Social care largely delivered by Councils with the help of a range of contractors and service suppliers needs to work smoothly alongside the NHS.
Councils have a vital role to play in helping reduce the burden on NHS hospitals. It is too easy to place elderly and infirm individuals into hospital where they should be safe, even though they do not need hospital treatment. They may go in for tests, only to have to stay because there is no sufficient care package to allow them to go home alone. Hospitals are also open all hours and at week-ends, whereas social care services may be more restricted outside weekday regular hours.
Social care nurses or executives may think it prudent to send someone for tests after an incident even though there areĀ no signs of harm and even though the patient is saying they areĀ not in pain or difficulty. It often takes time to assemble a case conference and assessment to upgrade care so an individual can look after themselves with suitable support.
Social care also needs to work well alongside GPs, and with hospitals after the discharge of patients. Elderly and infirm individuals may need help with daily tasks, and need some supervision or assistance with a course of treatment at home. It can be cheaper as well as better to take the care to the patient, but needs organising successfully.
Councils say they need more resource to do their jobs well, whilst hospitals are worried that they are still having to look after people who could manage at home with suitable help. The border disputes between the NHS and social care go back a long way and have happened under a variety of governments. There is no easy solution,Ā but it would be good if Councils and the NHS can improve their joint working where there currently issues with bed blocking or inadequate medical back up out of hospital.
I would be interested in comments on this matter. I am not raising it as a result of any local complaints which I would handle in another way.
October 19, 2017
Good morning
A simple solution to this is to make ‘Bed blocking ‘ illegal.
If a private care firm or council do such a thing then fine them.
You are parliament. You can make, amend and repeal laws. So do your job. Not having a go, just not accepting something.
The NHS is there for a specific purpose. To use it for other purposes is wrong and should be stopped. It is an offence to waste police time, so it can be an offence to waste NHS resources .
October 19, 2017
The money is there for the NHS you just need to get a rid of all the duplication and waste. Why does a national service need to be divided up into NHS Wales, NHS Scotland and NHS England? While in the latter there is also the subdivision of South and North. While under that we have all those trusts running their own cottage industries with their own payroll and HR depts.
October 19, 2017
Councils need radical reform and more accountability for the way its spends. NHB and CIL were introduced to replace the govt grant cuts to force councils to build. This was done int Andes with planninglaw reform with a presumption to grant. Instead of CIL being spent on infrastructure for the mass immigration build it is used on vanity projects, football salary staffing costs- why so many consultants when they are paid so much! Then of course there is a distinct lack of integrity testing councillors from developers. NHB goes straight into normal budgets. The councils gripe about cuts to its grants but forget to mention the huge amount of money from CIL and NHB.
Two tier councils need to be scrapped. There is no justification other then the small number of councillors who form cabinet actually make all the decisions, the other councillors a waste of space. Single unitary authorities of similar size with limited councillors and reform any form of so called cabinet. They are little fiefdoms with tyrannical leaders out of control.
Public service is the bottom of their agenda, first their salaries and expenses, then their power agenda and then the public service. Better value better procurement could be achieved by having similar sized local uthoroties and moreover than anything else far better accountability. Most hard working people are not interested or do not get involved in wha is going on. That is what these unscrupulous councillors rely on. Our community charge now paying extra sums for social adult care, flood defence which should be part of the quangos budget or from the existing community charge. We are being fleeced in tax three times for the same service! Come on JR get the monster to do his job, get off his arse and look among the weeds.
October 19, 2017
I went to hospital today, they introduced a new check when you book in. They ask, have you lived here for more than a year. Everyone says yes including the obvious East European before me! Good grief is this the best Hunt can come up with? Overwhelmed hospitals asking a stupid question like this? Why not demand NI number that can be verified?
October 19, 2017
no top down control and more laws are not the answer
the only real answer is to turn purchasing power and decision making over to patients and give them the real and genuine power to take their business elsewhere when the provider in front of them is not to their liking
stalanist state controlled enterprises never work, and the NHS and council controlled care system are just repeat proof of this fact
I am surprised no politicians are prepared to state the obvious and do the obvious
We need much better care for our citizens and messing around with the current system will never deliver it
October 20, 2017
To have the power to make decisions and to purchase adult social care, you need to have mental capacity (indeed quite a high level of competence) and money. If you have both and need care – say because you have a physical disability- there is nothing stopping you from having this power at the moment except a shortage of provision to choose from. The problem is that those who need the higher levels of care donāt tend to be competent empowered purchasers. Just handing them a personal budget is fraught with problems and who decides whether they should get such a budget and how much it is?
October 20, 2017
It doesnt need to be money, it can equally be a voucher or equivalent.
I am happy with the state being an insurance provider of funds for this care, funded through taxation, but the state should not be running providers of care, and the state should not be allocating care or providers.
Most people including in their old age know crap service when they see it, and giving people real buying power empowers innovative services to emerge and people to choose them of their own free will.
In the vast majority of cases ordinary people would make a better choice than the current clinical commissioning groups and councils do, in fact it would be hard to do worse. And many would get advice from family and friends like they do in other aspects of their life.
To design a system for the very few with no competence or family available to advise is not a good idea, sure this small group can be given extra help, but that extra advice would emerge anyway in the community if the individuals had real buying power to spend.
The fact no other mainstream developed country does it remotely like us, and the most successful give individuals buying power says it all. Indeed even Blair recognised that and tried (and failed) to introduce some patient power.
October 19, 2017
Just what we need – more laws
October 19, 2017
If the industry cannot control its excesses the it has to be dissuaded from such praticise of bed blocking. One would hope that it does not come to this, but ?
October 19, 2017
The NHS breaks the law every day already, not in court much though are they?
October 20, 2017
Even when the NHS does end up in court mostly the relevant managers and doctors never appear in court or feel any consequences, the NHS just pays lawyers to turn up in court. And the NHS usually happily pays big legal bills to outspend any challenge from ordinary citizens, so they win just because they can spend more.
So more law is never going to help fix the NHS.
October 19, 2017
Indeed, and the police have given up on enforcing most laws already.
October 19, 2017
They even advertise this!
October 19, 2017
Off topic
http://www.express.co.uk/news/uk/868245/Jeremy-Corbyn-labour-leader-to-meet-Michel-Barnier-and-Antonio-Tajani-Brussels-Brexit?utm_source=spotim&utm_medium=spotim_recirculation&spotim_referrer=recirculation
Someone should point out to this muppet that labour lost the GE, and pray God he’s doesn’t get the keys to number 10 in the near future, then there’s the fact he wouldn’t have a majority in Westminster and that if another GE was to be called the Labour Party would be wiped out, now the gullible and snowflakes have seen through him
October 19, 2017
He is, wittingly or unwittingly, likely to encourage the EU to continue to delay and obfuscate and make life difficult for the UK government. This will be in the belief that delay will help deliver the conditions for a second referendum and/or the promise of an excessively large dollop of cash. Either way his visit will not help the negotiating process or strengthen the hand of the UK government. In short it amounts to a betrayal.
October 19, 2017
Such typically brilliant and simple analysis from AEP in the telegraph today that i had to lift two paragraphs for those who missed it. Time to crack on, a short term status quo that require the City will become THE status quo:
“It is striking that German officials have been taking a softly-softly approach on the City of London. The Bundesbank and the regulator BaFin want the financial withdrawal process stretched over several years precisely because they know that Frankfurt, Paris, and other hubs cannot replicate the Cityās ecosystem quickly.
They know that the eurozone would risk an exogenous, deflationary shock if Britain left the EU abruptly without any framework for temporary equivalence. They also know that the risk ā for them not for us ā diminishes with time. It will be greatly reduced in four or five years, once the EU has succeeded in āshaking the treeā and capturing large chunks of Londonās business in clearing, derivatives, and capital market funding.”
October 19, 2017
Quite – in the whole leaving process, if the EU thinks that processes cannot be replaced it must allow the current status quo or risk its own exports/economy.
Our negotiating strength based on the Ā£80 bn deficit we run is severely underplayed.
Time allows adjustment. no time means no adjustment which means agreement to continue as is.
October 19, 2017
It has to be asked if the EU deploys these tactics why May entertains it? She should now walk away. It is clear to most that it is not possible to leave the EU with the mythical good deal. If it was every country would leave. I suspect May knows this but prefers the country to be in the EU under Labour than leave like so many of her colleagues.
Leave and consider bartering a deal at a later date.
