“Care Closer to Home”: the Torquay experience (not good)

Concerns that care in the community is failing some Torbay and South Devon residents have been raised by a health campaign body.

Gordon Jennings, chairman of the Community Health and Welfare Alliance, set up at the time of the consultation on the closures of community hospitals in Torbay and South Devon, said they feared the consequences of the closure of at least 74 beds across Torbay alone. One of the main providers of care in the area Mears Care was recently taken out of special measures by Government inspectors but they still rated it as ‘requiring improvement.’

It comes after Torbay and South Devon NHS Foundation Trust marked the second anniversary of the launch of the pioneering integrated care organisation in the area.

Mr Jennings said: “We are concerned as we have a high proportion of over 80s in the population, we should be making sure there are suitable arrangements for those people. The integrated care organisation’s argument is that the alternative to community hospitals is care at home. But they haven’t got the staff for home care. How are you going to get quality of care? Changes usually mean improvement, but it’s arguable that under the Devon NHS Sustainability and Transformation Plan (STP) this is not always the case and is a series of cuts – including the loss of 100 hospital beds.

“Evidence is being gathered on experiences under ‘Care in the Home’, but we would implore Torbay communities to become involved and share your experiences with Healthwatch Torbay, Paignton Library, who are conducting ‘have your voice heard today’ consultation on this and other health subjects.

“We need to remind ourselves that South Devon and Torbay Clinical Commissioning Group admitted at the consultation meetings in regards the lack of staff in this area. With your help it is our intention, not only to seek a meeting with the CCG, with these findings, but also Torbay Council Health and Well Being Board, who have a responsibility in this area.

“We have been seeking evidence that it isn’t working and we have had some cases come forward but we are looking for more. If people can write to us with their concerns we can take it up with the right people.”

Dr Kevin Dixon, chairman of Torbay’s independent consumer champion for health and social care, Healthwatch Torbay, said: “Healthwatch Torbay regularly shares an extensive variety of local feedback from Torbay residents on hospital discharge and community care with both Torbay and South Devon NHS Foundation Trust and the Care Quality Commission, along with relevant providers and health commissioners, in order to contribute to their intelligence reports and prompt them into any relevant action.

“Although we have heard public concerns with both discharge and community care, we have also received praise for both.

“The findings of the CQC report into Mears Care Ltd. were reflected in the feedback we have gathered from those people who shared their experiences with us, which indicated that although there was some improvement in the quality of care Mears have provided since the original CQC report in 2016, a number of issues still exist.

“We remain committed to escalating any public complaints and concerns directly with Mears Care Ltd. and continue to monitor the quality of care they provide. Healthwatch Torbay will carry on gathering local public feedback and sharing it with key decision-makers to ensure the public voice is listened to at a commissioning level.”

Michael Rennolds of Coombe Road, Preston, has muscular dystrophy and Muscular Dystrophy UK say the condition is a progressive and life limiting muscular wasting condition for which there is no cure and no effective treatment. That means he has high needs.

Joel Rackham, care and information advocacy officer has written to Torbay and South Devon Healthcare Trust saying Michael required constant individualised care and intervention over each 24- hour period including regular physiotherapy, support with food and drink, toileting and bathing needs.

They say it is critical an up-to-date care plan is in place. But they say he has lost out on several respite days as well as his care hours were reduced from 84 hours a week to 41 which the charity say is ‘insufficient to meet his care needs’ .

At the same time £16,200 was taken out of his bank account which would have been used to pay for care. The charity has asked for the money to be reinstated and say it is ‘not fair’ to expect his mother, who works part time to be expected to care for him as her health is being affected and she cannot be expected to handle Mr Rennolds on her own.

The charity has asked for a minimum of 98 hours of care per week, more than double the amount budgeted for.

