UK Homecare Services in Need of a New Business Model

LaingBuisson’s Homecare, Supported Living & Allied Services report has concluded that UK homecare services need a new business model if they are to survive in a climate of falling profitability and in which variable quality has undermined confidence in the sector.

Since the beginning of the millennium social care budgets have been shrinking, stricter eligibility criteria have crept in, to ensure reduced budgets are used to provide care to the most needy, and as a result the number of individuals in England receiving homecare through their local authorities has fallen from 415,000 in 2000 to roughly 279,000 now. Those receiving care in the home tend to have more complex needs and so the average number of hours of care provided per person have increased from 6.7 to 13 hours per week.

This reduction in users, and increase in intensity has evolved at the same time as a shift from in-house provision to use of independent sector organisations. Latest data suggests that 97% of publicly funded contact hours in England are now outsourced to independent sector providers. But despite having taken over almost the entirety of supply, independent sector providers serving the publicly funded market have suffered from a severe squeeze in prices and profitability, this is in stark contrast to the privately funded market which remains profitable, and reflects the downwards pressure on fees paid by those commissioning services, usually local councils.

On average each care provider will be dependent on 31% of private clients, with 69% of their services being bought by local authorities or the NHS. The sector is therefore highly dependent on public sector commissioning decisions, far more so than the care home sector where over half of demand is financed privately or quasi-privately. Heavy reliance on cash starved public sector commissioners is a major risk for homecare providers as austerity policies.

This dependency is alarming, according to report co-author and healthcare researcher Eleni Giatsi, given that since 2010 the gross social care spending envelope for English councils has fallen by 8% in real terms. Ms Giatsi commented “This cocktail of financial pressures, staffing shortages, a shrinking budget from local authorities, and various instances of quality concerns create a fragile ecosystem in homecare provision.

At the same time, however, local government and the NHS have started to view the provision of care and support services within peoples’ own homes as a lever for achieving integrated care goals and providing better care. What’s more, private individuals are increasingly exploring homecare as an alternative to moving into residential care settings.

This is a genuine ‘make or break’ moment for the homecare sector - either it will succumb to the pressures of a bust, price driven,’ time and task’ model and deteriorate further into a low quality product –or forward looking commissioners and providers will seize the opportunity to develop sustainable, outcome-based business models delivering integrated homecare services across the boundaries of social and health care.”

First BookShots Titles Sell 30,000 Copies in a Week

James Patterson’s new Bookshots project has been hailed as a success after selling over 30,000 copies of the first two titles during the first week of sales.

The BookShots imprint initiative overseen by Patterson, is designed to encourage reading by crafting short novels—all titles in the series are less than 150 pages, so can be read in one sitting, and retail for £3. Two to four titles will be published each month, initially the range will focus on fiction titles, with a number of non-fiction titles about current events being added. He will write some of the books himself, write some with others, and hand pick the rest.

Patterson’s Cross Kill, a new installment in his popular Alex Cross crime series, sold just under 18,000 copies according to Bookscan, placing it second on Publishers Weekly's latest trade paperback bestseller list, for the week ending June 12. Zoo 2, the second Book Shots title and a sci-fi thriller by Patterson and Max DiLallo, sold nearly 12,000 copies per BookScan, landing at #5 on their trade paperback list.

Mr. Patterson said the books would be aimed at readers who might not want to invest their time in a 300-400 page novel. He hopes they might even appeal to people who do not normally read at all. If it works, it could open up a big new market. Speaking in an interview in New York James said “You can race through these — they’re like reading movies.”

BookShots has its own website and mobile apps available on iOS and Android, readers can discover, purchase, and read BookShots ebooks and audiobooks across all devices. More information can be found at https://www.bookshots.com/

CQC Tells South Western Ambulance Service It Must Improve Safety of NHS 111 Service

The Care Quality Commission has told South Western Ambulance Service NHS Foundation Trust that it must make significant improvements to protect the safety of people using its NHS 111 services for Devon, Dorset, Cornwall and the Isles of Scilly after rating the service as Inadequate.

A team of inspectors found the 111 service was Good for caring, but Inadequate for safety, effectiveness, responsiveness and being well-led.   They found that there were often not enough staff to take calls, or to give clinical advice when needed.

Staff reported working long hours, many feeling high levels of stress and fatigue.  There were high staff turnover and sickness rates. Too many calls were abandoned, and patients were waiting too long for their calls to be answered and to be assessed, or to receive a callback with appropriate advice.

Inspectors also found that calls were sometimes answered by staff who were not trained to assess patients' symptoms and there was a risk that patients needing urgent attention were not given priority or could be put into a long queue awaiting call back.

Following the inspection the CQC has issued a Warning Notice requiring the trust to ensure that calls are responded to in a timely and effective manner, with enough suitably qualified staff on duty who are supported to deal with the volume of calls. The trust has been told that it must make significant improvements by 8 July 2016.

