The NHS must do more to help patients have a good death

Death is often said to be the last taboo, despite being the one event that we all have coming to us at some point. Talking about dying can be very difficult for many people, not just the individual and their loved ones but also medical professionals who may be equally uncomfortable approaching such a sensitive topic or regard death as the ultimate failure of their skills.

The NHS has over its lifetime played perhaps a leading role in this country in bringing up life expectancy to the point where  of the  nearly  half a million people who die annually, around four fifths are over 65 and two thirds are 75 plus. The major workload of the NHS has changed from treating working age adults with single acute problems to treating patients in later life – about of every ten patients in hospital around 6 will be over the age of 65. In later life, patients are more likely to be frail or living with more than one serious condition and so require a different  approach to their care.

The recent national confidential inquiry into perioperative deaths (NCEPOD) showed that the  NHS has yet to grasp universally that its success in making sure that most of us don’t die before we get old requires a rethink of its medical model and how it approaches care.

According to the report less than a third of acutely ill patients admitted to hospital got good care when they had a cardiac arrest. Whilst the report did not solely focus on older patients, the vast majority were over 65 and the mean age of people in the study was 77. And most people had at least one co-morbidity.

In nearly half of the admissions, patient assessment was deficient and in over a third of cases did not pick up warning signs that the patient was deteriorating and might arrest. Better training and understanding of geriatric care would, we believe, help medical staff to see beyond the immediate presenting problem and understand that an older person is likely to have other serious underlying medical issues, helping to better anticipate deterioration. All health professionals need to have the skills required to deliver healthcare in the 21st century. Continue reading “The NHS must do more to help patients have a good death”

The opportunity to reform social care must not be lost

 

Care in Crisis 2012 confirms what many older people and families already know: that social care in England is under phenomenal strain.  Our analysis paints a picture of a seriously under-funded care  system having an increasingly damaging  impact  on those older people who need support to live safe and independent lives.  It also shows that without additional resources the situation will get worse.

Care under-funding is not a new problem, but we are now living with the effects of declining real terms investment  over the last six years, combined with growing numbers of older people.  The inevitable result is that there are not enough services to go round.

Eligibility criteria have tightened, around 800,000 older people have unmet needs and the financial demands on those  who do receive services are rising.

Recognition that a funding gap exists  is also not new, but the problem is becoming starker  and the consequences for older people more profound as the spending cuts really bite.

Despite additional Government investment in care to help protect frontline services from cuts, our analysis shows that care budgets have still fallen in real terms by 4.5% in 2011-12.  This equates to  a shortfall of £341m and the money transferred from PCTs for care services does not fill the gap. There are additional cost implications even to maintaining services at 2010-11 levels.  Our analysis concludes that this year’s shortfall is £500 million and we project that the Government will need to spend £1 billion more next year compared to this year just to stop things getting worse.

These figures illustrate the scale of the challenge and at Age UK we are clear that additional money for care needs to go hand in hand with reform.   We have to do more than just subtly change the ways in which  services are provided to embrace wholehearted reforms that safeguard services for the future and  ensure they are of consistently high quality. 

At a time of austerity, it is all the more important that services are efficient and provide good value for money. That’s why we support the proposals put forward by Andrew Dilnot; they place the funding of care on a more sustainable footing and in our view they achieve a fair balance on the contributions needed from individuals and the State.

More broadly, our aim must be to create flexible and responsive care that gives older people the right support at the right time. Yet at present older people often tell us that they find the care system complex, unfair and inconsistent, and set up so it is impossible to plan ahead. 

Clearly, there is an urgent need for a single piece of legislation which articulates what people are entitled to and how they can access services. 

And looking ahead to the forthcoming Social Care White Paper we think there are two key challenges:

  1. Protecting existing services and funding the care system so that those who are currently in need can be confident of efficient, high quality and reliable services now.
  2. Planning  for the future to maintain and enhance the provision of care and the system that supports it, for the benefit of generations to come. 

As the political parties continue  their cross-party talks they must reach agreement on these crucial issues.  There is a golden opportunity for reform and it must not be lost.

