The Care Sector – 2015A personal view

Ian Turner

Chair Registered Nursing Home AssociationImplementation Advisor – DH /LGAThe Partnership in Care – Responsible individual

Health and well-being gap If the nation fails to get serious about

prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness

Source: NHS Five Year Forward View

Care and quality gap Unless we reshape care delivery, harness

technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should be cured, and unacceptable variations in outcomes will persist.

Source: NHS Five Year Forward View

Funding and efficiency gap If we fail to match reasonable funding

levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments

Source: NHS Five Year Forward View

Care Sector Major Issues Comprehensive Spending Review National Living Wage Auto-enrolment of pensions Duplication of inspection Immigration Safeguarding Meaningful dialogue Technology

Where is the sector? Fewer people are receiving state funded

care People’s needs are more complex The care market is fragile Quality is compromised Labour market is challenging There are impacts on the NHS

Source: ADAS and sector submission to DH

Submission to the CSR Cross subsidisation is endemic Increase in LA fees to implement National

Living Wage of the order of 5-8% annually Effect on National Insurance (Universal

Credit) Pension Contributions in next three years Productivity gains are simply not possible

in the provider sector

National Living Wage No provider is against the policy Business values will be reduced since

EBITA reduced Staff will expect differentials to be

maintained Labour market will not improve since all

sectors must implement the NLW

National Living Wage

Announcement of CSR later in November

Where is the money going to come from?

How elastic is the price for self – funders?

Auto-enrolment of Pensions Three issues:

When do you need to act? Your staging date

Who is to be your pension provider? How are you going to implement, clerically

or by software? Plan for the costs, employer contributions

1% to end Sept17, 2% to end Sept18, 3% thereafter. Employees contribute 1%, 3% & 5%

Cutting Red Tape Review Cabinet Office recently consulted

(summer 2015) on the Care Sector for potential to cut red tape

Major issue which emerged was the duplication of inspection by different agencies, CQC, LA, and CCG in the main

Different agencies requiring different standards / actions

Common issue: Zeroise risk vs minimise risk

Immigration Nursing shortage is now accepted as an

issue within DH Pressure for more integrated workforce

planning numbers, but no major change in the numbers in the short term

Nursing as a shortage occupation; the key issue

Be aware that the quota for restricted certificates of sponsorship has been reached for the first time this half year

Safeguarding

•Growing acceptance that safeguarding is being overused

•Complaints virtually disappeared•Poor practice should be recognised as

such and dealt with•Categorization of issues needs to be

addressed

Meaningful dialogue

•Financial reforms have shown the need for a more meaningful dialogue between providers and LA’s. 2020 is only four years away

•Need to determine an agreed mechanism and update process to discuss price

•Need to consider the offer for self funders both before and after 2020 (S18(3))

Meaningful dialogue Market position statements need to cover

the entire market and not just commissioned services

Workforce is the most pressing problem for all of us; what more initiatives can we jointly take? Are we all using a Question of Care or Care Ambassadors?

Integrated services; exactly what are we trying to achieve that is practical to clients?

Failure regimes and risk management

Transparency

•SoS is pressing for “intelligent transparency”

•Honesty about failings•Hence the Duty of Candour•Whether it is pressure area care,

medication incidents, or, in the case of the NHS, avoidable deaths, we need to prepare for greater transparency

Technology Expect the need to implement information

technology in the next few years:▫NHS mail to use on admission and

discharge of residents / clients, but also allows telemedicine being used in the current vanguards

▫Access to health records, which allows access to lab results, prescriptions ordered as well as full medical history

Future trends Enhanced medical cover, one Care Home,

one GP Practice with patient opt out of service to traditional GP cover

Telemedicine allowing more treatment wherever you live; eg Vanguards

Greater integration and transparency of services