Health and social care

For many years and under many governments the UK has puzzled over the relationship between social care and the NHS. All governments would like a seamless transition from the one to the other for patients who need both. All have looked at whether some administrative or management reform would make all the difference. No-one so far has come up with a perfect solution.

Some now say the answer is to put social care under the control of the NHS. Others say the local NHS in each area needs to work more closely alongside the Council’s social service department. There are concerns that the boundaries do not work well, with some Councils not moving quickly enough to provide social care placing greater strains on hospitals with elderly patients.

It is tempting to think we could reorganise to remove any boundaries between different public bodies providing services. Then maybe the unified budgets would lead to more optimal outcomes for both patient and taxpayer. However, it is difficult to see how you can avoid a boundary. If you put social care into the NHS you just shift the boundary to the one with Council provided care homes and sheltered housing. If you transferred local NHS control to Councils you would find it much more difficult to get benefits from national NHS policies, purchasing power and hospital planning. There would be a bigger tension between national and local NHS, with all the money coming from the national level.

As someone who has thought a lot about this problem as a former government adviser and someone helping with past Manifestoes there is no easy answer. I conclude it is best to start from what we have, and build in incentives and requirements for good conduct by both the NHS and local social care.What we want is a wide range of provision, with choice and capacity available for each different and often difficult case.

Someone in social care needs access to a good GP and or to a hospital Consultant for a worrying condition. Admission to hospital when needed is not normally a problem. Decent supervision of an elderly person should enable better management of any medical condition without emergencies or alarms in many cases.

Discharging an elderly person from hospital requires appraisal of their needs and prompt and helpful action by social services, housing and other relevant departments. This is where local accountability and Councillor supervision should wish to shine.

Promoted by Fraser McFarland on behalf of John Redwood, both at 30 Rose Street Wokingham RG40 1XU

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63 Comments

  1. alan jutson
    Posted May 8, 2017 at 6:13 am | Permalink

    Surely one of the problems John is that we have differing policies in the various NHS Trusts, and different policies in many Local Councils.
    Thus we have a post code lottery for many types of treatment and conditions.

    From my experiences with my Mother who passed away some 10 years ago after a series of devastating strokes.

    Immediate Hospital treatment was poor, as she was expected to die, she didn’t, but was left with so very many incapacities she was absolutely bed ridden and could do nothing for herself, and thus needed 24 hour care for 5 years.
    She spent 10 months in Hospital whilst I argued over Continuing Care with her Medical team and Social Services, I had to contest four medical assessments before eventually and reluctantly, those at a higher level agreed that she was entitled to Continuing Care.

    Her last 5 years were spent in an excellent care home here in Wokingham, she passed away aged 96 after having led a totally independent life for 90 years.

    From the questions being asked of me in the initial stages, it seemed they were more interested in if she owned her own home, than the best treatment, well being, and care for her.

    I could go on at length about financial barriers, responsibilities and lack of joined up thinking which I had to overcome for someone who was absolutely vulnerable at the time, and who at no stage could have made sensible decisions for themselves at the time.

    So fortunate I had Power of Attorney in place and could fight for her on her behalf.

    Until recently I still had all of my correspondence on file, which measured 125mm (5 ins) thick.

    From what I hear, it is now worse, so we really do need a sensible and grown up cross Party discussion and agreement about our Hospital and Care system.

    • Jerry
      Posted May 8, 2017 at 7:56 am | Permalink

      @alan jutson; “From the questions being asked of me in the initial stages, it seemed they were more interested in if she owned her own home, than the best treatment, well being, and care for her.”

      What an utter condemnation of how the NHS is being run, and that comes down from government, no6ty as so many appear to suggest from the bottom up. Were has the post WW2 cross party consensus that care, cradle to grave, will be provided on need and not wealth or some other means-test (which private medical/care insurance is, thus not the answer).

      • Lifelogic
        Posted May 9, 2017 at 1:59 am | Permalink

        Indeed, and absolutely typical. Also a good reminder to people to get lasting powers of attorneys and wills organised, both for themselves and their relatives. Also the UK tax and benefit system encourages people to spend (or give away) their assets in later life. The system says be feckless or you will be mugged.

