“Social care postcode gap widens for older people”: EDDC tries to claw back its mistakes too late

Last week, desperate Tories put a much-too-little! much-too-late motion to East Devon District Council:

“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”

https://eastdevonwatch.org/2017/12/13/effect-of-sustainability-and-transformation-plans-on-rural-communities-east-devon-tories-miss-the-boat-then-moan-about-it/

As Owl noted at the time, this is somewhat rich, as their Leader, Paul Diviani, voted at Devon County Council AGAINST sending the document to the Secretary of State for Health (where this could have been highlighted in the covering submission) against the instructions of his EDDC Tory Councillors and never having consulted other Devon Tory councils he was supposed to represent. He was ably assisted in this by former EDDC Chairman Sarah Randall Johnson, who as Chair of the DCC committee, railroaded their choice of action by effectively silencing any opposition (EDW passim)

This led to the accelerated closure of community beds in Honiton and Seaton, following on from earlier closures in Axminster and Ottery St Mary.

A subsequent vote of “No Confidence” in Diviani at EDDC (brought by non-Tory councillors) was defeated by the very Tory councillors he had defied!

Now we read that “Social care postcode gap widens for older people” and that social care is breaking down in deprived areas – many of which are inevitably rural.

… The knock-on effects for the NHS see elderly patients end up in hospital unnecessarily after accidents at home, while they cannot be discharged unless they have adequate community care in place. Among men, 30% in the poorest third of households needed help with an activity of daily living (ADL), compared with 14% in the highest income group. Among women, the need for such help was 30% among the poorest third and 20% in the highest third.

There is a growing army of unpaid helpers, such as family and friends, propping up the system. Around two-thirds of adults aged 65 and over, who had received help for daily activities in the past month, had only received this from unpaid helpers, the figures revealed.

Spending on adult social care by local authorities fell from £18.4bn in 2009-10 to just under £17bn in 2015-16, according to the respected King’s Fund. It represents a real-terms cut of 8%. It estimates there will be an estimated social care funding gap of £2.1bn by 2019-20.

While an extra £2bn was provided for social care over two years, a huge gap remains after the latest budget failed to address the issue. Theresa May was forced to abandon plans to ask the elderly to help pay for social care through the value of their homes, after it was blamed for contributing to her disastrous election result. The government has promised to bring forward some new proposals by the summer, but many Tory MPs and Conservative-run councils are desperate for faster action.

Ministers have dropped plans to put a cap on care costs by 2020 – a measure proposed by Sir Andrew Dilnot’s review of social care and backed by David Cameron when he was prime minister.

Izzi Seccombe, the Tory chair of the Local Government Association’s community wellbeing board, said: “Social care need is greater in more deprived areas and this, in turn, places those councils under significant financial pressures. Allowing councils to increase council tax to pay for social care, while helpful in some areas, is of limited use in poorer areas because their weaker tax base means they are less able to raise funds.

“In more deprived areas there is also likely to be a higher number of people who rely on councils to pay for their care. This, in turn, puts even more pressure on the local authority.

“If we are to bridge the inequality gap in social care, we need long-term sustainable funding for the sector. It was hugely disappointing that the chancellor found money for the NHS but nothing for adult social care in the autumn budget. We estimate adult social care faces an annual funding gap of £2.3bn by 2020.”

Simon Bottery, from the King’s Fund, said: “We know that need will be higher in the most deprived areas – people get ill earlier and have higher levels of disability, and carry that through into social care need.

“We also know that the councils that have the greater need to spend are, on average, raising less money through the precept [earmarked for funding social care].”

https://www.theguardian.com/society/2017/dec/16/social-care-for-elderly-postcode-gap-grows

Accountable Care Organisations: angels or devils?

Owl says: if you believe that Accountable Care Organisations are a good thing you will believe anything. Back-door privatisation a la USA and a ruthless way of enforcing rationing and post code lotteries rather than proper funding.

“Accountable care organisations have many strengths but should be openly debated before being implemented.

The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined.

The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging.

Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament.

Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health.

In June, NHS England announced that eight areas would be leading the accountable care drive. Greater Manchester is also adopting this approach, and many others are starting to use the accountable care language.

Accountable care has the potential to address many of the criticisms the most vociferous supporters of the NHS have made for many years. It goes a long way to replace competition with collaboration, and the NHS England chief executive, Simon Stevens, said it could mark the end of the infamous purchaser/provider split, which weighs down the health service with costly and often pointless bureaucracy.