Nic Bungay, director of Campaigns, Care and Information at Muscular Dystrophy UK told Devon Live: “Without the right support in place, the difficult job of helping Michael to get out of bed, get dressed, eat his meals and live his life will fall on his mother Susan. The severe and progressive nature of Duchenne muscular dystrophy means that any reduction in care is wrong, but cutting the hours in half and leaving an entire day without any provision is unthinkable. His hours need to rise to the recommended 98 hours a week immediately.”

Mrs Rennolds said the money has still not been reinstated and she had been told the consideration of her complaint had again been adjourned.

“The NHS have taken the £16,200 out of Michael’s bank account, because he wouldn’t sign some papers that were in dispute. Only an idiot would sign some papers they disputed. The charity has written stating that money has to be put back. Michael is really down about this.”

A Torbay and South Devon NHS Foundation Trust spokesman, said: “We are currently in the process of responding directly to Mr Rennolds’ complaint. “We are fully committed to providing our clients with the best possible care. We work hard to ensure that people stay as healthy and independent as possible and that those who would be at risk of injury, illness or isolation are cared for as a priority. Each client will have their individual needs professionally assessed on a regular basis and our health and care professionals will work with them to identify the best way for their needs to be met. This means we can be sure we continue to meet individual’s changing needs.

“Whilst we cannot discuss individual client cases, when clients have their needs and care plans reassessed, we always do this working in partnership with the person and jointly agree the outcome.

Direct payments are made to meet an individual’s specific care needs. In addition, as part of the national guidelines, all recipients of Direct Payments sign an agreement that states that we reserve the right to reclaim money that is not being used. If people in receipt of direct payments accumulate a significant amount of money saved from their direct payments, in line with these national guidelines, we will recover a proportion of this money which will then go towards providing care for other vulnerable people. When monies are recovered, we will always ensure a significant proportion still remains in their Direct Payment account to cover their own care costs as well as a contingency for any unexpected expenditure.”

Marilyn and Ivor Martin, of Salisbury Avenue, Torquay say they are struggling with the level of care offered at home after Ivor, 68, had a serious stroke.

Marilyn said he had a stroke out of the blue one lunchtime which has left him affected all down the left side and incontinent. She said: “I cannot fault the hospital staff at all, the ambulance staff they were incredible. He was moved to Newton Abbot and his care there was wonderful, impeccable. Then I had a visit from occupational therapy from Newton Abbot who said he was coming home. I said my house isn’t suitable.

“I have steps in my garden, I was told there was no money to do that. I have a corner bath and they said there were no aids to get him in and out of the bath so he would have to strip wash and he would need to for the rest of his life if needs be. If I wanted adaptations I would have to pay for it myself. I was offered handrails which would take six to eight weeks to install after he got home. He couldn’t get upstairs and I said I was not having him home if it was not safe. They said I would have to put a bed in the dining room. I don’t have a single bed but was told I would have to buy or borrow one. They put a rail on my bed upstairs, a commode, a rail around the toilet so he could get himself up.

“I was told if I don’t have him home he would have to go in a care home. That would cost hundreds of pounds, money which should be put into caring for people in the community. We had him home and within three days he had a hospital appointment at 12noon. I was told there would be transport but it would come at anytime between 9.30am and 11.30am, and they would pick him up any time between 1pm and 4pm. He’s incontinent, he would be sat at the hospital all that time without food. I was told ‘that’s the way it is’. We had three appointments in one week for the heart and lung department, but they said they couldn’t arrange for them all on one day so we had to get him up there three times. I took him up with my son’s girlfriend who helped, but I am lifting him in and out the car and I had open heart surgery last year. There is no thought about the carers.

“They said that while I was at work, there could be someone coming in the morning to dress him and someone to give him a sandwich at lunchtime. They said they could come any time between 7.30pm to 10.30am. He wouldn’t stay in bed that late, he’d be getting himself up and falling. I can’t have that. Then they could be back at 11am and 2pm getting him lunch. It’s ludicrous.