The CQC has also told the trust that it must make a number of improvements:

·         The trust must continue to review staff numbers to ensure patients can access timely care and treatment when first calling the service and when receiving a call back.

·         The trust must review the roles and responsibilities of Non Pathway Advisors (call handlers who are not trained to use the NHS Pathways triaging system) ensuring callers consistently receive the correct level of advice.

·         The trust must ensure that the call queues awaiting initial assessment and callback are robustly monitored and managed by staff with clinical authority to intervene and allocate resources.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said:

"NHS 111 services are an important part of the urgent care system. If patients needing help can't get a reply, if they are dealt with by someone who doesn't understand their immediate needs, or if they have to wait too long for a nurse or paramedic to call them back for an assessment before they are referred to the out-of-hours GP, it can have potentially serious consequences.

"We found that patients were at risk of harm because the triaging system was not good enough. Too many people whose call was urgent were not being assessed in relation to their medical needs in a timely manner.  A lot of people needing less urgent advice might have to wait all day for a call back.

"Despite the best efforts of staff - the service was not doing enough to identify why this was happening or what needed to be done to improve. The trust had known of these concerns but it took the staff to bring them out into the open to ensure that something was done.

"Since our inspection we have been working closely with NHS England, NHS Improvement and the local commissioners to ensure that our most urgent concerns around the triaging of calls are dealt with. The trust leadership has told us that they are well aware of the issues that we have raised. We expect them to take action – and we will be monitoring the service closely to ensure these improvements continue."

Margaret Atwood Awarded 2016 PEN Pinter Freedom to Write, Freedom to Read Prize

Canadian poet, novelist and environmental activist Margaret Atwood has been awarded the 2016 PEN Pinter Prize. The judges praised her political activism, calling the author an ‘exemplary public intellectual’.

The PEN Pinter Prize was established in 2009 by English PEN, in the memory of Nobel-Laureate playwright Harold Pinter, to champion freedom of expression in writing. The prize is awarded annually to a writer of outstanding literary merit who, in the words of Harold Pinter’s Nobel Prize in Literature speech, casts an ‘unflinching, unswerving’ gaze upon the world and shows a ‘fierce intellectual determination … to define the real truth of our lives and our societies’.

English Pen campaigns to defend writers and readers in the UK and around the world whose human right to freedom of expression is at risk. They work to remove inequalities, where they exist, which prevent people’s enjoyment and learning from literature. As well as matching writers with marginalised groups such as people in prisons in the UK, in refugee or detention centres and young people in disadvantaged areas, opening minds to reading and creative writing.

Margaret Atwood was chosen by this year’s judges Vicky Featherstone, Zia Haider Rahman, Peter Stothard, Antonia Fraser and President of English PEN and Chair of Judges, Maureen Freely. Reflecting on Margaret Atwood’s life, Maureen Freely, said “In a profession dominated by careerists who are content to tend to their own gardens, Margaret Atwood is the shining exception. She does not just stand up for her principles: in novel after novel, she has put them to the test. What she does as a campaigner has only served to deepen her work as a writer of fiction. She is an inspiration to us all.
Margaret will receive her award at a public event at the British Library on the evening of Thursday 13 October, where she will deliver an address and announce the winner of the International Writer of Courage award.

Margaret said she was humbled to receive the award, reflecting on her own time with Harold Pinter she said “he wrote the scenario for the film version of The Handmaid’s Tale, back in 1989 – and his burning sense of injustice at human rights abuses and the repression of artists was impressive even then. Any winner of such an award is a stand-in for the thousands of people around the world who speak and act against such abuses. I am honoured to be this year’s stand-in.”

Antonia Fraser, Harold Pinter’s widow, praised Atwood saying “Harold admired Margaret Atwood in three ways, as a writer, a campaigner and a person. He would be especially delighted by her generous response to this award.”

CQC Review into How the NHS Investigate and Learns From Deaths

The CQC is looking at how NHS acute, community healthcare and mental health trusts investigate deaths and learn from their investigations. Assessing whether opportunities to prevent deaths are being missed.

Following the publication of the Mazars report – which looked at the deaths of people using mental health or learning disability services run by Southern Health Foundation Trust, the government asked the CQC to look at how NHS trusts across the country investigate deaths to find out whether similar problems can be found elsewhere.

The review will look particularly closely at how trusts investigate and learn from deaths of people using learning disability or mental health services.

Following the review the CQC will publish a report setting out their findings and making recommendations. Ensuring that there is clear guidance for NHS trusts outlining expected good practice in identifying, reporting and investigating deaths and embedding learning to improve care. Trusts will then be measured against these standards during inspections.

