TrewCare - Live In Care and Home Care agency

Two new reports published by the Kings Fund ‘Improving Choice at the end of Life,’ and ‘Improving Environments for Care at the End of Life: Lessons from Eight UK Pilot Sites have both been published this week.

Steve Dewar, director of funding and development at the King’s Fund made a case for ‘Choice’ being the key to end of life strategy. Whilst there appears to be some innovative nurse led services in the pilot study, will any of these really be transferred into the wider comunity?

All the rhetoric is around ‘end of life,’ not dying and death. Until we as a society can actually talk about what we want as individuals when we approach death, we have very little chance of policy makers understanding the wider issues of delivering real choices to us……….yes it is us that will in the future find ourselves faced with whatsoever the policy makers decide.

Unfortunately there appears to be a reluctance to involve the independent sector when considering the provision of services. There are many of us providing care for those who are dying in the community and yet there is very little, if any, mention of the input made by the independent sector to end of life care.

Steve Dewar refers to the fact that people prefer to die at home, however only one fifthe manage to do so. All the research tells us that four out of five people either die in hospital or other institutions. If there really is to be a committment made to allowing us to die where we want to, there really does need to be some involvement of those of us who actually deliver care in the community on a daily basis, alongside the statutory and voluntary sector.

We, the independent sector can deliver innovative and responsive services, however we need to be involved by the policy makers….

Surely the pressure must be mounting on Gordon Brown to consider that his back is up against a wall ….if loyal labour MPs such as Frank Field are propelled into gathering fellow M.P.s signatures to petition for a compensation package to compensate those affected by the 10% tax change.

Interestingly Frank Field has identified the fact that the treasury has £1.2 billion in unclaimed tax credits which he feels could be used to fund the compensation package.

There are 39 Labour backbenchers signed up to Frank Field’s motion. Surely the government do not want to risk the humiliation of a defeat over this issue which has been boiling away for some time and looks likely to boil over completely on Monday, which is when the amendment is due to be debated.

We’ll wait and see what happens……………………………..my guess is some kind of climb down by Gordon Brown and his Chancellor.

its interesting to sit on the side lines and see the 10% tax debate heat up. A very thick skinned Alastair Darling appeared on ‘Breakfast’ yesterday, seemingly quite unpreturbed about the effect the elimination of the 10% tax band would have on individuals.

It would seem ministers have convinced themselves that if they keep repeating over and over again how much they have done for families etc. we’ll all fall into line and believe them

What they do not appear to be able to take on board is the fact that its young people under 26, many in their first jobs, trying to survive, together with women between 60 and 65, who will be effected. Just because they are not eligible for tax credits apparently means they must be totally ignored…….disgraceful.

Many very hardworking people come into the category where they will be penalised for working……..yes, I am going to repeat myself, CARERS come into this category.

THEY DO NOT DESERVE TO BE PENALISED

Alastair Darling looking quite unperturbed thought the subject may be revisited in the NEXT budget. Wake up and think, all these people vote, not only that, their parents, grandparents and family also vote.

Whereas money can be found to pour into banks who have for their own ends lent unwisely in the past, apparently there are no funds available for the lower earners in our society. Shame on you, a labour government. You have a chance to redeem yourselves to-day when the finance bill is debated, hopefully you will do something sensible to help those who have so cruelly been penalised for your decision.

Whilst we are in agreement that the new scheme for registering carers will be a good idea – The ISA scheme, short for independent Safeguarding Authority will cost each individual who wishes to work in the sector £28 to register.  This is in addition to the fee for a Criminal Records Bureau check, which is upwards of £36.00, £42.00 with a POVA plus the fee for processing which is dependent on the organisation used.

As employers we will have to request that staff have both a CRB check and ISA registration. Tell me who is going to want to pay over £60 just for the pleasure of working as a carer?

The ability to recruit and retain care staff will be seriously inhibited if this additional £64 costs for an ISA is implemented.  Commisssioners of homecare really do need to recognise the additional regulatory burden placed on us. There was no notice taken in the last round of contracting of the additional cost of increased holiday pay. The care sector cannot keep swallowing the increased costs, this must be recognised by commissioners if they want a thriving care sector.

This week we have seen the re-emergence of the long term care debate – otherwise known as Continuing Care.

There appears to be some confusion in the press about what is Contunuing Care, unfortunately there is a tendency to lump all care together and confuse access to all care as long term care. This is not very helpful to those in need of care.

As discussed in an earlier ‘blog’  – Continuing Care is fully funded by the NHS for all without any personal financial contribution. From October 2007 a new framework was put in place by government introducing for the first time national standards for Continuing care, and NHS funded nursing care in care homes, with one national amount for nusring care replacing the three levels previously in exhistance.

