TrewCare - Live In Care and Home Care agency

Mum and Me shown at 10.35pm on 20th May was billed as a documentary that was ‘jolly and uplifting’ about a mother suffering from Alzheimer’s disease.

Complete horror was felt when the mother ‘Ethel’ was shown on Christmas morning sitting on the toilet with the daughter cleaning the floor round her as she gaily announced that Ethel had peed on the floor.!!

If any person in a home, or being cared for at home by a service provider was found so blatently ignoring the privacy and dignity of the person they were caring for, all hell would break loose. Why is it acceptable for someone to have their privacy and dignity disregarded just because they are the mother of the documentary maker?

Why was this shown on national television and pronounced by some newspapers as being laudable……it was nothing more than insulting to those of us who strive to protect the privacy and dignity of those who are cared for…..never mind the individual herself.

Please show a little respect when filming those suffering from dementia. This was a week when Ivan Lewis held his ‘Privacy and Dignity’ web chat, it seems sad that whilst the message is being put out loud and clear to those in the caring professions, those outside appear to think filming older people sitting on the toilet is acceptable…it is not.

In the press briefing last Tuesday, the Health Secretary, Alan Johnson announced the rolling out of a £31 million programme of information technology ‘Telecare and Telehealth aimed at supporting people in their own homes.

Presumably this is the same scheme announced last June, which has been re-announced to impress the general population.

Cornwall was chosen as one of the pilot areas, alongside Kent and Newham. We tried to be involved with the pilot scheme in Cornwall, without success and would be interested to hear any information from any organisation or individual who was more successful.

Kent however is very forthcoming about their involvement in the pilot scheme. A very interesting presentation was given by Peter Gilroy, Chief Executive of Kent County Council concerning their very innovative approach to telecare and telemedicine.

For information on some of Kent’s technology, see www.KentTV.com where schemes such as web-based self assessment and the Kent card will be seen. The Kent card is a bank card developed for social care for direct payments which may include continuing care purchasing. All purchases monitored by the consumer…..watch this space….come on Cornwall, let us know how your pilot is going…

This was the title used last October by a reporter commenting on the government’s spending review which stated that :-

“The government believes that there are real opportunities for reform within a system that shares the cost between the individual and the state and that provides both universal and progressive elements.”

Yesterday, Gordon Brown announced that the social care system needs ‘radical reform.’ This all follows the report delivered by Derek Wanless for the King’s Fund in 2006.

Glancing through the PM’s press review, which of course starts by reminding us that the over 65 and 85 age groups will rise in the next 20 years….are government’s usually so good at forward planning I ask myself? Or is this some kind of scare tactic designed to galvanise us all into accepting less provision rather than more? This feeling is reinforced by the last of the bullet points, the system must be:-

“affordable for government, individuals and families in the long term………..”

This together with the sentence “government support should be targeted at those most in need,” reinforces the belief that unless miracles are about to happen, nothing much will change –  except that vast amounts of money will have been spent on consulting us.

HAVE YOUR SAY IN THE DEBATE, PLEASE.  You can comment on the PM’s web site on www.pm.gov.uk

Lord Darzi, the parliamentary Under Secretary at the DOH has been undertaking yet another review of the NHS, ‘Our NHS, Our Future.’ As Lord Darzi is a doctor rather than a politician, there is hope that this review will go beyond the politics and really look at the issues which affect patients.

Whilst the final report is due in July ‘08 the interim report offers some interesting ideas, one of which is increasing the access people have to their general practitioners.

There is the idea of a combination of models. Firstly that PCTs should facilitate greater flexibility in GPs opening hours. The aim is to to enable patients to have a greater choice when to see their GP with extended opening hours in the evenings and week-ends. There will be the introduction of new health centres in convenient locations e.g. supermarkets?, where people can access GPs even if they aren’t registered with the GPs at those centres.

For the 25% of local communities where there is the poorest provision , there should be new resources to provide new GP practices which may be provided by private providers or GPs as now.

The introduction of better access to GPs is very welcome for those of us who are working and have to take time off to visit a GP. Looking positively, it should improve the health of the working population as they will be able to access healthcare when they need it, without the worry of taking time off work.

Several years ago when undertaking an assignment for university I wrote about the idea of a ‘Patient Passport,’ whereby you would have a card akin to the driving licence photo-card, which when swiped would give access to the required information. This would be used by the GP of your choice when accessing their care. Recently I spoke with David Colin-Thome who gave me the distinct impression that once the information technology is in place, there may be a place for such a card. Will this happen in my life time and really open up patient’s choice of GP, we can only wait and see.

This week found me trundling up several motorways to the delightful town of Harrogate, as a delegate attending the managing Long Term Conditions forum which describes itself as, ‘the most important forum for all those involved in supporting people with long term conditions.’

How I wish there had been more than one of me to attend all the various workshops and fringe events. However, you just have to make the most of what you can assimilate!!

Writing this before I start to head for home, is my main overall impression taken from the conference. An address by David Colin Thome, Chairman, Managing Long term Conditions Advisory Board, filled me with hope. he truly believes that improving the lives of people with long term conditions is about the delivery of personalised, responsive, holistic care in the full context of how individuals wish to lead their own lives…….also empowering people to do so, by enabling each person to have choice and control over their own care. This ,I hope, will be music to the ears of people who have fought long and hard to access the care they require….someone has been listening!! 

However, it must also be remembered that not everyone has the resources to manage their own care, there are many who lack the capacity to decide and  have no carers to assist them. These people must also be considered in the rush to self care. Research shows us that it is in particular the older single female who receives the least care, we must not allow these individuals to slip through the care net.

Its time to ‘hit the road,’ more on the forum when I reach home and can unpick for myself some of the issues.

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.