People dying at home lack expert support

The NHS is failing to provide expert 24 hour support for the majority of patients dying at home in England.

People dying at home lack expert supportAround 92% of NHS clinical commissioning groups (CCGs) do not provide round the clock telephone help lines, the charity Sue Ryder said- even though there are half a million carers for terminal patients in England.

The research by Sue Ryder said there is an “obvious inequality” between help and advice for the start and the end of life, with 24-hour, seven-day-per-week help available for maternity issues.

The charity asked all of the 211 clinical commissioning groups (CCGs) in England whether they had commissioned 24-hour end-of-life care support, including help lines staffed by nurses.

Out of 180 CCGs which responded to requests for information from the charity, only 8% said their local area had a dedicated 24-hour help line and palliative care coordination centre.

A poll of 2,048 UK adults conducted by Populus on behalf of Sue Ryder suggested that around four out of five people support the availability of 24-hour advice for those who are dying.

Around the same proportion of people think 24-hour emergency home visits should be available to alleviate pain and other symptoms.

The Leadership Alliance for the Care of Dying People-  a group of government bodies, health experts and charities, published official guidance in June specifying that palliative care should include access to telephone support.

“Service providers and commissioners are expected to ensure provision for specialist palliative medical and nursing cover routinely 9am to 5pm seven days a week and a 24-hour telephone advice service,” the guidance said.

According to the National Institute for Curbing Expenditure (NICE), service providers should ensure that carers and terminally ill should be offered information “in an accessible and sensitive way, in response to their needs and preferences.”

Care should be “coordinated effectively”, the NICE guidelines from 2011 add.

Bee Wee, NHS England’s national clinical director for end of life care, said: “Over the past year we have been working hard to make changes and move towards a palliative care service that gives everyone a choice about how and where they spend their final days.

“It is really important that dying people, and those close to them, have access to care, support and advice whenever they need it, so we support this as an important issue to address.”
‘Terrifying experience’

Sue Ryder chief executive Heidi Travis said: “People who are dying, their carers and their families should be able to access the care they want, when they want. Unfortunately many areas of the country simply don’t have the services in place to make this ambition a reality.”

Despite concerns from some charities and carers, the UK has some of the best-rated end-of-life care in the world, according to the Worldwide Palliative Care Alliance (WPCA).

The UK ranks with the Australia, Austria, Norway, and the US as having the best-rated palliative care, while Egypt, Ethiopia, Morocco, Mozambique, and Pakistan have some of the worst-rated care.

Around 98 countries around the world have no hospice or palliative care.

Carers at breaking point Commissioner warns

More needs to be done to support carers who are at breaking point the Older People’s Commissioner for Wales warns.
Carers at breaking point Commissioner warns

Sarah Rochira who is the Older People’s Commissioner is concerned that too many carers across Wales are missing out on much needed help and their work is often undervalued.

She said it can often lead to a deterioration of their mental and physical health.

Ministers said much had been achieved in policy to support unpaid carers since devolution.

Speaking on Carers Rights Day, Ms Rochira is worried at the pace of progress in a strategy to help carers and said she wants to ensure Wales gets it right for its 370,000 carers.

“Without the care provided by unpaid carers in Wales, estimated to be nearly £6 billion a year, many of our statutory services would, quite simply, be unable to cope,” she said.

“Carers should therefore be seen and treated as one of our greatest assets. Many of the carers I have met as part of my Engagement Roadshow are at breaking point – they feel that no-one listens to them, despite asking for so little.”

“In so many cases they just want a little bit of help before a crisis occurs, such as information, advice, help to make decisions, practical help and training, and advocacy – someone to speak up on their behalf.”

Ms Rochira said the Welsh government’s Carers Strategies Measure, which was launched in 2010, was a “welcome step forward”.

It is a requirement on the NHS and local authorities in Wales to work in partnership to prepare, publish and implement a joint strategy to help carers.

But while she said improvements were starting to be seen, she added she had “real concerns” over the pace of the progress and that she intends to review the impact the measure is making with carers being at the heart of the review.