October 19, 2017
The BBC had their pro EU agent in Brussels and Sir Keir Starmer on this am. Both asserted no-one in the EU has mentioned a figure. Naturally this went unchallenged by the presenter who had been interrupting the let’s leave now man at every quarter sentence.
Does anyone remember the President of the European Parliament saying two nights ago on the BBC’s Newsnight that 20 billion was peanuts and that he wanted more like 50 or 60 billion? I rather think Evan Davies agreed 20 billion was peanuts. I suppose in mitigation to Today one could argue it is only a pretend parliament so its president doesn’t count, but he is still in the EU isn’t he?
Then Sir Keir went on to assert, unchallenged, that we had pensions liabilities and that we mustn’t walk away from our obligations to all these poor families – the Kinnocks? The Mandelsons? We have no obligations: they are not our employees; they are the employees of the EU and their allegiance is to the EU.
We do indeed need a rapid rebuttal unit.
October 19, 2017
When you leave a pension scheme, even if you leave your contributions to accrue until pensions age, you do not continue to pay in!
I do hope Mrs May has the guts to say no way to the EU on this!
October 19, 2017
Reduce national insurance and make private care insurance tax deductible.
Your government can not guarantee to help, but will give it free to those who can’t pay.
Even the deck by not making us pay for something we can’t access through taxes.
October 19, 2017
Spot on and throw in a hybrid model of some kind where you contribute and so does the state. Having had my mother with early stage dementia left on her door step with a bag of pills she had no way on knowing what to take at 11pm, none of us knew it was going to happen, or get dressed patiently for an ambulance that literally was hours later than promised or the council home care I paid for that came in, couldnāt give a damn apart from whizzing around and getting out again as quickly as possible, I am contemptuous of the people involved from politicians to the local providers. I was living and working 70 miles away and my sister 150.
Much to do with resources but also no common sense, sometimes commitment and certainly very poor organisation and protocols.
The answer is simple in the first instance, a lot more money, I do not normally agree with this but I have seen workloads at first hand.
I read the BS about the good overseas aid does and remember the treatment of my
mother, in hospital wonderfully kind, outside often appaling and I see our wealthy living in a bubble politicians continue to justify sending billions abroad. It wont of course happen to them with their wealth and influence, hence my contempt.
October 20, 2017
I agree. The truth is that those who provide Social Care in the home are stretched to the limit. They are sometimes poorly trained, poorly paid, and expected to travel from one client to another at their own expense.
I think that most people would prefer to be cared for in their own homes, if the care was good. Many are prepared to pay for it. I know I am, but will the help be there if I should need it?
Also, many people are confused as to why they are expected to pay. They were given the impression through the years that their NI stamp was contributing to this. We are now airily told, this was not the case.
We need these people and they should be adequately trained and paid, for the valuable help they give. Iām convinced there is money out there, but the Government just wastes it on their vanity projects. They need to do something, and fast!!
October 19, 2017
Similarly your government really should stop levying a proportion of NI on those contributing to the workplace pension scheme.
The long term aim appears to be to curtail the state pension so your government really shouldn’t be collecting our stamps.
If your government truly wants to save some money in the future, immediately moving public sector pensions to defined contribution schemes rather than defined benefit schemes seems to be a clever move.
October 19, 2017
Indeed encourage more and more people to go privately with vouchers and private insurance tax reliefs and for companies to provide cover for employees – thus encouraging some real competition rather then killing it dead with the “free at the point (of delays & non treatment)”.
October 19, 2017
They don’t give the care ‘free’ – it’s the paying residents in the same care home that pay for it.
Hence Mum is paying Ā£800 a week for a tin of diet Coke and a slice of cold ham. (recently in the press)
October 19, 2017
Either:-
Hospitals should not admit non urgent older patients unless an exit route is already in place.
Or if that is not practical then this:-
Leicester, where I live, has three hospitals. If the level of bed blocking is believed then one of them could be converted to essentially a much cheaper convalescence hospital leaving the other two to deal with people who need overnight stays without any loss of bed space.
Social services and local authority staff could then be based in the convalescence hospital so they can easily meet with themselves, patients and their families to determine a way forward.
October 19, 2017
Good Morning,
Local government/central government provided social care for the elderly should be costed as an alternative to a hospital bed. It should of course cost less. If all elderly people taking up beds unnecessarily in hospitals can be cared for better and appropriately in another place, there is a clear benefit.
The governments planned council housing expenditure should, for the most part given our aging population, be spent on providing the housing, convenience, assisted, and full care, for the people who need it. This frees up existing council housing for new families and provides the correct housing for the elderly.
Just seen Mr. Starmer interviewed on BBC, lots of talk how we should make a generous offer to EU citizens living in the UK, NO effort to get the EU to give similar assurances to UK citizens in the EU. Who are they working for?
October 19, 2017
I care not one jot for the NHS or indeed the public sector. It’s unreformed, wasteful, unionised beyond belief and run for according to the needs of the employee. Why should the productive work their guts out to see the unproductive retire at 55 on a fat pension, enjoying security of employment, privileged working practices etc etc?
The NHS and all the other public sector scam employment schemes are now beyond reform. Reforms have been attempted and politicians now simply throw debt financed cash at them to keep the unions quiet.
The main issue is to stop Corbyn and the unions from taking power. If they get back into power the UK will be bankrupt in a decade and its people crushed under an avalanche of socialist legislation across all areas of life
Get us out the EU. Get rid of May and Hammond. Abolish the opt-in system in the public sector to starve the unions, Labour and the left of taxpayer funding. Confront the Marxist menace
Court Labour’s traditional vote using the Leave EU card. Labour want to keep us in. Use that against them
Do the Tories appreciate just how dangerous Labour have become? I watched May at PMQ’s. Oh, my god, what a disaster. We need someone who looks deep inside the soul of Corbyn and exposes him for what he is.
October 19, 2017
Why is it that in my local surgery there are notices up all over the place saying if you go private, then you may be refused any ongoing treatment by the NHS.
I would have thought that if for many reasons a patient wants to go for a private consultation or treatment this would be welcomed by the NHS, on the grounds that it would reduce the waiting time and its workload.
Why the warning, when the NHS Practice Doctor could recommend a private specialist, from an approved list perhaps.
I do not have private medical cover, but would be willing to pay for some treatments if I thought I may get a better result, or wait less time (when in pain) to see a consultant.
October 19, 2017
They’re probably referring to dodgy cosmetic surgery, where the NHS should not, indeed clear up the mess later.
October 20, 2017
SJS
If it were just for this reason then I would agree, but it suggests it covers any visit to a private source for normal problems, including those which have long NHS waiting lists.
October 19, 2017
“… but it would be good if Councils and the NHS can improve their joint working ”
With Local Councils and the NHS, I know from experience their considerations of cost is at a minimum or just plain not there. You might think that laudable. You would if you had not seen them do it when there were costless alternatives or even when they dreamed up the “need” which was a fiction from start to finish. While ever we have politicians who need votes, we will get wholly inefficient and massively over-cost health and social services. There seems no end in sight, no end-game to the monstrosities of inept spending of other people’s money by Local Government and the NHS. We saw this in the Universal Credit debate in Parliament. Endless grandstanding and virtue-signalling with many MPs in competition on tear production and stressed pleas. TV cameras do not always serve the interests of democracy and democratic debate nor the write-ups by local hacks in regional papers as ” MP battles for the poor and needy!” It makes one so sick one may need social care to get over it…
October 19, 2017
The problem with making Social care under the control of Local councils is the post code lottery on what is available and its cost to the recipient.
Whilst there are rules, there are no national rules for treatment or care even within the NHS.
Thus with each individual local Authority and NHS area, the responsibilities are blurred.
Only those with an intimate knowledge of the system in any one region or area, have any clue as to what can be offered or be covered.
Patients are thus totally confused as what is regarded as standard in one area, is not in another.
“Continuing care” is but one excellent example where different regions have differing standards of interpretation for access or approval.
October 19, 2017
I write with the experience of many years spent on local Health boards, and caring directly for seriously sick relatives.
What is needed, vitally, is a local system of ‘halfway houses’ or convalescent homes, as they used to be termed. Modern medicine can be amazingly innovative, but it does NOT take into account the demands of rehabilitation or ‘social’ care that is involved. Acute hospitals are precisely that: acute. Setting aside wards within the acute hospital to provide rehab does not work – the wards are hijacked when the need for beds rises.
