Discontinuing Continuing Care

Not a lot of people know that the NHS has a responsibility to provide Continuing Care.    It’s not surprising because the whole issue is shrouded in confusion and complexity.    I will try to unravel the issues in this blog.

Basically if you have a continuing need for health care from a clinician, the NHS should provide it FREE.    But therein lies the problem, because the NHS is short of cash and has been for some considerable time.    The issue is about people who are chronically ill and have a long-term condition which requires the regular attention of a clinician, usually a doctor but it could be another clinical specialist such as a physiotherapist.

That continued involvement, particularly if it involves a hospital stay, can be very expensive.    Hence the confusion and complexity.     My first experience of the issue was in running nursing homes in the 1980’s and 1990’s.  Some of our residents with serious health conditions, were paid for in full by the NHS.      This was usually an alternative to them staying in hospital.

Then in 1993 everything changed when Social Services became responsible for assessing peoples’ eligibility for admission to nursing and residential care homes.     Along with that responsiblity came the liability for providing public funds for people with limited resources.   The conundrum was that there were still some individuals who were paid for entirely by the NHS because of their continuing health care needs.

Individual Health Authorities and Social Services Departments intepreted the boundaries of this type of care differently, which led to accusations that the NHS was not providing a universal service for people with the same condition.     The other big anomaly was the treatment of patients with dementia where previously many dementia patients were looked after by the NHS in long-stay wards.  Progressively those wards were closed and the patients moved into nursing homes.       This shunting of costs from the NHS to Social Services led to endless disputes and delays in transferring people out of hospital.

Then came the Coughlan case where a woman who had previously been funded by the NHS, was refused further financial support on the basis that there was no further treatment that the NHS could give her.  She contested that view in the Appeai Court and won, which opened the door to an ongoing argument about “Continuing Care” which exists right up to today.

In researching this blog, I looked up the Government Assessment Form for Long-Term Health Conditions, which was only eventually published in November in 2012.     It’s 18 pages long and full of loaded questions which can only easily be answered by qualified staff, even though it is intended to inform patients of their rights.

The ongoing arguments have spawned a host of legal firms specialising in advising on patients’ rights to long-term care.     Equally, on the NHS side of the argument, there are private health care consultancies whose aim is to restrict the number of people entitled to claim NHS financial support.    This whole issue has developed into a multi-million pound industry.

All because successive Governments have not had the courage to face up to the problem.    The reality is, particularly with dementia, the NHS cannot afford the cost of caring for the increasing numbers of people with a serious health issue to which there is no cure.

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5 Responses to Discontinuing Continuing Care

  1. davidwfreeman237 says:

    What an informative ‘blog’.
    My initital reaction is whow! and then trying to come to grips with the fuller question of care? if i have read correctly when there is no known clinically termed solution to a treatment, except the general terms ‘after care for life?? Question this is a very difficlut area to be ‘Glib’ about: however how do we face the inevitable, when our fellow man cannot define a future, and then in what terms do we define ‘Care for Life’? and for whom? do we all have the same rights? and as a society can we aford such a political/clinical decisions made about our individual health, welfare and care.
    I am on the JURY panel at present and must consider the ‘FACTS OF LIFE’, with solice from my god, who ever he or they may be.

  2. davidwfreeman237 says:

