Guest blog: Uncovering the incontinence taboo in social care

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Today’s guest blog is from Professor Paul Abrams, Chair of the expert group on LUTS and highlights the issues that arise when continence isn’t given the prominence it deserves.

According to the Department of Health, incontinence is second only to dementia as a precipitating factor in care home admissions and affects nearly 2 in 3 in nursing homes.

Despite this, new analysis published by the expert group on lower urinary tract symptoms (LUTS) demonstrates that the majority of local authority commissioners do not view incontinence as a priority.

Continue reading “Guest blog: Uncovering the incontinence taboo in social care”

Older people deserve better care in hospitals and care homes

This blog was contributed by Dianne Jeffrey, Chairman of Age UK and Co-chair of the  Commission on Improving Dignity in Care. 

Dianne Jeffrey CBE DL, Chairman of Age UK and Co-chair of the Commission on Dignity in Care
Dianne Jeffrey CBE DL, Chairman of Age UK and Co-chair of the Commission on Dignity in Care
I have always been clear that dignity and compassion must be at the heart of our health and care system.

This is why, in June last year, the Commission on Improving Dignity in Care for Older People (made up of, Age UK, NHS Confederation and the LGA) published its report, Delivering Dignity. It was the culmination of hundreds of written submissions and oral contributions from experts, clinicians and patients. In this report we set out a raft of recommendations for changing the way we design and deliver care as the numbers of older people who need care continues to grow. Continue reading “Older people deserve better care in hospitals and care homes”

Government responds to the Francis Inquiry

The first inquiry into Mid Staffordshire NHS Foundation Trust  catalogued extensive examples of neglectful care and appalling patient experiences. Stories of people being ignored, dehydrated, abused were visible signs of an organisation that had forgotten basic principles of care and at worst, wilfully put organisational considerations ahead of patients. Many, if not most, of the patients involved were older people.

The second inquiry reported in February and included 290 recommendations
that could help to avoid the same situation arising again, not just in Staffordshire, but throughout the NHS. You can see what we said about it in our blog. 440x210_care_home

The government yesterday gave its response to the report in a paper titled Patients first and foremost, and there’s much to be positive about in what it says.

The paper outlines changes to how services are regulated, reflecting an on-going review by the health and care regulator the Care Quality Commission (CQC). It describes much wider use of expert inspectors in hospitals including members of the public that bring expertise derived from their experience of care. Continue reading “Government responds to the Francis Inquiry”

Dying in hospital and the Liverpool Care Pathway

There has been a great deal of press interest recently in the Liverpool Care Pathway for the dying patient (LCP). It has been described in more colourful language, which I will return to later, but I should start out by explaining what it is – and just as importantly what it isn’t.

The LCP was developed in the late 1990s by a hospital in Liverpool and a local Marie Curie hospice. The aim was to bring high-quality hospice care for cancer patients to hospital settings. Later, this was expanded to non-cancer patients and has been adopted by a large number of hospitals throughout the NHS and other countries.

Why was (and is) this necessary? Modern hospice care emerged in the 1960s out of a desire to improve the experience of dying for terminally-ill patients. Hospitals are traditionally very good at delivering curative care, but do less well at caring for people whose greatest need is to be as pain-free and as comfortable as possible, and to have the reassurance that their families are supported to prepare and come to terms with a loved-one passing away.

The reality today is that the majority of people are in hospital when they die.  Though the circumstances may vary – for example they may have been recently admitted as an emergency, or they were being treated for an illness that they may not recover from – past reports have shown that poor experiences can be very similar.

Continue reading “Dying in hospital and the Liverpool Care Pathway”

Delivering dignity

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.

Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care
Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Carecare 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.

Find out more about the work of the Commission and read the final report

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

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”

Calling for your views on the Dignity in Care interim report

This blog was contributed by Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care.

Over the past few years we have seen report after report detailing shocking examples of care in our hospitals and care homes. In 2011 the Health Service

Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care

Ombudsman published its report Care and Compassionwhich told ten heartbreaking real life stories of older people subjected to undignified, degrading and harmful care. But the report was clear these ten accounts were the tip of the iceberg – they were not exceptional or isolated cases. So this begs the question ‘what exactly is going wrong in our hospitals and care homes? And what can be done to put it right?’

A determination to provide at least some of these answers led Age UK to join forces with the NHS Confederation and the Local Government Association to set up the Dignity in Care Commission. Our aim is to draw a line under the past, and focus relentlessly on what can be done in future to ensure each and every older person receives high-quality, dignified care. 

The Commission has now published their interim consultation report. We have heard expert evidence from right across the care system, including older people and their families, nursing, social care, medicine, management and commissioning. We have heard a great deal about the problems in the system and the impact on older people. But we have also heard much that is positive, highlighting where people are working with compassion and dedication to get it right.

This report is not a repetition of well-documented problems. Neither is it a best practice guide, much excellent work already exists and we have no desire to reinvent the wheel. Instead, we have focused on how to tackle the underlying causes of poor care which too often means excellent practice and innovation does not flourish.

We now welcome views from the public, professionals and organisations across the system on the detail of this report. We want to know whether there is anything fundamental that we have missed, or whether we should go any further in the changes we recommend and why. Most importantly, we want to know what we can do to make sure these changes take place. This is not a report intended to sit on our library shelves, we are committed to working collectively to bring these recommendations to life.

Read the interim report and submit your views

Find out more about the launch on the Age UK website