Friday, 6 November 2009

Members' concerns #5 - NHS: specialisation versus convenience

Had a chat with a member the other night who made an interesting point: that a relative had to go to Bishop Auckland, Darlington and Durham for three different parts of the treatment for the same condition. Another made the point that in residential care, it was seemingly impossible to find places - even private ones, which most are nowadays - which could care for patients with both physical and mental incapacity.

Are we specialising too much in our search for the Holy Grail of "centres of excellence"? Or is this a necessary price to pay for improving the expertise of medical staff? And if the solution should be somewhere in the middle, where is the right balance?

Comments please (especially anyone from the medical profession).


  1. Rob,
    I am not in the medical profession but involved in the delivery of care/nursing homes, principally in the private sector.

    The aging population means that as we live longer, we are all the more likely to suffer both physical and mental frailty.(not so long ago we tended to drop off our perch due to physical fraility long before we would have been suffered mental incapacity... this is no longer the case)
    Until recently homes were built as either Residential or Nursing homes but most are now being built to accommodate a wider spread of needs, including dementia.

    The private sector is of course looking to those areas of care which have the highest returns, and emi (elderly mentally infirm) represent part of that sector

    An utter lack of investment in the public sector means that most of their remaining care buildings are horribly antiquated, lacking the basics such as en-suite facilities that have been std in the private sector for 25 years.(i think dbc have disposed of all their stock?)

    The private sector actually considers the north east to be well provided for in terms of facilities for the elderly.However, nationwide there is a real paucity of good quality accommodation, a situation which will only get worse as the aging population outstrips supply.

    I believe that statistically we have never had more emi provision than today, but sadly this has not kept pace with demand. I am afraid successive governments have failed to act on this particular time-bomb.

  2. Ianh, thank you for your thoughtful - and knowledgeable - comments.

    This is clearly an area which is incredibly difficult for governments to increase public provision for without creating a precedent for massive and increasing future spending. But clearly a safety net is required for those who can't afford treatment.

    Interesting your comment that we now have more EMI than ever, but it's still not enough. I really have to say I'm not sure what the answer is, except continue to encourage private provision and allow construction of new facilities as far as is possible. Are there constraints on such construction?

    Ultimately though it's an incredibly difficult area, to which I don't have any silver bullet, as they say. Ian, what would you do if you were the government?

  3. I would like to say many of these old or infirm people are still looked after at home by friends and relatives who do so by claiming attendance allowance Rob (approx £40 a week)what are your views as PPC for the same Labour Gov. that in a green paper to be finalised on Nov 15th wants to take away this Attendance Allowance (and originally disability living allowance but were forced by massive pressure from organisations like the RNIB to back down on that part) as a personal benefit and give it to local councils by way of a central fund called social funding and I think we all know it will then not get to its intended targets.

    So if this terrible paper/law is passed and you take all the carers allowance (which is no way a payment to these friends and volunteers but to cover day to day things)will this Government not be putting more pressure on the old, sick and infirm to seek residential care and nursing homes?

    If you have family who can do this work everyday in many cases voluntry for approx £40 per week how will Labours new Social fund be able to cope, sending a council employed employee just an hour a day for seven days would cost more than the £40 this greedy government is clawing back from the most vunerable in society through it's own bad managment, money that it has squandered, wasted and in terms of expenses claims in many cases legally allowed to be stolen.

    Leave Attendance allowance alone or there will be a massive upsurge in people needing the care facilities you admit are already lacking.

    Have we learnt nothing from history, isn't this how Hitler started slowly picking off the undesirables and weak in society making way for his master plan.

    Are you even aware of the green paper wanting to remove peoples allowance and create an new social fund administered by local councils?

    We have all seen here in Darlington how good your labour leader is at balancing the budget, what will happen to all these old peoples allowances which they or their carers rely on, DBC will spend it on another hair brained scheme or to pay off existing debt. it is time for a complete clean out of the flotsum and jetsum in Darlington town hall's power structure. Many will vote for who can do this rather than party affiliation.

    Just to clarify todays code DBC, is Darlington Borough Council.

  4. Ianw, firstly thanks for your faith in me, but I'm not PPC for Darlington! The selection process will finish on Dec 5, when we'll find out who the candidate will be from 30 aspiring candidates.

    Ok, I'm not here to defend everything the government does unthinkingly, but to debate and understand the issue. My understanding is that this is a green paper - a consultation exercise - with 3 options. There is a further option under discussion to remove discretion from councils about the amount that carers receive, so that the money is effectively ring-fenced. In this case, it would surely be impossible for DBC to spend it on anything else, as you fear, although I'd agree it's a legitimate concern if they don't.

