Thursday, 6 January 2011

Welfare.


When the ConDem coalition started “liberating” the NHS, a colleague made a comment to the effect of “I hope they sort welfare out before they sort out healthcare.” This was a few months ago but some comments register and subsequent events have confirmed the incisiveness of this off the cuff remark within the context that it was made.

The “welfare” referred to here was social care in the UK as opposed to healthcare.

“Social care” is usually provided for by local councils via social services or social work departments. It is for things like home carers for elderly people, for example who help with preparing meals and dressing, or those with disability and a whole host of other things that aren’t strictly medical but often the line gets very blurred.

Since 1947 and the inception of the health service huge sections of UK society have realized that the old concept of “family” so beloved of any TV soap you care to watch has been replaced by any problem with anyone = ring the GP or go to A&E or ring social services. For many of our patients this is the default position.

An example might be a dementing relative living on their own in sheltered housing, becoming increasingly confused with an uncaring relative as the next of kin who is happy to pocket the benefits as the “responsible” adult/carer. If the relative’s carers ring and say there is a problem their response is to always ask for a home visit from a GP.

This is the current situation. The family don’t care. It is not their responsibility and they do not speak to GPs when requested to be present on home visit for often they don't bother to come. Social service carers ring for visits but they too are too busy to be there when GPs visit unless by chance. Home visits by GP are then useless for the demented patient perceives no problem and never remembers seeing the GP.

So who is responsible? Post 1947, clearly a priori the State, for when the family in the nanosecond they ring the NHS/social services are completely cleansed with bleach and Agent Orange of any iota of responsibility for their relatives because they cannot cope or more likely can’t be bothered.

If the NHS and social services cannot cope that ain’t the relative’s problem. They have their benefits and occasionally have paid their taxes too. (Note to readers this happens in both the least well off of society and those who could easily afford to pay it is universal).

So pre ConDems what happened? Social services would try and keep such people in their own homes but ultimately this was a no win scenario. The relatives become more drunk, sorry demanding, the patient becomes more frail and ultimately someone calls for divine intervention and dials 999.

Hear the Hallelujah chorus for instantly the family’s, together with the GP’s and social service’s, responsibility for a situation they can do nothing for is lifted for the demented uncared for by family Mabel is transported to A&E who realize that she cannot manage in anything other than a care home after she spends several days on a very expensive hospital medical ward.

This self evident fact was something that social services and GP had realized years ago but had been blocked by relatives and under the current rules of engagement we just play the game as per the rules. So Mabel becomes a bed blocker as relatives don’t want to lose her drink benefit they so freely spend.

This situation will tend to take weeks or months to sort out especially as the Mental Capacity Act will rear its ugly but well intentioned head and there are not enough psychiatrists to do the in depth assessments to determine Mabel’s mental capacity to make decisions for herself.

GPs and social workers know Mabel’s mental capacity is zero for they have seen it decline but the State thinks otherwise for Big Brother knows best. Mabel’s relatives are looking after their best financial interests and so will resist any change to their own personal vested interests.

So Mabel will block beds as Mabels and Georges have done for decades.

The problem is that there are more Mabels and Georges than ever and less hospital beds than ever. This is despite a 20% increase in population in our lifetimes, most of them elderly, and some councils up North are being forced to make 20% cuts in budgets with possibly the loss of 1 in 5 staff which will impact on social care which is becoming increasingly rationed usually on the cheapest, not necessarily the best, option available.

So will an at present cash strapped and under resourced council provided social service be able to cope with the Mabels and Georges as local authorities cut costs?

The answer is we don’t know as yet but the default position has been that if social care can’t cope Mabels and Georges become medical problems and hospital managers don’t like bed blockers for it deprives them of income. Doctors don’t like bed blockers for seeing the same face on wards rounds better, but going nowhere fast, deprives them of beds to treat ill patients.

So a reduction in social care, coupled with no real increases in healthcare spending and 100% bed occupancy is going to do what exactly? Discuss but remember what someone said at the start of the NHS liberation?

“I hope they sort welfare out before they sort out healthcare.”

Have they?

Praise be to the Party for by social cuts to the most vulnerable they will inevitably cut medical care to the more needy. Unless they sort out welfare well the health service is just going having to cope.

Is it time now for the Big Society (whatever that is?) or family (see above) to cope? Or do the ConDems know better . . .?

Logan’s Run anyone?

4 comments:

Anonymous said...

