Christmas day: Up early; Christmas presents opened; nappies changed; chicken pox still problematic; hospice visited – nurses appreciative; Christmas day church service – very nice; one turkey (and another turkey); Queen’s speech; tired 3 year old; curious 6 month old; tired 30-something’s.

Boxing day: The beach; The M6; gammon; motorised trains; pink champagne; the Bible TV series; exhaustion.

Today: Picture hanging; birthday party planning; watch fixing; shopping; cleaning; bathing; Charlie Brooker; whiskey.

This weekend I was in a Huddersfield with family. We had decided to conduct fireworks this weekend as I was attending the BMA academic trainees conference the weekend before. My four month old child had taken an uncharacteristically long time to settle in the evening and was waking up several times, hourly, that night. At 3am I elected to take him downstairs to see whether he would settle there, and to also provide my wife with some much needed rest.

On navigating downstairs I made my way to the conservatory, which hosted a long sofa that I could lie down on. The conservatory provides excellent views of the Yorkshire dales which, despite the neighbouring M62 motorway, offer low levels of light pollution of the night sky. Consequently, I was rewarded with a wonderful panorama of the night sky, which the belt of Orion, Venus, Sirus all easily visible with the naked eye. Almost immediately I saw a beautiful shooting star; the first time I’d seen such a sight. I’ve grown up in cities where it is often difficult to see any stars at night – this was a real blessing. Theo promptly fell asleep in my arms, almost as if he was satisfied with the event. I sat on the couch for a few minutes to ponder what just happened, after which I took him back upstairs where he slept soundly until the morning.

The night sky is really beautiful. I’m convinced Theo wanted to see it and show me the shooting star. It was really lovely; I thank God and Theo for such a nice moment.

Liverpool Care Pathway independent review: public call for evidence launched – News stories

https://www.gov.uk/government/news/liverpool-care-pathway-independent-review-public-call-for-evidence-launched

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

http://www.bmj.com/content/346/bmj.f1951

http://www.bmj.com/content/346/bmj.f1975

Source: money.co.uk

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:

1. £72,000 cap on how much individuals will pay

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).

2. How will you and I be able to pay for it?

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.

3. Means-testing threshold to rise from £23,250 to £123,000

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.

4. How will the Government fund its part?

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.

5. What about Scotland, Wales & Northern Ireland?

Social care in Scotland

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.

Social care in Wales

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.

Social care in Northern Ireland

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

Source: BMJ Careers

Authors: Caroline White 

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

cwhite@bmj.com