I have direct experience of patients who, despite being acutely ill and in some cases unable to move easily, are required to travel backwards and forwards to hospitals several times a week, over the course of months, for treatments and regular follow-up care, with no account taken by staff of the exhaustion and difficulties for both patient and carer. I know of (and have experienced myself) frequent cases where staff laugh at the suggestion that anyone in the hospital might help with transport issues or domestic care (how many councils provide recommended domiciliary physiotherapy? How do you get oxygen supplies for those with fatal lung diseases sent home to die? How do you transport a desperately sick patient to and from the nearest specialist hospital that is 30 miles away?).
Until the great panjandrums at the DoH, the NHS, the Kings’ Fund et al start addressing the CONSEQUENCES of modern medicine both to the individual patient and the budgets available, attempts to bring about partnership between Councils, GP surgeries and hospitals are simply fiddling while Rome burns (please forgive the cliche, I am too angry about the decades of neglect on this subject to finesse my language).
October 19, 2017
A very helpful post. Thank you, sm. The cottage hospitals/nursing homes/convalescent homes that were closed because they were to be replaced by so called “care in the community” should be reinstated within the “care model” forthwith. The absence of them simply means that there will be either people in hospital “bedblocking” who would be much better off in a convalescent home, or worse, that very ill people are sent home with a risible care package which cannot possibly meet their needs as they ought actually to be in a cottage hospital/nursing home/convalescent home.
October 20, 2017
sm
Agree with many of the points you raise, because of personal experience.
Care in the community may work in some case but certainly not all.
Recovery for many would be far faster where residential physio and care is given on a controlled multiple times a day/week basis.
October 19, 2017
There should be a price to pay for say deliberately flitting from a Yorkshire town where facilities are good and buying a dwelling in some barely accessible village in the foothills of the Pennines. If someone wishes to show their suppos-ed middle-class-edness by living in -no-mans-land-no facility parts of the UK then they should not expect the rest of us to pay for their airs and graces by forking out more tax for their social and health support. There should be a “Health-Tax, for certain UK areas” and a Fire-Service Tax” over and above the Council Tax formulations. When emergency and health workers are not only sent wandering over the moors then they are not available obviously elsewhere to look after humble unassuming folk as myself who lives in sight of all facilities I might need as a citizen. Alternatively I should get a Council Tax rebate for being Mr Sensible.
October 19, 2017
1. Require (by law) councilās to have an annually published strategy for adult social care that:
a) provides estimates and projections of the numbers of people needing care and the type of need (including young disabled coming into adult services);
b) gives specific details of the local services I.e. type of service (what type of need they provide for), capacity, CQC ratings;
c) provides specific transparent information about charging structures, what is covered, who is eligible, which funding streams are used etc
d) includes strategic consideration of how people with low prevalence complex disability may be catered for e.g. through consortia of local authorities.
e) reports on complaints and legal challenges over the previous year including the amount spent on dealing with them
2. Police this approach by employing civil service staff who actually bother to look at the returns, understand them and who have powers to impose sanctions on local authorities that default/arenāt adequate
3. Revisit the systems of centrally funded benefit vs local authority funding for packages of care for the severely disabled. This currently provides major incentives for local authorities to stop providing services themselves. They justify this with politically correct hot air about inclusion in the community, taking control of your own life etc but it is all about which pocket the money comes from.
4. Address the weak management and over generous term and conditions for local authority staff. The burden of having staff on long term sick leave and every other type of leave plus pensions has made authorities clamber to close down their own services and commission private providers whose staff have such poor T&C that they can only recruit those with minimal English, no skills etc. A balance has to be struck.
5. Ensure that families who have imported older and disabled relatives from overseas are not allowed to offload their long term care onto the taxpayer. If necessary, this has to involve withdrawing rights of residence.
October 20, 2017
All sounds very sensible.
October 19, 2017
I am not so sure that Councils, Contractors and Service Providers , the current fragmented system is the way to go. It divides responsibilities to the point where each tends to work for itself, rather than the patient. I do not base this on researched evidence, only on the current system which does not work. Separate organisations tend to act in ways that benefit the organisation rather than the most desirable outcome.
I would have more confidence in a seamless organisation, in effect making it part of the NHS. Then there would be a natural patient flow, theatre, ward, recovery care, and possibly long term care. The latter could be in the patients home or in a dedicated facility. The only system I would leave as it is, would be terminal care, which on the evidence I have seen works very well.
The hospital is the only part that knows what it’s requirements are, so I would put it in the direct control of the hospital. Apart from the allocation of money, the military is in control of all aspects of it’s operation. I would put the hospital in the same position of responsibility.
October 19, 2017
Does not seem out of phase with what others have suggested, why the delay. Saw your performance on the Daily Politics today. Apart from the periodic stream of over talking by the host, you made your points quite well She is a dead give away when she gives the remainers a free ride. I found it ironic to hear her ranting about RT’s political bias. Have the BBC no shame.
October 19, 2017
Not only are the UK Government starving English councils of cash, they have also passed the book when it comes to NHS England. The answer is NOT May’s proposal which is to strip every old person in England of their assets should they require care with the hated dementia tax or to continue imposing austerity measures on English councils whilst showing no bounds to their generosity when it comes to the rest of the UK with the skewed Barnett Formula or the rest of the world with their exorbitant and ridiculous foreign aid budget.
This is why England needs it’s own parliament so England at last would have someone standing up for it, unlike now, and demand equal funding with the rest of the UK. This Tory Government can find an extra billion for NI to keep them in power when NI was already receiving much more of English taxes per head than the English. It refuses to scrap the skewed Barnett Formula which sees Scotland and Wales receive so much more of our money per head than the English also. In other words, as long as the English continue to be subject to direct rule, UK Governments of all colours will continue to treat England’s young, sick and elderly with the contempt they do now and see England as nothing more than a milch cow where they put the needs of the rest of the UK first and England last every time.
October 19, 2017
If you need full time care in a care home they you are responsible for paying the cost of care until your assets go below approx Ā£23.5K. The situation is already that for some , their assets are used to pay for their care. My parents are in that situation so I speak from experience. The”dementia tax” exists already.
Thank you for asking this question John. The main issue we found was that the quality of different suppliers of social care varies quite widely. Depending on your needs you may not always have much choice. Good care companies are like gold dust. Even (as was the case for my parents) where it is the patient that is paying for the social care in the home, it is a sellers market. Discharge from hospital was often delayed because there were not the carers available to provide the care package. And costs aren’t cheap. Once you are into the realms of multiple visits per day for medication and help with meals, monthly costs can ramp up (unsurprising as the people doing the care deserve a living wage). Anyway, one way to improve this would be to find a way to increase the number of good quality suppliers of care, and also how to increase the supply of good carers. What are the blockers for this ? Remove them and you will lower NHS costs. It’s not for a lack of a market opportunity. I don’t have any answers here just observations!
Long term , this situation is only going to get worse. Modern medicine is very good at keeping people alive even if the the quality of that life is less than fantastic. If more money is needed for care, that has to come from somewhere. There may be some answers that come from technology – e.g. robotics for providing assistance with moving round the home , bathing and so on.
So if you want to do something this is one of those situations where politicians of all sides are going to have to come to a consensus. If nothing else no one party will get the blame even if no one party gets the credit.
Or maybe this is something where the long term solution may lie in a Manhattan project on dementia and the effects of stroke.
October 19, 2017
“The border disputes between the NHS and social care go back a long way and have happened under a variety of governments.”
This is so true, so I wonder how Vote Leave managed to miss this when they were writing their slogans on the side if their bus. š
Pouring extra money into the NHS, which the slogans did not (explicitly) state is not value for money, yet the MSM still push this line: it might highlight a lack of joined up thinking early on, before ministerial involvement, but it continues to be a dead end point of view and manages to ‘get it wrong’ in at least two departments!
The leadership of the Conservative Party have an excellent opportunity to act in a conservative manner but, after the cap on energy prices and the continuation of the Green Agenda, in spite of the difficulties being reported in Germany and Australia, I don’t hold out much hope!
October 19, 2017
Sorry to mention Brexit again, but I am delighted with the joint letter that has been published urging the prime minister to insist on discussions about trade or else Britain will move to WTO terms.
It does offer certainty and the possibility of a return to the negotiating table afterwards if the EU are more flexible.
Well done the Leave Means Leave group.
October 19, 2017
Well you obviously have to make the money follow the patient, so that organisations actually want to care for them rather than to push them from pillar to post as now.