The Review Process

The CQC’s report will be informed by a number of different activities:

• A national survey of NHS trusts (which will be sent out this month) and discussions with trusts through the CQC’s online portal for service providers.
• Work with bereaved families.
• Work with an expert advisory group made up of a range of people and organisations, including charities, campaigners and government bodies.
• Work with partner organisations, including NHS England, NHS Improvement and the Department of Health.
• Visits to a sample of acute, community healthcare and mental health NHS trusts to gather evidence over the summer.

The final report will be published in December 2016.

UCAS Equality Reports for Individual Universities Published

UCAS has published new analysis that extends its existing national equality reporting to individual universities for the first time.

The reports, created on behalf of around 130 larger universities, place the likelihood of being offered a place in the context of average offer rates for other applicants with the same predicted grades applying to the same courses at that university.

They also set the number of applicants and accepted applicants in the context of population differences, which is especially important for understanding representation in higher education for different ethnic groups.

The reports show some large differences in the share of the population who enter universities by background, sex and ethnic group. Although disadvantaged groups, young men and the White ethnic group are the most under-represented in higher education as a whole, this is not the case at every institution and there are complex patterns across some individual universities. Across the largest universities students of all ages from the top 20 per cent most advantaged areas were 2.4 times more likely to enter higher education, and had a greater chance of their applications being accepted over the review period.

The suite of reports include:

• reports for over 130 larger higher education providers, detailing applicants, acceptances and offer-rates by applicants’ sex, ethnic group, and background
• a guide to using the ‘sex, area background and ethnic group’ reports
• lookup tables to check whether the difference in offer rate and average offer rate (a key measure) is large enough to be confident it is not statistical ‘noise’
• summary-level reports by higher, medium and lower tariff universities
• an interactive explorer tool for more easily accessible comparisons

UCAS Chief Executive, Mary Curnock Cook said: ‘Universities have responded readily and rapidly to the White Paper challenge of greater transparency in the admissions process. Fair admissions is a hallmark of the UK higher education sector.’

Dame Julia Goodfellow, President of Universities UK and Vice-Chancellor of the University of Kent, said:

"It is good that the university sector is publishing this extra admissions data through UCAS. It highlights universities' commitment to transparency in the admissions process and to improving participation from all backgrounds.

"Publishing more data will not necessarily solve some of the longstanding problems in access to and participation in higher education. It will, however, allow universities to identify issues and solutions specific to their own institutions. It will allow us also to look at the picture across the sector.

"Universities UK's Social Mobility Advisory Group is currently looking at this area. It will report its recommendations to government and English universities this summer."

Exam cheating becomes a criminal offence in China

Exam cheating becomes a criminal offence in China.

Students who cheat in China’s national university entrance exams could now face criminal charges.  Named the Gaekao, or “high exam”, this tough national test is taken by more than nine million students who are vying for just 3 million university places. It takes place over nine hours over two days in June and results determine which university students will go to.

 

The huge pressure to perform well has meant that in previous years many students have resorted to cheating. But this year the stakes are even higher as anyone using underhand means are facing up to seven years in jail. They will also be banned from taking any other national examinations for three years.

The Gaoko is a notoriously hard exam testing school leavers on their Maths, English, Chinese, and another science or humanities subject of their choice. Such is the prestige of this exam - which has been a feature of Chinese education since 1952 - that those failing it face limited workplace opportunities, often reduced to low-paying blue-collar jobs. Owing to China’s previous one-child policy, many students are only children, increasing the pressure to succeed and support their parents and grandparents and avoid family disappointment.

Due to this pressure, exams have always been closely monitored to prevent cheating. But students have tried all means of tactics to get around it, from hidden earphones and watches, to T-shirts with built-in receivers.

  

Authorities have previously installed metal detectors at entrances to deter students sneaking in smartphones, and to scan students’ shoes. Security was so tight this year that SWAT teams accompanied the exam papers and police officers were deployed in test centres across the country. Last year, officials in Henan resorted to deploying a drone carrying a radio scanner to spot cheats.

Chinese parents desperate for their children to get into the best universities have even employed surrogate exam takers. Several million yuan is paid to people who are willing to take the exam on behalf of their children. Real photos are forged onto identity cards with the personal information of the real exam candidate. 

There are also short-term gaokao nannies – usually highly educated and successful graduates - who are paid top rates to move in and help students study. Some parents even pay for hotel rooms near the exam centres to minimise travelling time on the day. Despite hotels charging high prices, many rooms are fully booked each year.

One person full of encouragement for the students is Professor Steven Hawking, who took to the social media website Weibo to wish 2016 students good luck, saying they are the “next generation of big thinkers and thought leaders”.

Once exams are over, it’s customary for Chinese students to tear up their textbooks and throw them out the window. Other ways to de-stress include smashing watermelons and stamping on balloons.  

