Would you, in any circumstance pay to have someone visit your relative whilst they are in Hospital or a care home?

The Patient Advocacy Service is piloting what would appear to be a contentious service in the Nottingham area, according to todays’ Sunday Express.  In an article entitled,

“Hire a hospital visitor for £25 to escape the “chore” of mercy trips” 

The article and subsequent “Sunday Express Opinion” page questions the ethics of paying for a visitor and infers that people who would use a paid visiting service would do so to escape from the “chore” of visiting a relative.

Indeed, in an ideal world a service like ours would never get off the ground because family members would rally round the bedside, offering the solace, comfort and support needed by the ailing relative. Family members would chat with the nurses and get updates on how their loved one spent the night and maybe have a word with the doctor whilst on his or her round. They would pass on family news and gossip, bring in treats, fresh toiletries, books and newspapers. Any areas of concern would be addressed and if eating was a problem, for instance, then a family member would offer to come in at each mealtime to help feed the patient.

But what about those people whose family members live in another part of the country or abroad, or that don’t have any relatives. And what about the millions of people who do visit regularly but need a break or can’t visit as often as they would like because of work or family commitments or illness – what then?

We live in a world that upholds social mobility as one of the great benefits of a free society, but one of the consequences of this is that families are no longer together in one place. Consider your own circumstances. Do you have anyone in your family who lives and/or works away? Could you if the necessity arose, get to visit them in hospital or a care home on a regular basis. If the answer is “yes” then great! You won’t be needing us, but if it’s a “No” then there may be occasions when a”paid for” visiting service could be of some use.

The intention of this service is to provide reassurance to the patient and the relative alike that they are receiving the best possible available care whilst they are in Hospital or a care Home. It is not a substitute for a caring relative, but an additional service, another pair of eyes to double check that all is OK. It can offer respite for busy people. It can also, be put in place by the patient themselves before they undergo a hospital procedure, a kind of “check up on myself and look after my estate service”

But why not use a volunteer organisation like a church or charitable group to visit rather than a paid for service? There are some fabulous voluntary patient support groups some of whom will offer to visit you. Please do not hesitate to contact them for help as they are generally quite wonderful.

We offer a more structured service with guaranteed visits, written reports, checklists and an action plan (if necessary) for relatives. Our “visitor” can be introduced to the patient before they go into hospital if its a planned admission, so that they are not a “new face” when they visit. Our people are all DBS (Disclosure and Barring Service) checked which has replaced the Criminal Records Bureau and are trained carers. And yes we pay them. Our people are not volunteers. However, this is not a money making venture, but we do need to make money to cover our costs. We are an aspiring “Not for profit” organisation.

This service is at present, being piloted to ascertain whether there is a need for and to evaluate the potential for this service – In an ideal world, it wouldn’t be.

the Sunday Express article can be found here http://www.express.co.uk/news/health/417989/Hire-a-hospital-visitor-for-25-to-escape-the-chore-of-mercy-trips

The provisional report into the high death rates at 14 NHS hospital trusts as investigated by Sir Bruce Keogh, the NHS Medical Director, is due out today.

The Daily Telegraph, in todays issue discloses that all except one of the NHS trusts under investigation had a lower ratio of nurses to patients than the national average.

The newly released report by Camilla Cavendish –

“An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings”

deals with the inconsistent quality of Care found in both the NHS and in the wider social care sector. It calls for a national standard of care. This is to be achieved by introducing a recognised training qualification for all carers.

In the NHS she says

“Healthcare assistants (HCAs) make up around a third of the caring workforce in hospitals, but research suggests that they now spend more time than nurses at the bedside. If the NHS wants to improve patient care, it should see healthcare assistants as a critical, strategic resource. Yet many HCAs feel undervalued and overlooked healthcare assistants have no compulsory or consistent training, and a profusion of job titles. This confuses patients, who often assume that everyone is a nurse; and it makes life difficult for some nurses, who are not always sure which tasks they can delegate”

In Social care she says

“The social care support workforce dwarfs that of health. By helping people to live independently, it plays an essential role in supporting the vulnerable and reducing the strain on the NHS. So the high turnover rates – of 19% a year in care homes and up to 30% a year in domiciliary care – are worrying. For workers in this sector, “I’m only a carer” is too common a refrain.”

Cavendish goes on to say that inconsistencies in the level of training for carers are huge. Taking this fact along with the fact that more frail elderly people are being cared for – she has called for a “Certificate of Fundamental Care” to be introduced nationally.

Time = Quality of care

With constraints on budgets there is  pressure on home care workers time to get their visit over as quickly as possible. Cavendish goes on to say that it is “An inescapable fact is that good caring takes time”. later in the report she goes on to say,

“In general, frontline workers are very dedicated to those they look after; but frustrated that they cannot always spend enough time with them.”

