Care at home? Not if there are no carers for the homes

Care for 13,000 Britons at risk as provider seeks rescue plan

“The care of more than 13,000 elderly and vulnerable Britons could be thrown into turmoil after one of the biggest providers of home care visits in the UK warned it would go bust unless creditors backed a rescue plan.

Allied Healthcare, which has contracts with 150 local authorities and also provides out-of-hours services for the NHS, is asking for breathing space on its finances after cashflow problems that have been triggered in part by an £11m bill for back pay owed to sleep-in care workers.

The loss-making company has 12,000 employees and cares for 13,500 people in their homes via a network of 83 branches around the country. According to the Allied website it is the country’s largest domiciliary care business, twice the size of its nearest competitor.

Its Primecare division provides primary and urgent healthcare services, including NHS 111 telephony services, GP-led medical centres and end-of-life care. It also provides healthcare services in a number of secure settings including prisons, immigration centres and secure training centres.

Allied was bought by the German private equity firm Aurelius in a £19m deal in December 2015 but it has struggled against a backdrop of local authority funding cuts.

In a letter to creditors seen by the Guardian, its chief executive, Luca Warnke, said it had “significant funding pressures on our customers that have impacted on their ability to deliver financially viable health and social care services”. It added that it had taken the decision to pursue a company voluntary arrangement (CVA), an insolvency procedure that will enable it to agree a payment plan with creditors that include landlords and members of its pension schemes. It expects to file for the procedure on Monday.

Warnke blamed rising agency labour costs for its woes, pointing to the shortage of doctors and nurses since the Brexit vote as well as a potential £11m bill for backdated “sleep in” payments depending on HMRC’s calculation of the pay period.

Last year the government changed its guidance on how sleep-in carers should be paid, advising that they were entitled to earn the national minimum wage for the entirety of the time they were present in a house rather than just a flat rate. At that time some charities warned it could cost the sector £400m and potentially bankrupt many social care charities and providers.

The company said in a statement: “As with many independent providers in the UK health and social care sector, Allied Healthcare has been operating in a highly challenging environment for a sustained period of time, which has placed pressure on the company.

“As a result of these challenges, Allied Healthcare has has taken the decision to pursue a company voluntary arrangement as part of a prospective business plan that will ensure safe continuity of care across our UK-wide operations, place the company on a sustainable long-term footing and maximise repayments to creditors.

“The proposed CVA will not impact on the safe continuity of care that Allied Healthcare provides across the UK,” it said. “Allied Healthcare will continue to trade safely and it remains business as usual for Allied Healthcare employees and customers.”

The company insisted there were currently no plans for redundancies or branch closures.

A spokesman for the Local Government Association (LGA), which represents local authorities, insisted that councils have “robust” contingency plans in place to manage the care of individuals if necessary if the company were to fail.

“The absolute priority for councils affected is to protect the vital care and support that older and disabled people rely on and ensure it is able to continue without interruption,” a spokesman said. “The LGA is working alongside the Care Quality Commission and the government to support Allied, where possible, as it plans to financially restructure the business and continue to provide high-quality home care.”

Telegraph: Why is the NHS under so much pressure? Their answer: its our fault for getting older and fatter!

“An ageing population. There are one million more people over the age of 65 than five years ago. This has caused a surge in demand for medical care.

[Owl: this has been known for DECADES and should have been built-in to spending forecasts]

Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years. This has caused record levels of “bedblocking”; people with no medical need to be in hospital are stuck there because they can’t be supported at home.

[Owl: the NHS budget has NOT been protected! In real terms, funding has fallen enormously]

Staff shortages. While hospital doctor and nurse numbers have risen over the last decade, they have not kept pace with the rise in demand. Meanwhile 2016 saw record numbers of GP practices close, displacing patients on to A&E departments as they seek medical advice.

[Staff shortages are due to austerity cuts and an exodus of EU workers, who are not replaced. Changing nursing bursaries to loans had exacerbated this serious problem]

Lifestyle factors. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Growing numbers of overweight children show this problem is currently set to continue.

[Many lifestyle problems are due to the government’s policies: allowing food and drink lobbies to dictate the sugar problem until it is too late, and not putting greater taxes on cigarettes and alcohol as this would reduce government income, shutting Sure Start services that promoted better parenting].

