The future of adult social care in the UK

     

    Feature I | Feature II | Cases | FYI


    Feature I

    The future of adult social care in the UK

    Local Government analysis: Kyle Holling and Paul McDermott, partners at Trowers & Hamlins LLP, take a look at the current adult care system in the UK and outline potential areas where improvement could possibly be made.

    What developments affecting adult social care are on the horizon?

    Judicial review is the process by which the courts review the lawfulness of a decision or failure to act by a public authority. It ensures that the executive acts according to law and is thus an important form of control on the executive.

    There is an ongoing move towards the integration of the health and adult social care systems in the UK. Professionals in both systems recognise that the integration of health and care services is the best route to deliver a seamless support service for service users (which also avoids each system seeking to transfer people to the other in order to save money). There is also a belief that integration may eventually save money, as well as it being a logical route to transfer funding from acute services (hospitals) to fund services aimed at preventing ill health and to support people living in the community. Although the National Audit Office report of February 2017 acknowledges that health and care integration is better for the individual, it cautions that it will not deliver short term cost savings.

    Nevertheless, it is thought that this move towards integration will accelerate across the country in varying degrees. Currently, England and Wales both lag behind the fully-integrated system in Northern Ireland. However, progress is increasing in England, with the Greater Manchester area and other local areas such as Croydon pushing forward with a more joined-up approach. It is expected that other areas will follow in due course by at least coordinating the joint commissioning of key adult health and social care services. The move towards integration in Scotland, meanwhile, is already mandated.

    Other developments that have the potential to significantly impact the wider social care system are the proposed changes to the system of welfare funding for supported housing. The government is currently consulting on plans to cap eligibility for rent and service charges to the rates available for general private rented sector accommodation. There are also plans to alter the funding model of an estimated £6bn currently applied to specialist housing for older people and those with disabilities by taking part of it out of the housing benefit/universal credit system (where, broadly speaking, reasonable housing costs are met by the public purse in full) and placing it in a ring-fenced budget. The details remain to be confirmed but there is concern that the new budget will be administered in a way that will leave providers fighting for a finite resource, rather than increasing it to meet the increases in demand, or even being maintained in real terms to meet the current demand.

    The housing services mentioned above are proven to reduce demand, as well as lower the costs burden on other parts of the health and care system. The outcome of government’s consultation process must be one that does not stymie future development to meet the UK’s growing demand or, worse still, cause the existing sector to falter with closures on a large scale, thereby putting massive additional pressure on health and social care across the country. The stated aim of the government is to ensure that services are as good as they can be, both in terms of quality and value for money; this links to the integration agenda as housing is also a key determinant in health and wellbeing. However, changes to the welfare benefits system, if they also form part of an incremental move toward integration, might be seen as positive changes. After all, the key concern in the medium term for both commissioners and providers of these services is ensuring their ongoing viability as these changes are introduced.

    Another significant development is the issue of sleep-in shifts by care workers. HMRC has recently taken a different approach to its treatment of these, which has created a conflict between case law, regulations and Department for Business, Energy and Industrial Strategy (BEIS) guidance. The Voluntary Organisations Disability Group (VODG) estimates that, leaving aside the future additional costs to providers in pay obligations, the back pay bill owed to affected employees could come in at £400m. This is a cost that the provider sector cannot afford to bear, not to mention the fact that commissioners have no funds to meet it, which could force more providers out of the market. This change is part of a wider issue for the sector, which has come about due to the general increases in the national living wage. It has had a particularly significant impact on the social care sector given its staffing profile; significant numbers of care workers are paid at or near the minimum wage and the increase to it has an immediate impact on providers’ financial position.

    Could council elections this year and freezes to budgets undermine the implementation of the social care precept and lead to a potential funding black hole?

    There is already a huge and well-publicised funding shortfall in the UK social care sector, with the Local Government Association now estimating a £2.6bn deficit by 2020.

    On the topic of councils, it is interesting that Surrey County Council—a Conservative council in one of the most affluent areas of Britain—had to consider calling a referendum to increase council tax by 15% in order to protect services. The council leader said that the ‘demand for adult social care, learning disabilities and children’s services is increasing every year’. Most other authorities (of varying political colours) instead proposed to raise council taxes by the maximum permitted without the need to win a local referendum. Surrey appears to have secured additional funding from the government (by retaining all of its local business rates) and it appears to have ‘won’ its battle of wills with Whitehall. The government’s reward is Surrey’s cancellation of a potentially embarrassing social care referendum vote.