    Dear All,
    An open letter for consideration on aging and ‘Care’ with Living for the elderly.
    Daily Mail Tuesday 22 08 2017- Inside page 2-“lack—— end up in A&E”
    Another story of dementia, and old age, and the highlighting of statistical data that some 78.6% older people end up in A&E in the last year of their life. (Having been given a statistical total of some 4867 patients’ cases that have been researched). From this the alleged summary by the Department of Health [DOH] states 61% are cared for in their own homes, and that £2billion boost is being given by DOH to Local Authorities over the next 3 years.
    The premise is we are about to die in a care home? Or is this a myth? Can we die happy either at home or in a ‘Care home’ of sorts? What do you expect will happen? Answers on a postcard Please!
    Following on from both the recent media hype, and Johns Blog [discontinuing continuing care- 22/8/2017]. I reflect upon my own situation in a “Retirement Village”! One of the concerns I have is that the original vision is becoming blurred, and I now pose some hypothetical questions for you the reader to consider:
    1- The original concept of a ‘retirement village life’ was;
    a. Lead an independent life style
    b. Take an active interest in what the village means to you, and what the other residents and village staff offer as activities.
    c. The age profile of the village was mediated in group percentages (over the minimum age of 55), such as the majority of the residents were fit, healthy, (some mobility issues), and willing to volunteer a proportion of their time to running, organising activities (library, craft groups, social groups such as the village pantomime) within the village, and where interested in front of house management, such as offering; help with running of the reception desk, bar, café, shop, and helping in the restaurant and kitchen, as supernumery staff, and then again well-being (Health) , all these tasks with the guidance of management. Then there is the village media with input chiefly by the residents, published by the residents, with an invited and helping hand of management.
    What disturbs me is that the ‘Retirement village in 2007 had an average age of 72, as we now speak it is nearer 78/9. I personally at 75 feel a ‘shudder’ of ‘Old father time’, and what concerns me is that the majority age group are now approaching life; were mobility aids, ( scooters especially) etc., are the accepted norm for moving around both within and external to the retirement village. Provided that individual persons mind remains active, and the body fit to undertake the responsibilities as originally conceived when the retirement village was developed: all is good!
    I just wonder being a cold fish! Is there a “little something” we add to the concepts of a retirement village?
    One of the note aspects as the retirement village has aged is that now we have an average age of 78/9, I note:
    i/ regular visits of paramedics and ambulances
    ii/ the undertaker, and ‘’wakes’’ becoming a little more prevalent.
    Going back to the original concepts of the retirement village which I still uphold and thoroughly enjoy, are the social mix of residents who may wish to rent/share/lease properties, and the endeavours of the organisation/management to maintain an active profile of varying ages and mobility (regardless of sex), and those on domiciliary care. Thus enabling the retirement village to function as now and in the foreseeable future.
    Why all this scribbling and written words? I just ponder if the society/association of “ACTUARIES” could help in clarifying ‘end of life’? For the groups or mix of UK Citizens, and so assist the decisions or decision making process for new homes in the ‘’greater care industry” and retirement villages as to what they may become in the future with a healthy and vibrant group of resident?
    In days of ‘yore’ the Actuaries advised insurance/assurance/friendly societies on life spans and the health and welfare within different types of employment, so that the “termed” and ‘’whole life’’ policies could be considered an acceptable risk to all concerned, and allay any fears of the payee that their dependents are/will be provided for.
    Can this still be done for those needing elderly accommodation and care for today and tomorrow?

  3. davidwfreeman237 says:

    Further to my reply blogs as above, I have spent the past 90 minutes scan reading the Government Assessment Form for Long-Term Health Conditions, which was only eventually published in November in 2012 of which an updated 2016 on the paper on this site was end of life support by the NHS? all confusing. No where can I find the definition of dying, and I hasten to add, maybe through ignorance we are as a society becoming pre occuppied with death, and palative care upon the clinical definition of end of life! I just wonder if we have all collectively reached a compromise and agreed decision that the ”Dignitas Clinic” in all but name is now an option under the UK’s NHS service?? It is a long 60 page scan read!

  4. davidwfreeman237 says:

    from the 2012 report, definitions??

    26. It is difficult, if not impossible, to calculate the cost of end of life care in this
    country. This is partly because of the difficulty in defining exactly when end of
    life care starts. However, the key elements of expenditure can be identified.
    These are:
    Hospital admissions;
    Hospices and specialist palliative care services;
    Community nursing services; and
    Care homes.
    AS a joves comforter at 75 and in a retirement village, should I have Palative care/support from my 75 birthday to the end of lfe paid for by the NHS??? Do I have look into my gene pool for those good years, I may have left, and is it my right to be supported/supllimented by NHS policy, over and above medical treatment for the rest of my life? Or should next time I croak think hard about the costs to the nation and take up the ofer of palative care, with end of life? I hope not I trust the medical family, my family and I will at the right time come to a conclusion jointly when I should meet my maker???
    There are a lot of words written, and spoken about palative care, and for whom, without the reality of emotions and costs? We come into this world as a wish of love, and we must exit as a positive statement of love.
    I trust and hope we are not repeating events of the holocaust or genide on the elderly.

  5. davidwfreeman237 says:

    spelling please excuse supliment,offer,genicide?? even now am I correct???.

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