She also wants service providers to work together more effectively and focus on what carers want, not what they think the carers need.

The Welsh government said: “We should be grateful that so many people in Wales are prepared to care in this way.

The spokesperson said a refreshed carers strategy was published in June and “much has been achieved in terms of policy, legislation and service development” for unpaid carers since the first version in 2000.

This includes the Carers Strategies (Wales) Measure in 2010 which requires health and social services to engage with carers.

Social care in England has bleak future after £800 million cuts

Social care in England is facing a bleak future despite planned changes as services have been forced into budget cuts.Social care in England has bleak future after £800 million cutsResearch by the Association of Directors of Adult Social Services showed £800 million was likely to be taken from the £16 billion budget this year.

The group warned it meant “the bleak outlook becomes even bleaker”.

It comes as the government looks set to signal later in the Queen’s Speech its determination to reform the system.

The draft social care and support bill, which is expected to be included in the speech, will be used to clarify the law on social care and pave the way for the introduction of a cap on the costs people face for elderly care.

Currently anyone with assets of more than £23,250 faces unlimited costs, but ministers have said they want to see lifetime costs capped at £72,000 from 2016.

The result of the move would be that many more people would be brought into the state system. Estimates have suggested an extra 450,000.

Health Secretary Jeremy Hunt said the changes to the social care system needed to be made quickly, as the UK faced a “very big challenge” because of its ageing society.
Resorting to rationing

But the ADASS figures, compiled from a survey of directors at 145 of the 152 councils, illustrate the problem councils are facing trying to provide services to the elderly and disabled.

The projected £800 million reduction in spending comes after nearly £2bn has been trimmed from budgets in the past two years.

While social care directors said they were trying to make savings through measures such as more efficient working and better procurement, nearly a fifth thought the quality of life that could be provided would worsen in the coming years.

Half said the numbers able to access services would reduce too as councils resorted to rationing.

ADASS president Sandie Keene said: “Gazing into the next two years, without additional investment from that already planned, an already bleak outlook becomes even bleaker.”

Handling of care home closures disastrous says health minister

The way the potential closure of NHS residential homes in Northern Ireland has been handled has been “disastrous”, Health Minister Edwin Poots has said.Handling of care home closures disastrous says health ministerHe was speaking as the western trust became the latest NI trust to confirm it plans to close all its NHS homes.

The western trust defended its actions, saying it had tried to be “honest” with people during its discussions.

Deputy First Minister Martin McGuinness criticised the anxiety the plans had caused to elderly care home residents.

Mr McGuinness and Northern Ireland’s first minister, Peter Robinson, re-stated their backing for the policy of caring for older people in their own homes but they hit out at the health trusts.

“Unfortunately, we have seen fear and anxiety on our television screens over the last few days and that is unacceptable,” said Mr McGuinness.

The Southern trust’s decision will affect 80 residents, in the Northern trust the number is 154, and in the South Eastern trust area 128.

In the Western trust there are 128 places available. A spokesperson said 73 of these beds are currently occupied.

Belfast, the largest trust area, began the process in 1990 and has since closed 10 homes.

The remaining three, Pine Lodge, Chestnut Grove and Grovetree House, will close in five years, under natural circumstances according to a spokesperson.

The three have a total of 20 residents.

Over the past decade, a majority of older people who required care in Belfast have moved to places in the private sector/independent sector.

“I think it is incumbent on the department to get a grip on what is happening within the trust and make it clear that this is going to be dealt with in a very sensitive way to ensure that we meet the needs of our older generation.”

Mr Robinson said moving around was “not the kind of thing you want to be doing at any stage of your life least of all when you are in your 80s or your 90s.  That has to be handled very carefully and very sensibly.”

“I think the policy, which was to approximately reduce by half the number of care homes over the next five years, was a sensible enough policy. I’m not quite sure how any trust can justify the closure of their homes and I think they need to seriously look at that again.”

Care home companies face harder financial checks

Large providers of care homes in England are to have their financial records regularly checked in future to spot potential business problems.Care home companies face harder financial checksUnder the government’s plans, the Care Quality Commission and local authorities will also ensure care continues if a company does go bust.

