This blog was contributed by Dr Dan Poulter,Conservative MP for Central Suffolk and North Ipswich and a member of the Health Select Committee
Yesterday’s announcement by the Secretary of State for Health on the Government’s plans to radically reform the way we support and care for our older people is both welcome and long overdue.
For too long, our frail older people have been pushed from pillar to post when attempting to navigate our unwieldy social care system. The Caring for our future White Paper shows that this Government is getting to grips with reforming the system of social care so that frail elderly people are treated with the respect and dignity they deserve.
Alan Walker closed the twentieth Pensioners’ Parliament with a rousing speech which celebrated the achievements of the National Pensioners Convention, but also warned of the challenges ahead.
His challenges were especially chilling. Professor Alan Walker is a distinguished and sober academic, not given to wild assertions. He identified three arguments which the pensioners movement needs to take seriously.
There is a relentless threat to public and welfare services, driven by the belief that public services are bloated and bureaucratic whereas the private sector is lean and efficient.
Older people are expensive. Their ‘perks’ (bus passes, Winter Fuel Payments etc) cost the tax-payer about £5bn. But he argued that ‘perks’ for rich people -such as the higher rate income tax relief on pension contributions – cost much more, and in fact the benefits offered to pensioners are actually vital to the quality of life of most. We let the language of ‘perks’ gain purchase at our peril.
Older people are lionising precious state resources and cheating younger people of their opportunities. They are exploiting their electoral weight to feather their own nests.
These are all, Alan argued, baseless propositions, but compelling propaganda has been rooted in baseless propositions in the past. The NPC, he reminded his audience, is nothing if not a campaigning organisation, and rebutting these modern myths must be a top priority.
In seven separate debates over the three days of the Parliament, the delegates had focussed on current hot topics – social care, fuel poverty and pensions had a lot of attention. Rural areas were recognised as presenting special problems for older people. But throughout all the debates, the themes picked out and
crystallised by Alan Walker had been expressed and articulated by delegates. At least two participants in the transport debate flounced out in rage when one of the platform speakers suggested that we need an evidence base on the social inclusion facilitated by free bus passes to legitimise their continuation. There was anger that wealthy pensioners ostentatiously giving away their Winter Fuel Payments diminished the real lifeline that this money represents to millions of poor pensioners.
There was also anger that Paul Burstow pulled out from his speaking slot on the grounds of Parliamentary business (in Westminster). The NPC always looks forward to giving Government ministers a hard time, and delegates vented their disappointment by purchasing a large cabbage and placing it prominently on the rostrum. And throughout the proceedings, there was real frustration that the Government was still unable to show the necessary energy and determination to bring forward reform proposals on social care, and fix a system which has long since been past its sell-by date.
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This blog was contributed by Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care.
After many years’ service in health and social care I have seen much in both to be proud of. I have witnessed excellent examples of compassionate care, met many dedicated staff and seen how high-quality services have transformed lives.
Yet I have also been deeply saddened by the knowledge that in too many cases care has fallen short of these standards, letting people down when they are vulnerable and most in need of help.
That is why I have been delighted to co-chair the Commission on Dignity in Care; an independent commission established by Age UK, the NHS Confederation and Local Government Association to bring together expertise from right across the care system, including nursing, social care, medicine and commissioning with the voices of older people and their families.
Our aim was to help health and social care sectors to find long-term solutions to tackling poor care that work on the ground. We recognise that this is a difficult task, there are no silver bullets. Instead we wanted to understand the roots of poor care and find ways to support people to take action in their own organisations.
Today, just a little under a year since we began, we publish the Commission’s final report Delivering Dignity. The report’s main message is clear. Leaders in the health and social care sector must drive a “major cultural shift” to tackle the underlying causes of poor and undignified care of older people throughout care homes and hospitals.
The NHS already has ‘never events’, things that are considered so serious they should never happen, like operating on the wrong part of the body. The Commission has recommended ‘always events’, things which should never be forgotten and should be considered as basic rules for the delivery of dignified care in every hospital and care home.
This may all sound a bit theoretical at first glance. However our report has made 37 clear recommendations for steps that could practically be taken by people at every level from front line staff to board members. Ultimately it is the individual actions of people in the system doing the right thing which adds up to major change.
Delivering dignity will mean changing the way we design, pay for, deliver and monitor care services as the numbers of older people in care continues to grow. Alongside the consistent application of good practice and the rooting out of poor care, we need a major shift in the system to ensure care is person-centred and not task-focused.
This will require empowered leadership on the ward and in the care home, as well as a lead from boards and senior managers. It will also mean changing the way we recruit and develop staff working with older people.
We have to work with older people to shape services around their needs, and listen to patients and residents and their families, carers and advocates so we learn from their feedback and continually improve dignity in care.
We are also clear that it is the leaders of health and social care who are responsible for driving better quality care. Regulation and government action has a critical role to play, but it cannot alone deliver the cultural and organisational change that may be necessary.
In February we published an interim report to consult on our proposed recommendations. We were overwhelmed by the hugely positive response it received, with over 230 responses from across the health and social care sector, patient groups, members of the public and professionals. This clearly demonstrated to me just how passionately people feel about getting care right for older people.
Our next challenge is harnessing this passion and commitment to drive forward implementation of our recommendations.
I don’t underestimate the scale of this task and know we won’t see changes overnight. But from the very beginning we were determined that this wouldn’t be just another report that sat on shelf gathering dust.
In the autumn we will be launching an action plan. We will be seeking to work with people from across the health and care system, professionals and older people to make sure change happens.
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.
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”