Fighting Monsters

Both The Times and The Guardian reported that Southern Cross Healthcare Group have been launched into some kind of financial crisis following the failure to repay a loan of some £46 million.

Times are getting harder and a lot of firms are failing - but Southern Cross are the largest provider and operator of Residential and Nursing Care  Homes in the UK.

I actually have to say I have had no dealings at all with Southern Cross in the years I’ve been working. So can say neither good nor bad things about them from personal experience.

But just putting a few pieces of very rudimentary information together

The Guardian quotes the company spokesman as saying that the reasons for their financial difficulties are

.. tighter local authority spending for a period of disappointing occupancy rates. High fixed costs and disappointing occupancy rates meant Active Care in particular was performing “significantly below forecasts”. The company also said occupancy levels had been hit by several unexpected deaths of residents in its homes for the elderly.

I was going to say that I’m no cynic, but that’s probably not true - I was reminded of a story I wrote about at the beginning of May where CSCI (Commission for Social Care Inspection) criticised a Southern Cross Care Home for having poor basic dementia training among other things.

You’d think though, that a large company like this would have contingencies for ’several unexpected deaths of residents’

I know the previous time I wrote about Southern Cross it was in the context of a freeze on placements to a particular home following a poor CSCI report and the death of one of the residents. Disappointing occupancy rates? Quite possibly.

It’s strange that The Financial Times reported back in May that

‘The group has increased the cost of staying in its homes over the past six months, agreeing fee rises of 5 per cent on average with 85 per cent of its local authority customers.’

which is, more or less, in line with inflation and certainly higher than my proposed salary increase this year (!) so, less than six weeks later to blame failings on

‘tighter local authority spending’

seems more than a little churlish.

It seems one of the business practices of Southern Cross was based around building property to lease it back and making its profit partly on property portfolios and management.

The Times quotes the Chief Executive saying

“The care homes sector is cyclical and the cycle has turned down. The margins of two or three years ago will likely be squeezed and fall at least 5 per cent in the next two years.”

I am no accountant but surely cyclical also means, to some extent predicable.. basic kind of saving-for-a-rainy-day type stuff.

Anyway, I am the last person who should really be commenting on Southern Cross’ business model. My idea of wise investment is an instant access savings account.

But I can’t help but wonder what the implications will be for people who are in the residential homes that are failing.

A large proportion of care services,  both residential and domiciliary, has been out-sourced to private companies who have many different interests at heart not least, shareholders.

If they see a death as ‘a disappointing occupancy level’  and lurch towards crisis when there is a cyclical downturn it doesn’t really augur well for planning long term care.

Anyway, at least two of the execs who were in charge of running the company managed to sell their own stock when they were at a high of 550p in December before leaving the company..

The stock fell to 130p yesterday.

And other factors that don’t endear the company, which again, I have had no personal contact include one which was highlighted by Mental Nurse back in April indicating that they were involved in the landmark decision in the High Court which ruled that Care homes can evict residents by being the owners of the Care Home that was trying to do the evicting..

This is also the same Southern Cross that opposed the payment of £7.02 per hour for Senior Care Workers - many of whom were from the Philippines and were refused visas to stay on the basis of the wages that they were receiving - thus being deported.

It doesn’t get much better for Southern Cross (isn’t Google a wonderful thing) as, The Times says again, in another article that

‘In November, The Sunday Times conducted an undercover investigation, with a reporter posing as a carer, and documented a series of alleged abuses and said the home was under-resourced and understaffed.’

At, yes, a Southern Cross Home.

Between deaths, attempted evictions, seemingly poor payment and treatment of staff and undercover reporting that proves, if more evidence were needed, that there is a poor quality delivery of care due to understaffing and under-resourcing.. it is a little clearer why there might have been underoccupancy.

I’m sure in such a large company there are some good quality care homes among there somewhere but reputations do stick when placements are being made - I certainly know there are some companies that I am less likely to make placements with than others, on the basis of how some of the different homes that they own are run - rightly or wrongly you can’t take chances when you are choosing the place that someone is likely to be living for the rest of their life.

But at least some of the executives got out at the top..

I just wonder how this leaves and will leave those who are receiving the services at the moment.

I first saw on the news over the weekend about the report produced by the Institute for Public Policy Research related to  Personalised Budgets for Carers and it baffled me a little bit.

Don’t get me wrong, I completely think that carers need, deserve and are entitled to a lot more support than is available presently.

The Carers Allowance is, quite frankly, an insult to those who put in so many hours and whose lives are changed by the amount of care that is put in (as well as, on a less emotive level, the amount of money that is saved by both the NHS and Social Services). Also (for what its worth) it’s linked to Disability Living Allowance/Attendance Allowance and is means-tested. All of which contribute to its inefficiency.

