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Discussion in 'Dementia-related news and campaigns' started by la lucia, Nov 29, 2016.
Hammond facing growing Tory rebellion over social care crisis
He was asked about funding today in parliament. Gave a very brush offish reply.
I think a big issue other than funding is compartmentalising of funds. To give an example on funding. If someone has a procedure and is treated/ discharged as a day case, provided they are not readmitted within x number of hours, that is classed as a complete episode and suits statistics / targets and funding allocations. Now a day case procedure is certainly appropriate for some but most definitely not all but the emphasis is on fitting people into the day case scenario. However, the community and social care sections do not work with the acute sector as they used to. When I was nursing, part of admission planning was looking at and co-ordinating all needs pre and post admission. For example X was fine to go home, Y couldn't go home after one day and so a longer stay / transfer to a convalescent hospital was arranged with relevant aftercare.
My reason for a relatively easy example is that care was managed so much better when the teams worked together and there was a holistic approach to care.
This doesn't happen now as different sections are desperately trying to protect their budgets and targets even though that is obviously to the detriment to the patient. Well managed and co-ordinated care between the different sectors would be an overall benefit with consequent benefits to overall finance.
Does anyone else remember the hospital almoner which became the Discharge Liaison Team in my time. Don't think they exist now sadly.
There's a discharge planning nurse who may or may not work with the hospital social worker. As many of us know, it's important for relatives to flag up problems to both these jobholders when we feel a discharge home (or to previous accommodation) wouldn't be safe. Desperate NHS staff may be too ready to send home someone vulnerable to clear a bed for another patient who's in dire need of it.
Would PLEAD with you all to check out the draft NHS Sustainability & Transformation Plans (STPs) for your area. nitram has provided details of which areas are covered by STPs in the thread I started on STPs.
These local plans have the common thread of closing acute and community hospitals, selling off the sites and pushing healthcare onto the GPs (who are in no state to take up the slack - they're hard pushed to keep primary care going as it is, they can't take on the workload the hospitals used to carry out and they haven't got the kit, buildings or training to do so). My area's plan is fairly typical - planning to close one in 3 of our acute hospitals (including a national centre for kidney disease and urology) and 2 of our community hospitals and to push the work onto GPs (in spite of press articles from GPs saying they've reached crisis point, can't recruit new doctors, have GPs wanting to retire but unable to ... and all the rest of it).
Our plan says optimistically that the patients no longer able to access hospital beds will be cared for in their own homes. I'm wondering just how the many patients in the early stages of dementia are going to manage the new challenges of self-caring while they convalesce from moderately severe infections, cancer and the like.
I'm also wondering how such patients and others can be expected to cope at home when the home accommodation isn't fit for the purpose. When my Mum had broken several vertebrae and was simultaneously well advanced in dementia, unsteady on her feet, unpredictable, sometimes violent, averse to taking medication and doubly incontinent how was my Dad to provide safe care when there was no accessible downstairs loo or bathroom? The only safe, best and cheapest answer was to give Mum a bed in the community hospital - already a rare resource, now to become much rarer.
There are millions of patients and carers dependent on receiving at least the same level of NHS services as we've got now. I dread to think what will happen to all of us if these service levels are reduced.