    However, authorities in poorer urban areas—ones that typically have a higher service demand and lower tax bases—would still struggle financially in the current funding climate, even if they were able to introduce a council tax increase, like the one proposed by Surrey. There is a general lack of funding available in the UK to meet the ever-increasing demands on the already much-stretched services.

    Today, people are living longer with ongoing, often complex, health issues. Virtually all of us will know someone who requires some form of care services. The issue is whether voters will demand a better funded care system moving forwards, thereby prompting the corresponding challenge for politicians to find a way to fund it (for example, higher taxes, more service user contributions, or a combination of both).

    There has always been a tension between the local authority duty to meet the needs of the people and the funding they have available to do so (see R v Gloucestershire County Council, ex p Barry [1997] AC 584, [1997] 2 All ER 1 and R (on the application of KM) (by his mother and litigation friend) v Cambridgeshire County Council [2012] UKSC 23, [2012] 3 All ER 1218). It is possible that we will continue to see further challenges in this area, especially as financially overstretched providers have been and will continue to exit the market, thereby further reducing capacity.

    Do you envisage potential devolution deals and greater local authority involvement in health decisions as helping to alleviate concerns relating to adult social care?

    It is highly likely that more devolved areas will seek responsibility for health care as part of an integrated health and social care approach. However, this will not apply to all areas because English devolution is permissive and each area decides what responsibilities it seeks to be devolved and central government is free to accept, reject or amend those requests. Under the former Chancellor, George Osborne, the government insisted that devolved areas have an executive elected mayor (who would be responsible for key decision making) if key budgets, such as health, were to be devolved. This deterred a number of areas from seeking maximum devolution. It is not clear whether Theresa May’s government will make the same demand.

    Greater Manchester and, to a lesser extent, Greater London, have taken the lead on the issue of the devolution of health and care integration. In 2014, Greater Manchester became the first region in England to receive a transfer of powers from the national government regarding transport, housing, planning and policing. In 2016, they went on to become the first region to assume control of their own health and social care budget (worth around £6bn).

    The Greater Manchester Health and Social Care Partnership is the most advanced of its kind, aiming to provide a strategically planned joined-up service tailored for the benefit of individuals. However, there are no plans to create a unified health and care system (as seen in Northern Ireland) for Greater Manchester. This arises, in part, from NHS concerns that were raised during the passing of the Cities and Local Government Devolution Act 2016. Namely, that neither NHS England nor its relevant standards should be fragmented through devolution.

    No doubt other devolved areas in the UK will closely monitor the performance of Greater Manchester and Greater London in managing health before deciding whether to pursue a similar path.

    Nevertheless, it is reasonable to conclude that, in the medium term at least, the move towards the health and care sectors working more closely together may lead to both the NHS and regional authorities being more open to operating an integrated health and care service in the English local regions. The potential benefit of greater local authority involvement is that a more holistic approach of supporting people in need of care and health services will evolve. The adult care service may (over time) also stop being treated as the poor ‘Cinderella’ to the NHS’s relatively better-off ‘Prince Charming’.

    NHS involvement in care services also has the potential to reap significant rewards for adult social care. NHS commissioners and trusts will develop a better practical understanding of how strong care provision can enable the NHS to improve the delivery of health services (avoiding so called ‘bed blockers’). Some NHS trusts are already exploring options with local authorities and third sector bodies to develop and operate ‘convalescence’ centres to support those ‘too well’ for hospital but not quite ready to be discharged home.

    What lessons can be learnt from the approaches adopted in alternative jurisdictions with regards to these issues, particularly with regards to aging populations?

    Most countries (ones comparable to the UK) operate some form of compulsory health insurance for their citizens. The European and Japanese healthcare models, for example, ensure that all citizens, irrespective of wealth, receive health care. However, what is starkly different to the UK in such systems is that their citizens are required to make at least nominal payments for a number of services that are currently free in England and Wales. For example, fees are charged for a visit to the GP in France. It could be argued that this makes the citizens of these countries more prepared to adopt a similar system for social care. Compulsory social care insurance schemes have been adopted in Germany (1995), Japan (2000), France (2002), and Korea (2008), for example.

    The generously tax-funded Scandinavian care model is an alternative option. The Swedish health system is conceptually very similar to the NHS (although it is much better funded through higher taxes). Sweden, perhaps unsurprisingly, opted to adopt a similar tax-funded approach for adult social care back in 1983. Under the Swedish model, payments made by care services users are limited and where they do exist are capped.