        • Hope
          Posted May 9, 2017 at 7:45 am | Permalink

          Alan, I know several cases like yours. The council is more interested in forcing the social care rather than compulsory care so the person pays not them. A bank of people from the council attend to railroad the issue in their favour. I repeat if we have to sale our homes why are we paying twice in our community charge! May needs to sort out the rip off council services. Start with unitary authorities of similar size and cap pay of senior managers. No expenses for councillors or larger expenses for cabinet members. No whip vote in council meetings.

        • Jerry
          Posted May 9, 2017 at 7:46 am | Permalink

          @Lifelogic; “The system says be feckless or you will be mugged.”

          Nonsense! It is the feckless who are the ones getting mugged, such as your self Mr Lifelogic who have allowed themselves to believe the idea that only the private sector (or at least their involvement) can actually run anything in this world. These people are either allowing the NHS to mug them, in the name of ‘cost cutting’ [1] or they are getting mugged by the private health insurance industry.

          [1] the only cost cutting that is needed in the NHS is middle and upper management, not front-line care and post treatment-care

    • Hope
      Posted May 8, 2017 at 11:20 am | Permalink

      You appear out of touch JR. Council services are woeful. Small clique of councillors in a so called cabinet controlling overpaid but under talented council staff. Time for radical reform. They are simply clueless from social services, education, planning, flood defense, transport etc.

      Yet your govt has now added another expensive layer of imposed mayors to regionalise England to divide and rule. The public did not want this. We also do not want to pay three times for the same service! Community charge, now a separate add on for adult social care and we still have to sale our homes for our own elderly care home costs! If I have to sell my house why do I pay twice in community charge a small well? The same for flood defense. Education is nothing more than a poor uncontrolled babysitting service. No wonder good teachers leave in their droves leaving the poor uneducated teachers behind.

  2. Posted May 8, 2017 at 6:15 am | Permalink

    Are we expecting too much of the government? At the end of the day, looking after people who cannot cope ought to be the responsibility, not of the government, but of the family. I admit that neighbours are pretty remote nowadays in many places, but they ought to assist too, I should have thought. On the whole the state gives very little love and affection: what it is very good at is bean counting, ticking boxes and paying a lot of people a lot of money to supervise the whole thing.

    • Lifelogic
      Posted May 8, 2017 at 7:15 am | Permalink

      I expect nothing (but hassle and taxation) from government and I am rarely disappointed. Government is indeed trying to do far too much and is delivering generally very poor & rationed services. Killing thousands of people and damaging the economy in the process.

      Get government down to circa 25% of GDP and encourage people to provide for themselves. Kill the dire, virtual state monopolies in health and education (especially) now please.

      Why do the BBC keep calling Marine “far right” her economic policies are totally left wing.

    • Jerry
      Posted May 8, 2017 at 7:27 am | Permalink

      @Mike Stallard; “At the end of the day, looking after people who cannot cope ought to be the responsibility, not of the government, but of the family.”

      Oh what a post WW2 picture-book image of the modern family!

      Many ‘families’ now live miles apart [1] (perhaps even in different countries), and even when they live in the next road or even next door what of the families who can not give the care that is needed – our host wasn’t (just) talking about social care of the elderly but post-medical intervention care and as such even when care in the family home is possibly that will almost certainly cause additional costs to the NHS due to the need to provide either out-patient or visits to the home by a nurse/carer that would otherwise be in-house are the care home.

      [1] do you realise just how moral sapping it can be to an elderly person, even in good health, to be moved away from their circle of friends, even if they do have their family with them or close by?

      • alan jutson
        Posted May 8, 2017 at 10:06 pm | Permalink

        Jerry

        I agree, indeed the Hospital Consultant was getting as frustrated as I was with the delay in putting together a sensible and logical future care plan for my Mum, as she was in effect bed blocking treatment for others.

        It was he who finally asked “does your Mum own her own Home”

        I simply replied, “what has that got to do with her future care”

        The silence was deafening.

        I was then offered a meeting with the Chairman in charge of Social Services and the future care of older people.

        He agreed with me after we went through Mum’s file in detail together, that the medical assessments had been underscored and were incorrect, and as such the people in the system, had wasted 9 months of hospital and my time, by not getting it correct.

        I gained a fulsome apology, and a promise that he would resolve the situation without delay.