The report states that here are “over 1.3 million unregistered healthcare assistants and support workers working on the frontline of care: although a profusion of job titles and lack of role clarity means that an exact count is not possible, even within the NHS.”

In conclusion

This is welcome report! Highlighting, as it does, a number of issues, including the great variations in quality of care nationally. And the disjointed relationship between the the NHS and Social Care Services. It also shows that budgets are being squeezed and that many carers have low self esteem, and getting to spend less time with people because of monetary pressures – all at a time of rising demand as our elderly population increases.

The introduction of national standards of excellence and a national discussion on how we gear up our services to accommodate our elderly, is long overdue.

The Camilla Cavendish report in full, can be found here… https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/211482/Cavendish_Review_BOOKMARKED-_9-7-13.pdf

Jeremy Hunt, the Health-care Minister has said on BBC Radio 2’s Jeremy Vine programme today, that that the crises in Accident and Emergency wards is in part, due to the increasing numbers of elderly people visiting A&E.

He said that elderly people going to A&E, often suffer from complex conditions from which many will not recover – and that consequently they take longer to treat.  He questioned whether it would be better if the elderly are cared for outside of hospital, and went on to say that it was difficult to discharge elderly patients from hospital into social care because of bureaucratic complexities.

Andy Burnham, the shadow Health Secretary, in the same programme called for a more “joined up” system of care between Hospitals and Social care services, so to manage elderly people in a more structured way. Both men agree that how we care for the elderly needs to be debated and urgently.

So, the debate about who and how we should care for our older citizens has become a political football – In this lies the danger that views, on care, will become polarised around one or other party’s political manifesto.

Sometimes a political debate may produce excellent results, providing there is cross party agreement on how to proceed – Especially, if politicians listen to people who work with the elderly; care workers, hospital staff, charitable and social enterprises and the elderly themselves.

Unfortunately, politics and practicalities don’t often make for good bed-fellows as witnessed on the Jeremy Vine show today, as each political party blamed the other for the crises in A&E. Only then to blame GP’s for cutting “Out of hours” services, the patients  themselves for being irresponsible and the elderly for not having somewhere else to go.

There was no debate on how we should proceed from here, and no remedial action recommended.

The Care and Quality Commission (CQC) is this week is also under fire for the decisions taken by its old management board to allegedly suppress reports regarding the deaths in Morecombe Bay Hospital. These were decisions made by a board of directors seemingly, with a political agenda. Either to keep bad news out of the public domain or at best with a view that consideration should be given to managing what the public has a right to know.

To add to this, a Sunday Times report, this week says that David Prior, the CQC Chairman, has said that a shortage of qualified inspectors means that the public will have to wait six months before hospital (and we assume care home) inspections can be considered reliable.

The Patient Advocacy Service offers a patient visiting service for people in Hospital or a Care home, which is designed to help families who may be unable to visit a relative as often as they would wish. Further blogs and information is available at our website www.patientadvocacyservice.co.uk  or follow us on facebook

 

 

One GP practice has introduced new working practises which could lead to a 10% fall in A&E admissions if replicated throughout the UK.

A report on Sky news has highlighted a new rapid-access system, introduced by GP’s at Parkbury House surgery in St Albans. Patients who ring in are called back by a GP within the hour – and those who need a face-to-face appointment are usually seen the same day.

One of the doctors, Steve Laitner, said the system, designed with the help of the group Patient Access is so efficient it reduces pressure on the whole NHS. He told Sky News: “It’s safer, it’s a better experience for patients and a better use of resources – not just in primary care but across the system including A&E.”

This assertion is seemingly reinforced by new research by Imperial College London. The research suggests patients with the quickest access to their GP were 10% less likely to go to their local A&E unit.

If patients across England were able to see a GP with a minimal wait, there would be 111,739 fewer visits a year to casualty, according to figures published in the journal PLOS ONE.

A&E in Crises.

The Care Quality Commission (CQC) have stated that A&E departments are “Out of control”. David Prior, chairman of the CQC, has said that far too many patients were arriving at hospital as emergency cases – a crisis which, he feels, could be averted by earlier intervention through care in the community and better GP access.

A&E departments have been called “war zones” by the College of Emergency Medicine, which also told the Daily Telegraph that many services across Britain have reached “tipping point”.

Further, recent figures from the King’s Fund charity showed more than 300,000 patients waited longer than the Government’s four-hour target time for treatment in A&E departments in the first three months of this year – 40% more than the same period last year.

And according to the Independent, internal messages obtained by the Health Service Journal revealed that Jeremy Hunt, the Health Minister had been seeking up to £400m to rescue problem A&E units but had been deterred from doing so because of confusion about health service finances.

Patient Advocacy Services welcome Any initiative to help alleviate Accident and Emergency attendance. In particular with elderly people, who more and more are having to turn to A&E for treatment as GP out of Hours services have been cutback and even cut-out.