Indeed the best way, in general, is to start to charge the patient. Just as we do for nearly everything else. But the free at the point of rationing, incompetence, delays and non treatment the NHS is apparently “the envy of the world”. Well it is according to “BBC think” types anyway. This despite the appalling outcome statistics they have for almost all areas of activity (cancer in particular) and the huge delays for operations that prevent so many from getting back to work.
We have you taxes already mate so you are a liability go away and pester some other government department please! The NHS can never work efficiently as currently structured, yet no one dares to touch it. Other than the size of chocolate bars in the vending machines and asking everyone about they sexual preferences of course.
October 19, 2017
Why is care the responsibility of local councils? What expertise do they have in this area? They can’t even collect the bins on a regular basis reliably or mend the potholes in roads. They have virtually no direct labour force any more and are simply buyers of services.
Care should be the responsibility of the NHS and they should have the budget for it, properly funded from central taxation, ring fenced so that it is not paid out to managers and executives. We could then have lower Council Taxes which are ridiculous at the moment. Why should we pay Ā£50 per week just to get the bins emptied, which is just about the only service I get. We have no street lights, no-one ever sweeps the streets, police a rarer than hens teeth and will not come out for much less than murder.
Sending care assistants and nurses round to people’s homes if not needed long term is madness and costly. Doctors will not come out nowadays so is it sensible to do this? The old fashioned idea of convalescent homes worked as a halfway house between hospital and home is surely the best solution, updated for the 21st century to free beds in hospitals.
October 19, 2017
The govt have increasingly tried to take over the role of the family and is now struggling to pay for its new role. In the past women would get married and raise a family in partnership with a husband and grandparents would usually chip in to help, and when the grandparents could no longer manage their children would step in and care for them.
Now girls are encouraged to become single mums to qualify for scarce social housing and a life on benefits, thereby severing the dependency link with family. After being conditioned as part of the welfare dependent community they’re barely capable of caring for themselves let alone elderly parents.
As Lifelogic often points out, the government needs to do less and tax less.
October 19, 2017
John, why should health care and social care have separate service providers? They are intertwined aspects of one thing – care for the person.
In my experience it is the boundary between two systems that usually creates the most difficulties and it’s clear from your account that’s what’s happening here.
Would making the NHS responsible for social care help? With the appropriate resources, of course.
October 19, 2017
Nigel, the NHS always needs more cash and does not seem to use their resources efficiently and this would probably make the situation worse.
It was reported that Hillary Clinton used the NHS on her visit here and hopefully the NHS will send her an appropriate bill and that she will pay accordingly, unless of course it has already been settled.
October 20, 2017
I take your point but note I said ‘appropriate resources’ not more. I would hope that combining the two organisations would offer efficiency savings.
(Well, I can hope …!)
I also (in reply to comments below) have reservations about making the NHS bigger.
October 19, 2017
Making the NHS remit larger can never be the answer to any question
October 19, 2017
Make the NHS responsible for more? They mess up what they are already responsible for . Stop trying to reinvent the wheel and copy from countries that do health and social care a whole lot better, such as Belgium, New Zealand and so on…
October 19, 2017
The point made in your third paragraph illustrates that in these litigation-based times care staff have to over-react to every little “incident” otherwise they face accusations of negligence. My experience is that care management’s priorities are 1) to spend as little money as possible, and 2) to ensure their backs are covered if any complaints are made. It’s a sad state of affairs.
October 19, 2017
The point made in your third paragraph illustrates that in these litigation-based times care staff have to over-react to every little “incident” otherwise they face accusations of negligence. My experience is that care management’s priorities are 1) to spend as little money as possible, and 2) to ensure their backs are covered if any complaints are made. It’s a sad state of affairs, particularly for the vulnerable and their carers.
October 19, 2017
There is a lack of family support.
Parents often retire far away from families, which is great at first but becomes extremely problematic at the onset of old age which comes on quicker than everyone thinks.
I’ve spent the past two years traipsing up and down the country to assist with ailing parents, one recently deceased but still no end in sight.
They refused to move.
Please consider this when looking for that Dunroamin’ bungalow on-sea.
October 19, 2017
And it is still likely that care costs will be incured.
“Houses should not be something to hand down to children” a recent Tory.
Let’s drop the punishment element of this argument.
The carehome bit often comes after years of looking after parents, when they need professional help – because people are living a lot older and with far more complex conditions than they used to.
Medicine is a two edged sword and the NHS is a victim of its own success.
October 19, 2017
I know of a couple who sold up their Berkshire home to be near their daughter, son-in-law and and new-born grandchild who lived in the far north of Scotland. Unfortunately, soon after, son-in-law’s job moved to another country so leaving the grandparents increasingly infirm and so alone in the Highlands. Think ahead, folks!
October 19, 2017
David L – There are plenty of places called ‘God’s Waiting Room’ in remote resorts which draw retirees to their purpose built estates of bungalows designed with level living in mind.
I think the scenario you describe is less likely than mine.
October 19, 2017
Even in places where large numbers of people choose to go to retire, Bexhill springs to mind, the social care is setup badly. The roads are full of old drivers who have lost their ability to drive for one reason or another. And generally this country does a remarkably poor job of helping this population.
October 19, 2017
My elderly neighbour is getting very frail. She recently had a fall resulting in a chest infection and had to go in to hospital for 10 days. She was successfully treated and discharged to her home, once social services had organised a personal care package with a private care provider including “meals on wheels”. This was funded by social services for a 6 week period, after which she had to pay for it herself. She is not well off and is in receipt of pension credit and housing benefit and could not fund this, as a result she is getting into debt for apparently the first time in her life.
Social services liased well with the hospital and did attempt to comply with my neighbour’s wish that she did not want to be “put into a home”, but without providing additional financial support this is probably what will happen.
Which costs the council more, funding an adequate personal care plan enabling someone to live in their home or providing a place in residential care? We have a responsibility to our senior citizens to find a solution to this issue.
October 19, 2017
A Heath is exactly right today in the Telegraph – let us hope Hammond can finally get real. That or he should go as soon as possible.
http://www.telegraph.co.uk/news/2017/10/18/need-totally-new-tax-system-not-pointless-crumbs-young/
October 19, 2017
nice to see the rock stars agree with brexit
October 19, 2017
“Social care nurses” er there arnt any, in any part of the country I have lived?
There are health care assistants and nurses who work for GP’s
There are health care assistants and nurses who work for the NHS
Social services are normally staffed by less qualified home helps supported by social workers, with not a single nurse or health care assistant on the council payroll
October 20, 2017
Nurses havn’t ever worked for any other than the patient. We are an autonomous profession with our own professional body’ The Nursing and Midwifery Council. Dr’s do not take any responsibility for any of our intervention in patient care. It is the Nurse who is answerable to the public. Our Insurance is high . We have been demoralised by Drs from other countries who think we do as they say and band together when they realise we know far more in certain aspects than themselves and they prefer yes girls who are not qualified and cheaper. We will remain the patients advocate NOT the doctors advocate.
October 19, 2017
One of the problems with bed-blocking is that the old-fashioned convalescence home doesn’t seem to exist within the NHS.
An elderly single lady that I know had to have a heart operation, which went well, but she knew that she would not be able to look after herself for a few weeks. She made private arrangements to stay in a convalescence home for a month and was then fit enough to look after herself with a little help from neighbours.
But what would have happened if she hadn’t been able to afford the convalescence home? She would have had to remain in hospital “bed-blocking” until her local council got around to making arrangements for some home care, which would probably have taken longer than the month’s care that she arranged privately.
The NHS needs to have convalescence arrangements for those, like my friend, who don’t need further treatment. but are not yet fit enough to look after themselves
October 19, 2017
by the way if the chancellor goes ahead with his plan to rob from the old to subsidise the young you are going to fail at the next election big time
just because you are old does not mean you do not have young children or elderly relatives to support
the whole approach is nonsense
more misguided attempts at wealth redistribution away from those that earnt it
and not helping those in most genuine need, for example those who started a family but then have their earning power destroyed by death in the family or illness
still supporting massive public housing estates beyond commutable distance of any realistic jobs marker while at the same time flooding the country with immigrants
the Conservative party has completely lost the plot
and still not common sense on paying for old age care which lost you the last election, the status quo is not a solution
October 19, 2017
Care is a difficult area. Its ok for councils to scream they need more resources, but it would be a good idea if they properly managed the resources they already have. A elderly neighbour has carers coming in engaged by the Council. They are supposed to be there 2 1/2 hours a day made up of one 1 hour visit and 3 half hour visits. Being very generous an analysis of the care diary showed they actually worked 54% of those hours and a better kept diary by we neighbours showed it was less than 50%. But the Council have no control of what is or isn’t done and need to up their game. They could start by insisting there is a ‘clocking in and out’ system so there can be proper control and contractors are paid for what they actually do.
