Wanless And The Future Of Social Care

Submitted by tonyplant on March 30, 2006 - 13:47.

Following on from my semi-articulate post on the cost of caring, the Guardian carries an overview of the Wanless proposals for expanding basic social-care services to elderly people. Wanless calculates that the social care spend needs to triple to around £30 billion by 2026 to meet the anticipated needs of the baby-boomer generation.

Wanless comments that the present system means that only the rich or those on means-tested support "could meet the "catastrophic" costs of the care packages needed by the most infirm". He says:

there should be universal care for all older people needing it, including help with bathing, dressing and feeding. But instead of there being a limited service for free, as happened in Scotland, there should be a partnership approach funding more generous provision. The state should pay 66% of the bill and the rest should be funded equally by the state and the individual, he said. Anyone not wanting to pay this contribution could forgo the extra service. The poorest should get help via benefits to pay for their contribution...

By 2026 the number of people in England over the age of 85 will have risen by two-thirds. Up to 450,000 more people will need a care home place or social care services to stay at home.

The report is said to support the conclusion that greater spending on improved social care for elderly people would reduce NHS spending. More than 40 per cent of the NHS budget is currently spent on people aged over 65. James Bartholomew argues that "no country neglects its elderly as badly as Britain does". If elderly people genuinely account for more than 40% of the NHS budget that I should think there are few countries that are achieving such poor outcomes for its expenditure.

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With A Stroke Of A Pen...

Submitted by tonyplant on March 20, 2006 - 12:57.

Last week, Carers UK questioned whether carers' human rights were being observed in many of the policies and decisions that are made by the NHS and local authorities. A leaked document is reported in today's Guardian.  We learn that the NHS funding problems have triggered a review and there are outline standardised tests for determining who is eligible for fully-funded continuing care from the NHS: hint, if you suspect that some elderly or disabled people might be in the groups that may be excluded in the future, then you would be on the right track.

A trial run of these proposed standards on 20 older people revealed that only 2 people met the more stringent criteria for fully funded care. For 13 people with chronic illness and disabilities, 4 were said to have 'scraped through': people with MS and MND are among those who failed to qualify in this exercise. It's truly extraordinary to think that with a stroke of a pen, or a paper re-assessment, one can redefine and 're-baseline' the criteria for fully-funded care. The subject is unlikely to be significantly less impaired/ill/in need of assistance in that space of the time it takes to complete this reassessment but the difference in their financial and social status will be enormous. Nobody is suggesting that, Lazarus-like, the person in question will arise and walk after this reassessment - but there will be a striking difference in their status and future well-being.

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Do Carers Have Human Rights?

Submitted by tonyplant on March 16, 2006 - 17:50.

Carers UK is asking whether carers have human rights.  Carers UK report that

Carers, like everyone else in the UK, are entitled to rely on the protection of the Human Rights Act 1998, which should ensure that public bodies take account of their human rights when they provide services. Public services play a critical role in guaranteeing carers' human rights. They can ensure that carers have the support they need to maintain a normal life. The report we are publishing today shows that reality falls a long way short of this ideal.

 

Many carers are pushed to the brink of physical and mental collapse because of the lack of support they receive...

Why do carers seem to be the only group of people who are automatically exempt from the restrictions of the working time directive? Why are carers expected to work under conditions that are assessed as too much of a health and safety hazard for trained professionals? The Guardian offers several grim stories of overworked and exhausted carers that will be only too familiar to many people. In the light of today's news about tightening of eligibility criteria for care for elderly or disabled people, it seems as if relief will not arrive any time in the near future.

 

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Bad Week for Caregivers And Those Whom They Care For

Submitted by tonyplant on March 16, 2006 - 17:25.

It's a bad week for carers in the UK.  On Monday, Dr. Crippen posted a diary entry about his Monday morning surgery that detailed the plight of several carers. One of the carers knows that:

when social services “assess” her, she is classified as low need. She knows the system. She worked in it herself. “The best thing I could do is have a heart attack, then we would be high need” she says.

Today, Thursday, it has been announced that Councils To Cut Care For Old and Disabled. Four in five local authorities report that they are about to tighten the eligibility criteria for services for elderly and disabled people. This is in response to funding problems with the NHS that have led to greater than anticipated calls upon Social Care Services budgets.

Almost half the councils reported a cut in funding from local NHS primary care trusts. Councils highlighted the soaring costs of care for the ageing population, unprecedented increases in demand for services for children with a learning disability and rises in fees for care homes. Eighty per cent of councils said they would be tightening further their criteria for provision of services for adults. Thousands who would have received care will go without or pay privately.

So, it looks as if there is going to be no provision for those people who are classified as "low need". Even when there may be strong reasons to suspect that a lack of appropriate support now may lead to a breakdown in the carer's health and create more complex problems in the future. Some carers, like David, have never had a carer's assessment. He has been looking after his wife and son for many years. He says of his situation:

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Not For The Squeamish

Submitted by tonyplant on March 14, 2006 - 12:06.

The excellent Dr. Crippen has posted a blog entry about the Monday morning surgery from hell that is emphatically not for the squeamish. In fact, as I nearly fainted a few weeks ago when watching some surgical procedure in House (sad but true, my wife needed to put me in the recovery position) - I read the text but rapidly had to close my eyes and rely on my wife for a vague description of the photograph of the infamous pressure sore. The truly shocking story is at the end of Monday's entry: as with many of Dr. Crippen's posts, it is gut-wrenching, but you have been warned that it is more than usually so if you choose to look at the photograph.

Several of the entries for this infamous Monday morning are about carers. They call for a new airing of the tired lexicon of condemnation. Caregivers who are in despair about the level of care given to the person for whom they are caring when they are in hospital (neither cleaned nor fed). And carers who know that they are the victims of their own competence and will only qualify for more assistance if their own health undergoes a significant decline. Ruefully, one carer summed it up:

Trouble is, she is looking after her husband really well. So when social services “assess” her, she is classified as low need. She knows the system. She worked in it herself. “The best thing I could do is have a heart attack, then we would be high need” she says.

This account from a GP's surgery that could be somewhere near you is a bundling of the daily distress experienced by carers and a ghastly example of yesterday's report on elder abuse. Yet, as this took place in a hospital that could plead substantial staff shortages, does it somehow not fall within the legal framework that would allow the hospital to be prosecuted? Does it somehow fall under a Crown Properties exemption?

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