“I had help filling out the forms for attendance allowance but you can’t have that until they have been ill for six months. I have spent nearly £4,000 on having a ramp put in the garden and shower unit changed and putting in a second hand stairlift. The physios have been fantastic but suddenly they were told they weren’t coming again until October. His arm isn’t working at all and his hand is swollen. It’s not right. Having the physio in really boosts his morale as well. If you are going to have care in the community you have to the people to do it. Ivor could go swimming at Plainmoor Pool but there’s no way to get help taking him there, I have got to do it. If someone doesn’t have someone at home to help how do they get there?

“There needs to be an organisation that sets up a package and says you will need this, this and this and get it organised for you. In hospital they were fantastic every single nurse and doctor, but if you are going to do care in the community you need to set up what people need before you throw them out there. Nobody is helping us. “

Torbay and South Devon NHS Foundation Trust, the integrated care organisation responsible for social care in Torbay, said they could not comment as they had not had a direct complaint from the Martins. On the question of a shortage of carers a trust spokesman said: “We recognise that, like other places in the country, having enough people with the right skills and training to provide domiciliary care for people to be able to continue to be supported at home is a challenge. And there are a number of things we are doing to ensure the right level of care can be provided including supporting the campaign ‘Loving to Care’ to encourage more people to enter this very rewarding career.

A key part of how we are addressing the challenge is our partnership with a national provider of domiciliary care, Mears, This partnership helps to ensure enough carers are recruited, trained and supported to develop their skills. We extend our training and support so that carers working for all care providers are able to benefit from our training provision. This is an incredibly worthwhile profession and by supporting providers to be able to offer increased opportunities for development of their staff they are not only gaining important skills they also benefit from greater job satisfaction and are more likely to want stay in the caring profession.

“In addition to this support we also offer alternatives for people , such as direct payments which enables people to employ their own support assistant directly.”

Torbay residents can share their experiences by calling Healthwatch free on 08000 520 029, visiting upstairs at Paignton library, or even by rating and reviewing a local health and social care service online via http://www.healthwatchtorbay.org.uk. If you have a case write to Mr G Jennings, c/o Acorn Centre, Lummaton Cross, Torquay, TQ2 8ET.”

http://www.devonlive.com/news/devon-news/south-devons-pioneering-care-community-708511

NHS: where the money goes – short-term fixes

“The NHS spent almost £100 million on stand-in midwives last year, with the figure for England 20 per cent higher than in the year before.

Jon Skewes, director of policy at the Royal College of Midwives, said that the money could have paid for 4,391 newly qualified midwives or 2,731 more experienced staff.

Years of pay freezes were blamed for driving NHS midwives away, adding to pressure on Philip Hammond, the chancellor, to promise health workers a pay rise in next month’s budget.

The NHS spent £2.9 billion on private agency workers in 2016-17, down from £3.6 billion the year before after pay caps were imposed on nurses, doctors and midwives. Much of the fall was due to the NHS switching from external agencies to in-house “staff banks”, where workers are called in as required.

Data collected by the Royal College of Midwives found that private agency spending in English maternity units fell from £29 million in 2015 to £20.6 million last year. NHS bank staff costs rose from £43.2 million to £58.6 million.

Once overtime is included, spending rose from £72.7 million in 2015 to £87.3 million in 2016. For the first time, the college gathered comparable data from Scotland, Wales and Northern Ireland, finding that overall the NHS spent £97.1 million on maternity gaps.

Mr Skewes said: “The use of temporary midwives to staff permanent shortages is counterproductive and smacks of short-termism . . . It is costing more in the long run to pay agency, bank and overtime than it would if services employed the right numbers of midwives.” He added that the “average midwife has seen their salary decrease in value by over £6,000 since 2010”.

•Charities such as Macmillan Cancer Support, the Alzheimer’s Society and Age UK joined health bosses and senior doctors to issue a “cry for help” for more money. “Without additional resources there will be a further deterioration in what can be provided for patients, service users and carers”, says a letter also signed by Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, a group for the professional standards bodies that usually stay out of politics.”