Locally led, integrated systems are essential if we are going to shift the NHS from a 1970s-style hospital service to one that provides a community-based health and wellbeing service. Pooling budgets across the local area is not a ruse to disguise cuts. It is the most effective way to manage public money, irrespective of the level of funding.

The court case confuses the issue of how the NHS is organised with its funding and the role of the private sector. These are three different issues.

But the legal basis for accountable care is shaky. Faced with the wreckage left by Andrew Lansley’s infamous 2012 reforms, NHS England introduced STPs because trying to plan services through more than 200 clinical commissioning groups was never going to work.

As demand climbed, funding flatlined in the aftermath of the 2008 crash and managing long-term conditions became the dominant challenge; it was imperative to move from competition to collaboration and set a long-term goal of population health management. That is where accountable care comes in.

STPs and accountable care are operating under legislation meant for clinical commissioning groups – so collaborative systems typically serving 1.2 million people in which local government and all parts of the NHS have a say are underpinned by a legal framework for GP-managed competition overseeing populations of 250,000.

This is such a precarious legal balancing act that the 2017 Conservative manifesto promised to tidy up the legislation and regulations. But introducing an NHS bill now would be political harakiri for Theresa May, and most health service staff would prefer legal ambiguity to yet another round of organisational upheaval that would inevitably follow legislation.

So the choice is to either continue to find legal bodges to allow the NHS to collaborate and plan or – if the high court challenge succeeds – to return to the Lansley dream-turned-nightmare of full-blooded competition.

But although the thinking behind the legal challenge is muddled, that campaign and Labour’s early day motion highlight the major problem: a profound change in the management and leadership of the NHS is being introduced without informed public and parliamentary discussion.

The new approach has many strengths, but introducing it under the radar only serves to feed anxieties and misconceptions about the objective. NHS England needs to get the discussion about accountable care out in the open.”

https://www.theguardian.com/healthcare-network/2017/dec/15/under-radar-nhs-reforms-fuelling-public-anxiety

Size DOES matter! Failing company kept on by government – because it is too big to fail!

“The government kept funding training company Learndirect despite it being judged ’inadequate’ because of fears over the loss of such a large provider.

That was the conclusion of a National Audit Office probe, released yesterday, into why Learndirect continued to receive substantial public money even after regulator Ofsted criticised its effectiveness.

The NAO’s report said that although the normal policy of the Education and Skills Funding Agency was to withdraw funding from providers rated as ‘inadequate’ by Ofsted, it “believed that the size of Learndirect Ltd made it an unusual case, to which special considerations should apply”.

It continued: “Specifically, ESFA concluded that continuing to fund Learndirect Ltd for the 2017-18 academic year would best meet the interests of learners, allowing the company to wind down and let learners complete their courses with minimal disruption.”

The NAO said it conducted the investigation because “Parliament and the media have questioned whether Learndirect Ltd’s performance was subject to proper scrutiny, and whether correct and timely decisions were made about its continued funding”.

Learndirect grew to be by far the largest provider of skills training, with some 70,000 people on its books.

In 2016-17, it received £121m worth of central government contracts.

Labour’s Meg Hillier, chair of the Public Accounts Committee, said the report showed: “The government backed itself into a corner by letting itself become dependent on Learndirect.

“At a time when many further education providers are struggling with funding restraint, it is disgraceful that the Department [of Education] should be continuing to spend millions of pounds of taxpayers’ money on an inadequate provider.

“I am concerned that it took Ofsted so long to investigate. It knew Learndirect was a risk from as early as Spring 2015, but the inspection took two years to arrive.”

The NAO said Ofsted inspected Learndirect in early 2017 and in March that year issued a ‘notice of serious breach’ of apprenticeships standards.

It said Ofsted identified factors contributing to its ‘inadequate’ rating including poor management of subcontractors’ performance and weak oversight of learners’ progress.

Ofsted also covered the Learndirect affair in its annual report this week.

This noted: “The case of Learndirect limited has shown that no provider is too big to fail.

“This raises a question for us and for government about failure in market regulation and whether incentives drive the right behaviour.”

It said the episode raised questions about when providers of any kind “grow too big, too fast”.

