Archive for the ‘Public Sector’ Category

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Charteris partner Stephen Hewett publishes a hard-hitting thought piece article on the Local Government Chronicle website about the need for healthcare services organisations to collaborate in patients’ interests. Please see the link for the full article.

It seems that at least once a week there’s some new revelation making national headlines concerning the plight of the elderly.

Widely reported last week was the finding from the Care Quality Commission (CQC) that their ‘unannounced’ spot-checks on residential care homes and hospitals have revealed that more than a quarter of these establishments are failing seriously in their duty of care to residents and patients. This is the very time when people in their charge tend to be at their most vulnerable and so badly need proper support. Read full article »

Time and again, local authorities have been subjected to new demands and initiatives from central Government to reduce budgets and to identify and benefit from efficiencies in existing services, while still trying to deliver suitable and expected high-quality services to end-users. Read full article »

There are many negative perceptions of the efficiency and quality of the public service and the people employed within it.  Quite frankly, I am tired of hearing the narrow views of people who have very little understanding of, or appreciation for, the vast majority of people who work within the public sector.  In my experience, people who work in the public sector are very intelligent, hard-working, community-minded and adept at working in an environment that can be far more complex than many private sector organisations. Granted, dealing with shareholders can be tricky at times, but try dealing with the public and mixed political agendas! Read full article »

So why did these 78 organisations choose the Daily Mail for their letter last week?

Hardly a paper most of them are likely to read. However from an impact point of view it has hit the Tory target really well and got referred to across the media last week. The Mail is really poking the government hard on this one, with their ‘Dignity for the Elderly’ campaign. Today Labour kept the pressure up with some headline earning news, after a ‘Freedom of Information’ exercise on the differing costs of Domiciliary Care across the nation and general reduction in the amount of ‘paid for’ care being provided by Councils. The pressure is on and the Minister was unavailable for the BBC this morning.

In his absence a very sanguine Richard Humphries from the Kings Fund told the BBC Today Programme that the 11% reduction is not at all surprising in the light of the spending reviews and policies of both the last two governments. A representative from Brighton Council gently explained the apparent high cost of Domiciliary Care which was perfectly sound and just made the comparisons from the FOI exercise look quite banal. Labour’s shadow minister talked about all parties working together on this one.

What exactly are they going to do?

Nothing seemingly – the White Paper (Caring for Our Future) should have been published at Easter and now has not made it into the Queens Speech, so there is no legislation tabled. This does seem to be in the ‘too hard’ pile.

So far no one seems to be listening to two very bright ideas to help solve this conundrum, both of which get very little mention from the much hailed Andrew Dilnot report.

  1. It is well known but not really recognised that we give too many people too much care for too long. We’ve got to measure it out much more carefully and encourage people to regain as much of their previous independence as we can. This is extremely good for them and their loved ones and costs government a lot less. Such an approach defies the notion that today’s level of expenditure on social care is the starting point for all the demographic time-bomb doom merchants.
  2. When a person needs a change of domestic setting, let’s not make this an irreversible move into residential care.  It’s an old fashioned word but convalescence can deliver great outcomes – like recovery, for example – such that a person can get back home. Too often it is a death sentence, with the home being sold to fund a place in institutional care. If the home did not need to be sold then an escape route back to independent living would be possible. Too little thought has gone into the use of equity release which could give people this possibility in life. It works by releasing money from the value of an older person’s house to pay for convalescent care which is only repayable after their death from the proceeds of their estate.

Both these ideas start with a very optimistic but also very sensible thought which we all have; that we can get better. If we can get better – even if it is just a bit better – then we will need less care because we can do more for ourselves. Even if we don’t get better then we can still strive to enjoy what we did before but in different ways. Maybe we get a friend to drive us to church or the pub, rather than walking. It’s still about regaining as much as we can of our lives and ensuring we continue to enjoy those things that are most important to us. Too often, different, far more pessimistic expectations are set and the social care system then is set up to deliver those. 

The future for older people should be seen as very bright, surely?

  • we can remain active and independent for longer
  • we are not so subject to the killer diseases
  • we can connect with more descendants than ever (maybe three or four generations)
  • we have hard won wisdom to offer them.

The only ‘but’ is that all this means that later in life we are likely to meet our end quite slowly from a degenerative disease. This is the bit everyone is currently fixated by – the cost to provide a dignified end. What we are missing is reaping the savings made possible by prolonging happy independence for as long as possible by only giving people what they need. Here could be, both a better life lived, and at a lower cost to us all.

Turning these ideas into practice is not fanciful or terribly difficult. We have helped one mid-sized local authority’s adult social care department and its care provider market to make the first idea practical – it is generating better outcomes for people at lower cost. It is now described by Professor John Bolton as “perhaps at the forefront of adult social care in England”. There are pockets of activity exploiting bits of the second idea but it needs bringing together. We are looking for a local authority, residential home provider and a financial services company who would be prepared to let us help them with designing convalescent homes, short stays at which are funded by equity release. 

Most of us are needlessly seeing through a glass darkly on this one which is causing total stultification. It’s time the practical optimists got a chance to influence this long delayed white paper and actually start the process of caring for our future.

Jeremy Labram, Principal

Local TV in Britain is coming, but it seems an opportunity most people don’t know how to grasp.  The consultation period is over and bidders for Local TV licences should be hunkering down in preparation for the summer beauty parade.  But debate rages on. Read full article »

Last time I asked, in relation to public sector spinouts, ‘How do you properly balance the public sector service ethos with an appropriate bottom-line focus?’

In that blog I suggested that (generally speaking) a key feature of public sector service delivery is placing the people you serve at the centre of decision making, as opposed to the private sector’s focus on the financial bottom line. As I said: Read full article »

Social enterprises are organisations whose origins are numerous and which compete in the open market (often as limited companies) to deliver products and/or services for profit, but whose surplus is reinvested entirely in the business to benefit the particular community and/or in the social or environmental initiatives of its choosing. Social enterprises are part of the ‘not-for-profit’ sector, though in this case surpluses are made and reinvested. Read full article »

Late in 2010 I looked into the eyes of a group of public sector middle managers, some from a local authority and some from a primary care trust. They were all responsible for delivering health or social care services. I was meeting them to urge them to consider the enormous benefits that could accrue to them from setting up and running a social enterprise to deliver services to service users. Read full article »

I am actively contributing to the consultation on the Social Care Reform white paper call ‘Caring for our future’. In my view there is an encouraging vision for the future which is getting hampered by policy makers holding onto some ineffective ideas about how markets operate, as well as an absence of blueprint for how to make this vision practical.  However we believe we have a virtually proven design for a system which could deliver this vision consistently across the country. Read full article »