        Mum was then discharged on a temporary basis to a Local Nursing Home within a week, and to her final placement here in Wokingham after a further 6 days, although during those 6 days they managed to lose some of her clothes.

        A very, very sad indictment of the system at that time I am afraid.

    • Ian Wragg
      Posted May 8, 2017 at 9:19 am | Permalink

      I agree Mike but as someone who volunteers in the charity sector there seems a lot of scams.
      Husband and wife being paid as each others carers how does that work.
      Endless people claiming disability and getting free cars when they are fitter than me.
      The whole thing’s a mess.

    • sm
      Posted May 8, 2017 at 5:12 pm | Permalink

      Mike, what about those who have no families? What about the families who live in houses built in the last 100yrs that are too small to cope with the needs of an infirm or demented relative? What about the families who are already dealing with another relative with demanding health or behavioural problems?

      Modern medicine is often miraculous, but it has opened a Pandora’s box of consequences.

  3. Jerry
    Posted May 8, 2017 at 6:36 am | Permalink

    I think shifting social care to the NHS is the way to go, nothing is ever going to be perfect, the problem we face at the moment is that all the time local council controlled social care is being limited (deigned might be a better word) local authorities are not spending the money on social care whilst the NHS and society has the added costs of bed-blocking – might as well give responsibility to the NHS along with a proportion of the funding that LA get from the tax payer.

    As for the NHS more generally, much cost saving could be achieved by wholesale changes to the middle and upper management levels, sorry but the internal market and Trusts have been an utter failure – blame them both on EU regulation or what ever if the government needs to save face, just scrap them, go back to what actually worked, what actually put the patient first.

    • stred
      Posted May 8, 2017 at 9:14 am | Permalink

      Our experience of trying to find care for disabled relations was similar to Alan’s. Files were a foot thick. L.As and the NHS try to put responsibility onto each other. Local Authorities pass the buck to others. Competent assessment is hard to find and we found that the GPs gave most practical help.

      A separate local social services department, with senior staff salaries kept down in national guidelines, should operate with the NHS and provide services working together. The GP should ensure that care is found quickly and locally and that money is not wasted bt bed blocking.Enough funding should be provided to stop the wasted time caused by buck passing. This would save the wasted taxes overall.

      • Jerry
        Posted May 8, 2017 at 8:37 pm | Permalink

        @stred; “L.As and the NHS try to put responsibility onto each other. [..//..] A separate local social services department, with senior staff salaries kept down in national guidelines, should operate with the NHS and provide services working together. The GP should ensure that care is found quickly and locally”

        Sorry for the long quote but how of the second part any different to the first, in effect all your suggestion does is replace the LA with another department that will almost certainly act like the LA’s. Why can’t the same staff simply operate as part of the NHS, why the need for your suggested additional social services department?

    • Lifelogic
      Posted May 8, 2017 at 5:03 pm | Permalink

      The patient will never come first with free at the point of treatment (or non treatment), they will be treated as a nuisance just as they are now. To be deterred, delayed and pushed from pillar to post like the Liabilities (to the NHS) they are.

      • Jerry
        Posted May 8, 2017 at 8:45 pm | Permalink

        @Lifelogic; Nonsense, as anyone who actually uses the NHS knows!

        What Lifeilogic never answers is what his wish to privatise health care will do to those who can’t afford inflated health insurance.

    • Know-dice
      Posted May 9, 2017 at 8:20 am | Permalink

      Agreed Jerry…

      Shift social care to the NHS all under one organisation and one budget. I don’t think that Social Services are necessarily bad but certainly the left hand not knowing what the right hand is doing comes in to this as well as each side trying to push costs across to the other…

      As far as the rest of the NHS goes, in particular hospitals and GPs these need to be more integrated especially as care passes from one to the other. Both also need to improve their 24×7 care and out of hours availably.

      Certain departments within hospitals that operate a 9 to 5 regime need to be given a kick in the backside, in particular X-ray, radiology, scan departments, pathology and micro-biology the “core” diagnostics services are sadly lacking in this respect.

      Consultants and their “empire building” needs to be addressed to ensure monies are targeted at areas that will achieve the best outcomes for patients not just pet projects.