Unfortunately Alan Johnson the current Health Secretary doesn’t appear to understand who the baby boomers actually are. We aren’t Mr. Johnson, the ones who are going to reap the rewards of free medical care by living longer. Most of the evidence will tell him that the current baby boomers are the ’sandwich generation’ caring for their older parents whilst also assisting with their grandchildren. As a baby boomer himself, one would have thought that Alan Johnson would have realised that we are all not ready for care yet!!! and yes, I am also a baby boomer….

Unfortunately we have a system where access to all types of care whether what is termed ’social care’ paid for through social services or healthcare paid by the NHS is assessed by the gatekeepers.

The gatekeepers to care are the social services and NHS. If there is ever to be a system which the public will consider to be fair it needs to be one where assessment for care is made by those who are not affected by access to funding.

This week’s report from Bapen, the British Association for Parenteral and Enteral Nutrition highlighted the fact that there is still a large amount of malnutritian particularly in the older population.

9336 patients were screened on admission to hospital, of these 28% were at risk of malnutrition, 22% were a high risk and 6% medium risk.  Those at greatest risk were older women.

1610 Carer Home residents were screened, of which 30% were malnourished, 20% considered to be high risk and 10% medium risk. However interestingly residents admitted from hospital were more likely to be malnourished 35%, than those admitted from the community.

Despite many previous reports looking at hospital nutrition, the message apparently isn’t getting through. Hospital beds are expensive and research suggests that malnourished patients will occupy a bed for a longer period than those who are well nourished……isn’t it high time that the hard nut of nutrition was cracked and older people in particular could be confident of leaving hospital without the  burden of being malnourished.

At a recent conference organised by the national Council for Palliative Care, entitled ‘Dying with Difficulty,’ we discussed the problems of talking about death and dying. Although death is something that is definitely going to happen to each and every one of us, it is almost a taboo subject.

Somehow we need to bring death and dying out into the open, treated as an everyday subject, not something talked about in hushed tones with embarrassment. When someone dies we even hear them being referred to as ‘passing away, not with us anymore, moved on, ‘ its actually unusual to hear he or she has died.

Can we raise the profile of ‘dying,’ make having a good death something that everyone can wish for, just like a having a good life.

 Unless death occurs unexpectedly, or suddenly, the majority of people will be aware that they are approaching the end of their life and wish to make arrangements for before and after their death. Whereas excellent care was available to those dying from cancer by Marie Curie Cancer Care and Macmillan Cancer Support, those dying from other conditions were not so fortunate. This is in the process of being  addressed, the Government announced it was to prepare a comprehensive strategy in June 2006,which aims to improve the care of all people who are dying, working together with both health and social care organisations. One of its aims is to enable people to choose where they die…..this if it works is extremely important as the vast majority of people end up dying in hospital even if it wasn’t their choice. Statistics from 2003 show that whilst just under 60% of people wished to die at home, less than 20% actually did so.

However we cannot be complacent, in October 2006 a working paper for the Department of Health observed that :-

Commissioning of end of life care was often given a low priority by PCTs and local authorities and that there was no guidance to commissioning of these services except in relation to cancer. Adding that few Primary Care Trusts had comprehensive strategies for end of life care which assessed the needs of their local population.

More importantly there was no additional funding to support end of life care programmes. Why doesn’t that surprise us? How can additional services be provided if there isn’t the will to fund them.

Its up to all of us who are interested in ‘dying well’ to ensure that we ask what is provided locally and talk about what we want, also to give death and dying the importance it deserves by putting it on all our agendas.

How interesting to listen to the news and programmes such as ‘Money Box’ during the last few days, they are suddenly full of how  abolishing the 10p rate of tax will affect those on lower incomes….  apparently it took the Institute for Fiscal Studies to publish a report and of course the fact that from to-day everyone earning under £18,000 a year will pay more income tax. This will include many care workers, who most certainly do not deserve to be penalised in this way. It is hard work being a carer, in particular working in the community, going out in all weather, early mornings and late evenings.

The excuse made on behalf of the government is that the majority of people will be claim tax credit and therefore won’t be affected, they have not however factored in those who are under 25, those who do not have children, and those between 60 and 65. It seems really crazy to take more money off the people who actually work hard at the lower end of the income bracket to subsidise the higher earners…and that was achieved by a labour party who is supposed to care for the lower paid…….the mind just boggles…..

Its the same with immigration, doesn’t anyone in the government ever walk inside our hospitals? If we didn’t have immigrants working in the health and social care sector the hospitals would shut down. Yet, in their wisdom only those with qualifications are now to be given permission to work here, it will be interesting to see how long it takes for the strain to be felt in the health service especially with the recruitment of healthcare assistants, domestic and catering  staff.

Data taken from the Office of National Statistics suggests that 68% of care workers in London are born overseas, that there are 105,000 non UK born care assistants and home care workers and 535,000 born in the UK.  

‘Future imperfect,’ a study published in 2002 by the King’s Fund highlighted the fact that whereas the future could bring improvements in services, their was the risk of a looming crisis within years as there would be growing pressures from an ageing population and a dwindling workforce. Somehow the message doesn’t appear to have been listened to……………………….