care needs.

There are a variety of ways in which the elderly with the means to do so can free up £75,000, but one hope is that the insurance industry will start engaging with the issue and developing products that would cover old-age care.

Mr Hunt, who said 10% of people ended up paying more than £100,000 in care costs, said that “just as people make provisions for their pensions in their 20s and 30s, so we also need to be a country that prepares for social care as well”.

He added: “By setting an upper limit to how much people have to pay, then it makes it possible for insurance companies to offer policies, for people to have options on their pensions, so that anything you have to pay under the cap is covered.”

As well as introducing a cap, the government is expected to increase the means-tested threshold – there to ensure the less well-off get state help towards their care costs.

Currently anyone with assets of more than £23,250 has to pay for their care. Under the plans, it is likely the threshold will rise to £123,000 for people who need to go into a care home.

That reflects the fact that rising property prices over the years have effectively meant any home-owner falls outside the state system.

These proposals won’t do anything for the hundreds of thousands of elderly and disabled people who are facing a desperate daily struggle to get the care and support they need right now”

Mr Hunt is also expected to reveal that the plans will be part-funded by freezing the inheritance tax threshold – at £325,000 for individuals and £650,000 for couples – for three years from 2015.

That is despite Chancellor George Osborne’s Autumn Statement pledge, in December, to raise the threshold by 1% – to £329,000 for individuals and £658,000 for couples – in 2015/2016.

Other funding will come from previously-announced changes to National Insurance and pensions and cuts in government departments.

Labour said that, while the government’s plan would help “some people who need residential care in five or more years’ time”, it would not be fair “for people with modest homes”.

“And these proposals won’t do anything for the hundreds of thousands of elderly and disabled people who are facing a desperate daily struggle to get the care and support they need right now,” shadow minister for care and older people Liz Kendall said.

“We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people stay healthy and living independently in their own homes for as long as possible.”

“The reforms will start to open up the possibility of the financial services sector being able to help people prepare for care”

The National Pensioners Convention said the proposals “simply tinker at the edges” and that a £75,000 cap “will help just 10% of those needing care, whilst the majority will be left to struggle on with a third-rate service”.

“The current system is dogged by means-testing, a postcode lottery of charges, a rationing of services and poor standards and nothing in the plan looks like it will address any of these concerns,” general secretary Dot Gibson said.

Older people’s charity Age UK said it was disappointed at the “high cap” of £75,000 but added “a high cap is better than no cap at all”.

The Association of British Insurers (ABI) welcomed the plans but said it was “vital that people clearly understand the cap and what costs are covered, and a national awareness campaign will be needed to make this happen”.

And Economist Ros Altmann said the proposals would create a fairer system that would allow people to “plan and prepare for care”.



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Norman Lamb MP writes…The government will act in response to the Francis Report

Over the course of four years at Mid Staffordshire hospital, hundreds of patients suffered from appalling neglect and mistreatment. Relatives that voiced concerns were ignored; staff that tried to speak up were silenced. It was a shocking betrayal of trust of patients and their families.

Yesterday Robert Francis QC published his report into the Mid Staffordshire NHS Foundation Trust. The public inquiry lasted more than two years, heard over 250 witness statements, considered over one million pages of documentary evidence, and has produced a report nearly two thousand pages long. It makes 290 separate recommendations.

The story of Mid Staffs, the report says, is one of “terrible and unnecessary suffering of hundreds of people who were failed by a system which ignored the warning signs of poor care and put corporate self interest and cost control ahead of patients and their safety.” The overriding message is the need for a culture change across the NHS to make sure that patients always come first.

This is a message that the Government has heard. It is one that we are acting on. Achieving culture change across the system is something that will take time, effort and commitment from all involved in the NHS – not just Government but also commissioners, providers and regulators as well as frontline professionals and senior managers.

Yesterday we announced:

• Steps to strengthen the Care Quality Commission and appointing a new Chief Inspector of Hospitals to improve quality in hospitals
• A review of hospitals with high mortality rates so that urgent action can be taken on any Trust where serious concerns are identified
• Introducing minimum training standards for healthcare assistants to ensure staff can provide safe, effective and compassionate care
• A ‘zero harm’ patient safety review led by international expert Don Berwick
• A review of how complaints are handled

These come on top of a number of other steps we are taking to strengthen patients’ voice and to encourage openness and transparency, such as introducing the Friends and Family test, creating a contractual duty of candour, and giving more support for whistleblowers.

As a Liberal Democrat Minister at the Department of Health I am determined to build on these steps to ensure that patient care is the fundamental priority of every part of the system.

The Lib Dem manifesto included a commitment to require hospitals to be open about mistakes, and always tell patients if something has gone wrong. This is something I argued for when we were in opposition, and it is something I will push for within Government. I am also clear that there should be no more rewards for failure – despite the shocking failures of care that occurred at Mid Staffs, the Chief Executive Martin Yeates left with a large compensation pay off.

We know this is an important moment. I think that staff right across the NHS, the Care Quality Commission and other bodies recognise that too. The Government will consider all the report’s recommendations carefully and give a more detailed response next month – but doing what is necessary to promote and embed a culture of care across the whole system is our priority.

* Norman Lamb MP is Liberal Democrat Minister of State at the Department of Health



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Commissioning GPs would abandon CCGs if Labour’s plan to downgrade them to an advisory role went ahead, GP leaders have warned.

The warning came after shadow health secretary Andy Burnham unveiled the party’s NHS vision for England if it wins the next general election. Labour would pool the £104bn NHS budget with £15bn in social care funding, he said. Councils would have more power through health and wellbeing boards, with CCGs in a ‘clinical advisory role’.

GPs would take a ‘more active role’ in managing the ‘older at-risk’ population and keeping them out of hospital. The Payment by Results tariff could be replaced with a ‘year-of-care’ fee to incentivise providers to deliver more care at home, with greater emphasis on prevention, and NHS organisations would be given ‘preferred provider’ status.

Mr Burnham also reiterated his pledge not to scrap CCGs.

But GPC deputy chairman Dr Richard Vautrey and Family Doctor Association chairman Dr Peter Swinyard said GPs would give up commissioning work if CCGs lost control.

Dr Swinyard said: ‘Taking away the power of CCGs takes away their raison d’etre. Any hard-working GPs on CCGs would look at this and say, “Bother this for a game of soldiers.”.’

Pooling health and social care budgets risks more NHS cuts, Dr Vautrey claimed.

‘It could mean that NHS money would be used to prop up council services, which have been hit harder than healthcare,’ he said. ‘There is only one pot of money and no suggestion somebody wants to increase resources significantly.’

BMA council member Dr Clive Peedell, a leading critic of the government’s NHS reforms, backed Mr Burnham’s pledge to make NHS organisations ‘preferred providers’.

Dr Peedell, a founder member of the National Health Action party, set up to oppose the Health and Social Care Act, said the plans were ‘still quite woolly’. He added that Labour still had work to do to regain the trust of clinicians and the public on the NHS.

Labour will begin a consultation on its plans this month, holding meetings across England until June.


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