But the call for personalised budgets seems to be, as far as I can garner, more or less the same as Direct Payments for Carers - which is explained much better on the Worcestershire County Council site (thank you, Worcestershire - and no, I don’t work there - actually, I don’t think I’ve ever been there!) as follows

‘Support for Carers

A Direct Payment can be provided to enable family and informal carers to purchase the services they are assessed as needing as carers to support them and to maintain their own health and well-being.

A Carers Assessment and Support Plan should be completed to identify the impact of caring on the person’s life along with the support they require to continue caring or to take a break from their caring role.

Carers are able to use Direct Payments to purchase support in any variety of ways including:

• Short breaks for themselves and/or the people they care for;
• Personal assistance within the home;
• Sitting services;
• Social, education and leisure activities;
• Transport costs;
• Equipment
• Relaxation, stress management and holistic therapies.

Some of the intended outcomes of using Direct Payments for carers are:

• Promoting social inclusion through greater opportunities for carers to actively participate in family and community life;
• Greater opportunities for the personal development of carers;
• Promotion of the carer’s health, well-being and coping skills;
• More responsive, timely and consistent methods of providing support, with greater opportunities for creativity;
• Values the essential contribution carers make to family life and the wider community.

Under the service, young people, aged 16-to17-years, are also eligible to receive Direct Payments to support them in their role as young carers and to minimise any difficulties or isolation they may experience in undertaking their caring responsibilities’.

psd @ flickr

I have to say I like the direct payment scheme as it works for carers because it is incredibly flexible. Indeed, I’d say it is the easiest way to provide direct support to carers and in the most visible way - so I’ve got a fair amount of experience using it.

In a lot of ways, it is a lot more flexible than the direct payments provided for service users because it can be used for ‘anything that would support the carer’ - so gym membership, travel costs, parking costs, washing machines - there is the ability to be much more creative. ‘

And it exists now - today and has been used with frequency.

So that’s why I didn’t really understand the call by the IPPR for personalised budgets with no comment about what is actually happening in social services departments to support carers today. Maybe they are calling for more money to be a part of the personalised budgets (a good thing) or more control (although the control can be basically in the hands of the carer themselves), more exposure to issues that matter to carers or less scrutiny from local authorities who provide the funding.

I suppose I’ll have to actually read the whole report rather than just the reporting of it!

I noticed that Sophie Moullin from the IPPR wrote about this in the Guardian and from what she says, I can’t see any difference in the new system she proposes to what is actually, legislatively in place at the moment.

I am absolutely in favour of anything that will help though and if the proposed system will ringfence more money or provide more exposure or utilisation of services then I’m the first person to applaud it.

But to promote the new system which has a lot of links with Carers’ Direct Payments without discussing the failings of that particular system and to look at the issue as if this system didn’t exist, seems not to be giving a true picture of the situation as it is today. Perhaps more needs to actually be done to increase awareness of the system as it exists today and promote use and access to it.

Yesterday, one of the plenary sessions I attended at Community Care Live was a discussion of an initiative by Help the Aged called My Home Life.

As it says on the site, it is

‘a new initiative aimed at improving the quality of life of those who are living, dying, visiting and working in care homes for older people.’

And it certainly sounded like a lot of work had been put into looking at good practice that is currently happening in residential and nursing homes around the UK (although primarily the research has been based in England) and creating models the other residential homes can learn from and work with.

Julienne Meyer who is heading the project research, spoke passionately about the need to promote positive experiences in residential care as there was and had been historically, too much focus on ‘bad news’ stories.

The nature of these sessions is that they are short - in some cases that isn’t a bad thing but I really would have liked some more times to discuss some of the issues that were raised here.

The project has an online space for sharing resources and materials between residential homes and has some downloadable materials that can be used by care staff and managers of the homes.

There are a number of themes that are being focused on and it was good that one of the things that was emphasised was building links with and involving family members in the residential home.

There is an emphasis here on relationship-centred care which certainly makes a lot of sense and can make the experience of living in a communal environment a more positive one in my view.

It is a good initiative all round. My cynicism is based on some experiences (although by no means all) in working with residential homes where staff are paid at minimum wage levels and managers are being pushed by owners to cut costs. I like that there is some research that is based on good practice though. And there were some stories and ideas that gave hope to the goal of improving care standards for those living in communal environments.

I know, not least because I spent a good few years working in residential care as a support worker (where I was fortunate to work in a home which had created a wonderful environment and both promoted and demanded a very high quality of care where the importance of home was never forgotten) that there is a lot of good practice out there, it is just good to be reminded of it from time to time.

(And in less serious news, one day at Community Care Live netted me, 18 black biros, three mugs, two mouse mats, three coasters (although I don’t remember ever having used a coaster in my own home), one pencil (I was concentrating on the pens), some mints, a book about african culture and two cloth bags - It does look a bit greedy in retrospect but in my defence, the pens, at least two of the mugs and.. the coasters are heading to work with me!).