      Finally – The various layers of management need to be looked at and justified…

  4. Lifelogic
    Posted May 8, 2017 at 7:08 am | Permalink

    Well what you currently have is a silly damaging battle between various arms of government each trying to push the patient away and thus push the costs onto some other department. This is hugely wasteful and very damaging to patients and to their families too who often have to give up work. It is wasting money hand over fist while delivering very poor service indeed. Rather like most other areas of government in fact.

    People who can pay need to start paying, taking insurance and providing for themselves. The tax system should encourage them to do so, not make them pay four times over and encourage them to be feckless as it does now. We need lots of alternatives to the NHS not a communist state monopoly in health.

    • Lifelogic
      Posted May 8, 2017 at 12:42 pm | Permalink

      Labour now wants to get rid of car parking charges at hospital “paid for by increases to taxes on private medical insurance”. I can’t see free parking working very well in London hospitals as the car parks will always be full up if they are free.

      Exactly the wrong socialist, state monopoly, approach from Labour. But May & Hammond are just the same, having just increased IPT to 12%. Thus making people pay four times if they go privately. They should be encouraging people to make private provisions not killing it. What lefty twits they all are in all the parties.

      • Lifelogic
        Posted May 8, 2017 at 3:02 pm | Permalink

        “Taxing private health insurance more heavily” as Labour suggest would just push more people back on to the NHS and not raise any tax. Net it would be a big liability to the states finances. Labour are clearly economically illiterate, as we saw with Diane’s police proposals.

        But then of course Osborne & Cameron were too (and May and Hammond still are) just not quite as obviously so.

  5. sm
    Posted May 8, 2017 at 7:14 am | Permalink

    There must also be some very public and honest debates across society about the prolongation of life in the very elderly and infirm (no, I’m not advocating wide-spread euthanasia), which swallows up so much of the NHS/Council budget.

    At a large family gathering yesterday, cousins in their 50’s/60’s with their own serious health problems talked to me about 3 very elderly parents who all have major mental and physical health issues – and very little or no quality of life. My cousins dearly love their parents, but are despair at the way in which they are hauled back to life when they get really ill, and in some cases being denied medication that would help them cope because ‘there are long-term addiction problems’!!!

    We as a society need to start learning when to let go – and I write as someone who has had to go through that desperate process.

    • Jerry
      Posted May 8, 2017 at 8:51 pm | Permalink

      @sm; “[we need a] very public and honest debates across society about the prolongation of life in the very elderly and infirm (no, I’m not advocating wide-spread euthanasia)”

      Sorry, oh yes you are, perhaps not in the image of Dignitas but you are asking for someone to “play God” all the same.

    • Caterpillar
      Posted May 8, 2017 at 9:39 pm | Permalink

      sm,

      I think ‘dying well’ / ‘having a good death’ / ‘living to the end’ / ‘maximising final happiness’ has had a little more media time in the past few years, perhaps it needs much more.

  6. Anonymous
    Posted May 8, 2017 at 7:29 am | Permalink

    Patients are being shoved back out in the community early post operation. Nothing is being done to mitigate the increase on workloads for district nurses. Hospital targets for bed clearances are being met on an official level but the pressures are appearing elsewhere.

  7. Iain Gill
    Posted May 8, 2017 at 7:31 am | Permalink

    It would be best to transfer buying power wherever possible to the patients.

    • Lifelogic
      Posted May 9, 2017 at 2:03 am | Permalink

      Exactly!

  8. Dave Andrews
    Posted May 8, 2017 at 7:46 am | Permalink

    We had local council elections last week, and I didn’t bother to vote. Why bother, when councils are strait-jacketed into servicing statutory duties with practically no room for manoeuvre, including social care.
    As a council tax payer, I would like my contributions to pay for the things I enjoy locally, such as park maintenance and keeping the public conveniences open. But these and others are the schemes that are being squeezed of resources.
    Take social care out of local council responsibility and link it financially with the NHS, so it becomes economically sound to move people out of hospital into a care home, rather than the present system where local councils put barriers up so as to protect their budgets.

  9. Bob
    Posted May 8, 2017 at 7:47 am | Permalink

    I have a feeling that the cost of health and social care will always increase to absorb the amount of money available to it.

    Gordon Brown ruined UK private sector pension provision in order to pump more cash into the NHS, and here they are again asking for more.