Times (pay wall)

Air pollution statistics in East Devon

Particulates: 6.8 per cubic metre (should be lower than 2.5 but not amongst the worst offenders

Deaths: 3.9% of deaths attributed to air pollution.

Interestingly, Exeter is only slightly worse than East Devon:

Particulates: 7.4 per cubic metre and 4.2% of deaths.

http://www.telegraph.co.uk/science/2017/10/30/eastbourne-bracing-air-among-polluted-britain/

Taylor Wimpey and Cranbrook … not a happy partnership

Taylor Wimpey’s Facebook page has some VERY unflattering comments about their houses in Cranbrook, and Cranbrook itself – poor construction, parking problems, not enough shops, no 1 bed properties, size of rooms disputed, checks not made, repairs not done …

Oh dear.

Powerful Tory committee blocked Cameron attempt to protect Commons staff alleges Evening Standard

“In the Evening Standard today Joe Murphy and Kate Proctor says the backbench Conservative 1922 committee opposed a bid by David Cameron to introduce a binding code of conduct for Tory MPs that would have strengthened the protections available to staff suffering harassment. Murphy and Proctor say:

The powerful 1922 committee of backbenchers mobilised against an attempt made by David Cameron to create a binding code of conduct that would have included a right for staff members to seek arbitration.

Mr Cameron attempted to persuade the speaker and other party leaders to support the measures following a sex scandal but his move met resistance from MPs, said sources.

The former prime minister then attempted to get his own MPs to sign up voluntarily.

But this was blocked by the 1922 committee, which saw the plan as a whips’ plot to impose “central control” on backbenchers.

The story is on the front of the Standard under the headline – Revealed: How backbenchers blocked bid to shield staff from sex pests.”

https://www.theguardian.com/politics/blog/live/2017/oct/30/commons-sex-abuse-claims-dossier-intensifies-demands-for-ministerial-statement-politics-live

Could harassment scandal topple Government? Robert Peston thinks it might

Robert Peston:

“The growing fear among Tory MPs is that the sexual-harassment scandal is evolving into the equivalent of the MPs’ expenses debacle – and that it could bring down the government.

It’s all the fault of that bloomin’ list of MPs and their alleged misdemeanours that was compiled by Tory aides and was published by the Guido website overnight, with names blacked at.

The blacking out is not preventing reputational damage to a pair of cabinet ministers and several other senior members of the government.

Their names are being openly touted in Westminster – and it won’t be long till they are outed on social media, and on offshore websites.”

“Axe Valley health hub plan launched as campaigners fight hospital sell off”

“Campaigners will continue to fight plans to sell off Seaton Hospital and to support plans for a new health hub for the Axe Valley. …

[Independent East Devon Alliance] County councillor Martin Shaw [Seaton and Colyton] said: “Forty campaigners from the Axe Valley area met in Seaton this week to review the state of the campaign for the local hospitals.

“I told the meeting that while the battle to save Seaton’s hospital beds had been lost, it had put Seaton on the map in the forthcoming discussions about health services in the area.”

Mayor of Seaton, Cllr Jack Rowland, said that a meeting to set up a steering committee for an Axe Valley Health Hub would take place shortly.

He was encouraged that the Royal Devon and Exeter Hospital Trust was putting resources into this and he also pointed out that more than fifty services involving over a hundred staff were still based at the hospital.

Campaigners will continue to fight plans to sell off Seaton Hospital and to support plans for a new health hub for the Axe Valley.

In August, a vigil was held outside Seaton Hospital as the beds inside the hospital were closed, as protesters waved banners, shouted “shame”, and expressed their anger and sadness outside Seaton Hospital as the controversial closures of community hospitals began.

Plans to remove the beds from Exeter, Seaton, Honiton and Okehampton community hospitals have been met with strong opposition since they were confirmed in March.