October 19, 2017
The new prime minister, Clement Attlee, announced he would introduce the welfare state outlined in the 1942 Beveridge Report. This included the establishment of a National Health Service in 1948 with free medical treatment for all. A national system of benefits was also introduced to provide ‘social security’ so that the population would be protected from the ‘cradle to the grave’. The new system was partly built on the national insurance scheme set up by Lloyd George in 1911. People in work still had to make contributions each week, as did employers, but the benefits provided were now much greater.
This took the family out of care and put the State in charge.
October 19, 2017
“This took the family out of care and put the State in charge”
One of the first steps (of many) made in re-creating the Soviet Union in this land-an ongoing process which didn’t need any help from the EU-and will have to be tackled when/if we do leave.
October 19, 2017
Chris Graying Transport Secretary BBC Parliament today is taking questions. It would be better if there were no Yorkshire MPs whatsoever. Why? Each of them is standing up, making a quick touristy comment on how terribly beautiful it is..an example of rare truth-telling by MPs but then they complain of the “antiquated road system” and how Westminster has neglected Yorkshire road development. Yorkshire is beautiful because of Westminster road development “neglect”. All the improvements made for the past half century in roads has only served to make Yorkshire uglier.
In point of fact few people can sense beauty and it is beyond argument of all Rational that Yorkshire MPs are a virtual blot on our landscape.Manhole covers atop the Mona Lisa.
October 19, 2017
I believe that social care can do more harm than good as it reduces the responsibility of relatives and close friends who are the more traditional carers.
IMHO social care should be restricted to the destitute and severely disabled.
The more the state does, the less we do for ourselves and each other and the result is a selfish and less happy society.
Whenever I see a news story about bed-blocked elderly I ask āwhere are the children?ā
October 19, 2017
I worked and lived 70 miles away and my sister 150 and none of us wealthy and in jobs that could not be replicated locally let alone schools and house moves similar to a friend of mine who lives on the Sussex coast, works in London andcwhose parents are in the West Country.
No doubt Mr Knee jerk. You have a flippant solution for this as well.
October 19, 2017
thanks Nig l, I had a slightly less polite reply for Kenneth but I think you said it better.
October 19, 2017
Yes, another problem with allowing the state to take over our personal responsibilities is we end up with atomised families. Also bad for society
October 19, 2017
There’s a saying, no one wants you when you’re old unless you’ve got money to leave them! There are families that of course rally around and give the care packages themselves to their elderly parents, aunts and uncles but there are a lot of elderly people who don’t have this support network. Plus of course ‘the children’ are working later and later in life, not retiring until 67 instead of 60, my mother has only just entered retirement at the age of 70.
Protected from Cradle to GRAVE. This is what this generation of elderly was told, over and over. I heard this week that an elderly lady at the age of 90 broke her back three months ago in a fall, she was still independently living in her owned home that needs major renovation, she spent 3 months in a care facility I’m not sure if she has the cost of that lodged against her house sale value? Up to this major accident she has been little drain on the NHS and has been a very healthy lady, she survived her husband and only son all her siblings and has only one living relative who doesn’t live close. The house has a coke fire that gives her hot water and heats the whole house, there is no downstairs toilet. She has just been sent home to look after herself, she can’t get upstairs she’s been told she will have to buy her own stairlift, she has purchased an oil radiator because she can’t do the fire. The care package is reducing, she was supposed to get 4 visits per day for 6 weeks, the night time visit has been called off even though it is needed after 2 weeks, she also has to pay someone to clean and buy her food, an uncomfortable z bed and commode have been left in her living room. She has had to buy a microwave she doesn’t know how to use to reheat the meals she’s been told to buy. For the first time in my life, I’m truly afraid of getting old and ill.
I will go to visit this weekend and I’d really like her to sell up and move into Sheltered accommodation but I’m not family and I’m not sure if such an option is open to her or who would help her to do this.
October 19, 2017
What about the people who are childless?
What about the UK patient whose only living relative works and brings up his family in Australia?
What about the very elderly whose children are already OAPs and suffering ill-health themselves?
October 19, 2017
“Where are the children?” What about at work helping to make the country richer, even possibly roaming the world to improve the UK’s exports prospects?
October 19, 2017
In the case of a number of my friends they have emigrated to Australia or USA. I’m the only one in my circle who has their children living within 30 miles of them. Even so, it’s over a hour’s drive and they can’t fit in a visit every day.
October 19, 2017
Mine moved 5 hours from me via the most dangerous and inaccessible roads in the country.
I think they were trying to tell me something.
They did so in their mid 50s but the years roll on by.
October 19, 2017
My parents that is.
October 20, 2017
The children “got on their bike” as told to do by Conservative governments.
We do not live in a society where it is possible for most people to live in the same town their entire life, except those on benefits or very rich, everyone else has to go where the jobs are.
October 19, 2017
It is difficult enough to make two sections with different responsibilities to work together in a private business. How difficult depends on size and quality of management. Generally it is made to work because to fail will see then end of the business. Government and the public sector is different as failure rarely brings the appropriate punishment and the mindset of employers and employees is different as well as customer satisfaction by catering for their needs is not a high priority.
So the problem of social care and the NHS not working in each others interests is not intractable but made doubly difficult whilst funding and provision is completely in the hands of the state. As few see the advantage of reversing that situation then the only feasible solution is to bring both social services and healthcare under one body. Either all done by local councils or by national government. I suggest the former which I believe is the current thinking of most rational MPs not on the political left of course as they do not have rational thoughts.
October 19, 2017
Agree entirely with your view here. My mother lived in her own home, as she wished to do, until 95 years. We needed to pay for a carer to visit 3 times a day to oversee meals and medication taken. Many health professionals wanted her to be somewhere ‘safer’, but thankfully her wishes prevailed with help from a good GP. Hospital inpatient visits were a nightmare for various reasons – discharge held up because we were unable to collect her (being 90 miles away and at work), surely hospital transport cheaper for 20 miles to her home than more overnights in hospital?
October 19, 2017
Personally, I think the ‘health professionals’ sometimes cause more distress because of our total blame culture and total demand for anti-risk care once you go into care. My Great Grandma’s care home rules were really intolerable to her because her food and drinks were always totally cold or barely warm, she wasn’t allowed her own kettle, after looking after herself until she was 94, she also never got her correct clothes back from the washing. We took her out regularly for a meal until she became bed-bound just so she could eat something hot and get a decent cup of tea. Just because you get old and need some daily help and checking up on doesn’t mean you should be treated worse than a prisoner or totally have all of your freedoms stripped away so you eventually become like a small infant, this is why some people stay in their own homes for longer than they really should.
October 19, 2017
The increase in population and the evidence that longevity is an indisputable factor means there has to be a different allocation from our tax system . Obviously taking care of the elderly is costing more to central and local authorities ; this is at a level beyond the increase of our revenue . Of course there should be some breath of fresh air when we no longer send huge sums to the EU – however , this looks to be more of a drawn out affair than it should be . Meanwhile there is our spend in Foreign Aid that could – and should be re-allocated for the care of the old .
There should not be a dividing line between how elderly care is managed ; Local Authorities do not have a good record in efficiency and cost control , neither does Central Government offices . A new system should be created that is regionally administered to allocate resources and to supervise detail ; its funding should come from the 2 sources I have indicated above . I would place this approach as a priority in the Governments plans ahead of any attempt to placate with the young ( no pun intended ).
October 19, 2017
Not entirely off-topic, because care homes are particularly dependent on immigrant labour including citizens of other EU countries, it would have been much better if Theresa May had followed the leaders of the various Leave campaigns back in July 2016 and rejected outright the vile advice which was given by the UK’s top representative to the EU, Sir Ivan Rogers, that blameless EU citizens already settled in this country should be treated as “bargaining chips” in negotiations with the EU. It has been hugely damaging that she agreed to the idea that our future treatment of these people should depend upon the conduct of politicians in their countries of origin rather than on their own personal conduct. Now she has done what she should have done straight away fifteen months ago, without hesitation, but even now with unjust reservations. This has not been an episode which should inspire British people with pride at the decency of their country and its government, plus it has given the EU another excuse for unnecessarily delaying talks on important matters such as trade, and even security, while blackening our name around the world, as well as causing needless and unjustifiable worry to innocent people.