    Secondly, how do we know that the council would spend LESS than central government in this area? It could be the same or perhaps, with a clearer line of accountability at local level, they might even want to spend MORE, it's really not clear at this stage where the limits would be set. I think I would certainly be in favour of the ring-fencing option to protect carers.

    Ian, I think you are right to want the best possible system, but I need to understand why it's wrong to give more power at a local level, so long as it's properly regulated to protect against the actions of any possible rogue councils. In my experience, blanket national systems are rarely good, either. And, at the moment, what do we know about how much a carer will actually finally receive under these proposals?

    I'm sure you'll be delighted to inform me...

  5. Attendance Allowance (AA) is used by many to retain their way of life and independance so there is no need to go into homes (which we agree there is a shortage of and can be very costly) This is usually done by family and friends "mucking in" and in many cases doing many many hours a day/week.

    In the present set up the individual has choice of how to spend this allowance to best suit their individual needs.

    If it was taken away and the burden then placed on any council, that council will need to employ people, pay travelling expenses be on call etc. etc. all for the £40 AA they want to take away, could anyone do it?.. I think not! the only suffers would be the individual and the Council tax payer.

    The individual would lose their independance as there is no way any Council could provide anywhere near the same level of service they get from volunteers and family in terms of support and help and the tax payer as the system will fail! so once again the tax payer will need to carry the burden of the Governments short sightedness when it collapses under the strain and more residential and care homes are needed, but wait, there is already a shortage and a recession so just who will build these?

    There's an old saying if it aint broke don't fix it, on this subject I cannot see any benefit to the individual and to say the council would spend it on it's intended people is like saying...Hurworth comp. won't close!

    We have already had "a promise off a liar" and will not be so quick to fall for his lies again.

    Todays code "him" the promise breaker is John Williams DBC leader.

  6. Rob,
    in response to your question, "what would i do" then i would have top agree that there is no silver bullet.
    Sadly the aging population will mean an ever increasing dependance on healthcare facilities.
    The only answers all involve incressing expenditure, in both private and public provision. Too many elderly infirm residents are still in accommodation that do not meet their needs (i am talking only about those who can no longer manage at home)

    There is now an understanding that new care homes should provide a full spectrum of care to ensure continuity and avoid the risks assoicated with relocating extremely frail residents. Many residents coming into homes need predominatly physical care, with their menatal faculties deteriating with time.
    If residants need to be moved because the home can no longer cope with their needs then there is a very real risk of rapid detioration and even death. I have seent this both persoanlly and on a professional basis.

    Modern buildings utilising best practice in terms of design mean that some of this deterioration can be reduced or avoided.
    But these facilities cost money and the fees paid by the local authorities reaaly do not match those needed to provided first class provision.

    One area that could help those wishing to develope care home would be planning.
    Some areas can require huge sums from developers as S106 agreements, certainly tens and occassiionally hundreds of thousands of pounds.
    Planning Authorites, in my view, should give a priority to these sort of developments, perhaps removing them from their s106 requiremenst but alo recognising the benefits that they can bring to an area.
    They can ensure that residenst can remain in their local community
    They can releive pressures on local hospitals and healthcare facilities (though gp practices may not agree)
    The bring with them a significant number of jobs with a variety of skill levels.

    Too many authoritees see healthcare providers as little more than cash-cows, like any high street retailer rather than providers of key services to their communities

    Most importantly, modern high quality designs allow the older generation to live out their lives with dignity and safety, in the knowledge that help is at hand whatever their level of need.
    In my view the government should be looking to assist providers who are wanting to improve their facilities and levels of provision.

  7. Ianw, thanks for decoding only thought here really is that it doesn't seem clear that the government is necessarily saying that carers who are family members etc. will stop getting money altogether, simply that the budget will be devolved so that councils will administer, and even that may be dictated so that they can't skimp on it, as is your (quite justified) fear. And I'd agree with you that that is the most cost-effective way to use the money anyway.

    So I think it depends on what comes out of the debate, it's up to us I guess to lobby MPs and councils to make sure that what comes out is sensible.

    Ianh, it certainly seems to me a good use of scarce resources to incentivise providers to upgrade their facilities. I like the idea.

    Guys, by the way, as you probably have seen now from the front page, I am sadly out of the contest. I've really enjoyed our debates here, and I also hope you find the MP that the area needs.

  8. Hi Rob

    You say "it doesn't seem clear that the government is necessarily saying that carers who are family members etc. will stop getting money altogether" and that is the problem IT DOES NOT SAY but would you put your villa on thats what is intended?

    It was also going to encompass DLA disability living allowance which after a succesful fight we have won and that has been removed from the "pot" however only if you are UNDER 65 if they were going to take DLA from the most needed of individuals you can bet your bottom dollar they will be taking AA atendance allowance from their helpers.

    Another election winning plan from Nu Labour!

    Good luck in the future.

    Ian White


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