A Department for Education spokesperson said: “Our priority throughout has been the protection of learners and ensuring that they do not lose out – a point that has been acknowledged by the NAO.”

Ofsted, at the launch of its annual report, went on to warn that the new apprenticeship levy was “raising a very substantial amount of money to fund training, [which] carries the risk of attracting operators that are not committed to high-quality learning, as we saw, for example, with Train to Gain”.Learndirect has been approached for comment.”

“DAVID DAVIS WENT FOR DINNER WITH DAILY MAIL EDITOR AFTER BAILING EARLY ON FIRST ROUND OF BREXIT TALKS”

“Remember when David Davis ran out on the first round of Brexit negotiations after less than an hour? Now we know a bit about what he was doing instead.

The Brexit Secretary had declared it was “time to get down to business” ahead of the talks – but then skipped the majority of the discussions.

He turned up in Brussels at 8am on July 17, spent 15 minutes having a “friendly chat” with EU chief negotiator Michel Barnier and another 45 minutes in a meeting with their respective officials.

After being photographed without any papers and a quick press conference, he was on the Eurostar back to London.

A Government spokesperson told the media at the time that Davis had planned to leave early but denied that the decision was connected to a vote in Parliament.

So what did he get up to upon his return to London? Something more useful than dealing with the nitty gritty of Brexit negotiations?

Transparency documents published by DExEU last night offer us an interesting insight.

They show that on July 18 – while talks were still ongoing in Brussels – Davis had dinner with Daily Mail editor Paul Dacre. …

The Brexit Secretary only reappeared in Brussels when talks finished on July 20 for a press conference which didn’t go well.

Davis was criticised by Barnier over a “lack of clarity” in the Government’s position over the divorce bill.

That’s unsurprising given the extraordinary but real possibility that he may well have spent more time speaking to Dacre than Barnier about Brexit that week.

And it might also explain why, 18 months after the referendum, he’s only just made “sufficient progress” in negotiations.

Proud of yourself, Davis?”

https://politicalscrapbook.net/2017/12/david-davis-went-for-dinner-with-daily-mail-editor-after-bailing-early-on-first-round-of-brexit-talks/

Top ten government salaries in privatised rail industry

“The 10 highest-paid public servants in the country have been revealed – and every single one works in Britain’s widely-privatised rail industry.

Network Rail chief executive Mark Carne earns the most at up to £750,000 per year – almost five times more than Theresa May’s £150,000.

The head of HS2 Ltd, Mark Thurston, is in second place, earning as much as £605,000 while he maps out a multi-billion pound high-speed line.

Not one of the top 10 is a woman.

Cabinet Office figures show a total of 442 officials at government departments and quangos earn at least the same as Mrs May – up 14% in just one year.

This includes 70 who work for Network Rail, which is an “arms-length” public body, and 51 staff at HS2 Ltd, which is a firm funded by a government grant. Train firms are not on the list as they are private companies. …”

http://www.mirror.co.uk/news/politics/meet-britains-10-highest-paid-11702402

“£500,000 to get your first flat: A quarter of London homes bought by first-time buyers ‘worth half a million or more’ “

Remember, the “Help to Buy” scheme drops 20% of the purchase price of properties up to £600,000 into developers’ pockets and the government has just put an extra £10 billion into this scheme from other hoysing budgets.

The Help to Buy: Equity Loan can be used to purchase a new build property up to the value of £600,000, with a maximum equity loan of £120,000 (20%). In London, applicants are able to claim an equity loan up to 40% of the purchase price.

https://www.gov.uk/government/news/10-billion-new-funding-for-help-to-buy-equity-loan

“A record number of first time buyers must find at least £500,000 to get a foothold on the housing ladder in London, new research reveals today.

The dramatic surge in property values in the capital over the past decade is forcing young Londoners to raise vast sums that would have been unimaginable to their parents, it shows.

So far this year an unprecedented 25.9 per cent of the homes bought by debut buyers in London have been at or above the half a million pound mark, according to analysis of mortgage lending by agents Savills.

… The data, from trade body Finance UK, also shows that no mortgages at all were advanced to first time buyers for homes in the £125,000 to £175,000 bracket during the third quarter. It was the first time on record that this more affordable segment of the market has dried up altogether. …”

https://www.standard.co.uk/news/london/500000-to-get-your-first-flat-a-quarter-of-london-homes-bought-by-firsttime-buyers-worth-half-a-a3720361.html