    Closer to home (both physically and financially) is the Northern Irish model, which has operated as an integrated health and care service (with a mixture of free and means-tested care services) since 1973. Northern Ireland’s model came about almost accidentally; it was not adopted because of a desire to join up the two systems, but rather because few of the 26 local councils created at that time had big enough populations (or budgets) to support separate adult care departments.

    However, Northern Ireland does offer a ‘case study’ of how a fully integrated health and care system might work. Care and health are the responsibility of a single Northern Irish government department with five health and care trusts delivering and commissioning services in their geographic areas. Northern Ireland has full integration at policy, budget and delivery levels.

    Ultimately, it could be argued that other comparable countries have tackled the care costs dilemma by either introducing compulsory insurance schemes or introducing higher taxes (or both). However, it is extremely unlikely that health and care integration or efficiencies alone will fill our own funding gap in the UK. The major question for our citizens (and politicians) is whether or not we are prepared to pay more as a nation for social care and, if so, would we prefer to pay for this through compulsory social care insurance, higher taxes, or both?

    Aligned to funding systems is the services those systems will fund. With some exceptions, such as sheltered housing, the UK has traditionally been focussed on the hospital and the care home as the alternatives to citizens remaining in their own home. It has been suggested that any integration between health and social care should be coupled with innovation to better fill the gaps between these options. One potential solution might be more step-down/reablement facilities to better move people through the interface between the hospital and the social care system. Preventative services are also a highly important area to consider, as are new models of both care and housing.

    One area of interest for the UK is the retirement housing with care (or retirement village) model. It is currently very well established in New Zealand and Australia; cultures which share the British desire for homeownership and have similar wealth and age demographics. There are a variety of possible structures that would allow people to live in better quality accommodation than they might otherwise be able to afford using their housing wealth (there is over £1trn in the over 65’s population, most unmortgaged) on a ‘use now, pay later’ model. The concept is based around lifestyle, with wellbeing—which is essential to the health of people of all ages and something that can be negatively affected by the social isolation experienced by many older people—being considered as important as the availability of on-site care and support services. The UK sector is currently in its infancy in this area, but there is an increasing amount of evidence as to the social and financial benefits of this model.

    Any other trends or developments in this area?

    Adequate funding for adult care services and ensuring that service users are not ‘shunted’ between two systems for purely budgetary reasons remain the key challenges in this area. Over the last 12 months, the strains on both health and care have intensified. The seasonal winter stresses placed on hospitals have no doubt been, at least in part, caused by people being denied access to either affordable adult care or free primary health services.

    The lack of adequate funding to councils for care services has driven councils to squeeze payments to third sector and private care providers. Unless a sustainable funding solution is adopted it is reasonable to assume that the current steady exit of care providers (from council-commissioned services) might well become a flood.

    Public awareness about and corresponding concerns for health and care services has increased and this will lead to more political debate about how we collectively pay for and deliver them. It is unknown whether this will result in a ‘revamped Dilnot’ proposal (the previous report for funding care and fee capping), the introduction of compulsory social care insurance, or higher taxes. The real danger is that the system will be expected to ‘muddle on’ as it is. The one trend that is unavoidable, however, is that, as a nation, we are living longer and that as we age we require more care and health services than previous generations.

    Interviewed by Giverny Tattersfield.

    The views expressed by our Legal Analysis interviewees are not necessarily those of the proprietor.

    This article was originally published in LexisPSL Local Government

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    Feature II

    Accepting assistive technology in adult social care

    12/05/2017

    Local Government analysis: How is the use of assistive technology being embraced? Jim Ellam, commissioning manager and assistive technology project lead at Staffordshire County Council, explains the benefits and challenges and says a particular challenge will be the the willingness of developers to make the technology more person-centred.

    What is ‘assistive technology’?

    Few of us aspire to become dependent, and many people prefer to keep independent for as long as possible. Appropriate assistive technology can help reduce the gap between what we can and cannot achieve—from washing, dressing and travelling independently, to managing risks associated with long term conditions and dementia.

    A commonly used definition of what ‘assistive technology’ encompasses is ‘any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed’ (Royal Commission on Long Term Care 1999). This includes a wide range of devices from simple ‘low tech’ items such as calendar clocks, to more ‘high tech’ items such as automatic lighting and telecare sensors.