October 19, 2017
Unusual for your post to be slightly eccentric.
I think they should need to apply for work permits/self-support permits and eventually take a citizenship test and become citizens here. No citizens-of-nowhere please. Likewise our citizens in the EU. We’ll be a third country remember.
October 20, 2017
Why do you think it’s eccentric?
Our Parliament passed Acts so that (with very few exceptions) every citizen of those other countries would have the automatic right to come and work and live in our country for as long as they liked, and start families here, and send their children to school here, the lot.
At the moment about 3 million such people are living here having taken up what was in effect an open invitation extended by our politicians. They have in general done nothing wrong; I wouldn’t go along with Theresa May’s glowing commendations of them as exceptionally valuable people, but the basic fact is that they have done nothing wrong and are ordinary blameless people who should be treated decently and not unjustly punished for the sins of politicians, neither ours nor those in their countries of origin.
October 20, 2017
We shall never know whether the EU would have imposed its impossible conditions – oversight of ECJ, extra rights for EU citizens over British subjects, etc. – if Mrs May had done what Nigel Farage and the others wanted to do. We may never know either what Ivan Rogers’s real motives were. Was it because he knew what they were like and feared for the welfare of the British hostages on the Continent? Or did he have some other strategic reason?
October 21, 2017
Basically Theresa May unnecessarily handed the EU and its unpatriotic supporters in this country a stick with which to beat the government. I say it was unnecessary because it was never a realistic option that having previously invited these people to settle here the government would then turn round and embark on mass deportations, or even start passing laws to unfairly disadvantage them. She could have seized the moral high ground, but instead she has allowed our name to blackened around the world and so of course there will be questions about whether UK courts will be allowed to protect these blameless individuals.
October 19, 2017
“…. because care homes are particularly dependent on immigrant labour…”
They shouldn’t be.
Care home work requires a small core of senior qualified personnel, together with a large contingent of physically fit but minimally qualified staff. In bygone days, there were many unskilled jobs in factories, mills, coalmines, etc for the unskilled, and nowadays the lament of the workless is the loss of those industries “and that’s why I can’t get a sniff of a job”. Well now we have a burgeoning care sector that is labour intensive. Our own young people should be doing those jobs, but they aren’t, are they? Why would they when they can draw benefits and live off the taxpayer? And what about the good ones who sincerely want a job and would work in this sector? Well the minimum wage works against them.
We could try a few innovations, and see what happens. For example, allow care establishments to offer sub-minimum wage jobs providing they provide on-site single-person accommodation, meals, other benefits in kind (especially training courses). And you might have to rein in the Treasury. You might get purpose built care communities housing the frail patients in ground floor apartments, and staff in upstairs apartments. All under the control of a warden/ matron/ patron.
October 21, 2017
I know they shouldn’t be and it was not always the case that they were and they do not need to be in the future. But the current position is that if all the EU citizens suddenly went home they would be one of the sectors which faced acute short term labour shortages impacting on the residents. No doubt some of them will leave anyway because they never intended to stay forever.
October 19, 2017
We seem to be shutting cottage hospitals and older smaller hospitals used for convalescence etc. The nice old buildings are being turned into luxury flats, and are often in the most convenient positions for such a hospital to be. Was this wise? The NHS has now put the burden for this sort of care on to councils who never shouldered it before. No wonder we are losing our libraries and the care of our parks.
October 19, 2017
From 2003:
http://webarchive.nationalarchives.gov.uk/20120214222221/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4085947.pdf
“Keeping the NHS Local ā A New Direction of Travel”
With one section headed:
“Why services may need to change ā European Working Time Directive”
“The requirements of the EWTD for continuous rest periods, and the ruling of the European Court of Justice that time spent resident on call counts as working time, (the SiMAP judgement), mean that it will impact most strongly on services which require 24 hour cover. Currently much of this cover is provided by doctors in training. If working patterns stay the same, compliance with EWTD would imply a sharp rise in the number of doctors needed to run a 24 hour service. This would present real problems for many smaller hospitals with limited staff in individual specialties … This makes the EWTD a powerful force driving the NHS to look at how services are provided.”
Yet there are still those defenders of the EU who persist in claiming “these problems with our NHS hospitals are nothing whatsoever to do with the EU” even when by the government’s own published documentation they self-evidently are.
October 19, 2017
Main talking point of the day…brexit talks in brussels
Mrs may and the hard line tory right are still playing sill games.. the EU will see right through… So whats going to happen if there is no agreement for a future deal..presumably tben the 3 million eu foreigners won’t be so welcome..absolute nonsense we have to listen to…playing hard to get like children…then we have the option of walking away..walking away to where?
October 19, 2017
You should have said “My friends in the EU will see right through …”
October 19, 2017
You know what Jack, we’re getting tired of all the negative press. If they won’t ‘negotiate’ there is nothing to report, being told pay up or else isn’t a negotiation. All this relentless negative new stories and the BBC going into meltdown is obviously affecting people already upset that the vote didn’t go the way they wanted. The job of this government is to concentrate on the UK, spending our money wisely, getting some of the MPs to tell us of good work they are doing and things they are achieving in their jobs would be a start.
October 19, 2017
“presumably tben the 3 million eu foreigners wonāt be so welcome”
This attitude is quite the nastiest bit of Project Fear. Last year Mrs May went all round the 27 to get agreement on reciprocal rights. If there had been no British hostages in the EU this would not have been necessary, because the law abiding continentals already here were welcome to stay and everyone here agreed on that.
She got agreement for reciprocal rights from over twenty of the nation states. This was her very first proirity as PM. Who torpedoed that agreement? Who then added impossible conditions when they finally allowed it to be discussed this year? Who doesn’t want a sensible grown up agreement?
October 19, 2017
Rose- Mrs May is using the 3 million EU migrants as a bargaining chip that is why she made this statement early today and that is what it will be seen to be by people and political leaders throughout the world- a big mistake!
Right now the lies we were told by IDS and Gove etc are starting to show. The bavarian car workers are not falling over themselves to put pressure on the german government neither is the french wine industry and french farmers out there blocking the streets with their tractors in support of a EU UK deal.
At this stage we need some explanation and clarity from our political leaders on where we’re at and and where we’re going? If Liam Fox would only come out and give us some idea about the future trade deals he has lined up it would be a start.
October 19, 2017
The reason continental tradesmen are quiet is that we haven’t been allowed to discuss trade yet. So they have nothing to protest about yet.
The EU has concocted three conditions which have to be complied with before trade etc can be discussed.
The money has been dealt with by experts and lawyers on both sides: there is nothing to pay.
The Northern Irish border cannot be discussed until the trade is settled, so that is a deliberate obstacle to talks about trade. Anyway, if they were grown up about it and agreed to free trade, there needn’t be any change to the border.
The reciprocal rights for EU citizens here and British subjects there could have been settled last year when Mrs May first became PM. Nearly all the countries in the EU wanted to come to an agreement with her – except France, Germany, and the Commission. So who is making them into bargaining chips?
October 19, 2017
PS Liam Fox, as I am sure you know, is not allowed by the EU to make any trade deals. If they are not made, they are not going to be bandied about, are they?
October 19, 2017
Why don’t you ask him?
https://www.gov.uk/government/organisations/department-for-international-trade
October 19, 2017
Have these 3 million EU foreigners been abandoned by their governments? Are they a new form of refugee? They should still be able to vote in their own elections, and be represented by them.
They could even influence their governments’ behaviour and decisions, and for the better, for all concerned! š
October 20, 2017
Jason
Afraid the EU is using them as a bargaining chip wanting them to have ECJ rights over and above that of British Citizens.
Do you think it fair that an Immigrant should have additional rights over and above the rule of law in the Country they have moved to. ?
October 21, 2017
Ask Jeremy Corbyn whether Americans living in the UK should be able to appeal to the US Supreme Court over the heads of the UK courts …
October 19, 2017
Here’s a brilliant analysis by David Laws, Consultant Anaesthetist, City Hospitals Sunderland NHS Foundation Trust. Professor Charles S. Adams from Durham University.
http://www.progressivepulse.org/economics/is-world-leading-nhs-healthcare-an-affordable-proposition/
Says it all really and I’m so glad that many people in the NHS are waking up to the reality of the situation.
