The BMJ have run a series of articles discussing the fate of the NHS after the major NHS reforms are implemented this week. For liks to the articles please click the following links:
http://www.bmj.com/press-releases/2013/03/26/does-1-april-mark-end-nhs
In July 2011, economist Andrew Dilnot published his proposals on how to fund adult social care and make it both sustainable for the state and affordable for the elderly.
18 months later Health Secretary Jeremy Hunt has responded with the Government’s plans to revamp the care funding system in England.
We take a look at four changes to how social care for the elderly will be paid for – both privately and publicly – going forward:
Around 10% of people currently end up paying over £100,000 in care costs as they grow old.
From April 2016, the amount you’ll have to pay for “standard-rate” care in England will be limited to £72,000 with the rest paid by the state. This was originally set to be capped at £75,000 and starting in 2017.
However, if your non-health costs exceed this standard-rate then you’ll likely need to make up the difference even after hitting the £72,000 cap.
Non-care costs such as food and accommodation aren’t included in the cap, and these ‘hotel’ costs can account for as much as £7,000 to £10,000 per year in today’s money, which you’ll need to pay on your own.
The Government’s cap almost doubles Dilnot’s preferred £35,000 figure, even after inflation is added; it means 16% of over-65s should face cheaper bills (compared to the 37% that would have been helped under Dilnot’s proposals).
It is hoped that setting a worst-case-scenario upper limit for how much you may need to pay will at the very least give you a target to plan for financially, against your future care needs.
The Government also hopes the cap will also encourage insurance companies and even pension providers to start providing for social care into their policies, although it has been disputed in some areas whether this will actually happen.
Currently, elderly people who need to move into a residential care home are eligible for means-tested Government support if their total assets are worth £23,250 or less. £14,000 or less, and it’s free.
From April 2013, you will be able to claim some form of means-tested Government support for residential care up to a personal wealth threshold of £123,000. That figure is more or less in line with Dilnot’s proposals, taking into account inflation.
The Government hopes to generate 80% of its expected £1bn annual spend on social care from extra National Insurance contributions which will start alongside the single-tier state pension in 2016.
The remaining 20% will be funded by freezing the existing Inheritance Tax threshold at £325,000 per person (£650,000 for couples) for an extra three years, until 2019.
Currently, social (personal) care is available free to all pensioners living at home.
For elderly people living in residential care homes, the Scottish Government makes a flat rate contribution to your personal care or nursing costs, while ‘hotel’ or accommodation costs are means-tested.
However, at a current cost to the Scottish taxpayer of £500m per year there are concerns that Scotland too will face a social care funding gap as costs continue to grow.
There is currently a £50 per week cap on how much you’ll pay for care, provided you’re living at home and receiving non-residential services. However, there is no current cap on contributions toward residential care.
The Social Services and Well-being (Wales) Bill was introduced to the Welsh Assembly for consultation in January 2013; the effects of the changes made in England will be considered during its consultation prior to adopting or rejecting its measures.
Proposals for revamping social care in Northern Ireland were published in 2012, with consultation and review ongoing. Currently your personal assets are means-tested for Government support, similar to in England and Wales.
Read more: http://www.money.co.uk/article/1009567-social-care-changes-what-they-mean-for-you.htm#ixzz2Os863Xqj
Help the Hospices welcomes the publication of Monitor’s Fair Playing Field Review, which explores issues affecting the ability of charities to deliver NHS services.
For over 40 years, local charitable hospices have provided the vast majority of hospice care within the UK, caring for over 360,000 patients and family members each year. They provide over 80% of the specialist palliative care inpatient beds within the health care system and are major providers of home based care, yet they are frequently disadvantaged compared to other types of healthcare organisations.
The Health and Social Care Act 2012 placed a requirement on the Secretary of State to report back to Parliament on the way in which the health care system operates for different types of organisations. This requirement was influenced by a campaign led by Sue Ryder and Help the Hospices to encourage the Government to address the additional VAT costs that hospices face. Under current tax rules the NHS is able to recover VAT on certain non-business supplies that charitable hospices cannot. Hospices often cover this ‘VAT gap’ with charitable donations, diverting resources away from vital services.
Jonathan Ellis, director of policy and parliamentary affairs at Help the Hospices, said:
“With an ageing population and growing demand for end of life care, there is an urgent need to level the playing field for local hospices to support and develop their role as leaders, educators and major funders of end of life care within the communities that they serve.