We would urge GP practices throughout England and Wales to monitor the success of the Parkbury House rapid-access system and look at adopting & adapting its procedures to suit their own particular practices’ circumstances

 

A number of media reports this week have raised the fear that Accident and Emergency departments throughout England and Wales are as little as six months away from meltdown.

TV, Radio and Press interviews variously with NHS Foundation Trust Network boss Chris Hobson, Dr Peter Carter of the Royal College of Nursing, Andy Burnham the Shadow Health Secretary and Jeremy Hunt the Health Secretary have all highlighted the concern that accident and emergency facilities are at full stretch.

Reports that A&E attendances have risen by 50% in a decade and that this winter the NHS in England started missing its four-hour waiting time target.

A review by the College of Emergency Medicine – based on feedback from more than half the A&E units in the UK – said the scale of the challenge was the biggest for a decade.

It said there were shortages in both middle-grade and senior doctors.  As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.

It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.

Blame has been liberally distributed on GP’s who have cutback out of hours services, on irresponsible use of A&E services by non emergency patients, on the elderly for using the service more because of the lack of alternate social service care, on A&E staff shortages and on government financial penalties.

Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.

Shadow health secretary Andy Burnham said: “Warnings don’t come any more serious than this. He said,

“Too many hospitals around England are sailing dangerously close to the wind, operating way beyond safe bed occupancy levels.”

He told BBC Radio 5 live the situation could be improved by “the full integration of health and social care – a national health and care service, if you like”.

“As people get older, we’ve got to support them in their homes so they don’t end up in hospital,” he added.

Jeremy Hunt, the Health Secretary meanwhile says,  “It’s too difficult to access out of hours care”

He said that, since the government came into power, the number of people using A&E had gone up by a million a year.

“There is that pressure and we have to do something about it,” he said.

He admitted there was “a lack of joined-up thinking between health and social care system which we’re sorting out”.

He cited a care bill, set out in the Queen’s Speech, which will introduce a cap on the cost of social care and give carers the legal right to support from their local council.

“That’s also a very big problem because what you’re finding in a typical hospital is maybe 100 beds are full of people who actually don’t need to be in hospital but the doctors aren’t able to discharge them into the social care system.”

He said the government was putting £7.2bn into the social care system “to protect it against cuts”.

Data from the NHS Information Centre which examined safety incidents in the last month, found that that eight per cent of patients had been harmed during their care – suggesting that every year more than one million patients and care home residents suffer avoidable harm, as reported in the Daily Telegraph in an article by Laura Donnelly.

The article goes on to say that “bedsores were the most common result of neglect, with 5.6 per cent of patients suffering from pressure ulcers, which can be fatal. The other main causes of harm were falls, urinary tract infections linked with catheter use and blood clots”

In the same article David Prior, the New Head of the Care Quality Commission (CQC) said that his organisation had identified about 45 hospitals which have had serious problems dating back around five years. Those 45 hospitals would now become a priority for inspection in which regulators would take a much clearer approach in advising which hospitals should not be allowed to continue as they are. He went on to say,

“We (the Care Quality Commission) cannot give the public a cast-iron guarantee that there will never be another Mid Staffs or another Maidstone & Tunbridge Wells (where hundreds died after an outbreak of Clostridium difficile)”

Mr Prior also said, “I think primary care is in a bad shape…I think GPs ought to be responsible 24/7” referring to the decision to let family doctors give up responsibility for out-of-hours care which he feels has let patients down, particularly the elderly.

David Prior is a former Conservative MP. He became chairman of the health & social care watchdog in January. In his first major speech since taking up his post he said that too many people – especially the elderly – are arriving in hospital as an emergency, when they should have received help much earlier. As a result, he said the healthcare system is on the brink of collapse. He has called for large scale closures of hospital beds and investment in community care.

The Sunday Times reported yesterday, 28th April, that owners and directors of care homes where elderley people are abused could face jail under a new law making them corporately accountable for neglect and mistreatment.

Marie Woolf reports,

” Care homes that cover up incidents of neglect and abuse also face prosecution under a new legally binding “Duty of candour” for staff. Managers will be legally obliged to inform relatives if an elderly person is mistreated.

The new tougher rules, to be outlined in a consultation by the Department of Health within weeks, follow a series of scandals on care homes. In one of the worst cases, staff were filmed by the BBC’s Panorama abusing residents at Winterbourne View, near Bristol, a private hospital for adults with learning difficulties. Six staff were convicted, but its operating company escaped charges.

Under the new rules, owners and directors will be corporately accountable for the treatment of residents, and will have to pass a “fit and proper person” test to serve as a director of any home caring for the elderly or disabled.

The health department is also introducing a minimum level of training for all care-home assistants to ensure that they know how to look after vulnerable people, wash and dresss them and treat them with respect. from ts month on, residents and their families will be able to rate care homes and comment on their quality of care on the NHS Choices website. Homes with low standards therefore risk being publicaly named and shamed”