“Families seeking care funding from the NHS face a “postcode lottery” as to whether they will be accepted.”

Under “continuing healthcare” (CHC) rules, those with complicated medical conditions can apply for full funding from the health service. Families are not means tested and the decision is supposed to be made solely on the person’s medical situation.

But, despite the criteria being clearly set out in a national framework, differing interpretations of the rules mean your chances of being deemed eligible depend on where you live.

Telegraph Money is aware of hundreds of cases where regional health authorities have applied the rules differently – including some where patients have been approved by one authority and rejected by another just days later.

Ron Laycock, 87, was admitted to Cheltenham General Hospital earlier this year with a vascular condition. Despite living in Wiltshire, he was taken to a specialist unit in Cheltenham, in neighbouring Gloucestershire.

After he was deemed to be “rapidly deteriorating”, medical staff at the hospital approved him for “fast-track” funding under CHC, meaning his care at a nursing home would be paid for.

However, upon arriving at a home in Wiltshire, the county’s clinical commissioning group (CCG) – the NHS body responsible for determining eligibility – refused to recognise the hospital’s decision and rejected his application. This left Mr Laycock’s family having to find the £1,450 weekly cost of the nursing home themselves.

His daughter Becky Nicholls, 44, who works in human resources, said: “My father had Alzheimer’s as well as this condition and then caught pneumonia as well. He stopped eating and taking on fluids. A specialist at the hospital said he was clearly rapidly declining as he had stopped eating but Wiltshire flatly refused to accept that.”

She was refused an explanation from the CCG and said an administrator was rude over the phone. “I was just shocked after that phone call,” she said. “I hadn’t slept for weeks and that night I lay there just hearing her words in my head. My father couldn’t have been released without a care home to go to, so how can he not be eligible?”

She added: “I felt my dad was going to pass away before they took the time to respond.”

The family paid around £5,800 to the care home and Mr Laycock lived there for two weeks before he died. Further to this newspaper’s involvement, Wiltshire CCG acknowledged it had made a mistake and agreed to refund the money backdated to when Mr Laycock was discharged from hospital.

A spokesman said: “Wiltshire CCG takes all patient complaints and concerns seriously and can confirm that appropriate funding is being put in place for the care Mr Laycock received.

“We acknowledge the upset that Mr Laycock’s daughter has experienced and the director of nursing has spoken to her directly to apologise for any distress caused, as well as offering to meet with her in person in order to better understand the issues raised and ensure we learn from this.”

Andrew Farley, from Farley Dwek Solicitors, a firm specialising in CHC disputes, said his company is dealing with around 500 such disputes, many of which are related to cross-border discrepancies. “It’s clear from the national framework that if fast-track is granted, it should only be withdrawn in exceptional circumstances,” he said.

“The decisions should be the same wherever you are in the country, but they aren’t. There appears to be a postcode lottery as to whether you’ll get funding or not.”

CHC funding is available to anyone with “unpredictable” healthcare needs that go “over and above” what a local authority would be expected to provide, Mr Farley said. It is available for everyone, regardless of wealth.

He said families are often bamboozled by the complex nature of the system and suggested that the cash-strapped NHS may be encouraging assessors to deny funding.

“I think there is possibly a hidden agenda; that’s the impression I get having spoken to many families who have been through this process,” he added.

A spokesman for NHS England said: “Spending on CHC is going up as ever more people are being supported, but it’s CCGs that undertake eligibility assessments, using the national framework, based on each individual person’s specific circumstances.

“While recent improvements in practice mean variation in access to CHC has reduced, there is potential to make the process more efficient and effective for patients as the majority of people put through a CHC assessment turn out not to need it.”

DCC cabinet refuses to accept decision of Health and Social Care Scrutiny Committee and rushes in Accountable Care Organisation without checks and balances

Claire Wright’s blog:

“The all Conservative Devon County Council Cabinet has thrown out its own health watchdog’s unanimous resolution on deferring the implementation of Devon’s Integrated Care System, while a range of assurances were received.

Dozens of objections from members of the public came flooding in at the 22 March Health and Adult Care Scrutiny Committee meeting and my resolution on the thorny issue, which can be found here –…/devons_nhs_asked_to_provide_…

… had been backed unanimously by councillors.

