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Providing care to vulnerable people

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The news has been flooded today with two powerful stories related to the provision of care to vulnerable people.
On the one hand, the ongoing saga of Southern Cross, one of the larger providers of residential and nursing care in the country, has developed now into a situation where the company, estimated to be running at a £300 million loss, has taken the step of withholding a significant proportion of the rents it owes to commercial landlords who own the land and buildings from which it operates over hundreds of sites.
The effect of such a strategy is difficult to assess in the medium and longer term.
The effect is upon the company and – of course – on those sick, elderly, disabled and vulnerable residents who rely on the company for care and who will clearly be massively affected by the company going under.
It seems that the only option for the company (along with numerous other private companies in similar situations) is to make its services more “efficient”. This is the advice which appears to be provided from the Government’s reaction to the crisis and from several Local Authorities in whose areas the company operates.
Those Local Authorities hold more than a passive interest in such matters, as the statutory duty to arrange care for those people in need of care ultimately rests with the Local Authority in which the person resides.
Indeed many hundreds, if not thousands of Southern Cross residents are placed into those care homes by Local Authorities in lieu of their duties under Part 3 of the National Assistance Act 1948.
The consequences of home closures on any scale are daunting and create a dilemma for the Local Authority, and – by extension – central government and the tax payer.
If Southern Cross (or any private care home) can no longer operate viably and is forced to close, then the residents in those care homes will HAVE to be accommodated by the Local Authority, under its statutory duties.
This is a legal certainty.
What is uncertain is the practical effect on individual residents who may have to move from what is effectively their home…often a place which has been their home for years.
In addition, the vast majority of residents will not have received such care for FREE, as they will have paid either the full amount of their care (tens of thousands per year), or have been forced to sell their home and possessions to fund the care, or – even if funded by the state – still have been expected to pay ALL their income towards the cost save for around £22 per week.
The solution to make running the care homes more “efficiently” in a bid to regain commercial viability will – in many people’s eyes – inevitably lead to a reduction in quality, training, facilities and staffing ratios.
In turn this is likely to affect the standards of care which have been at the forefront of work developed via the Care Quality Commission (CQC).
Many people are already convinced that standards of care have dropped significantly over recent years as Local Authority budgets have been capped or reduced, whilst demands for community care services inevitably increases.
Local Authorities have always been able to choose the more cost-effective option to met a disabled or elderly persons needs (if that need can be met in more than one way), and – historically – have “pushed” the option of residential care as opposed to care provided in a person’s own home, especially if that person’s financial situation meant that they would effectively pay for their own care in a residential or nursing home, whereas the Authority would have to subsidise care at home.
The whole question of care standards, commercial viability, care home closures, increased choices to remain in the community rather than residential care – and a whole range of associated issues - will only lead to an inevitable additional burden on Councils at a time when times could not be tougher!
Whilst outwardly unrelated, the Panorama expose last night in which several care staff were filmed basically abusing service users in a residential/respite home for young people with severe learning difficulties and autistic disorders, is in my view – whilst an extreme case - part of an overall picture of reduced standards of care as the burgeoning care industry deals with reduced funding levels paid for by the state and with the never-ending drive to “efficiency”.
There are innumerable examples of poor care which I deal with every week. There are innumerable cases I come across where staff employed to care for individuals and groups are poorly resourced, poorly trained, badly recruited and appear only to meet a criteria predominantly set by matters of cost alone.
Do we want community care?
Perhaps when the community begins to care (and agrees to pay for it) we may be able to say that community care for our vulnerable, needy, disabled and elderly is more than ideal aspiration or commercial opportunity.