    For most people it can be summarised colloquially as helpful gadgets and gizmos that support independent living and/or provide support and reassurance to carers, gadgets that either work on their own or link to a call centre/mobile phone/pager.

    The world of assistive technology is changing rapidly since smart phones brought the power of the internet to wherever we are located—we now see smart home technology, advertised on the high street, which can control our home heating, lighting and appliances. Amazon Alexa and Google Home are disrupting traditional technology providers and offering low cost and easy to set up and operate systems enabling people to control their homes by spoken commands as well as supporting home entertainment.

    All of these can be considered assistive technology and if we consider the impact of these devices, we begin to understand how they can transform lives of people who are struggling with independent living. Just being able to go online and search for information is empowering and allows people to consider new ways of managing their independence. Many people chose to make their own arrangements rather than rely on state support, so online information tools are key to helping public and professionals understand what is available and how it can help.

    To get an idea of the wide range of solutions, it’s worth looking at the Disabled Living Foundation resources, and using the self-help tool AskSara which helps identify solutions to meet your desired outcome (this is used by a growing number of local authorities to help visitors to their websites self-serve simple solutions).

    How is it being deployed in local authority settings to support adult social care provision?

    Technology is increasingly integrated into our everyday lives, we use technology for entertainment, food preparation, communication and transport. The technology we use supports our ability to achieve the outcomes we want. However, we do not routinely consider the use of technology within delivery of health and care services, to support people’s ability to self-care and enable greater independence choice and control in their lives.

    There are a number of short videos illustrating the outcomes assistive technology will support on the Athome UK website from a range of perspectives. It offers demonstration guides and personal testimonials. The use of video helps many people understand how the technology works and how it can be used in a range of different ways.

    The use of community alarms and telecare is commonplace across local authorities to help people of any age and ability to live independently, safely and securely in their own home. It can also give family and friends peace of mind that they can be contacted in an emergency. Additionally, carers’ pagers can be provided which alert live-in carers only when help is needed, allowing them some respite from their caring role. This can be particularly helpful during the night when on site carers can sleep soundly with the assurance that the telecare pager will alert them when support is required (ie bed/door exit, epileptic seizure or fall etc).

    For health and care professionals, lifestyle monitoring technology like Canarycare and justchecking support the assessment process and are increasingly purchased and used by families to discreetly monitor their dependent relatives. Such technologies help monitor daily living activities which, when interpreted enhance the understanding of abilities and areas of dependency. It can help people self-manage their care and condition and identify when and where our input is required, rather than visiting people just in case, freeing up time and resources for those who most need it.

    Assistive technology will help people remain independent for longer and retain control. As state provision struggles to meet growing demand for care support, and as more people pay towards the cost of their social care it can be effective for all to increase the use of assistive technology to make best use of care workers’ time and skills. For example, there are simple gadgets to help you get dressed and prepare hot drinks, which cost under £50, and can reduce the need to pay for someone to help you, while paid care will cost around £2500 per year for a daily 30 minute care call.

    For people at risk of getting lost, or who may need to seek urgent support when away from home, there are a growing range of GPS devices which can be a specific battery powered device, or built into a mobile phone. Location is identified via GPS (a satellite based global positioning system as used in car satnav systems) and will enable authorised individuals, such as relatives or carers to receive an alert when you call for help, and or find out your location by logging onto the internet via a smartphone or a computer. Some come with a subscription for a monitoring service, others can be managed via family and friends.

    What has been your experience of using this technology? What works well and what doesn’t?

    Research has consistently confirmed that awareness of assistive technology is very low, held back by a combination of factors. A recent study led by Coventry University found that 60% of consumers questioned said that lack of awareness was a barrier to greater use/purchase of assistive technology. However, the same research also found that 85% felt that the costs of purchasing were worth it given that it would make life easier. This demonstrates that people are willing to consider paying, from their own pockets, for products and services, provided they feel it will help.

    In England, almost a third of the population are aged 55 and over, and an estimated 4.7 million people in England aged 65 and over have a limiting longstanding illness that affects them in some way (based on data from the Institute of Public Care). This equates to 48% of all people aged 65+. In many instances, assistive technology, when used as part of a wider package, can help maintain independence, enabling people to live longer in their own familiar home surroundings, thereby potentially helping to avoid having to consider moving into specialist housing or a care home in later life.