It comes after provider Southern Cross collapsed, causing distress and anxiety to its residents and their families.

Care minister Norman Lamb said the move would give reassurance to people.

The Care Quality Commission (CQC) will start to make checks on between 50 and 60 of the largest care companies in England, including those that provide care in a person’s home.

CQC chief executive David Behan said the measures – to be set out in new legislation – would provide early warning of potential company failures in the care industry.

The CQC will have the power to:

  • Require regular financial and relevant performance information
  • Make the provider submit a “sustainability plan” to manage any risk to the organisation’s operation
  • Commission an independent business review to help the provider to return to financial stability
  • Get information from the provider to help manage a company collapse

The Department of Health said the powers would bring care in to line with other services such as hospitals and holiday operators, which have procedures to check on the “financial health” of organisations.

In the case of the collapse of a national provider the effects would be felt in many parts of the country, so it would be unfair for local councils to have to deal with the problem, the department said.

Mr Lamb said: “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust.

“The fear and upset that the Southern Cross collapse caused to care home residents and families was unacceptable.

“This early warning system will bring reassurance to people in care and will allow action to be taken to ensure care continues if a provider fails.”

Southern Cross, the country’s biggest care provider, had thousands of elderly residents at more than 750 care homes across the UK when it collapsed in 2011.

The firm was brought down by having to pay a £250m rent bill as local authorities made cuts.

After its collapse, other operators had to step in to take over the care of more than 30,000 people.

Social care cost caps brought forward

The government will bring forward its overhaul of social care funding by a year the chancellor has announced.
Social care cost cap brought forwardA cap on the amount the elderly pay for social care in England – which was to be £75,000 but will now be £72,000 – would start in the same year.

Mr Osborne promised in his budget to “help people who are young and people who are old”, while sticking with the government’s deficit reduction programme.

The cap on social care costs, originally planned to be set at £75,000 and introduced in 2017, will now be introduced in 2016 at a level of £72,000.

This would only cover the cost of social care and people would still have to pay for accommodation and food – although some support will be provided.

Mr Osborne said the cap would protect people from “getting a disease in later life and having to sell their house” to pay bills.

For Labour, shadow minister for care and older people Liz Kendall said: “George Osborne is still failing older people and their families. Today’s minor adjustments to the government’s plan will still leave far too many selling their homes to pay for care.”

She added that any cap above £50,000 would not “provide adequate protection” for people on low incomes.

Ms Kendall said: “We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people stay healthy and living independently in their own homes for as long as possible.”

Mr Osborne said: “I agree that we need to spend more on capital, which is why I had taken the decision in December to increase the spending on capital – but paid for.

“In the end this country has got to pay its way. We can’t just keep on thinking the answer to our problem is more borrowing. You can’t get out of a debt crisis by borrowing more and more.”

But the chancellor defended the ring-fenced budgets for the National Health Service and international aid.

He said the 0.7% of national income earmarked for overseas aid was a “moral commitment” and “sound foreign policy for Britain”.

Elderly suffer from poor home care

A quarter of home care services provided to the elderly in England are failing to meet quality and safety standards, inspectors say.Elderly suffer from poor home careMore than 700,000 people above the age of 65 rely on home help for activities such as washing, dressing and eating.

But the Care Quality Commission found evidence of rushed appointments and botched assessments during its review of 250 services.

Campaigners said it was a sign of how much pressure the system was under.

Ministers have recently announced plans for a £75,000 cap on the amount the elderly will have to pay for social care in England – only the poorest get it free.

The proposal aims to stop the elderly having to sell their homes to pay for care.

But the move will do nothing to get extra money into the system, something the sector believes is vital if the quality of services is going to be improved.

Home help services are considered essential in keeping people out of more expensive care homes.

The numbers getting help is pretty evenly split between self-funders and those who get council-funded care.

This review looked at the support being provided to both – and found too many were struggling to maintain standards.

A total of 26% failed on at least one standard. One of the most common issues identified related to late, rushed or missed visits.

