Category Archives: health care

New impetus for dementia strategy is welcome

While most of the political world is focused on Ed Miliband’s speech at the Labour Party conference today, the government has quietly made an announcement that should give renewed hope to people with dementia, their families and carers; a renewed focus for the National Dementia Strategy.

It seems a long time since the strategy was launched in February 2009 amid much fanfare and talk of how it would improve care for people with the condition. What followed that was, well, very little, it seemed. Indeed, the National Audit Office was heavily critical of the implementation of the strategy – or lack of it – back in January.

While some thought that criticism was premature – one year into a 5-year strategy – little progress seems to have been made since, hence the new government’s re-fresh of it.

The Department of Health document Quality outcomes for people with dementia: Building on the work of the National Dementia Strategy highlights 4 main priorities:

  • Good-quality early diagnosis and intervention for all
  • Improved quality of care in general hospitals
  • Living well with dementia in care homes
  • Reduced use of antipsychotic medication.

The DH adds that the improvement of community personal support services is integral to and underpins each of the 4 priorities.

I can’t argue against any of those priorities, but carers, care service professionals and campaigners have been saying this for years.

There is also talk of developing an ‘outcomes-focused approach’ to dementia. ‘Outcomes-focused’ is an increasingly used phrase in health and social care and is starting to grate – isn’t all health and social care geared to delivering an outcome? I.e. improving the life of the service user? Or is it meant to stand for ‘as opposed to target-driven approach of previous government’?

However, cynicism aside, this is a major and welcome commitment from the government. For too long dementia has not received the attention it deserves from successive governments and, as a growing number of people develop the condition, it becomes an ever more urgent priority.

This annoucement has also gone down well with organisations in the sector, with the Alzheimer’s Society, the English Community Care Association and Counsel and Care all coming out in support of this.

But we have all been here before and as the original dementia strategy shows, good words and plans are one thing, but it means nothing if it does not deliver results for service users and their families.

My worry with this is that this could happen all over again. There isn’t too much detail in the document on how this will be delivered, although this is in part because the delivery strategy will be linked into the wider reforms of the NHS and social care, which will be announced in the coming months.

So, there is much to commend the revisions to the dementia strategy, but, as ever, words and intentions are one thing, but the real indicator of success will be in the implementation of this and tangible results for service users. So I’ll reserve judgement on it until later when – or if – the results can be seen among service users.

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NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

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Hospital car parking charges need reform

Today’s blog returns to an old hobby-horse of mine: hospital car parking charges.

This issue is back on my radar again as I will be making regular hospital visits for the next few months (my wife is pregnant) and was stung for more than £2 for an hour’s parking earlier this week.

Some of you may remember a recent blog where I highlighted/ranted at what I saw to be the scandal of hospital car parking charges for visitors and patients (Hospital car parking charge scandal) and how this should be ended. Pleasingly, it seems that I’m not the only one that thinks this way: consumer watchdog Which? has now called for charges to be revamped.

As reported by the BBC today, Which? has published a list of the best and worst performing hospitals in terms of clamping and fining car park users (or abusers, depending on your viewpoint). The worst were Epsom and St Helier University Hospitals NHS Trust (most clampings) and Leeds General Infirmary (biggest finer). Barnet and Chase Farm Hospitals NHS Trust charged the most at £4 – £4!! – for 2 hours.

The fines and clamping system highlights another issue I have with car park charging; having to be aware of how long you’ve got left on your ticket.

Again, I’ve experienced this one; having recently bought a ticket for 3 hours parking (which I assumed when I purchased it was more than enough) I had to dash out of a waiting room to extend my parking stay. I shouldn’t be thinking about a parking meter when being given important information about my unborn child.

Hospitals visits can be stressful enough without having to worry about the threat of extra charges, fines or even clamping, especially when it is usually through no fault of your own; we all know how hospital appointments can – and often do – run behind schedule.

Perhaps the worst bit is that there is little sign of this ending. While Labour announced plans last year to scrap charges for in-patients, their families and friends within 3 years, the new coalition government has made no such commitment. And with budgets cuts imminent, they are a useful moneyspinner for cash-strapped PCTs that they will not give up voluntarily.

Which? has called for a ban on clamping and towing, as well as “fairer” charging systems such as allowing patients to pay on departure rather than arrival – although some already do this, to be fair – or reimbursing patients for additional parking fees when appointments are delayed.

All good points, and hopefully, given the clout that Which? has, someone in power will listen.

But for me, it doesn’t go far enough; as I’ve said before, I’m not against charging per se, but it does seem ridiculous to pay more than £2 for an hour, given the costs of upkeep of a car park (not that much) and the number of people who pass through one on any given day (lots).

Surely a flat rate of, say, 50p to park would be fairer? After all, unless my memory is deceiving me, it’s not all that long since that was roughly the cost of parking at many hospitals. That would cut out the stress of the charging, but also still cover the costs of running it – car parks should not be there to make money out of people who have no option but to go there.

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Hospital car parking charge scandal

I was flicking through a copy of my local free newspaper, the Sandwell Chronicle, the other day, and one story had me re-reading to ensure my eyes weren’t deceiving me.

Last year, the 3 hospitals in the Sandwell & West Birmingham Hospitals NHS Trust – Sandwell General, City Hospital and Rowley Regis Community Hospital – brought in more than £1.5 million in car parking charges for staff and visitors. Here is how the local daily Express and Star reported it.

Now, hospital car parking charging is a particular bugbear of mine. Having spent more time than I would have liked during the past couple of years visiting various hospitals in the Birmingham and Black Country area, I have come to resent these charges vehemently. My logic is thus; I am visiting my loved one – or rushing them to A&E, in some cases – why should I be charged upwards of £2.50 for the privilege?

I also think charging staff to pay for car parking, as some do, is a bit rich. How many other places of work charge for spaces? I certainly don’t where I work.

These hospitals are by no means the only – or worst – examples, just the ones in my local area. For instance, last year the Birmingham Post reported that University Hospital (nee Walsgrave) in Coventry made £1.9 million from its parking charges.

While I understand that maintaining a car park does cost – paying for security staff, CCTV, upkeep of the land and automatic barriers etc – I doubt that it is that much.

It’s the way the costs seem to keep spiralling that irks me as well. I remember when some hospitals first started charging back in the 1990s, and then it was usually a flat rate of 50p. I didn’t have a problem with that. But now, they seem to increase annually – Sandwell & West Birmingham’s charges are going up by 20% in April – and it does tot up quickly if a loved one is having an extended stay in hospital.

For those on benefits or a pension, these charges come as even more of a whammy. Even the 8-tokens-for-£10 offers for those coming in every day still take a fair chunk of an average pensioner’s weekly budget.

The charges smack of profiteering – especially at those hospitals that have outsourced car parking to private firms – and, as ever, the poor old consumer gets hit in the pocket.

What would I do? In an ideal world, make it free. Realistically, go back to the flat rate of 50p – surely enough to cover the costs of maintaining a car park.

I’d be interested to hear others’ opinions on this…

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