  10. Margaret
    Posted May 8, 2017 at 7:52 am | Permalink

    In 1988 I got a post on an acute medical ward which rapidly became an acute medical ward for many elederly. Discharge was worked upon from admission . Different NHS agencies were brought in from Occupational therapy, physiotherapy , social workers , district Nurses whilst the patient was on the ward. Case conferences were held and all the necessary help was put in place. Then the patient went home and it all went pear-shaped. Private companies got involved who were low priced , competitive and always put the blame on to others. The NHS ethos which went out of being with alacrity was one of collaboration and a non blame culture. Our principles were far different from the cut throat non performing bosses and staff.

  11. JimS
    Posted May 8, 2017 at 8:09 am | Permalink

    The NHS can’t even integrate its own services. My mother fell and broke a bone and the hospital laid her flat on her back, ignoring her breathing problems and denying her access to her GP prescribed heart medication.
    They then spent the next week waiting for her to recover from the problems that they had caused before they could fix the problem that she came in for.
    During her stay we observed ‘domestic’ staff provide drinks to patients who were unable to hold a cup. Later the same staff cleared away the full cups. Meanwhile the ‘nursing’ staff had been playing with their computers, no doubt reporting ‘performance data’ to ‘management’.
    Stop ‘saving our NHS’ and get people from small engineering companies in who understand ‘specials’ and ‘work flow’.

    • fedupsoutherner
      Posted May 8, 2017 at 8:39 pm | Permalink

      @JimS Yes, my mother is like this. While I was present she was given soup in a cup to drink and a meal which she was miraculously expected to drink and eat while laying down flat on her back with breathing difficulties. When I asked if she could be sat up to eat I was told that nobody could lift her as they might hurt their backs. My mother is very heavy as she is filling up with water. She cannot use one of her arms since her stroke. Two staff finally arrived to alter her bed so she could eat with help from me. If I wasn’t there then her dinner would just have been taken from her.

      • Lifelogic
        Posted May 9, 2017 at 3:41 pm | Permalink

        This is not at all unusual. The system is just appalling and this despite the fact that there are still some excellent and dedicated staff working in the NHS. It is not at all helped by the fact that almost no one (especially in the state sector) can ever be sacked. Thus due to the workers rights that May wants “to build on” the PC tribunal systems and poor management.

        • Iain Gill
          Posted May 9, 2017 at 8:02 pm | Permalink

          A close relative (slight build) was sent home from the hospice to die, taken by ambulance (who mentioned no concern when leaving the hospice), when they arrived at the house the ambulance crew refused to lift the patient into bed as too much risk on their back, it was only resolved when relatives rang the duty local nurse who rang round the other nurses and a lot of female nurses turned up and 1 told off the male ambulance crew in no uncertain terms and 2 lifted the patient into bed.

          frankly nonsense like this is disgusting.

  12. A.Sedgwick
    Posted May 8, 2017 at 8:17 am | Permalink

    The problem is multi layered, part is the lack of encouragement by government for people to be able to downsize into managed/sheltered/retirement accommodation before their time. Older people clinging on to old homes increases risk of loneliness, falls, malnutrition, preventative attention. Even and perhaps especially in old age, people do not want to see their assets wasted. IHT, stamp duty and very expensive tiny retirement leasehold flats with complicated legalities do not help.

  13. Kenneth
    Posted May 8, 2017 at 8:24 am | Permalink

    I thought this was the GP’s job as part of his/her holistic care for the patient

  14. Javelin
    Posted May 8, 2017 at 8:27 am | Permalink

    Social care should be about the physical and mental health in the community – hence “social care”.

    Unfortunately over the past 40 years it was taken over by femminists and Marxists.

  15. Bert Young
    Posted May 8, 2017 at 8:32 am | Permalink

    There ought to be a smooth continuous line between the NHS and Care providers ; this can only be achieved under one roof . That the size of the NHS prevents an overall effective control highlights the difficulty in making this happen .

    I have argued for a long time for the “re-invention” of the NHS ; its layers of management interspersed with the medics in practice causes confusion and delays and the lack of business nous with medics handicaps effective running and organisation .

    It’s a question of whether to start again from the bottom up , or , from the top down . Many individuals have been imported from the outside to inject change but it has never brought this about . That a clean sweep is necessary is now beyond debate . “Get on with it ” is the message to Government .