The regulator also highlighted assessments that had missed vital information, such as a diagnosis of diabetes, and care records that were incomplete, meaning problems such as pressure ulcers could be missed by carers.

Concerns were also raised about the way services were monitored and complaints handled.

The regulator said home care providers, many of which are private companies, needed to work closely with local authorities to remedy the problems.

It warned the problems identified could have a “significant impact” on the elderly, many of whom did not complain because of a fear of reprisals or loyalty to their carer.

A million dementia friends to be taught how to diagnose and improve care

One million people are to be taught how to spot the early signs of dementia as part of a drive to spread knowledge about the illness and improve the care of sufferers.A million dementia friends to be taught how to diagnose and improve careDavid Cameron will also announce today that the Government will trial new medical technology that could potentially reduce the time it takes the NHS to diagnose dementia from about 18 months to only three months.

GPs will use iPad-compatible software to test people’s memory, and should be able to tell whether they have normal or abnormal memory in 10 minutes.

Those needing further investigation will be referred to a specialist brain centre.  Two pilot schemes will cover about 200 patients next year.

An estimated 400,000 dementia sufferers in the UK are not diagnosed and experts believe the tests, if introduced nationally, could double the diagnosis rate to 80 per cent.

The number of sufferers is expected to double in the next  30 years.

Mr Cameron, who launched his Dementia Challenge in March, will give a progress report today as he outlines plans to recruit “Dementia Friends.”  People will be educated in free sessions in church halls and workplaces on how to detect  tell-tale signs of the condition and provide support to family, friends and colleagues.  The hope is that the initiative will also help the public understand the illness.

The Prime Minister admitted that general awareness was “shockingly low”.  He said: “We cannot underestimate the challenge we face in dealing with dementia in our country.  There is still a long way to go in fighting the disease but together we can improve the lives of millions.”

From today people wishing to become “Dementia Friends” can text “Friend” to 88080 or visit  The Government hopes that one million will volunteer by 2015.  People will get a badge with a “forget-me-not” symbol after completing their training, so they can be identified as being able to help sufferers.

Other measures include requiring health care professionals to ask all patients aged between 65 and 74 about their memory as part of every standard health check. A £1m prize fund will reward any NHS organisation  finds ground-breaking ways to  reduce the number of undiagnosed people with dementia.

Jeremy Hughes, Chief Executive of Alzheimer’s Society said: “Dementia is everyone’s problem and we all need to be part of the solution. Day- to-day tasks such as going to the shop or catching a bus can become increasingly difficult for people with dementia. Without a helping hand, this can mean people are left feeling isolated, unable to be part of their community and in some cases even unable to continue living at home.”

The priority given to early diagnosis and increasing public awareness of dementia will be highlighted next week when the Government publishes its “mandate for the NHS” over the next year.

Dr Eric Karran, Director of Research at Alzheimer’s Research UK said: “At a cost of £23 billion  a year to the UK economy, we all agree that dementia is not a problem we can ignore.”


NHS hospital patients facing severe cutbacks if elderly care crisis not solved

NHS patients will see “severe” reductions in their care in the next few years if the Government does not close an estimated £2 billion shortfall in funding for care for the elderly, hospital chiefs are warning.NHS hospital patients facing severe cutbacks if elderly care crisis not solvedThe current system of care is in danger of becoming “unsustainable” if more money is not made available, they say.

A Government scheme transferring hundreds of millions of pounds a year from NHS budgets to care is no more than a “sticking plaster” and could cause serious problems for hospitals if it became permanent, they add.

The warning comes in a report by the NHS Confederation, which represents managers in health trusts, amid debate about the future of the social care system.

Around 1.2?million frail or vulnerable people in England rely on care services provided by their local council.

But it is thought that almost one million more are in need but do not receive help because they do not qualify for state support and cannot fund it themselves.

The report offers strong support for the recommendations of the landmark Dilnot report to cap the amount anyone would pay for care in their lifetime at around £35,000, to enable people to plan for old age and take out insurance.

But it warns that even if the Dilnot recommendations are implemented in full, the estimated £2 billion needed to fund the system would still have to be found by the taxpayer.

