This blog was contributed by Dr Nick Goodwin a speaker at Age UK’s annual For Later Life conference. Nick is CEO of the International Foundation for Integrated Care and a Senior Fellow at The King’s Fund, London where he leads their programme of research and analysis for improving and integrating care for older people and those with long-term conditions.
When my elderly father was in hospital recently his experience of an uncoordinated, chaotic and impersonal service was both dispiriting and disturbing to both him and his family. Whilst clinical decision-making was good, and as a result his physical health returned through the miracles of blood transfusions and intravenous antibiotics, the experience undoubtedly took a large piece out of his mental wellbeing and future self-confidence.
The underlying problem was a lack of care co-ordination. The lack of information sharing on diagnosis, procedures, results and next steps led to worried waits about the seriousness of his condition and what, as a family, we needed to put in place for home care support. Different and conflicting advice and feedback from doctors and nurses was unhelpful. The lack of communication between wards, and between nurses on the wards, meant that his medication regime for Parkinson’s was often ignored despite constant reminders. No help was given to support discharge, and no plan put in place. Continue reading “Guest blog – Mad as hell: Older people must demand a better care experience”
This guest blog was contributed by Richard Humphries, Senior Fellow at The King’s Fund. Richard joined The King’s Fund in March 2009 to lead on social care. His professional background is social work, having worked in a variety of roles including Director of Social Services and Health Authority Chief Executive (the first combined post in England).
Age UK’s new report – Care in Crisis 2012– is the latest clarion call to sort out a care system which even Government ministers accept is broken. The report sets
out in stark detail just how many people are going without the care they need. Public spending on care for older people is actually going down even though numbers are going up – especially frail very old people who need the most care. England is no different from all advanced countries in the world that need to devote a bigger share of the national wealth to an ageing population – itself a sign of social and economic success. Yet we are finding it remarkably difficult to rise to the challenge.
Here are four things you may not know about England’s social care system. It has its origins in the 1948 National Assistance Act when the world was a different place, with much lower standards of living, health and wealth. 64 years on, the care system must be the only public service that has never been fundamentally reformed to keep up with changing times (although it has been frequently reorganized, which is not the same thing). We wouldn’t dream of running any other major service as though we were still in the 1940s. The system has suffered from years of policy tinkering instead of sensible long term reform.
Second, if you have savings or assets of more than £23,250, you will be entirely responsible for the full cost of residential care, a cliff-edge so steep it makes Beachy Head look like a gentle slope. Many people do not realize this until it is too late. Some think , wrongly, that the NHS will pick up the bill.
Third, that even if you are relatively poor, it is unlikely that your local authority will help you. 82% of councils limit the help they provide to those with ‘substantial’ or ‘critical’ needs i.e. you will need to have become very dependent indeed before you can get help. England must be unique in simultaneously restricting help to those with the highest needs and the lowest means.
And finally, that your chance of needing care and support in later life is much higher than you think – one third of men and a half of all women will have a significant care need at some point in their retirement. So we all have a stake in seeing a better system fit for the 21st century.
The King’s Fund has been arguing the case for change, alongside many other charities, since our major review by Sir Derek Wanless in 2006. Since then White Papers and Green Papers have passed like ships in the night. The Government pledged to set up an independent commission to look at how care is funded. It delivered on that commitment and the commission headed by eminent economist Andrew Dilnot has produced proposals that command almost universal support from organisations involved in older people’s care. We agree that they offer a sensible framework in which the costs of care can be met. But reform of funding must go hand in hand with reform of how care is delivered.
The Age UK report sets out seven major building blocks for change including quality, safety and dignity in care. The Government will soon set out its stall in a White Paper and accompanying response to the Dilnot report – its authors could do worse than make sure Care in Crisis 2012 is top of their preparatory reading list.