A revised resolution that the Cabinet supported yesterday, merely noted that a new system was being set up and everything else was so watered down as to be almost meaningless.

The message was repeated at length that this was not an endorsement but simply noting that it was happening and that progress will be monitored.

I reminded the cabinet of the County Solicitor’s advice to the Health Scrutiny Committee in November that it is unique in scrutiny committees in that we provide a legal check on health services – the only legal check – and that our remit is to take up issues of public concern. And we were flooded with emails of public concern.

I then went through the issues as I saw them.

When summing up, Cabinet member, Andrew Leadbetter, accused me of bringing a set of ‘pre-determined’ proposals to the Health and Adult Care Scrutiny Committee.

This is a serious allegation and I immediately asked him to withdraw it. Leader, and Cabinet Chair, Cllr John Hart, backed me up and Cllr Leadbetter retracted his statement.

I had in fact prepared the proposals during the lunch-hour before the meeting. it is quite permissable (and very common) to conduct business in this way.

There was cross party support for the Health Scrutiny resolution with Cllrs Alan Connett, Brian Greenslade and Rob Hannaford also addressing Cabinet along similar lines.

Here is the Cabinet’s final resolution, which you can compare with my proposals which are set out in yesterday’s post below:

(a) that the original recommendations of the Cabinet (a – d), as outlined in Cabinet Minute *148 and reproduced below, be re-affirmed:

(i) that the key features of an emerging Devon Integrated Care System being a single Integrated Strategic Commissioner, a number of Local Care Partnerships, a Mental Health Care Partnership and shared NHS corporate services, be noted.

(ii) that the proposed arrangements in Devon as set out in paragraph 4 of the Report be endorsed, reporting to the Cabinet and Appointments and Remuneration Committee as necessary.

(iii) that the co-location of NHS and DCC staff within the Integrated Strategic Commissioner, subject to agreement of the business case, be approved; and

(iv) the Health and Adult Care Scrutiny Committee be invited to include Integrated Care System governance in its work programme.

(b) And, in light of the Scrutiny Committees deliberations, Cabinet further RESOLVE

(i) that the Health and Wellbeing Board is reformed to lead new governance arrangements for the development of integrated strategic commissioning of health and social care; and

(ii) that there is continued proactive communication to the public using clear and consistent messaging and where appropriate there will be relevant involvement and engagement.”

Here’s the webcast –…/po…/webcast_interactive/325467

“DCC cabinet decides tomorrow if to back Health Scrutiny resolution over controversial health plans”

Claire Wright’s blog, as she ploughs (with EDA DCC Councillor Martin Shaw) the lonely furrow of integrity and common sense – both sadly lacking in the DCC Health and Social Care Scrutiny Committee:

“Devon County Council’s cabinet will decide tomorrow whether to back the Health and Adult Scrutiny Committee’s resolution on deferring the implementation of the controversial Integrated Care System, which many local people have huge concerns over.

At the last Health and Adult Care Scrutiny Committee on 22 March, I proposed the following which was supported by the majority of the committee.

An additional line on a public engagement, was voted down by Conservative councillors:

Here’s what the cabinet will be considering. If it supports the resolution, it will be implemented with immediate effect…..

I will be speaking in support of the resolution tomorrow…… If you are keen to know the outcome or hear the discussion, the meeting is webcast live here –

(a) record the Committee’s concerns over the emerging Devon Integrated Care System being a single Integrated Strategic Commissioner, a number of Local Care Partnerships, Mental Health Care Partnership and shared NHS corporate services;

(b) defer the implementation of the Integrated Care System process until assurances are provided on governance, funding, the future of social care from a democratic perspective;

(c) recommend Councillor Ackland’s paper and proposals on the reformation of the Health and Wellbeing Board as a sound democratic way forward to provide the necessary governance on a new integrated system;

(d) give assurance that the proposals will not lead to deeper cuts in any part of Devon as a result of the ‘equalisation of funding’; and

(e) provide a copy of the business plan being developed and a summary of views from staff consultations.