October 19, 2017
It seems to me the incentives are wrong in the system.
If the Council had to pay the relevant NHS trust for the “hotel” and social care costs of the hospital stay after the patient was deemed to be fir for discharge, then they would re-organize their services to reduce the use of Hospitals for social care.
Obviously an interim process might be needed, reducing the time period where the NHS would pick up these costs, for XX days, with that reducing over time. A close eye would have to be kept on any perverse incentives that were introduced with this system (such as many people being discharged on a Friday afternoon, so the hospital isn’t responsible for the weekend costs)
It could lead to better joined up care, such as councils working with large hospitals to establish a “care wing” or short-term council ran care home next to the hospital to take over the social care short term, while putting a long term care package in place. Freeing up expensive hospital beds etc.
October 20, 2017
Good point!
October 19, 2017
Today,Ben Bradshaw still an MP for Labour, raised a question to the Leader of the House Andrea Leadsom. I do wish she were PM. He raised questions to the funding to a political party and an individual. He mentioned alleged Russian interference in western democracies. Of course he believes they were involved in the Brexit vote. Naturally it is in the interests of Russia that the UK remain in the EU and help for a rift between EU military/political/economic policy with Russian’s main enemy the USA. However despite Labour’s Marxist profile I think it unlikely that Labour Remainers are in the direct pay of Moscow. They are simply inexplicably misguided given their overt intelligence conveniently to the disadvantage of our glorious United Kingdom and the prosperity of the Russian regime.
October 19, 2017
āThe Secretary of State has refused any government funds for essential fire safety workā¦ can he confirmā¦ there will be no government funding for councils or housing associations for essential retrofit fire safety work?ā
Can I just ask a question about this fire safety work please?
These blocks are rented out by the Councils aren’t they?
How much do they charge per tenant? or How much does the Council make each year from the letting of these flats per block?
Are the flats fully owned by the Councils or are they mortgaged or PFI’d does the rental cover maintenance and renewal figures on top of the loan repayment or not?
How many are the flats in the block paid by Housing benefit (is this a central government cost)?
SO, if the Council is receiving money to own and run these blocks why haven’t they got a provision to ensure they are kept safe and within regulations from the money they charge out for the accommodation? If this was a privately owned block of flats would we expect the taxpayer to provide the sprinkler systems required?
October 19, 2017
Off topic, may I say how badly treated you were by Jo Coburn on the Daily Politics, three times she allowed Jenny Chapman , the Labour Brexit spokeswoman , an uninterrupted chance to say her thing. You on the other hand were treated to aggressive interruptions every time you tried to make any argument. The media are hardly bothering to hide their support for the EU, for this bias is common across all media channels.
October 19, 2017
But Jenny Chapman’s thing did not extend to saying how much Labour would be prepared to pay the EU. The direct question was asked, but as always with Labour MPs she deliberately avoided giving any answer. She claimed that Labour would be much better at the negotiations, and I expect that they would get on much better simply by giving the EU everything it wanted and offering more on top.
October 19, 2017
Agree with many of the points above, including cottage hospitals. They are a bridge between two types of care, they are local, responsible and accountable through their local presence.
My point: Individuals and families MUST take responsibility for their own health, physical and intellectual. Too many people are too sedentary and lazy and eat the wrong sort of foods in too large quantities and do far too little exercise. Supermarkets and makers of processed foods and prepared meals are rubbing their hands on the way to the bank. You and readers were probably too busy to see the BBC’s programme revealing the massive gap between birth age and body age in many – of those shown, body age at least 50% greater than birth age, with accompanying severe health problems – knee replacements much earlier in life, type-2 diabetes, heart attacks, strokes, earlier onset of dementia etc. If you have just 2.5 minutes, watch this clip: http://www.bbc.co.uk/programmes/p05hchl9. Tina then took the 12-week course of action – major change in diet, much more moderate exercise, and within 12 weeks her body age was much closer to birth age AND her type-2 diabetes had gone. The NHS in particular is having to carry the vast, vast burden of our life style. One participant had a birth age of c47 and a body age of 92.
SO: Tax sugar. Tax processed foods (perhaps by taxing the plastic containers .. and thereby also help reduce the catastrophic problem of plastic entering the ecosystem and food system) Tax big. The percentage of obese in our population is too high not to do something like this.
Perhaps introduce a reduction in council tax for all those families who weekly attend a local minimum 60-minute walk involving moderate, not excessive exertion (tokens required to demonstrate attendance). Or equivalent activity – eg help maintaining community gardens.
I fear I am serious. Marks & Spencer et al won’t like it, but our British farmers and fruit growers will, apple growers in particular. Less road pollution and wear and tear from the freight. Get veg growing back to the UK, we need our food security.
Also increase the messages to the population about the importance, and pleasure, of staying fitter longer. Dr Van Tulleken’s and Angela Rippon’s programmes were sobering – the last one is still available. http://www.bbc.co.uk/programmes/b095gd8f
PS Please, we must NOT give in to the EU’s wiles, nor the Remainers’ devious behind-the-scenes machinations. No deal is the way to go.
October 19, 2017
MP after MP like peas popping the pod come down to ” Deprived people in deprived areas turn much more to smoking than anyone else and have increased propensity to cancer and a whole host of other ailments.” A Zen Buddhist teacher might say these Peas are on the first step to Enlightenment. But they should take a Great Leap over the second step and land on the third step which, coincidentally, is the final step to Enlightenment and chant several times so it sinks in “Deprived people in deprived areas get sick quicker and easier than anyone else.” Now try clapping with one hand!
October 19, 2017
What are the facts, statistics about bed blocking ? One hears of just such cases but not how they were resolved. Some hospitals manage this well but others do not. Does anyone collate this information so that a procedure could be set up everywhere.
October 19, 2017
Last year I had two complete knee replacements at the Royal Surrey County Hospital. On both occasions, and since I live alone, I was assessed and provided with a ‘Care Plan’ to ensure a successful rehabilitation at my home on discharge. Transport was provided and the very next morning a Carer arrived to prepare my breakfast and to ensure I was set-up for the day. This continued for three weeks at the end of which I was able to discharge myself from these services and get on with my life. The whole process ‘ran on rails’ from start to finish.
October 19, 2017
Well done on the Daily Politics, JR, but isn’t it about time that the public was made to understand just how little we have gained from the EU Single Market?
From the table on the front page of this report:
https://www.bertelsmann-stiftung.de/fileadmin/files/BSt/Publikationen/GrauePublikationen/Policy-Brief-Binnenmarkt-en_NW_02_2014.pdf
the per capita GDP gains of some countries like Germany have been around or above the estimated EU average of just over 2%, but for the UK the gain is given as 1.0%.
As repeatedly pointed out over the years this is a pathetic mess of pottage, and yet our europhile politicians keep claiming that the economic benefits have been huge.
October 19, 2017
Off-topic, it seems that including the government leaflet the Remain campaigns spent more than twice as much as the Leave campaigns:
https://twitter.com/JackBMontgomery/status/919967355660271623/photo/1
Ā£28.3 million v Ā£13.4 million.
And they also told many more lies, but they still lost …
October 19, 2017
NEW POLITICAL DOCTRINE
At its 19th National Congress, diligently reported by the BBC as if it were a cross between a Papal Conclave and a meeting to determine the new Global Order, Chinese ‘Communism’ has announced that it now has a new political theory.
It’s known as ‘Xi Jinping Thought’. It has 14 principles (as yet unstated), and is summarised as:-
‘Xi Jinping Thought on Socialism with Chinese Characteristics for a new Era’.
The doctrine replaces the two previous ones, which were, ‘Scientific Outlook on Development’, and the ‘Theory of Three Represents’, (??).
And who said Socialism was a load of pretentious, sociological, self indulgent, crap?
But until I can buy a small book describing ‘Mrs May Thought’, I’ll stick with ‘Thatcherism’. At least I can understand what it means.
October 19, 2017
https://euobserver.com/tickers/139546
“Irish prime minister Leo Varadkar said Thursday “further concessions” from the UK are needed to achieve sufficient progress for Brexit talks to move into future and trade discussions in December.”
Clearly unconcerned that it will be impossible to sort out arrangements for his border with the North until those other discussions have made “sufficient progress”.
This is what the EU does, it softens brains.