And it argues that any attempt simply to take that money from the NHS would amount to “robbing Peter to pay Paul”.

More immediately, it warns the Government that a temporary system involving transferring money to social care from the NHS cannot be sustained in the long term.

The Department of Health is giving councils up to £2 billion a year by 2014 to spend on care for the elderly and disabled amid swingeing cuts to local authority budgets.

That will include up to £1 billion a year being diverted directly from the NHS into the crisis-hit social care system.

“We recognised this as a necessary ‘sticking plaster’ in the short term, however, the transfer did not represent a long-term solution,” the report says.

“In many areas this money has had to be used to paper over the cracks in the system and local authorities have had to plan on the basis that this money will continue to be available.

“Without further action on funding, even the basic social care that we currently expect for the very old will not be available in the future from local authority-funded social care.”

The report outlines how, although NHS funding is being protected amid the cuts, it is coming under greater pressure than ever, with the ageing population fuelling demand.

It estimates that so-called “bed blocking” alone costs the NHS £200 million a year – a cost expected to rise as social care becomes more scarce making it harder for hospitals to discharge elderly patients from wards.


Home care cap would still leave elderly with huge bills

Middle class families will still have to pay up to 90 per cent of the cost of having a relation in a nursing home under plans to overhaul care backed by David Cameron, a leading Tory MP claims.Home care cap would still leave elderly with huge billsJohn Redwood broke ranks with his party leader to attack proposals by the economist Andrew Dilnot to cap the cost of care. He made his comments as it emerged that Mr Cameron has given his full support to the plans.

In a landmark report published last year Mr Dilnot called for a new system of funding which would mean that no one would have to pay more than around £35,000 for care in their lifetime.

But in a recent paper Mr Redwood questions whether it is “morally right” to use taxpayers’ money to fund a cap, claiming it would only serve to benefit well off families who want to protect their inheritance.

He also argues that the £35,000 cap is misleading and would not provide the level of protection which people think it would.

In a paper for the think-tank the Centre for Policy Studies, he insists that people could still face huge bills for care because much of the money they spend would not count towards the cap.

The Dilnot report makes clear the cap would only apply to care costs- so excluding the bills families would pay for their loved one’s accommodation. But it would also depend on assessments made by local councils of how much someone’s care should cost.

If people want to go to a care home which charges more than the amount the council approves, they would have to make up the difference themselves – as is the case at present.

However, under the Dilnot proposals, the extra money would not count towards the cap. In theory, it means that people could spend far more than £35,000 before the cap takes effect.

In some parts of the country, particularly southern England, many care homes already charge more than the local council is prepared to pay, meaning that even residents who get their fees paid by the state still have to top it up.

Using a model designed by Partnership, an insurer, Mr Redwood argues that families could end up paying 90 per cent of the costs themselves over four years, even under a capped system.

At present councils pay around £461 a week, including accommodation, for people who qualify for residential care. But in southern England weekly fees average at £817 a week, or £42,500 a year, Mr Redwood says.

He calculates that only £271 a week paid by the resident would count toward the cap.

That would mean it would take two and a half years before they are judged to have spent £35,000, by which time they would have racked up bills of £105,500.

Even then the resident would only get their care costs paid up to the level set by the council, he adds. Over four years the resident would still have had to pay £149,000 even with a cap, compared with £170,000 without a cap.

“It is a cap but it is not the size of cap people thought it was,” said Mr Redwood.

“I don’t feel I’m a heretic, I just feel it is important that we have an informed debate.  I think a lot of people who support Dilnot haven’t actually read the proposals and don’t understand the location of the cap.”

In his paper Mr Redwood argues that families should be prepared to use the value of loved-ones’ homes to fund their care and claims that most people do not actually need to inherit their parents’ home.

“The only real reason the children want to inherit is they would like to have more money,” he says.  “That is an understandable wish, but not necessarily one that should be fulfilled at the expense of the taxpayer.”

Michelle Mitchell, director of Age UK, said: “Social care is a highly complicated issue and so trying to find a solution which scores 10 out of 10 for everyone involved is probably impossible.