As someone who was a hospital social worker until 2002 and since a commissioner i think this analysis is a little too bleak. No doubt there are some families who regard their older relative as a source of income, Attendance allowance being the main culprit. Those who have not learned the skills of lieing on application forms or who fail to badger the GP for support, but struggle to just about cope, do not get it, but I have seen it awarded to a man who could play three rounds of golf a week. Not all familial relationship are happy and it is easy to criticise relatives, but if you were an abused child would you feel like giving up your middle years to caring for your former abuser? I frequently see comments, sadly sometimes from health staff who should know better, about uncaring relatives who put granhy in a home but d they seriously think they would liek to spend their lives looking after a demented relative, lacking insight, empathy, gratitude or personal hygiene? We often see people who drive themselves into the ground trying to look after an aged relative alone. Not every baby boomer has had a successful career, successfully exploited the housing market and ended up with an index linked pension at 55. Only a few poor decisions - divorce, illness, job loss or just bothering to bring up your own children instead of taking maternity leave and then bunging them in a nursery - may mean you face old age in poverty or in some dire rented accommodation because the family home your parents scrimped to buy has to go to fund their nursing home. The middle classes tend to take avoiding action early and often manage to obtain state funding because councils dont have the resources or the will to pursue them.

hospital discharge policy has become utterly ruthless, old people are given no time to recover, are assessed too early as 'no rehab potential' needing 24 hour care and find themsevles in a nursing home with their own wishes barely discussed. social services are forced to go for the cheapest option - no doubt a consultant will have been expensivly employed to override the judgements of permanent staff - and it is actually far cheaper to place someone in a home than try to support hem at home, past a cerain basic level. Community hospital and step down beds have been generally cut and replaced by intermediate care teams - fine for some people but these scenarios often fail disastrously with enormous suffering and stress for both the older person and families. Perhpas some people should try a week doing 12 hour shifts in a dementia home before they criticise families so easily.

My day to day knowlege of the current system has made me firmly decide to end my life before I get too old to have control over my destiny - and it is going to get worse. The big care homes businesses are losing money and soon we will see more atrocious care and suffering as corners are cut before shareholder dividends.

Anonymous said...

As someone who was a hospital social worker until 2002 and since a commissioner i think this analysis is a little too bleak. No doubt there are some families who regard their older relative as a source of income, Attendance allowance being the main culprit. Those who have not learned the skills of lieing on application forms or who fail to badger the GP for support, but struggle to just about cope, do not get it, but I have seen it awarded to a man who could play three rounds of golf a week. Not all familial relationship are happy and it is easy to criticise relatives, but if you were an abused child would you feel like giving up your middle years to caring for your former abuser? I frequently see comments, sadly sometimes from health staff who should know better, about uncaring relatives who put granhy in a home but d they seriously think they would liek to spend their lives looking after a demented relative, lacking insight, empathy, gratitude or personal hygiene? We often see people who drive themselves into the ground trying to look after an aged relative alone. Not every baby boomer has had a successful career, successfully exploited the housing market and ended up with an index linked pension at 55. Only a few poor decisions - divorce, illness, job loss or just bothering to bring up your own children instead of taking maternity leave and then bunging them in a nursery - may mean you face old age in poverty or in some dire rented accommodation because the family home your parents scrimped to buy has to go to fund their nursing home. The middle classes tend to take avoiding action early and often manage to obtain state funding because councils dont have the resources or the will to pursue them.

hospital discharge policy has become utterly ruthless, old people are given no time to recover, are assessed too early as 'no rehab potential' needing 24 hour care and find themsevles in a nursing home with their own wishes barely discussed. social services are forced to go for the cheapest option - no doubt a consultant will have been expensivly employed to override the judgements of permanent staff - and it is actually far cheaper to place someone in a home than try to support hem at home, past a cerain basic level. Community hospital and step down beds have been generally cut and replaced by intermediate care teams - fine for some people but these scenarios often fail disastrously with enormous suffering and stress for both the older person and families. Perhpas some people should try a week doing 12 hour shifts in a dementia home before they criticise families so easily.

My day to day knowlege of the current system has made me firmly decide to end my life before I get too old to have control over my destiny - and it is going to get worse. The big care homes businesses are losing money and soon we will see more atrocious care and suffering as corners are cut before shareholder dividends.

Anonymous said...

Wait until DLA becomes PIP in 2014 and is cut by 20% as promised. There will be a lot of people out there currently relying on their DLA to cope in the community who will now be looking elsewhere for that help.

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