Click on this topic in the TAG CLOUD for the earlier blogs on this subject.
The title of this blog was a response two years ago to the Government’s focus on “dignity”. No-one could possibly disagree that elderly people are entitled to respect and dignity. There is however, a real danger that a focus on this issue will provide the Government with a smoke screen, to obscure much more fundamental problems which the NHS faces with care of the elderly. Hence my title “Dignity Be Damned”.
The “Delivering Dignity” report reads as though everyone on the Commission Group took it in turns to make a recommendation for improving dignity. Given it is only a draft report, you could be forgiven for thinking there is nothing wrong with that. All the recommendations have merit. Although simply asserting that best practice should be carried out everywhere, fails to address the starting premise of the authors, of trying to understand why things are failing so badly at present. Without knowing what the problems are, you will never find the right solutions.
I think it is possible to judge from the report’s paragraph headings, that they see a failing in leadership at Board and Management levels. Reading between the lines, you can also assume from the weight of words and recommendations, that they feel there is a lack of compassion from front line staff.
On both counts I think they are in danger of treating the symptoms and not the cause. I believe that the vast majority of managers and staff in the NHS and residential care have every intention of delivering good care to older people. It is not an easy area to work in and staff would not stay if they were not fully committed. I say that, having worked for over 20 years in the ExtraCare Charitable Trust, as a Managing Director who was frequently on the front line with many thousands of care home and former NHS staff. Most of the Commission’s recommendations are in line with the working practices of ExtraCare Charitable Trust, so it goes without saying, I am a strong advocate of the proposals.
However, before they hone the details of their recommendations, they must first strategically address the fundamentals.
Over the last two years I have been writing about this issue on my GrumbleSmiles blog and I am sorry I missed the opportunity to submit my comments as evidence to the Commission. However, I did get the opportunity to speak to Dianne Jeffrey, after her speach on the report, at the Age UK Life Conference.
The fundamental issue is that the NHS is being overwhelmed by the changing demographics of the elderly population. The NHS was never designed or resourced to deal with the complex and chronic conditions of so many elderly people. Fast track acute hospitals are geared for rapid throughput and are the wrong place to attend to long-term care. This situation is further compounded by the overlay of dementia present in so many elderly people.
To cope with this tsunami situation, we need nothing short of radical re-engineering of the service, albeit done in an organised transition. My recommendations to the Commission are:-
1. Resources should be transferred out of the NHS into a new “SENIOR HEALTHCARE ENTERPRISE“. (Similar to the formation of the Housing Corporation, whose funding enabled the expansion of Housing Associations and facilitated the transformation of social housing provision in the latter quarter of the twentieth century.) This organisation would be responsible for commissioning capital and revenue funded projects in the community, to as far as possible look after the health and social care needs of elderly people in their own homes. They would also commission a network of HEALTH IMPROVEMENT CENTRES (see my blog on “New Vision of Later Life 2”) which would support community work with specialist clinicians and offer hotel style rehabilitation and respite care. These would be the hub for telecare and telehealth and also be the coordinating base for domiciliary care. Resources should be moved from Social Services so that we end up with a fully integrated health and social care system.
This would allow the NHS to concentrate on acute, short-term interventions.
2. We should develop a new qualification of second level “NURSES FOR THE ELDERLY“. They would lead all care services for older people. In addition, all carers should be NVQ Level 2 Qualified in Care including dementia.
3. In all residential care provision, webcams and Skype should be available to all elderly clients, so that they can open up a visual communication channel to relatives and advocates who can remotely monitor the service they are receiving. This service could be further developed to include telecare and telehealth (this is an enhancement of the Commission’s recommendation 29).
I’m not suggesting this re-engineering be done quickly. A rapid change would be too big a shock to the existing system and would likely meet major opposition from interest groups who would prefer to maintain the current situation. I would start with a pilot programme underpinned with new funds provided by the Senior Healthcare Executive. Soft loans and grants would be offered to promote innovative services provided by best practice organisations from the public, voluntary and private sectors. Building on success would allow the gradual expansion and transfer of elderly services away from the acute sector of the NHS and into a re-invigorated and integrated health and social care service.
These ideas are discussed in greater length in my GrumbleSmiles blog in the thread on “New Vision of Later Life”.