    Many people automatically shy away from technology fearing it’s complicated and hard to use and understand. However, we use technology in everyday living from TV and phones, to washing machines and motor cars, without thinking of it as anything special. Technology supporting independent living has, for a long time, been seen as something the state provides, and it’s failed to develop its own place in the wider market place. This is starting to change: with an ageing population we are seeing more purveyors of assistive technology enter the retail market and almost all assistive technology solutions can now be purchased as a retail customer rather than depending on state provision.

    There is a wide range of mobility aids and daily living aids to suit all budgets which are designed to make things such as bathing, housework, meal preparation, eating, drinking and getting out and about that little bit easier. The more you look at what’s available, the more solutions you will find which can help you or someone you care for to live a more independent, dignified and fulfilled life. Some of the assistive technology is readily available on the high street and is designed to look and feel good in any household.

    There are constantly emerging innovative technologies which are being promoted, but there is no one solution for all scenarios. The success of any technology in supporting a person achieve their outcome, or providing reassurance to carers will depend on whether it is right for the person and the function it is intended to do.

    What works best is technology that people understand and trust, find easy to use and offers them good value. Community alarms and telecare are good examples of longstanding services which, in recent years, have increasingly been funded by the end user who realise the value to them of a modest weekly payment. Standalone prompts and reminders such as calendar clocks and devices that will play a recorded message on movement or at set times are always popular and now are being joined by apps which work on tablets and smart phone for the growing number of older people who are comfortable with smart technology.

    These open up a new world of information communication and technological solutions wherever you are located. The internet of things makes it possible to link home technologies and appliances with great potential for our homes to start to help us seek support if our usual routines vary. The challenge is public and professional awareness of emerging solutions and the willingness of the developers to make them person-centred, easy to use, and to appeal to those who may need care and those who provide care and support.

    How can collaboration with partners in health, housing and the third sector help better integrate these technologies and reduce the need for intervention?

    Paying for the technology as a single agency is harder as budgets have been reduced, developing a market when people and partner agencies can fund. With an ageing population and relatively low unemployment there are pressures in funding and retaining health and care staff to meet current and future demands. Housing services have been under pressure to continue to provide housing-related support, and the third sector is evermore active in supporting people in the community through advice, information and services.

    Using personal care and personal health care budgets will allow more people to exercise choice and control on how their support services are delivered and encourages a more flexible and creative provider market than traditional block contracts. Integrated service provision through pooled budgets allows partners to share the risk/reward of investing in solutions that may create bigger savings to partners. This includes building greater public awareness of things they can fund themselves as a preventative and reassurance measure before they meet eligibility criteria for support from health and social care.

    Some housing schemes no longer routinely offer linked alarms to all tenants as many people did not need them. Instead, by working with telecare providers the people who need linked alarms can purchase these as and when required. Telecare providers are realising they can grow their market by smarter marketing and offering new customers a ‘try before you buy’ deal which generally sees a conversation rate of over 70% to new long term customers.

    There are strong links to be made between community alarm/telecare provision home improvement agencies, integrated community equipment provision to create a whole system independent living offer. A challenge is bringing together different funding streams across partner agencies and ensuring that the service is sustainable—balancing state provision with personal responsibility and reaching out to people earlier to encourage them to invest in their future when considering home adaptions and housing options ahead of retirement.

    Can this engagement and co-design of this technology prove useful in providing cost-effective solutions to adult social care provision? Are there any barriers to this?

    Technology is only cost effective when it delivers the anticipated savings or efficiencies. It can be challenging to realise cashable savings, and cost diversions are frequently made by other agencies. There is a lack of robust and credible evidence despite a number of large scale centrally funded projects.

    It is often considered that if you evaluate technology in place today it will be outdated by the time the evaluation is completed. What has been shown is where technology is used as part of a wider service transformation it will support new more effective models of care and deliver savings and efficiencies across a wider health and care system.

    Manufacturers are quick to claim significant savings are made through investment in their products, but the lack of widespread adoption at scale indicates budget holders need more convincing. Person investment is still growing as the state redefines its offer, and this market offers greatest potential for growth. But it needs a mind change from manufacturers and suppliers to develop this market—highlighted in the Comodal project.

    People’s reluctance to consider the use of technology within caring is still a major challenge. Some of the technology looks dated and few would describe it as aspirational. It’s frequently been marketed in a negative way, focusing on risks and dependencies rather than as enabling opportunities and independent living.

    Are there any other innovative solutions currently being trialled in the area of adult social care?