  16. Posted May 8, 2017 at 8:40 am | Permalink

    One thing that seems to no longer exist is the convalescent home, somewhere giving nursing care but without the full services of a hospital.
    A widow that I know recently had a heart operation and she went to a convalescent home afterwards at her own expense for about a month. Otherwise, I suspect she would have become one of the notorious “bed-blockers” as she would have been unable to look after herself at home without assistance, and she would have probably remained in the hospital for the month whilst the NHS and local council discussed her care.

  17. alastair harris
    Posted May 8, 2017 at 8:53 am | Permalink

    The flaw in the design of the NHS is the idea that you can have a successful bureaucracy running a large number of disparate services. All it does is concentrate power (money) in the the centre, to the detriment of patients, both in terms of outcomes and experience. Same issue as any Communist country had. The answer is to break them up. And fund on the numbers of patients they can attract. They have to be able to fail, and no monopolies.

  18. agricola
    Posted May 8, 2017 at 8:58 am | Permalink

    I suspect that having two separate organisations, local government and the NHS responsible for what should be a joined up service, only leads to conflicts of interest. With adequate funding I would opt for it all to be the responsibility of the NHS. The NHS would have a vested interest in making it work, if only to remove bed blocking with it’s domino effect on waiting times.

    As to funding we have a grossly inflated Overseas Aid budget and the prospect of an additional £10 billion plus per annum from 2019 onwards when we leave the EU. It would also do the citizens of the UK a favour by reducing council tax. There has to be a political plus in that. I look forward to reading what the conservative manifesto has to say on the subject.

  19. Antisthenes
    Posted May 8, 2017 at 10:03 am | Permalink

    Like all public sector and state agencies and organisations the NHS and social care are riddled with inherent systemic flaws. All emanating from one factor. The lack of any sustainable means to implant the necessary incentives to be efficient, productive or have anything more than superficial concern for their customers. The reasons are because they have monopolistic powers and are supported by powerful vested interests and that other great incentive not to give the best possible quality and price for what they offer. The lack of a profit motive or credible system of reward for success and punishment for failure.

    Whilst the NHS and social care remain in it’s current form whereby the bulk of it’s provision and funding remains under the remit of the state then achieving acceptable performance levels and maintaining them will never be possible. Not helped of course by the legislature being more concerned with socialising society and imposing laws and implementing policies without concern for economic reality and the far worse unintended consequences. All because of either it is popular, misguided and/or because it complies with the currently preferred ideology.

  20. John Probert
    Posted May 8, 2017 at 10:24 am | Permalink

    Carers in the community that are paid properly & have a realistic schedule that
    spend a minimum of 30 mins with each person

    District Nurses providing support at home

    I am sorry to have to say that until GP’s are retrained into the thinking of
    Preventative Medicine and stop the addiction of medication which is damaging
    there will be little progress

  21. Oracle
    Posted May 8, 2017 at 11:12 am | Permalink

    The Tory Party should promote, for the very first time, competition in Health and Social Care Services. No, competition in terms of trade unions.

    The unions associated with the NHS are either Corporate Trade Unions, which in effect are arms of a faction of the Labour Party ( ie financed by Local Authority tax-payers, salaries for its officials and financial practical help with its 12% turnout trades union official elections ), or, other trade unions which do not sport the idea of being Corporate but are directly controlled from and by another faction of the Labour Party

    It is a bit daft for say Mr Hunt to spout in Parliament that he or his Offices are having discussions or negotiations with the BMA and others when in fact he may just as well as personally talk with Mr Corbyn and whoever is the chief rightwinger of the PLP.It would save alot of time and mucking about generally.

  22. Denis Cooper
    Posted May 8, 2017 at 11:19 am | Permalink

    Off-topic, I see several reports that the Tory manifesto will repeat the existing pledge to cut net immigration to the tens of thousands, but the pledge I really want to see is:

    “During the forthcoming negotiations on the UK’s withdrawal from the EU we will insist on reclaiming complete control of our immigration policy”.

    After that, well, we can argue among ourselves precisely what that policy should be, just as happens in most normal countries.

    • Chris
      Posted May 8, 2017 at 8:44 pm | Permalink

      Precisely, DC.