Read Care in Crisis 2012

Find out more about the cost of social care for older people

Find out more about Age UK’s Care in Crisis campaign

 

 

Missing a Trick – The Older Consumers Business Forgot

In case you hadn’t heard, the UK is getting older. There are now more people in the UK aged 60 and over than there are under 18. That number is projected to rise by over 50% in the next 25 years .

And, if those statistics aren’t impressive enough, in 2010, as a group, they spent £111 billion – a not insignificant sum by anyone’s calculation, particularly in these straitened times.

So, it would seem common sense that everyday services and goods, automated or not, from mobile phones to booking cinema tickets or paying bills, should all be designed to be easily accessible to this growing section of the population..

Sadly, that’s not generally not the case.

Age UK is regularly contacted by older people who are perpetually frustrated at their experiences trying to carry out every day chores whether it be doing the shopping or contacting their energy provider or bank.

Automated phone systems seem to be especially disliked. They are hard to use for those with hearing problems. The multiple choices they offer can be confusing and frustrating and not just for those in later life. Continue reading “Missing a Trick – The Older Consumers Business Forgot”

Celebrating Human Rights Day?

So it’s Human Rights Day tomorrow. How will the UK be marking it?  Most likely it will pass unnoticed or derided as another manifestation of political correctness. Yet, surely having laws that protect the basic rights of everyone in the UK, including people at their most vulnerable, is something to be proud of? So why aren’t we celebrating?

Sadly, it is because we have allowed the myth that the Human Rights Act is nothing more than a rogue’s charter used by lawyers to protect the undeserving, to take hold.

We read misleading and inaccurate stories involving cats and immigration or burglars and fried chicken. What we read less about are those vulnerable older people in the UK who depend on the act to protect them or to  improve the  fundamental services on which they rely .

Dignity and respect are at the core of human rights. Unfortunately, older people are sometimes treated in a way far removed from this. What is most shocking is that this can happen when they are at their most susceptible, needing care in hospital, or even in their own homes.

You need only glance at the shocking findings uncovered by  the Equality and Human Rights Commission’s  recent inquiry into homecare for older people. It revealed major and widespread breaches of human rights ranging from physical and financial abuse, lack of help eating and drinking to scant regard for the  privacy and dignity of those being care for.

Or the Staffordshire hospital where solicitors acting for 119 families, argued that some patients, the majority of whom were older people, received such appalling care it amounted to inhumane and degrading treatment breaching human rights law.   This included people left sitting in their own faeces and left without pain medication. Although the hospital did not accept there had been human rights breaches, it paid out just under £1.4m to individuals and their families.

Or take the case of the couple who were about to be separated after 65 years together as the husband needed residential care but his wife was told by the local authority that she did not qualify. They successfully argued that the local authority had breached their human rights and the authority reversed its decision.

However the HRA is much more than a legal cosh to bash public bodies with when they fail. It actually gives them a positive duty to protect human rights providing a great basis for improving their services they provide and as such should be celebrated not feared.

We may think it is not necessary to have laws to make us treat people with respect and dignity. Perhaps it shouldn’t be. But, sadly, whilst some older people continue to be treated so badly, they continue to need the protection the Human Rights Act provides.

So next time someone claims that we don’t need it, perhaps, they just need to remember it protects everyone – including their mum, their grand-dad or, yes, even them. 

Read our guest blog to mark Human Rights Day

Read our feature about older people in Colombia

Find out more about our international work

 

Evidence uncovered by the EHRC home care inquiry is shameful

The news that older people are being stolen from, left  hungry and  dirty by local authority funded  care workers  responsible for looking after them is truly shocking and a sad indictment of how our supposedly humane society allows older people to be treated.

The findings in the Equality and Human Rights Commission’s report into home care   show that in too many cases support  provided to many older people in their own homes fails to uphold  the basic rights enshrined in law that most of us would expect as a moral obligation.

