The Dales Nursing Home

A Message from Lord Pickles and Lord Blunkett, followed by The Dales Nursing Home's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from The Dales Nursing Home is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

www.thedalescare.com

BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
32 | HAZEL COURT SUPPORTED LIVING
These initiatives have led to our staff
becoming extremely experienced
and we do not often employ those
without this essential experience. This
does not necessarily mean academic
achievement; instead, we look for an
understanding of the system and life
experience that can contribute to the
effective support of the individuals we
care for.
Greater funding leads to
wider change
In our local area of Manchester, there
has been a recent and concerted
effort to help support the homeless
and make sure they are able to
access suitable accommodation. As
we deal with care leavers who are,
or previously were, homeless, we
welcome these efforts but would like
to see more done. If more support is
given to the homeless, especially the
young homeless, our own efforts will
be supplemented, and we will be able
to contribute to a much wider change.
Beyond this, we would like to see
more funds invested in young people’s
services, especially in terms of focusing
on mental health support. Not only
do we cater for physical needs but we
also work to provide total support,
including therapy and mental health
support that goes beyond the basic
requirements of care. Mental health
issues can often be underestimated,
and their impacts can be clear.
Many of those we support had no
record of their mental health issues
until they became homeless, and
earlier interventions can prevent this
happening. We see ourselves as a
service that tries to cover all aspects of
support, but this is costly: it is far easier
to simply place someone in supported
lodgings than try to tackle the root of
their issues.
We are working to acknowledge
these issues, and, in the future, we
are planning to invest in the higher
end of complex needs and expand our
model. We would like to progress into
mother-and-baby units, ensuring we
can provide support to two vulnerable
people at the same time. This will
take place alongside our work with
unaccompanied asylum seekers and
we feel if we continue to develop our
services, and consolidate the progress
we have made, we will be able to
support a larger range of people
regardless of their individual needs.
Believe and
achieve in
these young
people
Our staff continually
look for ways to
improve their own
base of knowledge and
expertise, positioning
them well to unlock the
true potential of our
young people
33THE DALES NURSING HOME |
CARE
Manager Marie Brown
Exeter’s leading provider of
nursing and palliative care
Wade Newmark is the owner and designated
responsible person at The Dales Nursing Home in
Exeter – one of the city’s oldest and most respected
nursing homes. Established in 1988, The Dales is Exeter’s
leading provider of nursing care, with a specialism in palliative
care. Wade tells
The Parliamentary Review
that staffing is one
of the Dales’ central focuses – among its partnerships are
Exeter College, through which they employ apprentices, and
the service will shortly be applying to become a Home Office
accredited employer, allowing them to bring staff from beyond
the EU into theirteam.
Care is hard. The Clinical Commissioning Groups, county councils and the NHS
understand the increasing and significant costs but are powerless to do anything
to address them. We have seen a 42 per cent increase in the minimum wage since
2010, as well as an additional burden of the 3 per cent pension contribution for
staff from this year. On the income side, the erosion of councils’ ability to cover
these increased costs has led to an inexorable erosion of our ability to reinvest
in our business to deliver the best for our residents, let alone make a return on
ourinvestment.
Cuts to social care have only served to accelerate the exposure of a growing
problem. As NHS budgets have tightened and local authority reserves have
dwindled, while demand has risen, public services are not getting better for less.
For us, no matter who is in political office, the problem of our ageing population,
and a diminishing pool of funding, is now pressing.
FACTS ABOUT
THE DALES NURSING HOME
»Manager: Marie Brown
»Responsible Person:
WadeNewmark
»Established in 1988
»Based in Exeter
»Services: Nursing care with a
specialism in palliative care
»No. of employees: 40
The Dales Nursing Home
THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
34 | THE DALES NURSING HOME
We need to plan more effectively for
the future and find an intergenerational
solution. There are three building blocks
to creating a sustainable solution:
improved allocation of current funding
resources; improved systems of
compliance and delivery; and sustainable
long-term funding for the future.
Improved allocation of current
resources
In 2016/17, according to Age UK, nearly
one million hospital bed days were lost
thanks to an inability to access social
care. An excess bed day in the NHS costs
between £2,089 and £2,532 a week
for non-elective and elective inpatients
respectively, compared to about £519
for a place in residential care, £750 for
nursing care and less still for homecare.
The total cost of these excess bed days
amounts to £284 million.
Meanwhile in care homes, there are
approximately 41,000 beds available.
Assuming the NHS organised a block
contract with the sector for an average
of £615 per week, that would deliver
an immediate saving of £196 million.
Until this becomes a Department of
Health policy, inertia will continue to
prevail both at local and national level.
Improved systems of
compliance and delivery
We hear a lot about the benefits of
“big data” and the power it has over
consumers within our society. We
have seen a number of initiatives in
the health sector, the most beneficial
of which in recent years has been the
successful roll-out of the Summary
Care Records by the NHS. Nevertheless,
the system still excludes care homes.
For resident admissions, we are still
predominantly reliant on paper and
the same is true for compliance. All
this paper makes mistakes more likely,
adds unnecessary workload and makes
large-scale patterns or problems hard
to spot.
At the heart of this initiative should be
the CQC. Across England, a staggering
one in five homes are currently
rated either inadequate or needing
improvement. The CQC, like so many
government agencies, is perennially
under-resourced. One of the most
time-consuming parts of an inspector’s
visit, and interim interactions with
homes, is the physical inspection of
records. The industry is already moving
toward using integrated person-
centred care systems that give CQC
inspectors the ability to remotely view
records and to periodically review
individual cases on an “as needs”
basis. Ideally, the CQC should have
a digital reporting framework into
which care providers’ records can be
submitted in a uniform manner.
Sustainable long-term funding
for the future
Our estimate of care home turnover is