October 19, 2017
For commenters on this site who have yet to wake-up to the fact that the “hard” Brexiteer caucus, are going for the Singapore option – and always have been btw – the Singapore healthcare model has to be considered for the post Brexit agenda.
Singapore basically has a healthcare system where users pay for their own healthcare with Medical Savings Accounts, usually mandatory, individuals (and in some cases, their employers) make regular savings into funds which they then use to pay for care when they or their family members need it. Very similar to the mandatory workplace pension scheme in the UK. Which, btw, will be the operating model for the introduction of the UK’s, Singapore style, health system.
Singapore, has a number of parallel payment systems to cover the anomalies that inevitably occur. These include direct subsidies to hospitals, voluntary back-up insurance to cover high health care costs, and a government funded safety net for low-income people.
Health and social care, particularly in old age, are mainly financed by individual out-of-pocket spending which includes support from adult children. Singapore does not have a social welfare system that gets anywhere near EU standards. Sounds like a perfect Neo-liberal Conservative Party policy to me.
BTW. UK government currently spends circa Ā£2,200 per person on the health of its citizens (COFOG 07 definition of health spending that is).
Reply Nonsense
October 19, 2017
Nonsense you say JR. For people like you and me, and the rest of us in the top 5% of UK income distribution, Brexit will not be a problem; we all have made the necessary financial arrangements to counteract Brexit. My fear is that the little people, in millions, will be looking to hold the “metropolitan elite” to account when they find out that Brexit screwed them every which way.
October 19, 2017
I am used to your short replies, but this “nonsense” is nonsensical.
October 20, 2017
I’ve suffered the same thing when talking about the NHS – he does not debate or offer reasoned refutation because basically, either he genuinely does not have a clue or he is hiding his governments real intentions.
Reply: Nonsense (there I’ve saved you a job JR)
October 19, 2017
JR is quite right but I’ve give you a chance, acorn. So name the members of the “hard” Brexiteer causus who both favour such a healthcare model and might be in a position to impose it on the rest of us; and explain why you think it is only those who want to leave the EU who are inclined to that model and those who want to stay in the EU will necessarily be opposed to it; and tell us what the role of the EU would be in one way or the other, and perhaps while you are at it also try to justify the EU having any such role at all, especially when successive governments have constantly tried to pretend that the EU has nothing whatsoever to do with our healthcare system …
October 20, 2017
Look up European Research Group and Change Britain, but don’t bother asking them for a membership list, they are not that brave.
October 19, 2017
The difference being that the EU and the UK are bankrupt – and largely because of the NHS.
I’m an advocate of Dignity in Dying. Having seen the wretched loneliness and discomfort in advanced ageing and the agonies long, terminal illness I see nothing to commend either. With the appropriate checks in place it would be the most humane course and the one I hope for myself.
October 20, 2017
Who are the ‘hard Brexiteer caucus’ and where have they published anything to do with the Singapore option?
October 19, 2017
J, Watched you sparring with another great political has been on Tuesday breakfast. Glad to see you having a laugh as well as debating the serious points. I like Piers because he’s upfront and always seems to dig up some dirt in the past such as the UK joining the euro!!
October 19, 2017
There is something strange about the conservatives. They suggest that they will seize all your assets for social care, giving you a fraction back to āpass on to your childrenā. They change the welfare system so that people have no money for weeks ā but will get you into debt by offering a loan to bridge the gap. So you starve and get evicted.
After this they think that all those people will with a cheer, happily vote them in again…?
Now, if you can pump Ā£500 billion in quantitative easing into the economy, creating asset bubbles everywhere, I believe it is not unreasonable for the electorate to view āwe cannot afford welfare or social careā with a degree of skepticism. But not if you’re conservative apparently.
Dismiss this if you will ā the electorate clearly did not.
Its time to start boosting the UK economy and businesses to create careers not jobs and get all those barista with PhDās into productive tax generating work to pay for what we want. To do that we need an industrial policy and a sensible pro-UK focused government to support and regulate UK businesses.
So that means getting the hell out of the EU superstate.
We can argue about where we spend money, but its all pointless unless WE the British control it. That is why nothing is more important than self determination, whatever your political colour. Something apparently lost on people in the Corbynista alt-left.
October 19, 2017
Make councils responsible for paying for the cost of keeping someone in hospital once they are declared medically fit for discharge. A hospital bed costs thousands per day, social care hundreds. Councils will follow the money.
October 19, 2017
Two great performances today on TV doing a good service for the country.
October 20, 2017
I saw one brief clip. One was of Alistair Campbell who attended at least two Grammar schools, blows into bagpipes before advising Tony Blair on settling the Iraq question once and for all.
October 19, 2017
http://www.express.co.uk/news/uk/868531/brexit-news-uk-latest-eu-john-redwood-alastair-campbell-sky-news-david-davis-brussels
Congratulations Mr Redwood and Piers Morgan on showing this muppet Campbell for what he and the Labour Party are, completely out of touch with the voter out side of the London bubble, the sooner we are shot of the eu the better and if the eu luvvies want to stay part of it then pack your bags and move to Europe but be prepared if your 18-30 to join a conscripted army, BYE BYE you will not be missed well not by me šš
October 19, 2017
We could start thinking big with planned “retirement villages” in warmer lo cost area with facilities to make them attractive. They could in the UK or elsewhere in a friendly country with historic links and with proper security etc . The staffing for these facilities could be rotated in and out like contract workers or they could reside locally. We could then use our massive overseas aid bill to fund a hospitals & medical course and infrastructure which would also be available to train the locals in medicine etc.
October 20, 2017
If and it is a massive if, for intelligent people like Brexiteers, we humans evolved then we started our journey in volcanic smoke-filled environments. We adapted, or, the theories of evolution break down.So, The Lancet is as wrong as it has been historically..very wrong.
http://www.bbc.co.uk/news/health-41678533
October 20, 2017
John, you asked for our opinions on social care, and many of our responses made the point about the essential need for convalescent homes.
When you have the opportunity (and I appreciate your sterling efforts on the part of Brexit within the media are exceptionally time-consuming), would you give us your response?
October 20, 2017
From ongoing experience with an elderly family member …
When an elderly person at home needs urgent help beyond the local GP, there is only one option which is to dial 999 and be admitted to hospital through A&E (an exhausting experience for any elderly person btw). Only once in hospital, occupying a bed, can the professionals start the process of working out how and where best to treat and/or care for the patient. As a minimum, this takes several days of hospital bed-space, even if little or no hospital treatment turns out to be required.
Until there is any other option at the point of urgent need for help, it is hard to see how the pressure from emergency elderly patients on hospital space can change. Residential care homes are clearly not an emergency option, not set up or equipped to receive urgent cases 24/7.
Perhaps the only way to reduce ‘border disputes’ is to have common funding and management across social care and health so that the two can really have a chance to work smoothly together – National Care Service alongside a National Health Service.
October 20, 2017
Again, as I keep pointing out, a large part of the problem is immigration. People tell me that we need immigrants because we have an ageing population. They forget that immigrants age as well. We don’t need immigrants. We have never needed immigrants. The government should base its policy assumptions on organic population growth (which includes natural migration from closely-kindred ethnic European and ethnic British societies), not on allowing all-comers to enter the country. We can then have sensible social policies and if an ageing population is still a problem, we can adjust to that and ask people to accept more responsibility for themselves – we should be doing that anyway, surely.
The NHS was designed 70 years ago for a different sort of society. Healthcare isn’t expensive, once you strip away the unnecessary costs and political interference. The whole system should be privatised and the state should withdraw – not just from healthcare, but from education and all other services. If you let people and communities look after themselves and run their own lives – self-government – there will be winners and losers, but in the long run we’ll be a stronger, more self-reliant nation.
October 27, 2017
Why are we getting things so badly wrong in this Country? Today’s article in the Telegraph about Asylum seekers accommodation in Manchester is just appalling we don’t treat cattle so badly. If the government is spending Ā£600m in care to private agencies why aren’t they being inspected, one woman has lived in appalling conditions with mice for six years! Why don’t our Charities report this properly to their MP?
Asylum seekers should be allowed to work in return for their free accommodation to clean up their accommodation and do minor repairs, painting, damp proofing and at least be given brushes to clean up their own rooms. We should not have to pay cleaning teams for them and should expect them to look after their allocated space and do some work in return for our care. BUT it should also be care. We should not continually give everything for free nor should we pay companies to provide homes that are worse than farm sheds! Let’s hear from our MP that is responsible for this to show s/he intends to just SORT THIS OUT.