  23. ian
    Posted May 8, 2017 at 11:24 am | Permalink

    Hospital, and the doctor should be king in these matters. Once the doctor and the hospital have decide the person is ready to leave hospital, and is not remove by the council or the government after two weeks of the order to remove the person from the hospital the council and the government will be fined 1000 pounds a day each, which come to 14000 pounds a week for each person not remove after two weeks of the order being given, and the hospital to use that money for new equipment and training only.

  24. Mark B
    Posted May 8, 2017 at 11:33 am | Permalink

    Good afternoon.

    Perhaps if we diverted some of the Foreign Aid budget to this it would not be such a problem. Also. If the government used some of the money it collected in NIC and put it into a Sovereign Wealth Fund and used the other monies more wisely we would not be in such a situation.

  25. Denis Cooper
    Posted May 8, 2017 at 12:18 pm | Permalink

    Also off-topic, it seems the fifth column in the civil service is at work again:

    http://www.independent.co.uk/news/uk/politics/government-hires-war-negotiator-william-ury-advise-brexit-talks-a7722381.html

    “Government hires expert negotiator who helped avert nuclear war to advise on Brexit talks”

    “William Ury previously acted as a mediator in conflicts in the Middle East, Indonesia, and the Balkans”

    That seems a good idea, just in case the EU deliberately tries to inflame tempers during the Article 50 negotiations, as they’ve already started to do before the negotiations even have even started, but, no, an anonymous “source” sees it very differently:

    “A source close to the negotiations told The Sun that Mr Ury was advising civil servants about negotiating when emotions are running high.

    “It’s astonishing,” said the source, “that before the negotiations have even started, the Government have pressed the nuclear button by bringing in a war negotiator.””

    Is there no way of identifying this traitorous “source” and disciplining him?

  26. margaret
    Posted May 8, 2017 at 12:37 pm | Permalink

    Whoops..silly move by Mrs May. We voted for Brexit to Stop inward migration. Labour may still get in because of hat broken promise.

  27. Tory non-manifest
    Posted May 8, 2017 at 1:10 pm | Permalink

    Anything in the next Tory Party manifesto about reinstituting the concept of free speech in the UK and an abandonment as a necessary condition pc?Or isn’t that allowed to be written or suggested or intimated or thought about without a dead-pan expression on ones face subject to committee scrutiny?

    • Lifelogic
      Posted May 8, 2017 at 7:02 pm | Permalink

      Free speech in the UK? It seems rather unlikely given the absurd PC state sector and the absurd libel laws. I see that in Ireland even Stephen Fry is under police investigation for blasphemy. Etc ed

      One has to be free to offend. Without that you simply do not have free speech at all – and we do not really have it in the UK now.

      • Tory non-manifest
        Posted May 8, 2017 at 8:22 pm | Permalink

        Home Secretary Amber Rudd is a champion of free speech, just not for people having it.

      • Jerry
        Posted May 9, 2017 at 5:55 am | Permalink

        @Lifelogic; “Free speech in the UK? It seems rather unlikely given the absurd PC state sector and the absurd libel laws.”

        Sorry Mr Lifelogic but if you do not already have free speech here, if our host is deleting the majority of your comments, I hate to think what else you rant on about (and how) daily bases…

        • Edward2
          Posted May 9, 2017 at 8:06 am | Permalink

          Says Jerry in his eighth post on this topic !

        • Tory non-manifest
          Posted May 9, 2017 at 2:34 pm | Permalink

          Jerry, an old joke but it has truth in it ” I didn’t get to where I am at the bottom of the pile by keeping my mouth shut.” The first time I heard it was via the TV show of the late Arthur Haynes circa 1959. Those Were The Days my friend we thought they would never end.

  28. acorn
    Posted May 8, 2017 at 5:09 pm | Permalink

    The NAO “Health and social care integration” summary, tells the classic story of a bureaucracy driven mad by frequent policy changes by frequently changing amateur ministers. It’s just like planting a row of carrots and pulling them up every day to see if they are growing. https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration-Summary.pdf

    The NAO also did its forensic best with its Select Committee report “December 2016
    Briefing on EU-UK finances”. https://www.nao.org.uk/wp-content/uploads/2016/12/Briefing-on-EU-UK-finances-2.pdf .