about £13.2 billion. At March 2016,
just under half of care home residents
Thirty years in Exeter
In 2016/17,
nearly one
million
hospital bed
days were lost
thanks to an
inability to
access social
care
BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
34 | THE DALES NURSING HOME
We need to plan more effectively for
the future and find an intergenerational
solution. There are three building blocks
to creating a sustainable solution:
improved allocation of current funding
resources; improved systems of
compliance and delivery; and sustainable
long-term funding for the future.
Improved allocation of current
resources
In 2016/17, according to Age UK, nearly
one million hospital bed days were lost
thanks to an inability to access social
care. An excess bed day in the NHS costs
between £2,089 and £2,532 a week
for non-elective and elective inpatients
respectively, compared to about £519
for a place in residential care, £750 for
nursing care and less still for homecare.
The total cost of these excess bed days
amounts to £284 million.
Meanwhile in care homes, there are
approximately 41,000 beds available.
Assuming the NHS organised a block
contract with the sector for an average
of £615 per week, that would deliver
an immediate saving of £196 million.
Until this becomes a Department of
Health policy, inertia will continue to
prevail both at local and national level.
Improved systems of
compliance and delivery
We hear a lot about the benefits of
“big data” and the power it has over
consumers within our society. We
have seen a number of initiatives in
the health sector, the most beneficial
of which in recent years has been the
successful roll-out of the Summary
Care Records by the NHS. Nevertheless,
the system still excludes care homes.
For resident admissions, we are still
predominantly reliant on paper and
the same is true for compliance. All
this paper makes mistakes more likely,
adds unnecessary workload and makes
large-scale patterns or problems hard
to spot.
At the heart of this initiative should be
the CQC. Across England, a staggering
one in five homes are currently
rated either inadequate or needing
improvement. The CQC, like so many
government agencies, is perennially
under-resourced. One of the most
time-consuming parts of an inspector’s
visit, and interim interactions with
homes, is the physical inspection of
records. The industry is already moving
toward using integrated person-
centred care systems that give CQC
inspectors the ability to remotely view
records and to periodically review
individual cases on an “as needs”
basis. Ideally, the CQC should have
a digital reporting framework into
which care providers’ records can be
submitted in a uniform manner.
Sustainable long-term funding
for the future
Our estimate of care home turnover is
about £13.2 billion. At March 2016,
just under half of care home residents
Thirty years in Exeter
In 2016/17,
nearly one
million
hospital bed
days were lost
thanks to an
inability to
access social
care
35THE DALES NURSING HOME |
CARE
had their fees paid fully or partially
by local authorities. It is anticipated
that the UK will need at least 75,000
additional elderly care beds by 2030,
almost a fifth more than we have now,
and that, based on recent trends,
demand will outstrip supply by 2022.
Ignoring inflation, that means another
£2.4 billion will have to be found to
cover this.
To date, the UK has explored lifetime
caps, forced sales of family homes and
what is widely regarded as a “raid”
on families’ inheritances. Overall,
especially for the elderly, this has been
regarded as a wholesale “moving of
the goalposts” after a lifetime of hard
work and saving. There is a solution,
but to achieve it requires long-term
vision and commitment across the
political spectrum.
What Germany has done is well
worth considering. It has created a
sustainable self-funding system far
removed from the “pay as you go”
system in place in the UK. In 1995,
Germany was the first European
country to implement an obligatory
care insurance policy in order to reduce
the pressure on the state pension and
insurance sectors. The achievement is
impressive: there are approximately 79
million subscribers to both government
and private care insurance and the
level of private expenditure on health
and nursing care in Germany has now
reached 10.9 per cent of GDP.
Long-Term Care Insurance was
introduced as the fifth pillar of social
insurance after health, industrial
injuries, pensions and unemployment
insurance. This fifth pillar is financed
by The Care Fund. Insurance is
also provided for people who need
extensive care owing to the degree of
their long-term care needs. Old and
sick people are no longer dependent
on social security if in need of care.
LTCI funds are managed by legally
distinct health insurance schemes
in each region of the country. The
individual contribution rate is currently
2.5 per cent of wages payable up to
a contribution ceiling, with childless
adults paying a little more. For those
in work, employers pay half the
premium, while the retired pay full
contributions, thus helping to address
intergenerational equity concerns.
LTCI membership is compulsory
and non-employed people are
covered by employed householder
insurancecontributions.
Long-term care is a social risk requiring
social protection. This is not a partisan
position: the need for reform,
the introduction of LTCI and the
subsequent scheme expansion were all
agreed by both main political parties
in Germany at the time. Securing a
similar cross-party agreement over a
much-needed different care-funding
model is the biggest challenge facing
the UK.
The CQC, like
so many
government
agencies, is
perennially
under-
resourced
Our house dog, Hettie, is
a regular visitor

www.thedalescare.com

This article was sponsored by The Dales Nursing Home. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from Rt Hon Elizabeth Truss.

Rt Hon Elizabeth Truss's Foreword For The Parliamentary Review

By Rt Hon Elizabeth Truss

Even by the standards of the day –this has been one of the most exciting and unpredictable years in British politics.

The leadership election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU.

As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices.

The essence of free trade is in the title: freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back.

One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime Minister and US President. But I’ll also be talking to other partners including New Zealand, Australia and fast-growing Asian markets.

And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future. It is this excitement, optimism and ambition which I believe will come to define this government.

For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs.

As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre broadband in every home and proper school funding, so everyone shares in our country’s success.

2019 has been the year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbo charges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage.



Rt Hon Elizabeth Truss
Secretary of State for International Development