Most of the funding to provide hospice care comes from local people, not from the Government. Addressing the VAT burden on charitable hospices would help them in a difficult economic climate to use charitable funds to do what they do best – provide more care to more patients, families and carers in the local community.
Hospices are unique among providers of health and social care because they contribute so significantly to the funding and provision of end of life care – raising more than £30 for every £10 of government funding. As the report acknowledges, there is a need for stronger partnership working, using the expertise of both the third sector and the NHS to renew focus on providing services for the benefit of the patient. It is now up to commissioners and care professionals to work in partnership to turn this into reality.
We welcome the approach that Monitor has taken in conducting this review, listening to the voice of local hospices and we now encourage the Government to take early steps to deliver greater fairness for charities like hospices.”
Publication date: 05 Mar 2013
Medical registrars are struggling to cope with “unmanageable” workloads, jeopardising the safety of patients and the quality of hospital care and compromising training, the Royal College of Physicians has warned.[1]
Hospitals cannot afford to let the situation deteriorate any further, concludes a report from the college on the future of the hospital workforce. The report draws on evidence gathered in 2011-12 from online surveys and face to face interviews with 2800 medical registrars (doctors in the later stages of training to become consultants and who specialise in hospital medicine rather than general practice or surgery) in England.
Hospitals are too reliant on medical registrars to provide the bulk of hospital services, particularly at night, the report says. More than one in three (37%) trainee doctors described the medical registrar workload as “unmanageable,” and more than half (59%) said it was “heavy.” Just one in 20 GP registrars thought this way about their workload.
This situation threatens patient safety and heightens the risk that the most able junior doctors will be put off pursuing a career in acute hospital medicine, the college suggests.
Its report calls on hospitals to review the workload of medical registrars and their associated teams as a matter of urgency. Hospitals should adjust rotas and redistribute basic clinical and administrative tasks to other staff, it says. Additional resources should be provided when the workload puts patient safety at risk, it adds.
Hospitals also need to change as a result of the increasing number of female trainee doctors in the workforce, the report says. It recommends that local education and training boards promote flexible training posts for medical registrars to ensure that women don’t desert medical specialties.
The report also argues that the quality of training provided is too variable and that training is further compromised by registrars’ heavy workload. Only 38% of registrars thought that their training in general medicine was “good” or “excellent,” compared with 75% in their main specialty.
Medical registrars and other trainees should routinely attend post-take reviews of all patients they have dealt with, including ward referral patients, the report suggests. Hospitals should also ensure that medical registrars can maintain their practical skills, including specialty skills required of them.
The report calls on the Department of Health to reassess the value of the second year of foundation training for those wishing to specialise in hospital medicine and to explore the benefits of extending core medical training.
The uneven distribution of consultants around the country serves to compound problems in the medical registrar workforce, it says. Patients in London have almost double the number of consultants per head of the population as those in the East Midlands, it points out.
Andrew Goddard, director of the Medical Workforce Unit at the Royal College of Physicians, said that medical registrars were the “unsung heroes of hospital care.” He said, “Their skills are not being used to best meet patients’ needs. The NHS will soon struggle to provide the best care for patients if this situation is not urgently reviewed.”
The data on the availability of consultants across the country reflected poor workforce planning, he added. “National and local education and training structures must get to grips with this straight away,” he urged.
Ben Molyneux, chairman of the BMA’s Junior Doctors Committee, said that medical registrars’ excessive workload was bad for training and for patient care. He called for hospital services to be redesigned.
“If we don’t do this we risk the next generation of consultants avoiding careers in acute medical specialties,” he said. “All junior doctors should get decent training and be properly supported if we are to deliver the highest standards of care for our patients.”
Caroline White freelance journalist, BMJ
Authors: Caroline White
Current doctors are more likely to train and work near where they grew up than previous generations were, indicates research published in the Journal of the Royal Society of Medicine.[1]
The authors assessed the geographical mobility of more than 31 000 doctors who qualified in the UK between 1974 and 2008, though cohorts that qualified after 2000 were excluded from some comparisons because they had not progressed far enough in their careers for the comparisons to be valid.
The proportion of doctors whose first career post was in the region where they trained was higher among those who qualified in 2000 (78%) than among those who qualified in 1974 (51%). The proportion whose first career post was in the region of their medical school was also higher in the 2000 cohort (50% versus 36%).
