Older Mind Matters

Post NHS health care

Dave recently asked:  “What's your take on ‘any willing provider' and the Lancet's analysis that the NHS is at risk of transformation in all but name to something else. In particular how will this affect older people.”  

What a question! It really set me thinking.

The Lancet article concludes “as it stands, the UK Government’s new Bill spells the end of the NHS.”

As a voter and citizen, I certainly had no idea that this was what was at stake when I cast my vote in the general election.

As the adult child of two parents struggling with multiple health problems it fills me with foreboding.

As an old age psychiatrist, I am gravely concerned about the possible implications for older people with mental health problems and in particular dementias.

I worked in the NHS for a number of years and I know that practitioners are very good at trying their best to make the system work on the ground despite the many changes that politicians throw at them (at considerable cost to themselves), but I also know how difficult it has become to provide a service at a time when money is tight and pressure on organisations relentless.

 I also know that whatever we say, and however important dementia is in demographic, financial and human terms, we are still up against prejudice and stigma.

Dementia is a result of brain disease and yet it’s all too easy to label people’s needs as ‘social’ to get them out of the healthcare budget.

Dementia services and dementia research just don’t have the impact on the media, the public and the politicians that cancer and other conditions have, despite the best efforts of the Alzheimer’s Society and others.

Mahatma Ghandi is credited with saying: "A nation's greatness is measured by how it treats its weakest members."

My challenge to anyone out there who reads this is this: how can we help people with dementia and their families to get the care they need in a post-NHS healthcare system?

PS. I am a member of the West Midlands Dementia Community blogging team and originally wrote this piece for that blog - you can read and comment on our Dementia Community blog here.

PPS. Until today I had avoided controversy in this blog and confined myself to OMM work. I'm wondering whether I should use it to flag up important issues as well ...

PPPS this is a link to Care and Compassion

5 comments (Add your own)

1. Emyr wrote:
I'll only comment on one issue, where our recent, and not so recent experience, experience in laboratory medicine might help you understand "any willing provider". We have been threatened by "willing providers" for a long time, but what they are willing to take off our hands are high volume, low cost tests where a small profit per unit turns into a large turnover. They don't want the complex stuff: we've even had to face the possibility that Boots the Chemists would perform full blood counts - but they'd want no part of investigating the cause of your anaemia or leukaemia. The government was even willing to allow these willing providers to avoid the stringent accreditation standards that NHS laboratories have to meet, just to allow them a toe-hold. Dare I suggest that there may be just one or two nursing homes that have demonstrated a greater willingness to take the profit than to provide an acceptable service? Or have my trips to the Coroner’s court made me sceptical?

Tue, February 15, 2011 @ 1:55 PM

2. Angela Hill wrote:
In my position as chair of the Support Association for Mental Health part of the remit I have is to supervise users who visit the wards at Bushey Fields, this is adults and older adults, I myself cover the dementia ward. One thing that is very obvious that relatives of the patients rely very heavily on professionals to make the decisions necessary, the main one being the social worker. I hear the social worker says he or she would be better in this home, a home that is totally unsuitable and means a lot of travelling for the family.
Advise them to challenge the social worker or any professional its I could not do that, I would and do. This attitude of professionals (not all ) worries me because these vulnerable elderly can not stick up for them selves.

Dudley and Walsall Mental Health Partnership Trust in their wisdom have very good dementia services (so I am told) in Walsall and what as Dudley got a sensory room, marvellous. Funding that was given to Dudley as some how disapeared to cover some deficit or other no doubt.

In another hat that I wear as the Mental Health Lead for Dudley Link a letter as been written to a random sample of six nursing home who in their profile say they have dementia beds. Under the guise if hygiene and nutrition questions were asked, kind of slipped in, questions like whats your staff ratio to residents on the afternoon shift, from a previous life I know what it is, Not one home replied direct, they went through DACHS (local authority) so now we are going along the enter and view approach, see what happens.

Tue, February 15, 2011 @ 7:19 PM

3. Julie Grainger wrote:
People with dementia are indeed stigmatised - I can only comment on the small way we at Wolverhampton try to help reduce stigma and help people with dementia and their famillies through our own Alz Cafe. We have recently made it independent from statutory organisations. We have become self funding (through fund raising and donations) with our own set of guidelines which suit our attendees - the structure of the cafes has been informed by the attendees and we have three carers on our 'steering group/committee to keep informing us about what the people who really matter need and want. Fortunately my own work colleagues (mainly from the OT dept) are as passionate about it all as me and willingly give their time to make the cafe a welcoming and comfortable place. We have had fantastic feedback from those who attend and attendance figures are rising. I think the point I'm trying to make is that if we can do it surely this sort of thing could be replicated elsewhere? But I do worry and wonder where it will all end?

Tue, February 15, 2011 @ 9:03 PM

4. Dave J wrote:
Thanks for the opener and the comments

This is surely a massively important matter. As Emyr says the commercial model and the management language which supports it do not fit with the complex health and psycho-social care needs of individuals or populations. At every turn patients and families ask for personalised patient-centred services and politicians say: 'Yes that's right'. But Commissioning (World Class!) breaks services down into fragments which can be bid for piece-meal, allowing big organisations to Cherry Pick those low risk elements which can generate a high yield with little or no regard for the need for comprehensive, flexible, integrated responses.

Even within the present system there are weaknesses and omissions together with poor practice. This week we have the Ombudsman's report 'Care and Compassion' (ironic title I think) which uses care summaries to illustrate some of the worst examples of CareLessness within hospitals and the community. The stories of Mr W and Mr L are particularly pertinent for those of us in the dementia field. What do you make of them?

The suggestions from both Angela and Julie are very helpful. It is people who might make a difference to improve what we do now. People must be given the right to monitor and control changes in practice which are being initiated within public services

Thu, February 17, 2011 @ 10:51 AM

5. Susan wrote:
Thanks for the comments.
Emyr comments that the providers in laboratory medicine don’t want ‘complex stuff’ and refers to the world of turnover and profits. I agree with Dave that unfortunately older adults with complex comorbidities don’t fit neatly into this Big Business world and one of the risks is that quality (which we already know to be variable, see Care and Compassion) slips even further down the agenda. How do you cost in care and compassion? (I’m glad that Dave has raised the ombudsman’s report – sobering reading for us all.)
Angela argues that people using services and their families need to be more assertive in challenging the care and advice they are offered. I agree wholeheartedly but I also think that health and social care professionals have a responsibility to support service users and families in standing up for flexible person centred services that meet their needs. That can face staff with a conflict of interest if their own organisations are the ones providing inflexible or inappropriate services.
Julie provides a ray of hope in her description of an innovation she’s involved in but asks where it will all end. I worry about that too. We know a lot about how to provide good care and support for people with dementia and other mental illnesses in late life but good care and support costs money and I think one of the fundamental issues is that we still don’t see older adult services as worth the investment. That’s rather worrying as we all hope to grow old and, looking at the figures, pretty soon we’ll be the ones using whatever services are left.

Mon, February 21, 2011 @ 2:45 PM

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