The report reveals not only extreme abuse but  a  pattern of lower level insidious  and uncaring  ill treatment. Examples include carers talking on their mobiles  while working , treating those they care for as invisible or leaving someone sitting on a toilet. A disrespectful approach  undermines the  dignity and self- worth  of people  who  often find it difficult to complain or are afraid to do so out of fear of reprisals , enabling the abuse and neglect to continue unabated.

How is this allowed to happen? Funding is part of the answer – local authority spending cuts have led to many councils cutting back on spending on care and support for older people. In some areas this will mean that care packages will be cut, leaving older people to struggle on alone with  only the most disabled receiving  any care support. In others, a less than generous care package will have been further cut back meaning that older people will be visited fleetingly with,without doubt, visits from home carers which are  too short to enable proper care let alone any of the social interaction so important for us all, and so needed by those already isolated.

Low wages and status for care workers does not help in creating a motivated and professional workforce and training should be urgently addressed. WE must place the needs and humanity of those needing care at the centre of our thinking, not treat them merely as the subjects of a list of tasks to be completed. And we need to let those who hold the budgets that we want sufficient funding to allow care reflect the respect and dignity that should be accorded to older people.

Horrifying as today’s report is – we hope that it will be read and reflected on by those who have the power to change the situation.

Age UK believes   it is incumbent on  every local authority and care provider to pay much more attention to the basic human rights of the people who rely on them for care .That means  setting budgets which allow  proper support  and  carefully  monitoring  contracts with  home care providers to ensure  they are working properly. A number of recent court cases have upheld this view, forcing local authorities to  reconsider their budgets and planned  cuts to care services. National government must acknowledge that it has a role to play in ensuring that sufficient funds reach the frontline of care provision and ensuring a sustainable future for social care in this country.

We as a nation must decide whether as a society we are prepared to let older people – and that will include each one of us one day – to be treated in this way. If we are sickened and appalled by what this report has uncovered then we need to let our leaders know that we want change.

Find out more about our Care in Crisis campaign

Understanding dignity in care

In July we launched a new project with the NHS Confederation and the Local Government Group to examine the standards of care older people receive in hospitals and care homes. The ‘Commission on Dignity in Care’ aims to understand why older people continually face poor standards of care and what changes will help to drive improvement.

The Commission was established in light of a series of reports ranging from the Mid Staffordshire NHS Trust inquiry to the Health Ombudsman’s report on patient complaints. We regularly read reports criticising the unacceptable levels of care and the Commission hopes to come up with some practical solutions to combat these problems. We know that some hospitals and care homes are delivering excellent care and we want to share what it is they are doing and how they have done it. The truth is that we rely on NHS services and move into care homes when we are often at our most vulnerable and in need of high quality care and compassion. The Commission hopes to identify how leadership, values and culture can be influenced to ensure that people are treated as individuals and standards of dignity in care are improved.

Last week we held the first oral evidence session as part of the Commission’s enquiry. This first evidence session was very encouraging in the openness and frankness with which all the participants spoke. Perhaps the strongest point which was made a number of times was the failure of hospital and care home staff to treat people, who may have multiple and often complex health needs, as well as emotional needs, as individuals. Kathryn Hudson, Deputy Parliamentary and Health Service Ombudsman said she felt that in some places a culture exists which fails to respond to the whole person and instead treats patients as a ‘nuisance.’ Dr Jane Martin, Local Government Ombudsman suggested a ‘zero tolerance approach to neglectful behaviour’ was needed.

Whilst we won’t be able to make recommendations until we have heard all the evidence even at this stage it is possible to identify some of the commonly cited problems; poor discharge planning, failure of hospitals and care homes to deal with complaints and absence of care plans or failure to properly follow plans. Advocacy schemes, better data and improved training were seen as part of the solution. Sharon Blackburn from the National Care Forum said problems often stemmed not from a failure of technical competence but rather from the way in which care was delivered, and that good relationships between staff and patients or residents created the conditions for ensuring dignity in care.

Further oral evidence sessions will be held this month then the commission will consult on a draft report and recommendations and plans to publish a final report during the spring of 2012.

Find out more about the Commission on Dignity in Care

Read the Terms of Reference for the Commission