For more background on Integrated Care Systems see my blog
post –…/devons_nhs_asked_to_provide_…

The Crowdjustice judicial review of Accountable Care Organisations – update

“Update on OUR NHS – Comprehensive Healthcare for All – STAGE 3

Hello Friends

As a backer you know our Judicial Review, challenging NHS England’s contentious Accountable Care Organisation contract, will be heard on Tuesday 24th April at Leeds High Court, 1 Oxford Row Leeds LS1 3BG

We’d like to invite supporters and fellow campaigners to a rally outside the courts from 9. 30am, to support the vital NHS principles our Judicial Review aims to defend. We will be inviting Press & Media.

This week we had a really good meeting with our legal team from public law firm Leigh Day and Landmark Chambers, to discuss the ‘skeleton case’ – a summary outline – which is due to be sent to the court in the next few days.

The skeleton case is based on our deep concern that the payment mechanism proposed for the Accountable Care Organisation contract is not only unlawful under current NHS legislation – but will lead to restrictions and denial of NHS care, and the abandonment of the core NHS principle of providing comprehensive care to all who have a clinical need for it, free at the point of use.

This would mean replacing treatment based on patients’ clinical need with treatment based on assessments of financial risk and returns – a total departure from core NHS principles, replacing them with health insurance company principles.

This is because the Accountable Care Organisation contract requires NHS commissioners to pay a fixed lump sum to cover the whole range of services for the population in a given area – rather than the present system which pays NHS providers an agreed price for the treatments they have actually delivered to patients.

Without reference to the number and complexity of treatments delivered to patients, the ACO contract’s proposed fixed population payment would pass financial risk to the providers – and from providers to us the patients.

Why? Because if providers were to get more patients needing more complex treatments costing more than the fixed lump sum they receive, they would face spending money they don’t have. They’re not likely to want to do that. The only way to avoid that would be to restrict or deny patients’ access to treatments. Particularly patients whose treatments are more costly and whose prognosis means their treatment is not such good value for money.

In our view, NHS England is playing fast and loose with existing NHS law about how prices are set and payments are made for health care provided to NHS patients.

Although we don’t in any way support the 2012 Health and Social Care Act, which increased private companies’ access to NHS contracts, fragmented the NHS and removed the Secretary of State’s duty to provide a universal, comprehensive health service in England, it is the law.

If NHS England wants to change price setting and payment methods for the provision of NHS services, it should do it in accordance with the law. If changing payment mechanisms means changing the law, that is something for Parliament – and the public that puts MPs there – to decide.

Ask yourself… “what happens when government and its quangos decide they are above the law?” It doesn’t bear thinking about.

As well as being undemocratic, NHS England’s proposed changes to how NHS services are priced and paid for would undermine the NHS as a comprehensive health service for all who have a clinical need for it.

They are about enabling moves to a cut price, bargain basement NHS that uses the same business model as the USA’s limited state-funded health insurance system that provides a restricted range of health care for people who are too poor or old to pay for private health insurance.

Thanks for your support so far.

Please share this with friends and campaigners.

We will fight this all the way.”

“There’s enough tax money to feed hungry children – it’s just in the wrong pockets”

” … Over the past two years, health bosses have charged £5.8m on taxpayer-funded credit cards to finance their lavish lifestyles.

Purchases included helicopter lessons, go-karting outings, bookings at five-star hotels, trips to cocktails bars, and stops at fast-food joints.

This behaviour shines light on a deep hypocrisy from health bosses, who on the one hand work to implement a sugar tax – effective today – to discourage taxpayers from consuming sugary drinks, and on the other hand use the same taxpayers’ money to fund their own trips to McDonalds.

Putting the hypocrisy aside, there is a wider issue here, of how taxpayer money is spent once it’s in the hands of the state.

We are always told that the solution to any given problem is more spending, and consequently calls to ramp up taxes naturally follow. But that argument fails down flat when nearly £6m that could have been used to top up a low-income parent of three, or go towards a health service we are perpetually told is “in crisis”, has been spent on public officials to live their weekends like rock stars.

The UK government is already spending around 40 per cent of GDP – the majority of that is from tax intake, but tens of billions are still borrowed from future generations.

There is no justification for increasing the burden on taxpayers by a penny more. There are already funds in the system that could help the most needy. They are just sitting in the wrong pockets. …”