If you would like help ensuring your course work reads well, then check out http://www.wordsworthreading.co.uk/academic-proofreading.php

Experts call for employers and universities to do more to address STEM skills shortages

Professor Sir Nigel Shadbolt and Professor Sir William Wakeham have published the findings of their independent reviews into how universities and employers can help develop a pipeline of highly-skilled graduates in the crucial subjects of science, technology, engineering and maths (STEM) to ensure the UK workforce can meet the long-term needs of the economy.

The Shadbolt review looked at the accreditation arrangements for computer science degrees to ensure that they continue to be fit for the future. It focused on the purpose and role of accreditation and how the system can support the skills requirements of employers and improve graduate employability.

Computer sciences graduates have in recent years experienced lower employment rates, when compared to graduates from other disciplines, despite the growth across the digital sector. Unemployment stands at 11.7% for computer science graduates after 6 months, compared to an 8.6% average for all STEM graduates.

The Wakeham review looked at the employment situation among other STEM graduates, who suffer from relatively poor employment outcomes. The report focused on the skills requirements of employers, how STEM graduates’ skills and knowledge relate to labour market demands, and how existing accreditation systems support this.

The review identified the following subjects as needing further research - biological sciences; earth, marine and environmental sciences; and agriculture, animal science and food science.

Both reviews identified:

• That students would benefit from universities and employers working together to expand and improve the array of work experience opportunities available - embedding the learning from work experience more consistently in degree programmes.
• That professional bodies need to strengthen their accreditation systems so they support universities to deliver high-level STEM skills that are most relevant to industry. 
• The need to improve the collection and publication of data on graduate job prospects. Helping applicants understand how course choices lead to different employment outcomes. This recommendation has been developed into proposals for the provision of employment data in the Government’s higher education white paper, Teaching Excellence Framework, which will see the introduction of reputational and financial rewards for universities based on, among other things, their success supporting all students into employment or further study. 

Universities and Science Minister Jo Johnson said ”I’m extremely grateful to both Sir William and Sir Nigel for their thorough reviews into graduate employment outcomes and I welcome their clear emphasis on the importance of building much closer links between universities and employers.

The UK has a world-class higher education system but, as these reviews recognise, more must be done to address the variability in outcomes for some graduates and to ensure all students receive the highest quality teaching. That’s why we are taking action to reform our higher education system, and the findings in these reviews provide valuable insights to ensure students and employers get the best returns on their investment”

CQC to Begin Assessing NHS Trusts & Independent Hospitals Against WRES

Back in 2014 the NHS Equality and Diversity Council announced that it had agreed actions to ensure employees from black and minority ethnic (BME) backgrounds would have equal access to career opportunities and receive fair treatment in the workplace. 

As a result of their work NHS organisations are now required to demonstrate progress against a number of indicators of workforce equality laid out in the Workforce Race Equality Standard (WRES). 

The first WRES report comparing the results of the experiences of black and ethnic minority (BME) and white staff in every NHS trust in the country has now been published.

The report looked at four indicators across acute trusts, ambulance trusts, community provider trusts, and mental health and learning disability trusts. The results show a picture of variation across the health service with some trusts making progress, whilst others still have a considerable way to go.

·         75% of all acute trusts show a higher percentage of BME staff being harassed, bullied or abused by staff in comparison to White staff. 22% of acute trust returns (33 organisations) show a lower percentage of BME staff report being harassed, bullied or abused by staff. Five organisations report the same response rate, indicating no gap between BME and White experience.

·         Whereas a much higher proportion of BME staff report harassment, bullying or abuse by staff in the last 12 months compared to White staff, the levels of harassment, bullying, or abuse from patients relatives or the public are similar for White and BME staff.

·         In 86% of acute trusts, a higher percentage of BME staff do not believe that their organisation offers equal opportunities for career progression or promotion in comparison with White staff.

·         Most acute trusts (81%) report a higher proportion of BME staff having personally experienced discrimination from a manager, team leader or colleague than White staff.

Simon Stevens, Chief Executive of NHS England, and co-chair of the NHS Equality and Diversity Council said: “This report provides unvarnished feedback to every hospital and trust across the NHS about the experiences of their BME staff. It confirms that while some employers have got it right, for many others these staff survey results are both deeply concerning and a clear call to action. As this is the first year of the WRES, it provides a transparent baseline from which each employer will now be seeking to improve.”

Progress against the WRES is now considered as part of the 'well led' key question for CQC’s inspections of NHS and independent provider hospitals. Service providers must publish an annual WRES report on their website each July. These reports and the accompanying action plans will be analysed, with Trusts being asked how they are addressing any issues identified.  BME and white staff will also be interviewed by the CQC about their experiences of working in their organisations.

The next CQC WRES report will be published by the end of July.