The North, East and West (NEW) Devon Clinical Commissioning Group (CCG) said the move will see more people being given care at home and save £2.6million.

Although the battle to save the hospital beds has been lost, a new campaign though has been set up in the Axe Valley area to support the development of a health hub in the region.

County councillor Martin Shaw said: “Forty campaigners from the Axe Valley area met in Seaton this week to review the state of the campaign for the local hospitals.

“I told the meeting that while the battle to save Seaton’s hospital beds had been lost, it had put Seaton on the map in the forthcoming discussions about health services in the area.”

He was encouraged that the Royal Devon and Exeter Hospital Trust was putting resources into this and he also pointed out that more than fifty services involving over a hundred staff were still based at the hospital. ‘Don’t let anyone say the hospital is closed’, he said.

The meeting, chaired by Paul Arnott of the East Devon Alliance, agreed that it was necessary to establish which health services could most usefully be based in Seaton and Axminster hospitals, and this might involve canvassing the views of local residents and a number of people present offered to help with this.

The meeting decided to set up a new Axe Valley Hospitals Campaign to support the development of a health hub around the two hospitals and to oppose any proposals to sell off hospital sites.”

http://www.devonlive.com/news/health/axe-valley-health-hub-plan-699423

“Campaigners put pressure on government to improve ‘dire’ Devon education funding at national lobby”

As yet there appears to be no similar East Devon campaign group and our two MPs simply dole out meaningless platitudes without concrete follow-up action. Swire seems more preoccupied with who to back for next PM (or maybe ex-PM!) in order to regain a foreign office ministerial post while Parish’s preoccupations remain farmers and dualling the A303.

… “Tamsin Higgs, mother-of-three from Braunton, has been leading the parent-led and non-political Fair Funding For All Schools campaign in North Devon since the beginning of this year. For more information you can visit the campaign’s Facebook page here. Tamsin has also set up a campaign group in Torrington who recently met with Torridge MP Geoffrey Cox. …

… Tamsin said she regularly meets with the central school funding campaign group in London who, alongside the National Education Union, planned the national lobby at Westminster against school funding cuts. The group decided to take part in the lobby, which attracted more than 1,000 people, to apply pressure from all constituencies on the central government to increase funding and ensure schools are not losing out. …”

http://www.devonlive.com/news/devon-news/campaigners-put-pressure-government-improve-700472

Council Finance Officers should ALL be responsible for scrutinising Local Enterprise Partnerships

“Section 151 officers [Responsible Financial Officer of a council, often called a Chief Financial Officer] should be given a beefed up role in ensuring Local Enterprise Partnerships spend public money wisely, according to a government-commissioned review.

The review, by Department for Communities and Local Government (DCLG) non-executive director Mary Ney, was instigated after MPs raised concerns over transparency and governance.

It found a lack of consistency in how section 151 officers overseeing LEPs are able to influence decisions and provide advice.

The review said that, accordingly, the government, in association with CIPFA (the Chartered Institute for Public Finance and Accountancy), should revise the National Assurance Framework (NAF), which sets out what government expects LEPs to cover in their local assurance frameworks.

Ney said: “The clarification of the role of the section 151 officer could also consider the scope for the LEP chief executive and the section 151 officer to provide a formal joint annual governance statement which is reported to the LEP board.

“It is also recommended that the NAF sets a requirement for the section 151 to provide a report to the Annual Conversation on their work for the LEP and their opinion with a specific requirement to identify any issues of concern on governance and transparency.”

Changes to the framework should cover:

mechanisms the section 151 officer uses to fulfil their role;
requirements in terms of access to decision-making bodies;
ability to provide written and verbal financial advice;
role of their transactional services;
operation of normal checks and balances in approving expenditure;
management of risk of fraud and corruption;
monitoring of programme spend against resources;
treasury management and borrowing;
role of internal audit and external auditors and provision of an audit opinion for the LEP;
visibility of reporting arrangements to both the accountable body and the LEP
production of accounts;
inter-relationship with the LEP’s own accounts, if relevant.
Last year, the National Audit Office identified concerns in governance arrangements for LEPs.