    Only man can make his life this complicated. I haven’t got a clue how much the Brexit severance charge will be. There are a multitude of implied contractual obligations we will be withdrawing from. How much of a bung will the EU want for a future trading relationship? How much is Mrs May prepared to pay?

    BTW. Where is our Emmanuel Macron and our equivalent of the “social liberalist” La République En Marche?

    • alan jutson
      Posted May 8, 2017 at 10:28 pm | Permalink

      Acorn

      It is reported today that the legal advisors to the EU have said after thorough research, that there is no legal case to charge the UK anything on leaving, as there is no legal process in place to do any such thing.

  29. SecretPeople
    Posted May 8, 2017 at 8:55 pm | Permalink

    It’s almost as if a halfway house is needed, so that once people are safe to leave hospital but still need to be rehabilitated, they could move to a semi-supported environment which benefited from occupational health, physios, district nurses who could get to know their patients prior to their returning home.

    Hospital leavers could then be taught stoma care, how to manage diabetes, remobilised etc, without blocking hospital beds, and without being sent home before they were independent and ready. Having said that, the elderly often do not respond well to being moved frequently, so careful consideration would need to be given as to who might benefit from such an arrangement.

  30. anon
    Posted May 8, 2017 at 9:24 pm | Permalink

    Perhaps – the NHS should build or purchase “outpatient care homes” to aid with the discharge process from “active care” in or near hospital grounds.

    NHS should directly control initial assessment of the level of care directly if anyone ends up admitted in hospital.

    Any cases not then immediately agreed by the NHS & local authority should go to ajudication and harsh penalties imposed on the bureaucrats e.g. reprimands and loss of job if they have failed in their duty of care to the individuals.

    Funds should follow the person and assessment should be made irrespective of patients financial status. Such questions asked before the case is agrees should result in reprimands at a minimum.

  31. Caterpillar
    Posted May 8, 2017 at 10:00 pm | Permalink

    I am wondering if there could be a different ‘asset grab’ model for the elderly in care homes, rather than their life’s work minus 23,250 (asset + income). Is it not possible for lone survivor elderly to pass their house to the council as local authority housing stock for the duration that they are in care + Some years, and then return to the estate. This gives the council additional housing and generates part of the costs for the care home, and the elderly person still feels they are leaving something to their loved ones. I appreciate that this falls short of care home costs (perhaps only covering 30 – 50%), but at the same time care home costs do currently seem to be somewhat high.

  32. Lindsay McDougall
    Posted May 9, 2017 at 12:13 pm | Permalink

    I am in favour of the maximum possible separation of health and social care. The main reason is to avoid the NHS’s idiotic free-at-the-point-of-consumption financial model being imported into adult social care. Two things cannot be stressed enough:
    (1) Spending on the retired elderly is investing in yesterday.
    (2) Most retired people in the south east of England have plenty of resources.

    Most pensioner households are asset rich, owning their own homes. For the first time they are also relatively income rich, having nosed ahead of non-pensioner households.

    Pensioner households have available:
    – their pensions
    – their investments
    – their houses
    – freedom from NI payments
    – free prescriptions
    – transport concessions
    – even cheap haircuts etc

    To finance their social care, pensioners can use their incomes, their savings and equity release from their houses, before they need help from their children or to declare themselves to be paupers.

    What is needed is some level of government to ensure that social care is provided to the extent that it is needed. This is not a financial obligation but an obligation to see that things happen, so that hospitals may discharge bed blockers promptly. I propose that District Councils are best placed to discharge this responsibility and to ensure that their costs are recovered.

    Finally, many of the retired wish to have a pleasant retirement and death rather than to extend our lives to the maximum possible extent. There is, though, a conspiracy between the various branches of the God squad, the medical profession, the caring profession and politicians to deny the elderly their freedom. it seems that they positively want the elderly to survive long enough to fall victim to dementia.

    Suicide, including assisted suicide, should be part of the legal framework. Why should any of us spend thousands of pounds going to Switzerland just because the House of Commons won’t legalise assisted suicide here?

  33. NB
    Posted May 11, 2017 at 2:32 am | Permalink

    We have to stop.this tyranny of mental illness robbing the NHS of money to treat real illnesses. Counsellors should work free for the Church.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

    Promoted by Fraser McFarland on behalf of John Redwood, both of 30 Rose Street Wokingham RG40 1XU

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