Overall, more than a third of doctors (36%) had gone to medical school near their family home, and almost half (48%) undertook specialty training in the same region as their medical school. Once they became hospital consultants or GP partners, a third (34%) settled in the region where they had lived before becoming a medical student.
The researchers said that younger doctors’ career expectations and practice patterns seemed to differ from those of their older colleagues. “Younger generations are more likely to take into account the preferences of their spouses than older generations,” they wrote. They added that greater emphasis in recent years on “work-life balance” may have prompted more doctors to stay close to their parental home.
But they warn that a reluctance to move could be problematic for patients and lead to an inequitable distribution of doctors around the country.
“We are already aware that the equity of distribution of general practitioners in England has fallen since 2002,” they wrote. “Reduced geographical mobility may not be sustainable: doctors have to go where the jobs are.”
HealthCare Chaplaincy has announced the publication of the new, expanded edition of the free “Handbook of Patients’ Spiritual and Cultural Values for Health Care Professionals.”
Cultural and spiritual sensitivity contributes to patient-centered care and, in the United States, helps meet Joint Commission requirements.
Cultural and spiritual sensitivity requires knowing what those values, beliefs, practices, and traditions entail.
That is why a number of years ago HealthCare Chaplaincy in New York introduced its first Handbook (or Dictionary) of Patients’ Spiritual and Cultural Values for Health Care Professionals and made it available for no charge on its website.
Sandra Stimson, executive director of the National Council of Certified Dementia Practitioners, said: “The handbook is a guide that should be on the desk of every person who is working with patients – including chaplains, physicians, nurses, activity professionals, volunteer coordinators, recreation therapists, dieticians, dietary managers, social workers, admissions staff, discharge planners, administrators, physical therapists, occupational therapists, speech therapists, nursing assistants, etc.”
The handbook, currently 89 pages long, is updated periodically when HealthCare Chaplaincy obtains new or revised information from specialists in a given area. This new edition adds content on three areas not covered before – Africa, Asia, and Hawaii and standardizes the categories.Download it as PDF file.
HealthCare Chaplaincy encourages the use of this free handbook by health care professionals, and requests, when distributing it, credit as follows: “This content is used with the permission of HealthCare Chaplaincy in New York, the leading multifaith organization for the integration of spiritual care within health care and palliative care through research, professional education and clinical practice.” Learn more on the HealthCare Chaplaincy website.
HealthCare Chaplaincy welcomes new contributions for content and feedback on the handbook’s value for one’s organization. Please send those to the Reverend George Handzo.
Credit for the new content on Africa, Asia, and Hawaii goes to:
Additional cultural sensitivity resources are available on HealthCare Chaplaincy’s website, including “Cultural & Spiritual Sensitivity – A Learning Module for Health Care Professionals” along with links to materials from the Joint Commission, City of Hope Pain & Palliative Care Resource Centre, and the Association of Professional Chaplains.
The National End of Life Care Programme in the UK has helped increase the proportion of cancer deaths that happen at home and in hospices, and reduce hospital deaths.
In a new study published in PLOS Medicine, researchers found that there has been an increase in the number of home and hospice deaths for people with cancer since 2005. They suggest that this is due to the work of the National End of Life Care Programme, which was established in 2004.
The researchers used death registration data from the Office of National Statistics to identify place of deaths for all the adult cancer deaths in England between 1993 and 2010. They then used this data to look at the changing pattern of place of death, and identify the factors that influenced place of death.
Over the period of the study, 48% of cancer deaths occurred in hospital, 24.5% at home, and 16.4% in hospices. The proportion of deaths at home and in a hospice increased from 2005, while the proportion of hospital deaths declined.
The research identifies cancer site, marital status and age as the three most important factors associated with place of death for patients with cancer – patients who died from haematological cancer, who were single, widowed or divorced or aged over 75 were less likely to die in home or hospice.
They also highlight a ‘worrying trend’ that shows that the differences between place of death for those who lived in advantaged and disadvantaged areas widened during 2001–2010.
The authors call for further efforts to reduce hospital deaths and increase home and hospice deaths. They suggest that people who are single, widowed or divorced should be a focus for end of life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age and deprivation.
Use of the Liverpool care pathway for end of life care has been heavily criticised in the media. The BMJ and Channel 4’s Dispatches asked doctors for their views.Krishna Chinthapalli reports in this BMJ feature.
Amara Nwosu