Amyas Morse, head of the National Audit Office, said: “LEPs’ role has expanded rapidly and significantly but they are not as transparent to the public as we would expect, especially given they are now responsible for significant amounts of taxpayers’ money.

“While the Department has adopted a ‘light touch’ approach to overseeing Growth Deals, it is important that this doesn’t become ‘no touch’.”

A subsequent inquiry by the House of Commons local government select committee concluded that the DCLG, “should enforce the existing standards of transparency, governance and scrutiny before allocating funding. LEPs themselves also need to be more transparent to the public by, for example, publishing financial information”.

Separately, this week’s review found that many LEPs are frustrated by the mismatch between long-term LEP spending programmes and annualised budgets resulting from central government funding arrangements.

Nye’s report said: “This could also impact on good governance if late and speedy decisions are made by LEPs which give insufficient time for all the checks and balances of the normal processes.

“The annual uncertainty of funding also has the consequence of some LEP staff being on fixed-term contracts, which is counter-productive in terms of efficiency and may have unintended impacts on good governance if it leads to insufficient organisation stability and continuity.”

http://www.room151.co.uk/151-news/report-calls-for-bolstered-s151-role-for-leps/

Foreign companies pay no corporation tax on UK commercial property sales

“… According to the British Property Federation there is about £871bn worth of commercial real estate in the UK – 10% of our nation’s net wealth. Not only is this hugely important in its own right, its value impacts on the price of land, and hence of new homes. About 20% of commercial real estate is sold each year – worth an eye-watering £115bn in 2015, according to Her Majesty’s Revenue and Customs.

When a seller is a UK individual or company, they are subject to UK corporation tax on their capital gains. Yet where the seller is foreign they are not. Approximately one-third of all UK commercial real estate – including most high value property – is held through offshore companies. Typically these companies are in tax havens, or structured so they pay no tax on the capital gain. Indeed, British taxpayers should be asking tough questions as to why their government turns a blind eye to anyone who holds UK property in offshore companies. …

In 2015 the then chancellor George Osborne made a big deal of taking action against non-doms who avoided paying tax – ending permanent non-dom status and changing the rules on inheritance tax. He also introduced capital gains tax on residential property sales by non-doms – but crucially not commercial properties. This has created the world’s most obvious loophole where overseas individuals and companies can repurpose property as commercial to avoid it. Closing this loophole could be very lucrative – estimates suggest it would raise between £5bn and £8bn per year.

Those worried that this would put Britain itself at a disadvantage against our competitors can be reassured: the United States taxes foreigners making a capital gain on US real estate, as do Spain, France, Germany, Italy, Canada and Australia. The Organisation for Economic Co-operation and Development rules explicitly allow nations to tax foreign-owned companies on the sale of their real estate. Yet successive UK governments have quietly let this injustice continue.

Last week I [Stella Creasey, Labour MP] tabled legislation to try to tackle this – but the government didn’t want to know. Treasury minister Mel Stride simply said it would be too “complex” to implement. With such sums at stake, our public services cannot afford for us to leave this in the “complicated” box any longer: the dividends could make a real contribution to our cash-starved schools and hospitals. In addition, it would improve the fairness of our tax system and help take some of the heat out of the UK’s inflamed property market.

We have another opportunity this coming week to finish what Osborne started. Parliament can act by supporting my amendment to the finance bill at its report stage on Tuesday 31 October. With cross-party support already building for it, this Halloween it’s time to give those overseas companies not paying their taxes a real nightmare.”

https://www.theguardian.com/commentisfree/2017/oct/30/egregious-loophole-property-capital-gains-tax-close-foreign-owners-commercial