    The growth of smart home technology apps, artificial intelligence and robotic carers (carebots) offers new opportunities for technology to change the way we live and are supported.

    Various grants are made available to trial new and emerging technologies. This will subsidise the cost to participants while they are used and better understood. ADASS recently held an event showcasing a range of new technologies which included a significant number focusing on integrating data sources.

    Video links with health and care home settings continue to be explored in many area allowing virtual visiting and more flexible specialist input when required. It supports agile working and improves business efficiency.

    There are a number of companies promoting integrated systems which bring together a range of data sources into a shared system. Many universities are working with councils and care providers in testing and developing robotic assistants to deliver personal care and lifestyle monitoring. We have seen how robots have aided manufacturing processes and many agree there is a role in supporting an ageing population, but while the concept is here, developing understanding of what the market could be and what is acceptable is still being developed. It’s clear there is a need for public and professional consultation of where and how they can be use—and for adoption there needs to be wider awareness and creating a culture of acceptance.

    Increased use of technology has frequently been criticised for reducing human interaction. Therefore, there is likely to be a need to balance the increasing demand for care support against a limited workforce, and to develop a consensus on how and where these emerging technologies will add value to quality of care and quality of life.

    Jim Ellam contributed to ‘Digital Healthcare: the essential guide’ (Otmoor Publishing, June 2016).

    Interviewed by Nicola Laver.

    The views expressed by our Legal Analysis interviewees are not necessarily those of the proprietor.

    This article was originally published in LexisPSL Local Government

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    Cases

    R (on the application of Liverpool City Council and others) v Secretary of State for Health [2017] EWHC 986 (Admin)[2017] All ER (D) 08 (May)

    The claimant local authorities’ challenged the defendant Secretary of State’s failure to fund adequately their implementation of the deprivation of liberty safeguards (DoLS) regime for people lacking capacity. The Administrative Court rejected their application for judicial review. The court held that although the claim had been filed just within the three-month time limit for seeking judicial review, it had not been brought promptly and therefore had to be dismissed. It was necessary to bring a challenge to a budgetary decision of central government very swiftly because it potentially threatened the budgetary arrangements of the government for an entire year. The court also considered the merits of the claim, but rejected the claimants’ arguments.

    N v ACCG and others [2017] UKSC 22[2017] All ER (D) 154 (Mar)

    The Supreme Court dismissed an appeal by a father concerning the services provided to his son, MN, who lacked capacity within the meaning of the Mental Health Act 2005. The first respondent clinical commissioning group had refused to fund extra carers required to meet the parents’ proposals that MN’s mother should be allowed to help with his care when she visited his residential care home and they should have contact with him at the family home. The Court of Protection found that it could not order the first respondent to accept the parents’ plan, and there was therefore no point in it embarking on a best interests analysis of their proposals. The Supreme Court held that the Court of Protection had been entitled to find that a full hearing of competing cases would have served no useful purpose.

    R (on the application of Davey) v Oxfordshire County Local Authority (Equality and Human Rights Commission intervening) [2017] EWHC 354, [2017] All ER (D) 113 (Mar)

    The Administrative Court dismissed the claimant’s application for judicial review of the defendant local authority’s decisions, to reduce his personal budget and to revise his care and support plan. There was no legal error which warranted the interference with, or granting of relief in respect of, the authority’s decision.

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    FYI

    Home care market on 'brink of collapse'

    The current UK home care market is on the ‘brink of collapse’, new analysis from the Local Government Information Unit (LGiU) and Mears suggests. In the report, ‘Paying for it’, the LGiU recommends that councils look carefully at the impact of reductions to their hourly rate.

    Public Guardian practice note: Acting as a professional attorney

    The Office of the Public Guardian has published guidance for professionals preparing to act as an attorney under a lasting power of attorney (LPA). It covers the period before the attorney begins to act under the LPA. The guidance is intended to ensure professionals who agree to act as a fee-paid attorney under an LPA have adequately prepared for the role and that they have appropriate discussions with the donor before loss of capacity. See: Agreeing to act as a professional attorney—a good practice guide.

    CQC adopts new equality objectives to improve care for minority groups

    Despite progress on equality, the Care Quality Commission (CQC) highlights that people from some groups are still less likely to receive good quality health and social care. In view of this, it has decided to focus its equality objectives for 2017-19 on its regulatory role in improving equality. Through inspections, the CQC will assess how health providers remove barriers and improve access for different groups.

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